House Republicans Push To Make Drug Price Legislation Bipartisan

House Republicans push to make drug price legislation bipartisan |  FierceHealthcare

Source: Fierce Healthcare, by Robert King

House Republicans want their Democratic counterparts to endorse more bipartisan-friendly reforms to drug pricing as the chances of a bill to give Medicare negotiating power look dim.

Republicans on the House Energy and Commerce Committee endorsed during a hearing on Tuesday legislation that includes a series of reforms including an out-of-pocket cost cap for seniors on Medicare Part D. The comments come as Democrats are pressing for the inclusion of legislation to grant Medicare power to negotiate for lower drug prices in a massive infrastructure package.

Republicans say the legislation will likely pass the Democratic-controlled House but will stall in the Senate as Democrats likely can’t get enough Republicans in the Senate to pass it.

“Why aren’t we working together on something that can be signed into law,” said Rep. David McKinley, D-West Virginia, during the hearing. “Unless we change the course, the projection of this legislation, we know how this story is going to pan out.”

Republicans endorsed the “Lower Costs, More Cures Act” introduced last month that includes several provisions aimed at lowering costs on Medicare and Medicaid.

The legislation would create a $3,100 out-of-pocket cap on Medicare Part D costs for seniors and give incentives for providing a share of Part D rebates to be delivered at the point of sale.

Another provision would call for increased price transparency by expanding a Medicare online tool to enable “beneficiaries to compare costs across three settings: hospital outpatient department, ambulatory surgical centers, and the outpatient prospective payment system,” according to a fact sheet on the legislation.

It would also demand a site-neutral payment to providers for the administration of drugs reimbursed under Part B, which are drugs such as chemotherapy that are administered in a doctor’s office. It would require a payment at the lower “physician fee schedule rate rather than the rate paid to hospitals, lowering federal spending and beneficiary cost-sharing,” the fact sheet said.

The legislation is far different from the “Elijah E. Cummings Lower Drug Costs Now Act” that gives Medicare the power to negotiate for lower prices and requires commercial plans to adopt the prices that Medicare negotiates.

The bill passed the House in 2019 and languished in the GOP-controlled Senate.

But now Democrats are trying again as they have control of the White House and Senate, albeit by a 50-50 margin in the Senate with Vice President Kamala Harris breaking any ties.

“For too long, Americans have been forced to ration their medications, go without, or exhaust their life savings in order to afford the drugs they need, all while large pharmaceutical companies continue to make record profits,” said Rep. Frank Pallone, D-New Jersey, the chairman of the full committee, during the hearing.

Experts also testified that the provisions in the legislation, including the Part D cap, will not be enough to lower costs.

“Capping out-of-pocket costs doesn’t lower spending,” said Rachel Sachs, an associate law professor at Washington University. “It just moves money around in the system.”

She said the cap could increase Part D premiums overall and increase Medicare spending as a subsidy for those premiums.

“The restructuring of the Part D benefit is critical to help seniors afford the cost of prescription drugs, but because it moves money around the other items are important,” she added.

Walmart To Acquire Telehealth Provider As Part Of Retail-Based Care Strategy

Walmart to acquire telehealth provider MeMDSource: Modern Healthcare, by Matti Gellman

California’s State-Run Retirement Savings Program Not Preempted By ERISA – 9th Circuit

California's state-run retirement savings program not preempted by ERISA - 9th  Circuit | ReutersSource: Reuters, by Daniel Wiessner

A U.S. appeals court on Thursday said California’s state-run individual retirement account program for workers is not governed or preempted by the federal law on employee benefits, even if its mandatory contributions are “irritating or even burdensome” to some employers.

A unanimous three-judge panel of the 9th U.S. Circuit Court of Appeals said the CalSavers program created in 2017 is not an “employee benefit plan” under the Employee Retirement Income Security Act of 1974 because it is maintained by the state and does not require private employers to establish their own retirement plans.

The ruling, which rejected a challenge to the program by advocacy group the Howard Jarvis Taxpayers Association, marked the first time a federal appeals court has weighed in on whether state-run IRAs are preempted by ERISA. Several states have followed California’s lead by adopting similar programs.

“Nothing in law supports HJTA’s effort to recast ERISA’s preemption provision as a sword that would allow employers who do not offer their own retirement plans to thereby deprive their employees of the ability to participate in a state-run IRA savings program,” Circuit Judge Daniel Bress wrote.

Laura Dougherty, a staff lawyer at HJTA, which advocates for tax cuts in California, said the group is considering its options. The California State Treasurer’s Office, which administers CalSavers, did not immediately respond to a request for comment.

