Hospital Groups Push Back Against Stiffer Penalties For Failing To Publish Prices

Hospital groups push back against stiffer penalties for failing to publish  prices | FierceHealthcareSource: Fierce Healthcare, by Robert King

Hospital industry groups are pushing back against a proposal to jack up fines for health systems that don’t publish their prices, arguing that facilities are putting all their resources behind combating the COVID-19 pandemic.

The groups wrote in comments to the 2022 Hospital Outpatient Prospective Payment System (OPPS) rule strongly opposing a proposal to apply fines for noncompliance with a price transparency requirement on a per-bed basis. The current rule fines hospitals $300 a day.

The Centers for Medicare & Medicaid Services (CMS) wrote in the proposed payment rule released in July that hiking the fine could lead to greater compliance. The agency said its own independent audits and outside analyses have found widespread noncompliance with a regulation that requires facilities to post payer-negotiated rates online.

But the American Hospital Association (AHA) charged that “there is no evidence that the current penalty amount impacted early compliance with this rule,” according to the group’s comments. “In fact, to date, CMS has not actually issued any penalties.”

CMS has sent more than 100 warning letters to hospitals for noncompliance with the Trump-era regulation. If a hospital doesn’t turn things around, it will face a penalty of $300 a day for each day of noncompliance.

The agency proposed back in July to keep the $300 a day penalty for smaller hospitals with 30 or fewer beds. However, it would also apply a penalty of $10 per bed a day for hospitals that have more than 30 beds, and the penalty cannot exceed $5,500 a day.

A full year of noncompliance could cost a hospital more than $2 million a day, the agency said in a release back in July.

The agency said the penalty hike is in response to concerns from consumers about widespread noncompliance with the rule that went into effect in January. A study published back in June in JAMA found that 83 out of 100 random hospitals were not compliant, and another analysis from the group PatientRightsAdvocate found that only 5.6% of hospitals analyzed were fully compliant.

But hospitals charge that they are facing an unprecedented financial strain from the COVID-19 pandemic, and that has likely shifted facilities’ attention.

“The personnel required to comply with this rule have been overwhelmed with more pressing assignments, such as bringing hospital surge capacity online and assisting with the monitoring and tracking of vaccine distribution,” the AHA’s comments said.

CMS gave hospitals leeway on other federal requirements, and “such flexibilities should be granted for these policies as well,” AHA said.

If CMS moves forward with the proposed hike, it should be changed to not just reflect a hospital’s bed size but to also reflect progress hospitals have made in complying with the rule, hospital groups say.

“Hospitals may have invested already scarce resources to implement a comprehensive cost estimation tool that provides useful information that empowers consumers to make informed decisions about their care,” wrote America’s Essential Hospitals, which represents safety net providers.

The Association of American Medical Colleges also wants CMS to give hospitals more time if they do install the stiffer penalties. The group commented that CMS should delay implementation of the new penalties.

The group said hospitals should at least get one year after the end of the COVID-19 public health emergency, which is expected to run through 2021, until the new penalties go into effect.

But the stiffer penalties did get major support from powerful political figures.

Reps. Frank Pallone, D-New Jersey, and Cathy McMorris Rodgers, R-Washington, voiced support in a letter to Department of Health and Human Services Secretary Xavier Becerra. Pallone is the top-ranking Democrat, and Rodgers is the top Republican on the powerful House Energy and Commerce Committee.

“We are concerned with troubling reports of low hospital compliance with the final rule,” the lawmakers wrote.

Blasting 340B and site-neutral payment cuts … again

Hospital groups also made renewed pleas to CMS to halt continued cuts to the 340B drug discount program and to off-campus hospital clinics to bring Medicare payments in line with physician offices.

CMS is proposing to maintain a 22.5% cut to payments for certain drugs discounted under the 340B program, which requires drug companies to offer discounts to safety net providers in exchange for participation in Medicare and Medicaid. The cuts were first proposed by the Trump administration back in 2018, and CMS will continue to exempt rural sole community hospitals, children’s hospitals and certain cancer hospitals.

The proposed rule also continued a Trump-era cut to off-campus hospital clinics of 40% of the outpatient payment rate. The goal was to bring Medicare payments for such clinics in line with those to physician offices. The cut was originally installed in 2019.

