About Covid-19
When US ICUs Are Full, Most States Ration Care by Age: “In the spring of 2020, Dr. Sulmasy and his team identified 35 published, state-endorsed pandemic preparedness plans. Most of the plans were written in 2020 in response to the novel coronavirus pandemic.
Of the 35 states with plans, 17 used age or the idea of maximizing the number of life-years expected to be saved as a prime consideration in rationing care, the study found. Seven states considered only the chances for short-term survival regardless of age.”
US Doubles Global Donation of COVID-19 Vaccine Shots: “President Joe Biden announced Wednesday that the United States is doubling its purchase of Pfizer's COVID-19 shots to share with the world to 1 billion doses as he embraces the goal of vaccinating 70% of the global population within the next year.”
What to know about coadministration of flu and COVID-19 vaccines: Advice from the AMA: Bottom line is the two vaccines can be administered at the same time.
DiaSorin Molecular Nabs CE Mark for COVID-19 and Flu Test: “The multiplex test detects nucleic acid from the SARS-CoV-2 coronavirus that causes COVID-19 infection as well as viruses that cause influenza A and influenza B from the same patient sample. The assay, which analyzes nasopharyngeal swab samples, is for use on DiaSorin’s Liaison MDX themocycler.”
A New Covid Testing Model Aims to Spare Students From Quarantine: “An increasing number of school districts are turning to testing to keep more children in the classroom and avoid disrupting the work lives of their parents. The resource-intensive approach — sometimes known as “test to stay” or modified quarantine — allows students who have been exposed to the virus to stay in school as long as they take frequent Covid tests, which are typically provided by the school, and adhere to other precautions.”
Israel’s struggles to contain COVID-19 may be a warning for other nations: “Public health experts differ about exactly why a country of 9.3 million that is vaccinating so aggressively still has one of the highest rates of reported infections per capita in the world, more than twice that of the United States. Extensive testing and social factors may play a role. But David Dowdy, an infectious disease epidemiologist at the Johns Hopkins Bloomberg School of Public Health, says it’s a sign that ‘providing booster shots alone does not dramatically change the course or trajectory of transmission at a country level. Because the majority of transmission is still occurring from people who are unvaccinated.’ Israel’s vaccination rate—64% of its population has received at least two doses—puts it ahead of the United States but behind some 30 other countries…
Among Israelis 60 and older who received a booster, the risk of infection fell 11-fold in August and the risk of severe disease 20-fold compared with their twice-vaccinated peers…
A significant portion of the new infections is occurring in the 2 million Israeli children who are younger than 12, for whom vaccines are not yet approved. Whereas this group represented 24% of new infections on 14 August, that number had risen to 42% in the week ending 16 September.”
About health insurance
Interventions to Reduce Hospital Length of Stay in High-risk Populations: This research shows that a “one size fits all” approach does not work.
”This systematic review identified evidence for 8 hospital-based interventions targeting high-risk patient populations: discharge planning, geriatric assessment or consultation, medication management, clinical pathways, interdisciplinary or multidisciplinary care, case management, hospitalist services, and telehealth… aside from interventions for patients with heart failure, interventions were not consistently associated with reduced hospital LOS for medically complex populations. It is important to note that patients who are medically complex do not exist in silos, as older patients may also have chronic conditions, such as heart failure; therefore, identifying interventions that could reduce LOS across populations is important.”
Some Medicare Advantage Companies Leveraged Chart Reviews and Health Risk Assessments To Disproportionately Drive Payments: From the HHS OIG: “Our findings raise concerns about the extent to which certain MA companies may have inappropriately leveraged both chart reviews and HRAs to maximize risk-adjusted payments. We found that 20 of the 162 MA companies drove a disproportionate share of the $9.2 billion in payments from diagnoses that were reported only on chart reviews and HRAs, and on no other service records. These companies’ higher share of payments could not be explained by the size of their beneficiary enrollment. Each company generated a share of payments from these chart reviews and HRAs that was more than 25 percent higher than its share of enrolled MA beneficiaries.”
Opportunities Exist To Strengthen Evaluation and Oversight of Telehealth for Behavioral Health in Medicaid: Also from the HHS OIG: We “recommend that CMS: (1) ensure that the three States that are unable to distinguish telehealth from in-person services implement indicators to identify which services are provided via telehealth, (2) conduct evaluations, and support State efforts to evaluate the effects of telehealth on access, cost, and quality of behavioral health services, and (3) conduct monitoring for fraud, waste, and abuse, and support State efforts to oversee telehealth for behavioral health services. CMS concurred with the first recommendation but did not explicitly indicate whether it concurred with the other two recommendations.”
COBRA Users Face End to Temporary Premium Payment Help: “The program could push millions of people into the market for individual and family health coverage Oct. 1.
The program, created by the American Rescue Plan Act of 2021 (ARPA), provided billions of dollars in aid to help displaced workers keep their usual employer-sponsored health benefits in place during the COVID-19 pandemic, by paying 100% of the premiums for COBRA health benefits continuation coverage.”
Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage: “Results from a recent KFF poll indicate that 90% of the public says expanding Medicare to include dental, hearing, vision is a ‘top’ or ‘important’ priority for Congress. Policymakers are proposing to add coverage for these services as part of budget reconciliation legislation, and a provision to add these benefits to traditional Medicare was included in the version of H.R. 3 that passed the House of Representatives in the 116thCongress.
The Biden Administration endorsed improving access to these benefits for Medicare beneficiaries in the FY2022 budget. Addressing these gaps in Medicare benefits is grounded in a substantial body of research showing that untreated dental, vision, and hearing problems can have negative physical and mental health consequences. Adding these benefits to Medicare would increase federal spending, and they will be competing against other priorities in the budget reconciliation debate.”
Oak Street Health Selected by AARP as the Only Primary Care Provider to Carry the AARP Name: “Oak Street Health, Inc., a network of value-based primary care centers for adults on Medicare, today announced it has been selected by AARP as the only primary care provider to carry the AARP name.”
CMS Investing $15M in Medicaid Mobile Health Crisis Intervention: “Federal authorities are awarding $15 million in rescue plan funding to 20 states to help expand mobile health intervention services for Medicaid patients in crisis.
The planning grants, administered through the Centers for Medicare & Medicaid Services, will help state Medicaid agencies and community health organizations develop emergency intervention services for people experiencing a mental health or substance abuse disorder crisis. This may include the use of mHealth apps or telehealth services to connect those in crisis to a behavioral health specialist or other care provider.”
About hospitals and health systems
Hospitals slam Lown Institute's social responsibility ranking: A followup to the article in yesterday’s blog: “The ranking from the nonpartisan healthcare think tank was released Sept. 21. Some of the metrics used in the ranking are inclusivity, pay equity, avoiding overuse and clinical outcomes, as well as cost efficiency, a new metric that evaluates how well hospitals achieve low mortality rates at a low cost.
The AHA claims that the index from the Lown Institute draws ‘sweeping and arbitrary conclusions’ and uses ‘old and incomplete data.’
In particular, the AHA said that the inclusivity metric only looks at Medicare data, which is not representative of the community hospitals care for.”
12 hospitals planning upgrades, expansions: A reminder that even during the stresses of the Covid-19 pandemic, expansions continue. In a related article: Penn Medicine to open $1.6B hospital in October.
About pharma
Physicians’ actions to help end the nation’s drug-related overdose and death epidemic —and what still needs to be done.: From the AMA: Despite a 44.4% decrease in opioid prescriptions (from 257.9M in 2011 to 143.4M in 2020), overdose deaths are at an all-time high. Read the document for an excellent discussion if the problem and useful actions.