Workers in California whose employers do not offer retirement savings plans are automatically enrolled in CalSavers, though they may opt out. The program requires private employers to remit payroll deductions to CalSavers worth up to 5% of an employee’s pay.

As of October, more than 4,300 employers had registered for the program and nearly 90,000 workers had been enrolled, according to filings in the 9th Circuit case. More than one-third of eligible employees have opted out of enrollment.

HJTA and two of its employees in a 2018 lawsuit in Sacramento federal court claimed that CalSavers qualified as an employee benefit plan under ERISA, which preempts any state law that “relates to” a benefit plan.

U.S. District Judge Morrison England last year disagreed and dismissed the case. The hallmark of an ERISA-governed benefits plan is that it is established and maintained by an employer, which was plainly not the case for the state-run CalSavers program, the judge said.

HJTA appealed and the 9th Circuit on Thursday affirmed. ERISA preemption is broad, the court said, but does not extend so far that states are precluded from adopting any law dealing with employee benefits, even if it places requirements on businesses.

“When employers merely perform mandatory administrative functions in a government benefits scheme that do not require the employer to exercise more than a modicum of discretion, the employer … is not engaging in the type of conduct that ERISA seeks to regulate,” Bress wrote.

The panel included Circuit Judge Andrew Hurwitz and U.S. District Judge Clifton Corker of the Eastern District of Tennessee, who sat by designation.

The case is Howard Jarvis Taxpayers Association v. California Secure Choice Retirement Savings Program, 9th U.S. Circuit Court of Appeals, No. 20-15591.

CAA’s “No Surprises Act” – Changes To Health Plans Coming In 2022

CAA's “No Surprises Act” - Changes to Health Plans Coming in 2022 | Word &  BrownSource: Word & Brown, by Paul Roberts

In late December 2020, the Consolidated Appropriations Act (CAA) was signed into law. The bill’s $2.3 trillion price tag is one of the largest spending measures ever enacted in American history, and also the longest bill ever passed by Congress.

The CAA contained some of the most significant COVID-19 relief since April 2020’s CARES (Coronavirus Aid, Relief, and Economic Security) Act with about $900 billion of relief to taxpayers, businesses, and the economy. It also included a myriad of different legislative items impacting an array of sectors, not directly related to the COVID-19 pandemic. One of those sectors is the health care and health insurance industries.

The CAA contains three major sections of importance to health insurance brokers and their clients, all of which relate to health plans. One of those sections allows employers optional flexibilities for their Health Flexible Spending Accounts (FSAs) and Dependent Care FSAs. Another section contains new requirements for transparency, which will require “covered service providers” to create and release written disclosures describing direct or indirect brokerage compensation to plan fiduciaries. The third section is the remainder of the items in the “No Surprises Act,” as contained within CAA, which provides protections for consumers against surprise medical billing.

These CAA changes are deep and far reaching. At the time of this article’s publication in May 2021, regulations are not yet available for these changes. Regulations tell us how a new law will be facilitated, administered, and enforced. As regulations are released, we will learn more about these changes and how to implement them. For now, we only have the letter of the law itself, which is what this column is based on. We focus this month on the federal “No Surprises Act” changes related to surprise-billing, some of which resemble language in California’s 2017 AB 72 law. Other CAA changes will be detailed in future columns, especially on transparency requirements, as further regulations become available.

Surprise bills arise when a patient receives care at an in-network facility by an out-of-network provider; or when a patient receives emergency services, without having a say in where they are treated under such emergency conditions. Surprise bills are often shockingly expensive, and hard-hitting to health care consumers. The CAA’s No Surprises Act battles such occurrences, and implements changes which apply to individual- and group-health plans (grandfathered and non-grandfathered) with effective dates beginning on or after 1/1/2022.

The key provisions of the No Surprises Act on surprise billing are as follows; keeping in mind that this article is only a brief summarization of major items within the law and is not a comprehensive analysis.

Balance Billing: Surprise bills must be covered at in-network rates. 

Health plans may not extend surprise medical bills for emergency services rendered by out-of-network providers/facilities, air ambulance services (if the plan provides air ambulance services facilitated by in-network providers); and services provided by out-of-network providers at in-network hospitals or facilities. Ground ambulance services will be impacted, too; however, details are pending. For these services and circumstances, out-of-network providers may not balance bill patients (or hold patients liable) for any amounts exceeding in-network charges.

Health plans must keep their provider directories up to date, and verify they are accurate every 90 days. 

Additionally, carriers must also establish a “response protocol” system, allowing them to respond to covered individuals, within a newly required one-business-day timeframe, when asked whether a provider or facility is considered “in-network.” If incorrect information is given, a health plan must cover the services rendered by that provider at in-network rates.

Health plans must provide price comparison tools to consumers. 