The hospital industry has fought both cuts in federal court but has failed so far. The Supreme Court will hear in their next term a challenge brought by the AHA against the cuts.

Hospital groups decried CMS’ decision to continue the cuts in the OPPS.

America’s Essential Hospitals charged that since CMS has instituted the 340B cuts, hospitals have faced reduced drug payments of more than $6.5 billion.

“CMS has not analyzed whether the policy has met its intended goals, how it has affected patient access, whether it has lowered drug prices or how it has affected hospital operations,” the group charges. “In fact, drug prices have continued to rise since implementation of the policy and hospitals continue to see their operations affected by their declining outpatient margins.”

Health Provisions in House’s $3.5 Trillion Domestic Policy Proposal

House Passes $3.5 Trillion Budget Plan for Vast Expansion of Safety Net -  The New York TimesSource: News Quick24

House Democrats are devising a $3.5 trillion domestic policy package that includes billions of dollars in hospital infrastructure, health manpower, nursing shortages and increased insurance coverage.

The House Energy and Commerce Committees, and Method and Means Committees that share jurisdiction over health spending and programs, passed their bill provisions this week in line with party politics, with the House hoping to pass the full Efficiency Improvement Act recovery “by the end of the month.

“The Committee on Energy and Trade today passed a Transformation Act that invests in the American people, responds to the challenges of our times, and builds a better future for future generations,” said Chairman of the Energy and Trade Council Frank Pallone (DN.J.) in a statement …

Republicans argue it’s too expensive and are frustrated by Democrats who use a process that denies the need for bipartisan support.

In the Senate, Democratic leaders are still working on a package that could win the support of all 50 party members. Senator Joe Manchin, a moderate West Virginia Democrat, is a key voice and has said he will not support the $3.5 trillion bill, which means anything that happens in the House of Representatives could be cut back.

Here are some key messages from the House of Representatives proposals that could impact the healthcare industry:

Infrastructure

In particular, leaders of social welfare hospitals say their facilities are in desperate need of modernization, as they were originally built for small populations.

The Greater New York Hospital Association has demanded at least $100 billion, but only $10 billion was included in a bill passed this week by the Energy and Trade Committee. This funding will be a priority for projects that increase capacity, renovate communities in need, prepare for public health emergencies or natural disasters, and protect against cybersecurity threats.

The bill also includes:

  • * $10 billion in grant funding for federally certified health centers to renovate, renovate, expand, or build facilities.
  • * $500 million to improve, upgrade or modernize the infrastructure of mental health centers and health education centers.

Health workforce

The pandemic highlighted the limited health workforce, especially in rural and underserved parts of the country. There is a shortage of healthcare workers across the country, especially nurses, and the problem is expected to worsen in the coming years as the US population ages.

Bills passed by committees of the House of Representatives include:

  • * A new program that will fund 1,000 scholarships per year for medical students from rural and underserved communities if they agree to practice in these communities after graduation.
  • * 1,000 new residency places per year starting in 2026 for medical schools committed to providing cultural skills training, community learning, and increased mentoring for students.
  • * $1 billion in grants for underserved areas medical schools that can be used to recruit and retain students, including racial and ethnic, underrepresented medical students, rural people, and low-income people. Funding can also be used to develop a curriculum that focuses on caring for rural and underserved populations, building medical schools in areas where they do not exist, hiring teachers, or modernizing or expanding facilities.
  • * $1 billion to increase the number of teachers and students in medical schools with a priority for people from rural areas or underrepresented racial or ethnic groups. Schools providing care in underserved areas will have priority.
  • * $6 billion in training at medical centers to create new postgraduate medical education programs or to maintain or expand existing programs.
  • * $300 million to help pay off loans for Registered Nurses and Advanced Registered Nurses who agree to work in a nursing shortage or teach in a nursing school.

Pandemic preparedness

Public health departments say they have been underfunded by states and the federal government for decades, making it difficult for them to respond to COVID-19. While President Joe Biden has called for at least $30 billion in public health funding, Democrats in Congress, faced with competing priorities, have included about half of that amount.

  • * $16 billion in funding to strengthen the country’s response to the pandemic, including $5 billion to renovate, expand, and modernize state and local public health and CDC laboratories, and $8 billion to replenish strategic national stockpiles and strengthen supply chains …
  • * Of this amount, $1.25 billion will be used to improve and strengthen public health surveillance in hospitals and other healthcare facilities.