These tools, which must be available by phone and internet, allow covered individuals and in-network providers to compare expected cost-sharing amounts for covered services.

Health plans must provide advanced Explanation of Benefits (EOBs) to consumers upon request, and to consumers proactively before scheduled care. 

For health plans with effective dates beginning in 2022, consumers may request advanced EOBs to see how services would be covered before they are provided. Health plans must provide advanced EOBs explaining benefits and estimates of cost-sharing before scheduled care. They must furnish such good-faith estimates, within three business days, of what the plan will pay and what the patient cost might be for covered services (whether the provider is in-network or out-of-network). For services scheduled within 10 days, the advanced EOB must be distributed within one business day. This may be challenging for carriers, since the timelines are tight and because it can be difficult to predict charges for any related issues that may be discovered during the procedure with the doctor.

Providers must also furnish good-faith estimates of expected charges for services 

including related billing and diagnostic codes in advance of a service. Providers are also expected to furnish charges for services that are reasonably expected alongside the scheduled services. This is likely to combat the related challenges mentioned in the aforementioned advanced-EOB section.

Health plans must notify individuals when a provider/facility leaves its network, and must provide related transitional continuity of care to patients in some circumstances. 

Required by the No Surprises Act, health plans must notify covered individuals when a provider/facility leaves a plan’s network(s). For patients receiving certain types of ongoing care from affected providers or facilities, health plans must provide up to 90-days of transitional coverage (or until treatment ends) by those providers, at in-network rates. Such transitional coverage is generally available for patients being treated for serious/complex health conditions, inpatient care, non-elective surgery, pregnancy and terminal illness.

Carriers must update and re-release physical and digital ID cards, 

which (for plan years beginning January 2022 or later) must list plan deductibles and out-of-pocket maximum limits.

Regulators are working out the details of these new changes, and are expected to release regulations by summertime. Carriers will only have a few short months to implement changes in their health plans, and will likely be challenging to execute. As further regulations are released, we will keep you updated. Stay tuned for further columns to follow over the coming months on these CAA items, and the transparency item included in the law as more information is released by enforcing agencies and regulators.

It May Be Time To Relax Indoor Face Mask Mandates, Fauci Says

Dr. Sanjay Gupta: The complicated calculus of mask-wearing

Source: CNN Health, By Lauren Mascarenhas and Christina Maxouris

Dr. Anthony Fauci says federal guidance on wearing face coverings indoors may change soon.

Sunday on ABC News, Fauci was asked whether it’s time to start relaxing indoor masks requirements. Fauci replied, “I think so, and I think you’re going to probably be seeing that as we go along, and as more people get vaccinated.”

The US Centers for Disease Control and Prevention will be updating its guidance almost in real time, as more Americans get vaccinated, said Fauci, director of the National Institute of Allergy and Infectious Diseases.

The CDC relaxed its guidance last month on wearing masks outdoors, but still advises both vaccinated and unvaccinated people to still wear masks in indoor public spaces, such as a mall, movie theater or museum.

“We do need to start being more liberal, as we get more people vaccinated,” he added.

Sunday on CBS’ “Face the Nation,” Dr. Scott Gottlieb, former commissioner of the US Food and Drug Administration, said face mask requirements should be relaxed now that the Covid-19 risk is dropping.

“Certainly outdoors, we shouldn’t be putting limits on gatherings anymore,” Gottlieb said. “The states where prevalence is low, vaccination rates are high, and we have good testing in place, we’re identifying infections, I think we could start lifting these restrictions indoors as well, on a broad basis.”

Lifting pandemic restrictions when they are no longer necessary will make it easier for public health officials to reimplement them if cases rise again, such as a potential winter surge, Gottlieb said.

The US probably will be back to normal by next Mother’s Day, if enough people get vaccinated against Covid-19, Fauci said on ABC News.

“I hope that next Mother’s Day, we’re going to see a dramatic difference than what we’re seeing right now,” he said. “I believe that we will be about as close to back to normal as we can.”

There are some conditions, he noted.

“We’ve got to make sure that we get the overwhelming proportion of the population vaccinated. When that happens, the virus doesn’t really have any place to go,” he said. “You’re not going to see a surge. You’re not going to see the kinds of numbers we see now.”

White House Covid-19 response coordinator Jeff Zients told Jake Tapper on CNN’s “State of the Union” Sunday that the country is “turning the corner” on the pandemic — but stressed the importance of all Americans getting vaccinated.

He noted that President Joe Biden set a goal of having 70% of adults vaccinated by July 4.

“We’re at 58% today. So we’ve got a path ahead of us,” he said.

Zients said that despite some mask fatigue, Americans should continue to follow the science when it comes to wearing masks indoors, and wait for new CDC guidance before changing their habits.

“We all want to get back to a normal lifestyle. I think we’re on the path to do that, but stay disciplined, and let’s take advantage of the new privileges of being vaccinated and not wearing masks outdoors for example, unless you’re in a crowded place,” he said.

3 things that may defeat vaccine hesitancy

The US has an opportunity to get ahead in the Covid-19 pandemic by getting more people vaccinated — and three key things can help address ongoing concerns, one expert says.

“People were worried about safety. We now have hundreds of millions of doses out there, so we have great data on safety,” emergency medical physician Dr. Anand Swaminathan told CNN on Saturday. “People were worried about efficacy,” he said, adding there is now real-world data showing how effective the vaccines are.

And finally, Swaminathan said, some Americans were concerned that the vaccines didn’t have FDA approval and had only received emergency use authorization. But Pfizer/BioNTech announced Friday an application for full FDA approval of the vaccine for people 16 and older — making it the first Covid-19 vaccine in the US to be assessed for full approval.

“What’s the difference between FDA emergency use authorization and full approval? It’s really time and money,” infectious disease specialist and epidemiologist Dr. Céline Gounder told CNN on Saturday.

“But for some people, seeing a full approval from the FDA will indeed give them more confidence that these vaccines are safe and effective — and look, they are safe and effective,” she added.

The FDA “will move as expeditiously as possible,” without compromising its safety standards, to assess Pfizer’s Covid-19 vaccine for approval, Zients said Friday.

More than 151 million Americans — roughly 45.6% of the US population — have received at least one Covid-19 vaccine dose, according to CDC data.

More than 112 million Americans — almost 34% of the population — are fully vaccinated, CDC data shows.

US official: Vaccine confidence only one piece of puzzle

For officials across the country, getting more Americans vaccinated will now be an uphill battle, as experts say the US has now reached those who weren’t as eager to get a shot or still have questions.

Vaccination rates are already falling. For the first time since early March, the seven-day average of Covid-19 vaccine doses administered in the US fell below 2 million per day, according to CDC data published on Saturday. But on Sunday, the seven-day average edged back above 2 million per day, the CDC said.

But confidence in the vaccines is only “one piece of the puzzle,” when it comes to the challenges the US faces in its vaccination efforts, US Surgeon General Dr. Vivek Murthy said during a White House Covid-19 briefing on Friday.

“The barriers to getting vaccinated fall into three main categories,” he said. “Vaccine confidence, motivation and access.”

And local, state and federal efforts are ongoing, he said, which aim to address all three pieces.

“I know it’s been a difficult year and that everyone in our country has been asked to step up and sacrifice in a big way,” Murthy said. “I want to be clear that this pandemic will end. The faster we get vaccinated, the faster that day will come.”

J&J pause ‘cast a shadow’ on vaccinations

One factor that may have contributed to the slowing vaccinations was the recommended pause on the Johnson & Johnson Covid-19 vaccine, one expert said Saturday.

That recommendation was lifted last month and officials said the label would be updated to warn of blood clot risks. Experts concluded the vaccine’s benefits outweighed its “known and potential risks” and the vaccine continued to meet “standards for safety, effectiveness and quality,” acting FDA Commissioner Dr. Janet Woodcock said at the time.

But the recommendation to pause had its own effects.

“(The) Johnson & Johnson pause did cast a shadow over the momentum that we had gained,” Dr. Jayne Morgan, clinical director of the Piedmont Healthcare Covid Task Force, said.

Two weeks after the J&J recommended pause was lifted, that vaccine accounts for a very small share of doses administered in the US — and the current pace of administration lags significantly from the pace before the pause, CDC data shows.

Over seven days, the J&J vaccine accounted for just about 3.5% of total doses administered, according to data published Friday by the CDC.

Job Openings Surge To Record 8.1M, But Businesses Struggling To Hire Workers

A now hiring sign in posted in front of a Taco Bell restaurant

Source: Fox Business, by Megan Henney

U.S. job openings climbed to a record high in March, highlighting the growing demand for workers as more Americans are vaccinated and states reopen their economies.

The number of available positions increased to 8.12 million during the month, the highest in data that dates back to 2000, according to the Labor Department’s Job Openings and Labor Turnover Survey, or JOLTS. It marked an increase from the upwardly revised 7.53 million open jobs in February.

“The increase puts job openings 16% over pre-crisis levels and points to surging labor demand as the economy reopens,” said Daniel Zhao, a senior economist at Glassdoor.

But many companies have reported difficulties in onboarding new employees, and the report showed that job vacancies exceeded hires by more than 2 million, the largest gap on record. Nearly half – 44% – of small businesses have said they could not fill open jobs in April, according to the National Federation of Independent Business.