Health insurance

After passing the Affordable Care Act in 2010, Democrats lost control of Congress and lost the ability to make any changes to the law. When Democrats regained their Senate and White House majority this year, they pledged to “lean” on the ACA. Bills passed this week:

  • * Continuously expand the Affordable Care Act subsidies for people with incomes of 400% of the federal poverty level or higher, and make subsidies more generous for people on low incomes. In the COVID-19 relief package passed by Congress earlier this year, these changes were only made for two years.
  • * Provide coverage for over 2 million low-income adults in 12 states who have not accepted the Medicaid ACA extension. Initially, these people will be eligible for ACA grants. Beginning in 2025, they will be eligible for a new federal Medicaid-like program that will be run by managed care organizations in non-expanding states.
  • * $10 billion a year in government reinsurance programs to reduce premiums, deductibles, and other personal expenses.
  • * Require states to provide health insurance to prisoners 30 days before they are released.

Maternal and Child Health

According to the Centers for Disease Control and Prevention, black women are three times more likely to die from pregnancy-related causes than white women. Several provisions in bills passed this week address maternal health with a greater focus on inequities in health, including several proposals from Rep. Lauren Underwood, Illinois. The bills will be:

  • * Requires states to give postpartum women 12 months of full Medicaid and Child Health Insurance benefits. Requires states to grant 12 months of continuous entitlement to children enrolled in CHIP, rather than excluding them due to income changes.
  • * Include $1 billion in support of maternal mortality, including grant programs to improve the social determinants of health, diversify the health workforce, tackle mental health and substance use disorders, and reduce discrimination and bias in health care.
  • * Continuously fund the Children’s Health Insurance Program, which currently requires congressional reapproval every few years, sometimes resulting in state funding delays.
  • * Get Medicare coverage for vision, dentistry, and hearing benefits.

Medicines prices

The House Methods and Remedies Committee this week passed a regulation that would allow Medicare to negotiate lower prices for prescription drugs with pharmaceutical companies. The same provision did not pass after three moderate Democrats raised concerns about the potential impact on new drug development. The House of Representatives will need to resolve these differences before voting on the full package of proposals. The nonpartisan Congressional Budget Office estimates that this version of the policy will save the federal government about $450 billion over ten years. Since the House bill is counting on those savings to pay for part of the package, it could ultimately be cut if Democrats don’t come to an agreement on drug prices.

“While I am disappointed that we were unable to move the price negotiations outside of the committee today, lowering the cost of prescription drugs remains a top priority for Democrats,” Pallone said. “The most effective way to curb the skyrocketing drug prices is to finally allow Medicare to negotiate lower prices, and I am confident that this will be part of the final drug improvement bill.”

15 Million People Could Lose Coverage After Public Health Emergency Ends, Report Says

Almost 90% of pandemic-era Medicaid enrollees at risk of losing coverage |  Modern HealthcareSource: Becker’s Hospital Review, by Nick Moran

A new report by the Urban Institute, funded by Robert Wood Johnson Foundation, anticipates that 15 million people could be out of Medicaid coverage when the pandemic public health emergency ends.

Medicaid enrollment initially swelled as a result of early pandemic joblessness and continuous coverage requirement of the Families First Coronavirus Response Act, according to the Sept. 15 report.

With the public health emergency in place through the end of 2021, researchers estimated that Medicaid enrollment could grow to 17 million new members since the start of the pandemic. That would bring the total number of Medicaid beneficiaries under the age of 65 to 76.3 million.

Should the public health emergency conclude at the end of 2021 as anticipated, however, 9 million adults and 6 million children could lose coverage through 2022, according to the report.

The report highlighted possible ways to tamper disenrollment, such as making American Rescue Plan Act Marketplace premium tax credits permanent, which would assist nearly a third of adults at risk of losing coverage.

Over half (57 percent) of children at risk of losing coverage would qualify for Children’s Health Insurance Program coverage. An additional 9 percent could be eligible for Marketplace coverage via tax credits.

Is Digital Health The Key To Making The Industry More Efficient?