Experts have suggested there could be several reasons for the seeming labor shortage, including lack of available child care, fear over contracting COVID-19 or the extra $300-a-week boost in federal unemployment benefits.

The debate over the sweetened jobless aid intensified last week following the release of the Labor Department’s April payroll report, which showed that employers added 266,000 jobs last month – sharply missing the 1 million forecast by Refinitiv economists.

Republican lawmakers were quick to blame the supplemental benefit for one of the biggest downside misses on record, with Rep. Kevin Brady, the ranking member on the tax-writing House Ways and Means Committee, accusing the Biden administration of “sabotaging our recovery.”

“The White House is also in denial that many businesses – both small and large – can’t find the workers they need … because the benefits are discouraging work,” Brady, R-Texas, said.

But President Biden on Monday rejected a call by Republicans to end, or severely curtail, the $300-a-week unemployment benefit extension included in the American Rescue Plan.

“We’ll insist that the law is followed with respect to benefits, but we’re not going to turn our backs on our fellow Americans,” Biden said. “Twenty-two million people lost their jobs in this pandemic, through no fault of their own. For many of those folks, unemployment benefits are a lifeline.”

There are roughly 8.2 million fewer jobs than there were in February 2020, before the pandemic forced an unprecedented shutdown of the nation’s economy.

Biden: Workers Can’t Turn Down Job And Get Benefits

President Joe Biden signs an executive order during an event in the State Dining Room of the White House on Jan. 21, 2021.

Source: The Hill, by Morgan Chalfant

President Biden announced Monday that his administration would affirm that workers cannot turn down a “suitable” job they are offered and continue to take federal unemployment benefits.

“We’re going to make it clear that anyone who is collecting unemployment who is offered a suitable job must take the job or lose their unemployment benefits,” Biden said in remarks on the economy from the East Room, noting there would be “a few COVID-19-related exceptions” to the guidance.

After a monthly report showed a slowdown in job growth last week, Republicans and business groups have argued that the supplemental unemployment benefits incentivized people not to work and should be done away with.

Certain workers can get a $300 weekly supplemental unemployment benefit through the $1.9 trillion coronavirus rescue package that Biden signed into law in March. The increased benefits are slated to last until September.

Critics argue the latest disappointing jobs report is evidence some aren’t returning to work because of the benefits. Others argue there is little hard evidence to suggest this is a factor. Biden administration officials have also pointed to the problem of child care as being a serious issue that is preventing some workers from going back to work.

Biden’s remarks on Monday signal the administration does not want to be perceived as providing benefits that might serve as a disincentive to work.

The president did insist there was no evidence that the expanded unemployment benefits contributed to the slowdown in job growth during the month of April.

“Americans want to work,” he said.

“No one should be allowed to game the system and we’ll insist the law is followed but let’s not take our eye off the ball,” he said. “We need to stay focused on the real problems in front of us — beating this pandemic and creating jobs.”

The Labor Department is expected to send a letter to states this week to “reaffirm that individuals receiving UI may not continue to receive benefits if they turn down a suitable job due to a general, non-specific concern about COVID-19,” the White House said in a release.

Workers are exempt from the policy if they are unable to take the job due to child care responsibilities or the worksite is not complying with federal or state health guidelines.

Biden is also directing Labor Secretary Marty Walsh to work with states to reinstate work search requirements for those receiving unemployment insurance if it is healthy and safe, the White House said.

Data released Friday showed that the U.S. economy added 266,000 jobs during the month of April, coming in far below economists’ expectations. Biden and administration officials have repeatedly characterized the data as a sign of continued progress and tried to blunt Republican attacks on Biden’s economic agenda.

“I never said, and no serious analyst ever suggested, that climbing out of the deep, deep hole our economy was in would be simple, easy, immediate or perfectly steady,” Biden said Monday.

“Some months will exceed expectations, others will fall short. The question is, what is the trend line? Are we headed in the right direction? Are we taking the right steps to keep it going? And the answer is, clearly, yes,” he added.

Biden said that his rescue package would be implemented over the course of the next year, noting that funds to state and local governments and hard-hit restaurants would be disseminated this month. The Treasury Department on Monday launched an application portal for state and local governments to apply for funds to support public service jobs. The administration is sending out the first grants to 16,000 restaurants on Monday.

Kaiser Permanente Researchers Exploring How AI Can Improve Care For Heart Disease Patients

Kaiser Permanente researchers exploring how AI can improve care for heart  disease patients | FierceHealthcare

Source: Fierce Healthcare, by Brian T. Horowitz

Kaiser Permanente is exploring the use of artificial intelligence to cull through doctors’ medical reports and help identify patients with aortic stenosis, a common heart valve disease, and other chronic health conditions.

As part of ongoing research into the predictors of valvular heart disease, researchers looked at whether they could train AI software to spot which patients have valvular heart disease by studying echocardiogram reports, according to Matthew Solomon, M.D., Ph.D., a physician researcher with the Kaiser Permanente Division of Research and a cardiologist.

According to the team’s research findings, published in Cardiovascular Digital Health Journal, a computer taught to intelligently recognize certain abbreviations, words and phrases was able to read through nearly a million electronic health records and echocardiograms from within Kaiser Permanente and identify 54,000 patients with aortic stenosis.

“In our case, the large data set was a giant trove of echocardiogram reports that were collated over the past decades,” said Solomon, lead author of the study.

The goal of the project was to improve care for patients with valvular heart disease, Solomon said.

Grants from the Permanente Medical Group Delivery Science and Applied Research and Physician Researcher Programs supported the work of the researchers.

Solomon noted how complex written text can appear when it is computerized, so natural language processing (NLP) algorithms helped medical professionals make sense of the data. Kaiser uses IQvia’s Linguamatics platform to construct the NLP algorithms.

“It’s a complicated problem because doctors write their reports quite differently,” Solomon explained. “They don’t always write them in the same way, and as we all know, doctors like to use a lot of abbreviations. So there was a lot to teach the computer.”

In addition, by using AI, the researchers were able to reduce the amount of time to cull a million EHRs down to mere minutes, Kaiser Permanente said in a blog post. It would take doctors years to read through this volume of medical records, according to the health system. NLP algorithms can scan through medical records just as Google can scan web pages, Solomon notes.

For the study, Solomon and his team studied the echocardiograms of Kaiser Permanente Northern California patients from January 2008 through December 2018. The team used about 1,000 of the echocardiogram reports to teach the NLP algorithms to understand various ways that doctors describe aortic stenosis and other heart findings.

NLP helped researchers overcome the limitations of procedure codes or diagnosis codes, according to the study’s senior author Alan Go, M.D., a senior research scientist at the Division of Research and the regional director of the Kaiser Permanente Northern California Clinical Trials Program.

“There are a lot of limitations to only using procedure codes or diagnosis codes to identify populations of patients with a condition of interest,” Go said in the blog post. “We were able to train the computer to do what a physician or trained abstractor would do, but on a large scale and without ever getting tired or making mistakes. Importantly, we were also able to train the system to look at the information and measurements from the exams to tell us not only whether a patient had aortic stenosis, but the severity of their condition.”

Healthcare organizations are ramping up their use of AI and NPL to analyze clinical data and aid in decision-making at the point of care. The American College of Cardiology (ACC) is planning a trio of studies that will measure whether personalized clinical guideline support delivered by an AI tool at the point of care can improve heart patients’ outcomes.

Mayo Clinic recently launched a new initiative to collect and analyze patient data from remote monitoring devices and diagnostic tools and to use artificial intelligence to accelerate diagnoses and disease prediction.

Healthcare executives at hospitals, life sciences companies, health plans, and employer organizations say they are accelerating or expanding their AI deployment timelines in response to the pandemic, according to an Optum survey published in November. For hospitals, AI is being used primarily to improve reimbursement coding, monitor the Internet of Things (IoT), and accelerate research, the survey found.

The Kaiser Permanente research team intends to train the computer to identify other types of heart conditions. If this work is successful, the next step would be to teach the computer how to analyze patterns in the medical records that could identify patients at risk for aortic stenosis, which would boost the use of AI for actual disease prevention, according to Kaiser Permanente researchers.

In the future, AI tools such as NLP will help medical professionals identify who is sick or at risk for a certain disease so they can improve treatment. They will learn from the work the team has done with people with hypertension and diabetes, according to Solomon.

“In the future AI techniques might be able to identify patients who are at risk for chronic diseases, so we can intervene earlier and prevent them, rather than simply identifying those who are already sick, so we can make sure we take better care of them,” he said.

Small Businesses Recovering Despite Pandemic

Small businesses recovering despite pandemic | Accounting TodaySource: Employee Benefit News, by Michael Cohn

Small businesses are gaining more revenue this year despite the lingering challenges from COVID-19 and reversing last year’s losses, according to a report from Intuit’s QuickBooks unit.

The report examined how small and midsized businesses performed financially in different industries and geographies from March 2020 to March 2021, analyzing anonymized revenue data drawn from approximately 1 million QuickBooks Online customers. Despite their pandemic challenges, 61 percent of industries managed to increase their revenues over that period. A diverse group of businesses actually managed to perform well during the pandemic based on their annual revenue data from QuickBooks Online data. Mortgage bankers saw a 30 percent increase in annual revenue ($148,000 per business) compared to their pre-pandemic performance. Retail nurseries saw annual revenue increase 17 percent ($75,000 per business) while hardware store revenue was up 14 percent ($94,000 per business), thanks to a surge in home improvement projects.