Is digital health key to making the industry more efficient? | Modern  Healthcare

Source: News Quick24

As healthcare continues its digital transformation, questions arise about what role technology such as remote patient monitoring and virtual healthcare platforms will actually play in a post-pandemic.

“In a sense, COVID has provided an opportunity for healthcare stakeholders to improve and try to focus on leveraging these innovations to better manage healthcare services,” said Jailandra Singh, Senior Equity Research Analyst at Credit Suisse. “I think digital health can be seen as a tool that can make hospitals, doctors and clinics much more efficient.”

Many digital health firms believe that the greatest opportunities to move forward will lie in collaboration, rather than competition with traditional healthcare providers.

“We had very interesting discussions before the pandemic, during which everyone told us that they liked what we were doing, but that they would be ready to move on in that direction in about two years,” said Mario Anglada, CEO of Hoy Health, the primary digital center. A care services platform designed to meet the health care needs of populations in need of health care. “When a pandemic hits, these conversations quickly change to people asking to immediately connect to our system.”

Launched in 2017, Anglada said the company’s goal was to create the first bilingual, integrated network focused on primary health care, targeting an estimated 140 million people who are estimated to be either uninsured or underinsured.

In addition to telemedicine and remote patient monitoring services, the company also offers access to medicines through a virtual pharmacy, as well as health literacy and life coaching support in 19 different languages.

California Has The Lowest Coronavirus Rate In The Nation. Here’s What We Know

California has the lowest coronavirus rate in the U.S. - Los Angeles TimesSource: Mercury News, by Staff and Wire Reports

California has the lowest coronavirus case rate of any state, federal figures show, illustrating the progress made in the ongoing battle against the highly infectious delta variant.

The state has been among the national leaders in that metric for the last week, as the number of newly confirmed coronavirus infections continues to tumble from a peak earlier this summer. But while infections have plummeted in highly-vaccinated Bay Area and Southern California, hospitals are struggling to keep up with a crush of cases in the Central Valley, underscoring how vaccines are so critical in combating serious illness.

California’s new case rate per 100,000 people is less than half of neighboring states, according to data from the U.S. Centers for Disease Control and Prevention. Some hard-hit states have more than quadruple California’s numbers.

Statewide

As of Monday, California’s seven-day case rate was 95.3 per 100,000 people. The next-closest state was Connecticut at 126.5.

The comparable rates over the same period were 385.1 cases per 100,000 people in Texas, 287.2 in Florida, 250.1 in Arizona, 234.7 in Oregon, and 202.5 in Nevada, federal data show. West Virginia was the country’s highest at 715.8.

With the latest update, California’s coronavirus transmission level has once again fallen to “substantial,” according to the CDC. Every other state currently remains in the “high” transmission category.

The federal figures illustrate the recent success California has had in turning the tide of the delta variant-fueled coronavirus wave.

Over the last week, the state has reported an average of 8,849 new cases per day — down about 33% from two weeks ago, according to data compiled by The Los Angeles Times.

COVID-19 hospitalizations, too, have plummeted lately. At the height of the current surge, more than 8,300 coronavirus-positive patients were hospitalized at one time statewide. Now, that daily census has fallen to just about 6,000, state data show.

But the progress has been uneven. While the Bay Area, in general, experienced the least-severe summer surge and Los Angeles has had success with new measures to slow the delta variant, the Central Valley and parts of rural Northern California have been harder hit.

Bay Area 

According to the state dashboard, the 7-day daily average case rate in Santa Clara County is 10.6 per 100,000. In San Mateo County, it’s 9.9 cases, and in San Francisco it’s 11.1 cases. In Alameda County, it’s 12, and in Contra Costa County, it’s 16.7 cases. Statewide, it’s 19.9 cases per 100,000, meaning the region is faring better than California as a whole.

Hospitalizations in the region have also started to decline. Santa Clara County had 151 COVID-19 patients in the hospital as of Sept. 19, down from 250 at the start of the month. Alameda County had 147, down from above 200. Contra Costa County had 133, down from more than 220 in late August. San Francisco had 72, down from north of 120 in mid-August, and San Mateo had 34, down from around 60 in late August.