The report indicates that businesses had different experiences during the pandemic, and while some have managed to survive and even thrive, many have not fared well and failed to survive. According to a report released earlier this month by Facebook and the Small Business Roundtable, 22 percent of small businesses in the U.S. were closed in February, close to the highs seen last year at the height of the pandemic, according to CNBC. The Federal Reserve estimates that approximately 200,000 businesses closed as a result of the pandemic last year.

However, at least based on QuickBooks Online data, specialist retailers saw strong growth during the pandemic, with revenue for motorcycle dealers and RV dealers up by 17 percent and 15 percent respectively, and for meat and fish markets increasing 23 percent.

“Intuit QuickBooks data has provided extraordinary insights into the pandemic’s effect on small businesses, for worse, and for better. We can see where the recoveries are, and are not,” said Susan Woodward, founder of Sand Hill Econometrics, in a statement. “Only QuickBooks can see genuine small company revenues, monthly, by industry and location with such accuracy and timeliness.” Intuit commissioned Woodard to do the analysis for the report.

Even some of the hardest hit businesses seem to be back to pre-pandemic levels in some cases, at least for those that have managed to survive. Government aid programs like the Small Business Administration’s Paycheck Protection Program have helped cushion the blow for many companies. For instance, personal care businesses (barber shops, beauty salons) saw a 52 percent drop in monthly revenue when the pandemic first started. Of these, barber shops were the hardest hit, down by 82 percent (equivalent to $12,000 per business) that month. But in nine out of the past 10 months, they have been down less than 20 percent. In March 2021, they were 16 percent above their pre-pandemic revenue.

Clothing shops saw their monthly revenues plummet by 50 percent in April 2020. Of those, women’s clothing shops experienced the largest decrease, down by 56 percent (roughly equal to around $10,000 per business). In nine out of the past 10 months, though, women’s clothing shops have been down by less than 10 percent. Last month, they were 14 percent above their pre-pandemic performance.

“From bowling alleys to dentists, and from coast to coast, no small business was immune to the challenging circumstances that COVID-19 presented this year,” said Alex Chriss, executive vice president and general manager of Intuit QuickBooks, in a statement. “Despite these challenges, our data shows that small businesses are on a path to recovery, demonstrating the resilience and tenacity that small businesses embody for all of us. The spirit of resilience and recovery is evident across the entire QuickBooks platform, and Intuit is committed to helping businesses learn new ways to grow and thrive in the future.”

By the end of last month, all 10 U.S. sectors were back above the monthly revenue benchmarks they set before the pandemic, according to Intuit. Monthly revenue for the construction industry in March 2021 was up by 30 percent; retail was up 22 percent; and manufacturing was up 20 percent.

For the top seven performing industries (finance/insurance, agriculture, fishing/hunting, building/gardening materials, utilities, forestry and crop production) monthly revenues were only down for April and May of 2020, according to Intuit. However, by June, six of those industries were back to pre-pandemic monthly revenues and by September all seven of them were ahead of their pre-pandemic levels.

To be sure, the pandemic closed down many businesses and hurt revenues even in those that have managed to hang on. Businesses in high-density, urban areas — particularly on the East and West Coasts — experienced a bigger negative financial impact than those in rural areas. Small and midsized businesses in Manhattan saw their annual revenue decline $58,000 per business compared to pre-pandemic levels. The other hardest hit cities were San Francisco (with a decline of $36,000 per business) as well as Brooklyn, Honolulu and Santa Monica, all of which saw a decline of $26,000 per business compared to pre-pandemic levels.

On the other hand, businesses in Gilbert, Arizona, saw their annual revenue increase $15,000 per business. Other cities that experienced increases include Boise, Idaho (with a $13,000 increase per business), and Colorado Springs, Colorado (with a $10,000 increase per business).

A Guide To Applying For PPP Loan Forgiveness

A Guide To Applying For PPP Loan ForgivenessSource: Forbes, by Rohit Arora

As the second round of the Paycheck Protection Program (PPP) winds down on May 31, small business borrowers who have already secured their funding and spent their loan proceeds on covered expenses will soon be applying for loan forgiveness.

After all, the beauty of the PPP is that it was designed to keep Americans working by having their companies continue to pay their salaries. The program reimburses struggling small businesses—ultimately enabling them to survive—by allowing them to apply for forgiveness of the PPP loans they used to keep employees on payroll and certain other expenses.

Before applying, it is important to know the terms of forgiveness for both PPP Draw 1 and PPP Draw 2 loans.