Still, hospitalizations remain far above where they were in May and June. In late May, John Muir Health had just five COVID-19 patients at its Concord hospital and zero at its Walnut Creek facility. On Monday, said spokesman Ben Drew, the system had a total of 43 COVID-19 patients at the two acute care medical centers. While that number is slightly higher than the 36 people hospitalized Friday, Drew said, “it has been a downward trajectory for the past couple of weeks.”

L.A. County

Los Angeles County continues to report improvement in weekly COVID-19 cases and hospitalizations.

About a month ago, the county was averaging more than 3,400 new coronavirus infections a day over a one-week period, according to a Times analysis of state data. But over the last week, L.A. County averaged nearly 2,200 new cases a day.

And as of Sunday, 1,034 coronavirus-positive patients were hospitalized countywide — down roughly 42% from the month prior.

Central Valley

But the situation remains grim elsewhere. Hospitals throughout the San Joaquin Valley — which the state defines as Calaveras, Fresno, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Joaquin, Stanislaus, Tulare and Tuolumne counties — have reported having less than 10% of their cumulative staffed adult ICU beds available for 19 straight days.

Some health care facilities in the region are still so overwhelmed with COVID-19 patients that some critically ill people are waiting days to be transferred into the intensive care unit from the emergency room, officials said.

One Fresno area hospital had nine critically ill patients who were unable to get into the intensive care unit for more than three days, interim health officer Dr. Rais Vohra said at a news conference last week. This forces emergency room staff to treat patients needing ICU care, disrupting the health care of other patients with less severe illness.

“We’re basically really straining what the emergency department has to do,” Vohra said. “We still anticipate at least a few more weeks of thoroughly impacted operations” in ICUs and emergency rooms.

Hospitals in Fresno County are teetering on the need to ration health care and implement “crisis standards of care,” Vohra said. In these situations, hospitals conclude that they no longer can provide the same standard of health care to everyone and must choose whose lives to prioritize in order to keep as many patients alive as possible.In Fresno County and the greater San Joaquin Valley, hospitals remain extremely busy, said Dan Lynch, director of the Central California Emergency Medical Services Agency. Most of Fresno County’s hospitals are running at 108% to 110% of standard capacity, while Clovis Community Medical Center near Fresno has been running at 130% of capacity.

Moderate Democrats Sink Pelosi’s Aggressive Drug Pricing Bill In Key Committee Vote

Democrats push proxy voting amid coronavirus relief battle - POLITICO

Source: STAT, by Rachel Cohrs

House Speaker Nancy Pelosi’s aggressive drug pricing package failed a key committee vote on Wednesday, prompting questions about whether the measure can survive a full House vote.

Reps. Scott Peters (Calif.), Kurt Schrader (Ore.), and Kathleen Rice (N.Y.), all Democrats, followed through on their threats to vote against the provision in the House Energy and Commerce Committee’s markup. Republicans unanimously opposed the measure, too, leading to a tie vote that means the provision failed to advance to a full House vote.

Before the vote, Peters said he opposed the legislation on the grounds that it would stifle future investment in drug development. He cited a Sept. 8 letter in which over 400 biotechnology investors argued that the Democrats’ bill was “draconian” and would “immediately halt funding of drug discovery and development.”

“This bill can be fixed,” Peters said. “It needs to be. I hope my colleagues on both sides will consider a different approach, one that protects both our patients and our future.”

Peters said he planned to introduce an amendment that would substitute his own bill for House Democrats’ current bill, which would create a dramatically scaled-back Medicare negotiation scheme that applies only to drugs whose market exclusivity has expired, but still lack market competition. And it would have only applied to outpatient drugs, which the committee chairman, Rep. Frank Pallone (D-N.J.), said was not broad enough.

But following Peters’ remarks, Pallone said Peters had agreed to withdraw his amendment without forcing members to vote.

The three Democrats’ votes came despite the fact that they voted to support a nearly identical version of the legislation in December 2019, and again in June 2020. But during his remarks, Schrader called the old bill “a partisan approach,” and said he only supported the old bill “reluctantly.”

Pelosi’s current proposal, Schrader said, is “an unacceptable solution to the high cost of drugs that sets up a vicious cycle of killing jobs and innovation.”

The vote may not stop House leadership from pushing forward with the bill, however, as a separate panel is also marking up the legislation. House Democrats only have a three-vote margin on the House floor, and the vote attracted the attention of House leadership. The drug pricing provision will “remain a cornerstone of the Build Back Better Act as work continues between the House, Senate and White House on the final bill,” Pelosi spokesperson Henry Connelly said in a statement.