First Draw PPP Loan forgiveness terms

First Draw PPP loans are made to eligible borrowers who qualify for full loan forgiveness if they have done the following during the 8- to 24-week period following their PPP loan disbursement:

·        Maintained employee staffing and compensation levels

·        Spent the loan proceeds on payroll costs and other eligible expenses; and

·        Used at least 60% of the loan for covering payroll costs

Second Draw PPP Loan forgiveness terms

Similarly, Second Draw PPP are eligible borrowers who qualify for full loan forgiveness if they have done the following during the 8- to 24-week period following their PPP loan disbursement:

·        Maintained employee and compensation levels in the same manner as required for the First Draw PPP loan

·        Spent the loan proceeds on payroll costs and other eligible expenses; and

·        Used at least 60% of the loan for covering payroll costs

How and when to apply for loan forgiveness

Small business borrowers can apply for forgiveness once all the money from the loan for which the borrower is requesting forgiveness have been spent. Borrowers can apply for forgiveness any time up to the maturity date of the loan.

If borrowers do not apply for forgiveness within 10 months after the last day of the covered period, then PPP loan payments will no longer be forgiven, and borrowers will begin making loan repayments to their PPP lender.

Small business owners or their CPAs/accountants can apply for loan forgiveness by using AICPA’s free online platform

Frequently asked questions:

What does payroll include?

Payroll includes salaries, wages or similar forms compensation; payment of cash tips or equivalent; payment for vacations or parental, family, medical, or sick leave; severance for dismissal or separation; payments for employee benefits, including health insurance premiums; payment of retirement benefits; and state or local tax assessed on employee compensation of employees.

PPP reimbursement covers salaries with a cap of $100,000. All employees regardless of salary above 100,000 are eligible to be counted in PPP loan forgiveness. However, anything above the $100,000 threshold his not covered. For instance, if an employee’s total paid compensation is $125,000, then PPP will cover $100,000 of that individual’s compensation, the remaining $25,000 will not be covered by the program.

Part-time employees do count toward total payroll for PPP calculations. To calculate the compensation amount for part-time workers, take the average of hours worked multiplied by the employee’s hourly rate. However, it is important to note that contractors and other 1099 workers do not count toward the payroll of a business. The reason is that 1099 workers and other self-employed contractors can apply for PPP independently.

What types of businesses are eligible for PPP loans?

·        Self-employed individuals, independent contractors, and sole proprietors.

·        Small businesses with employee count of 500 or fewer.

·        Non-profits – 501(c)(3) and 501(c)(19) with 500 or fewer employees

·        Franchises on a location by location basis

For more information specific to Small Business Administration business size requirements visit SBA table-size standards.

What type of documentation does small businesses need to apply for PPP loan forgiveness?

Documentation required to apply for PPP loan forgiveness may vary based on type of business. Loan forgiveness applicants should be able to provide documentation for all payroll periods that overlapped with the covered period of the PPP loan. These documents include:

·        Bank account statements or third-party payroll service provider reports documenting the amount of cash compensation paid to employees.

·        Tax forms (or equivalent third-party payroll service provider reports) for the periods that overlap with the covered period.

·        Payroll tax filings reported, or that will be reported, to the IRS (typically, Form 941).

·        State quarterly business and individual employee wage reporting and unemployment insurance tax filings reported, or that will be reported, to the relevant state.

·        Payment receipts, cancelled checks, or account statements documenting the amount of any employer contributions to employee health insurance and retirement plans that the borrower included in the forgiveness amount.

Non-payroll expenses covered by PPP include: 

·        Business mortgage interest payments. (Provide a copy of lender amortization schedule and receipts verifying payments, or lender account statements.)

·        Business rent or lease payments. (Provide a copy of current lease agreement and receipts or cancelled checks verifying eligible payments.)

·        Utility payments (Provide copies of invoices and receipts, cancelled checks or account statements.)

·        Operation expenditures related to business software or cloud computing service

·        Property damage costs related to vandalism or looting

·        Payments made to a supplier of goods

·        Worker protection expenditures (masks, sanitizer, etc.)

Covered items have expanded from the first iteration of PPP forgiveness, which focused primarily on salary expenses and rent, to items including PPE, software, and supplier costs. Once the documentation is compiled, the small business owner is ready to submit the loan forgiveness application to the lender. If the SBA undertakes a review of your PPP loan application, your lender will notify you of the review and, ultimately, of the SBA’s review decision.

Business owners whose PPP forgiveness requests are denied will have the right to appeal certain SBA loan review decisions. Your lender is responsible for notifying you of the forgiveness amount paid by SBA and the date on which your first payment will be due, if applicable.

Last Updated 05/12/2021

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