Pallone alluded to ongoing negotiations between the House and Senate on drug pricing policy, as Senate Finance Chair Ron Wyden (D-Ore.) said Tuesday that Pelosi’s measure does not have the votes to pass the Senate.

“I do believe that we are going to have a provision in this reconciliation bill with the Senate’s support that will pass that will address drug pricing. And I would really like to have you at the table over the next couple of weeks as we negotiate this,” Pallone said, addressing the three moderate members.

Social Security Works, an advocacy group that supported Pelosi’s proposal, did not hold back in its criticism of the three moderates.

“It is disgusting when politicians who supported Medicare negotiation in the past switch their votes in exchange for pharma cash,” said executive director Alex Lawson.

Peters accepted a flood of campaign cash from drug makers after co-authoring a letter that criticized Pelosi’s drug pricing plan for being partisan. Rice and Schrader also signed that letter, which was sent in May.

The failed vote represents a major win for Republicans, who have long derided Pelosi’s drug pricing bill as “socialist” or as a “government takeover” of health care. In a statement, Rep. Cathy McMorris Rodgers (Wash.), the committee’s top Republican, called the plan “a radical price control scheme” that would lead to less innovation.

Drug makers also took a victory lap Wednesday, as they have opposed Pelosi’s bill for years. The brand drug lobby PhRMA said the vote signals that lawmakers have real concerns with Pelosi’s plan.

“These concerns have been known for months yet they’ve been ignored by House leaders,” said PhRMA Executive Vice President for Public Affairs Debra DeShong.

Mercer: 3 Ways Employers Can Continue To Enhance Benefits Options

Mercer: 3 ways employers can continue to enhance benefits options |  FierceHealthcareSource: Fierce Healthcare, by Paige Minemyer

Employer health supports have a meaningful impact on workers’ resilience and well-being, according to a new survey from Mercer.

The survey found that the pandemic did significant damage to the mental, physical and financial health of workers. For example, more than half said they experienced some kind of stress in the past year, and one-fifth said they were less financially well off than before the pandemic began.

However, 53% said their employer offered effective support through COVID-19, and these workers were less likely to feel the pandemic’s impacts as mostly or wholly negative, according to the survey.

“There is nothing more important to the health of a business than the health of its people and the communities in which that business operates. COVID-19 challenged our global healthcare system, but the ability of employers to have a positive impact on employee health and resiliency is one of the most important findings from our 2021 Health on Demand survey,” said Martine Ferland, president and CEO of Mercer, in a statement.

“The research is clear—employers that place health and humanity at the center of business transformation will build a more energized and adaptable workforce that is better able to persevere through periods of crisis,” said Ferland.

The report offers several takeaways for employers looking to further enhance their health supports for employees.

  •  * Offer benefits that are varied and high-value

More than half (55%) of employees surveyed said they find the ability to customize their benefits packages to better suit their individual needs to be either highly or extremely valued. Variety is key to this, Mercer said, as the more options people have, the better they can customize their benefits to their lives.

The survey found that 52% of people offered 10 or more health and well-being benefits or resources said their benefits are a reason to stay with their company. By comparison, 32% of those offered between one and five benefit options said the same.

Workers with access to more benefits also said they felt more confident that they could afford their care, the study found.

  • * Make digital health options accessible

The pandemic significantly drove up telehealth use, and people who did try it say they’re likely to stick with it, the survey found. A fifth of workers said they used telehealth for the first time due to COVID, and 23% said they grew their usage.

Of those who tried telehealth for the first time, 73% said they plan to continue using such services, the survey found.

  • * Many mental health needs remain unmet

Mental health remains a significant healthcare challenge and one that employers are increasingly focused on. Almost half (49%) of U.S.-based respondents said programs that lower the cost of mental health care are highly or extremely valuable.

With behavioral health needs on the rise due to COVID, accessing such care is often difficult, with 40% of those surveyed saying it’s hard to find and access quality mental health care. Among low-income workers, that number rises to 47%.

In keeping with the overall growth in telehealth use, many employees said they value virtual options for mental health care. Forty-two percent said they would value counseling conducted by video chat, and 38% said they would value virtual counseling via text.

Hospital Execs See Delta Pressure Dragging Into Early Fourth Quarter: Jefferies Poll

Safety net hospitals near 'breaking point,' advocacy group says |  Healthcare Dive

Source: Healthcare Dive, by Rebecca Pifer

Dive Brief:

  • * The delta variant’s impact on hospitals that began to emerge mid-July is expected to peak late in the third quarter or early in the fourth, according to a new survey of 40 hospital CEOs and CFOs conducted by Jefferies.
  • * Elective and non-emergent volumes were tracking down by about 30% in early September, leading Jefferies to expect a net 15% to 20% decline into the year’s end.
  • * As a result, the investment bank lowered third quarter outlook for medical device companies with revenues heavily tethered to surgical volumes, including Boston Scientific, Medtronic and Stryker, to account for the headwinds.

Dive Insight:

Though COVID-19 cases are trending a bit down, the pressure on hospitals that kicked in mid-July as cases rose due to the highly infectious delta variant has extended into September and is unlikely to go away for a while, Jefferies analysts said.

Hospitalizations have increased 1% over the last two weeks, per a New York Times tracker, and the U.S. is averaging roughly 1,500 deaths a day, for the first time since March. Some coronavirus hotspots are reporting extremely stressed hospital capacity, with Idaho hospitals this week beginning to ration medical care amid skyrocketing COVID-19 cases.

According to HHS, more than 80% of ICU beds in the country are currently in use, with seven states — Alabama, Arkansas, Florida, Georgia, Kentucky, Mississippi and Texas — reporting 90% or more of their ICU beds are filled.

Many expected hospitalizations to drop this summer following the vaccine rollout. But inoculation rates have lagged, and the holdouts are fueling current COVID-19 outbreaks, leading President Joe Biden to announce plans Thursday to require employers with 100 or more workers to mandate COVID shots.

The findings from Jefferies’ new survey of 40 C-suite execs jibes with the investment bank’s hospital tracker, which continues to indicate volumes have reverted to about 15% to 20% below pre-COVID-19 levels.

Nearly 60% of respondents reported seeing up to 30% declines in elective procedures coinciding with elevated delta variant cases through early September, in line with warnings from other healthcare companies finding a rise in hospitalizations offset by contracting outpatient and non-COVID-19 volume.

Hospital leaders expect those headwinds to persist into the late third quarter and early fourth, Jefferies found, with majority of execs surveyed saying they think delta cases will peak in that timeframe.

The consensus is that elective procedures will decline between 17% and 28% through the end of 2021, Jefferies said, with those headwinds partially offset by the continued return of care that was delayed earlier in the pandemic.

Roughly half of executives said they expect to recapture the full volume of delayed care by year’s end, while the other half expect those tailwinds to extend into 2022.

But the elevated delta case counts across the US, combined with executives’ input, led the investment bank to forecast downside pressure for many health companies in the second half of 2021. As a result, Jefferies lowered its third quarter outlook for companies with high surgical exposure, including medical device companies Abbott, Abiomed, Boston Scientific, Medtronic, Stryker and Zimmer Biomet, to account for at least two months of lower procedure volumes.

Jefferies analysts noted they expect hospitals to begin recapturing those volumes in the fourth quarter, depending on timing for the U.S. delta peak.

Providers And Insurers Want More Details, Leniency On Surprise Billing Ban

Providers and insurers want leniency on surprise billing ban | Modern  Healthcare

Source: Modern Healthcare, by Michael Brady

Biden Announces Sweeping New Vaccine Requirements For Workers

Biden announces sweeping vaccine mandates affecting millions of workersSource: Roll Call, by Mary Ellen McIntire and Niels Lesniewski

President Joe Biden is requiring most federal workers to get COVID-19 shots, without an option to instead get tested weekly, and will propose that workers at large companies get vaccinated or undergo testing.

The president’s plan will also double fines for people not in compliance with federal masking requirements, such as on airplanes. Enforcement of the federal mask mandate on interstate public transportation has not been consistent.

The president on Thursday expressed the frustration of many vaccinated Americans about those who have not yet received the readily available vaccines.

“What more is there to wait for? What more do you need to see? We have made vaccinations free, safe and convenient,” Biden said. “The vaccine is FDA-approved. Over 200 million Americans have gotten at least one shot. We’ve been patient, but our patience is wearing thin, and your refusal has cost all of us, so please do the right thing.”

White House Press Secretary Jen Psaki said there will be limited exemptions for medical or religious reasons for federal workers, and the requirements for those employees would fully take effect in about two-and-a-half months. Biden signed two executive orders Thursday to start implementing the plan.

“So, how this will work is the task force — the interagency task force — would provide a ramp-up period, and we expect federal employees will have about 75 days to be fully vaccinated,” Psaki said at a Thursday White House press briefing. “That gives people more than enough time, in our view, to start and complete their vaccination series. If a federal worker fails to comply, they will go through the standard HR process, which includes counseling and face disciplinary action, face progressive disciplinary action.”

Some federal workers already have COVID-19 vaccine requirements, including members of the military.

“Each agency’s going to work with employees to make sure they understand the benefits of vaccination and how the vaccines are free, easy and widely accessible, but it will start to be applied once the second order is signed,” Psaki said.

She said the penalty for noncompliance could include termination from federal employment.

Thursday’s speech comes as the White House is trying to recast its efforts to control the pandemic as hospitalizations and deaths have risen.

One of Biden’s executive orders requires vaccinations against the coronavirus for most federal workers. The order goes further than a previous policy requiring federal workers to attest to their vaccination status or undergo regular testing.

In the second executive order, the administration’s message is in effect that if a company wants to sell products or services to the federal government, they should get their workers vaccinated.

Challenges in implementation are already arising, however. The American Federation of Government Employees said the union supports vaccinations for its members, but it pushed back against a mandate outside of collective bargaining.

“We expect to bargain over this change prior to implementation, and we urge everyone who is able to get vaccinated as soon as they can do so,” American Federation of Government Employees National President Everett Kelley said in a statement.

Biden will also direct the Labor Department to issue a rule that would require businesses with over 100 employees to require COVID-19 vaccinations or at least weekly testing, which the administration says would affect over 80 million private-sector employees.

“The bottom line: We’re going to protect vaccinated workers from unvaccinated co-workers,” Biden said of the upcoming Labor Department regulation.

The administration will also require health care facilities that accept reimbursement from the Medicare and Medicaid programs to mandate vaccinations for staff, which would affect about 17 million health care workers and cover most health care facilities in the United States.

The Occupational Safety and Health Administration would also require employers to provide paid time off for employees to get vaccinated.

The administration is also preparing a campaign for already vaccinated Americans to get booster shots once such a policy is approved by the Food and Drug Administration and the CDC’s Advisory Committee on Immunization Practices.

The president also urged schools to use a previously provided $10 billion to set up testing programs.

The administration will also require staff in Head Start programs, Department of Defense schools and Bureau of Indian Education-operated schools be vaccinated. The Department of Health and Human Services will issue rulemaking for the Head Start program.

Biden also called on governors to require school staff to be vaccinated, which nine states as well as Washington, D.C., and Puerto Rico have already done. Several Republican governors are unlikely to set such a requirement.

The administration is also taking steps to increase COVID-19 testing, including by invoking the Defense Production Act and purchasing $2 billion in rapid point-of-care and over-the-counter at-home COVID-19 tests, totaling 280 million tests.

Walmart, Amazon and Kroger will all offer COVID-19 tests at cost for the next three months, meaning tests will be up to 35 percent cheaper at those retailers by the end of this week, according to a white paper released by the administration. Medicaid will also cover the cost of at-home tests for beneficiaries.

But the lower price for the test kits may not matter as much if there’s limited inventory. The popular Abbott BinaxNOW rapid test kits were out of stock on both the Amazon and Walmart websites ahead of the president’s speech.

The administration will also double the number of DOD clinician teams to support hospitals that are handling a surge in COVID-19 cases. Officials will also increase the amount of monoclonal antibody treatments to states by a further 50 percent this month, up from an average of approximately 100,000 doses that were shipped weekly in July and August.

The administration’s COVID-19 surge response effort will also expand to include monoclonal anitbody strike teams that will deploy personnel to administer the treatments. HHS will also amend the Public Readiness and Emergency Preparedness Act declaration so that more providers, including pharmacists, can provide the treatment.

Last Updated 09/22/2021

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