CMS Finalizes Drug Transparency, Pharmacy Quality Rules

CMS finalizes drug transparency, pharmacy quality rules

Source: Fyne Fettle, by James Schneider

CMS on Friday finalized a rule it estimates will save the federal government $75.4 million over the next decade in Medicare Advantage and Part D payments, with the agency crediting cost-savings to several measures enacted to curb prescription drug spending.

Under the new rule, CMS expanded drug and medication therapy management programs that require Medicare Part D plans to review potentially-risky opioid use trends with providers and patients. The final law also requires Medicare Part D sponsors to report payment suspensions against pharmacies facing fraud allegations to CMS, falling in line with the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT Act. The legislation also mandated Medicare Advantage and Part D plan sponsors report inappropriate opioid prescriptions and insurers’ actions to CMS via a secure internet portal.

In addition to cracking down on providers’ opioid prescriptions, the new rule includes steps to reduce out-of-pocket drug costs for Part D beneficiaries, standardize insurers’ process for reviewing pharmacy quality and allow enrollees to know more about their prescription drug costs in advance. The new rule follows an earlier set of Medicare Advantage and Part D updates CMS made in May 2020.

CMS will now require insurers to tell the agency how they calculate pharmacy performance measures by January 1, 2022, after complaints from the pharmaceutical industry the criteria used were unfair. CMS will publicly report the metrics to help insurers standardize the process for reviewing pharmacy performance, the agency said.

The federal agency will also give Part D plans the ability to create a “preferred” specialty tier of high-cost drugs with lower cost-sharing for enrollees by January 1, 2022. That change could help negotiate lower prices for expensive medications with drugmakers by promising them access to the so-called preferred tier.

Continuing the Trump administration’s efforts to reduce healthcare spending through increased transparency and lower drug costs, CMS wants Part D prescription drug plans to offer beneficiaries access to patient-specific drug costs in real-time by January 1, 2023. As an example, CMS said this tool will allow consumers to compare the price of similar, cholesterol-lowering drugs to see which requires the lowest individual copay. The final rule pushes this requirement back a year from its initial proposal.

“The changes in this final rule provide desperately needed transparency on the out-of-pocket costs for prescription drugs that have been obscured for seniors,” CMS Administrator Seema Verma said in a statement. “It will strengthen Part D plans’ negotiating power with prescription drug manufacturers so American patients can get a better deal.”

The final rule also updates Star Ratings and Quality Bonus Payment ratings, although CMS did not give details on the specific changes. The agency added that it is also working to codify policy changes related to supplemental benefits and provisions aimed at reducing the administrative burden for Programs of All-Inclusive Care for the Elderly, or PACE.

Retired Doctors And More Syringes: Biden Lays Out Plan To Get America Vaccinated

Retired doctors and more syringes: Biden lays out plan to get America  vaccinated | Reuters

Source: Reuters, by Trevor Hunnicutt

U.S. President-elect Joe Biden on Friday said he would order increased production of syringes and other supplies to ramp up vaccinations against COVID-19 and improve upon the Trump administration rollout that he called a “dismal failure.”

Under Biden’s plan, federal disaster-relief workers would set up thousands of vaccination centers, where retired doctors would administer shots to teachers, grocery store workers, people over 65 years old and other groups who do not currently qualify.

The Democrat would invoke the Defense Production Act to increase production of equipment needed to distribute the vaccines, such as glass vials, needles and syringes, according to a document released by his transition team. He would also use the law to support vaccine refrigeration and storage.

Biden said his team has identified companies that are ready to be activated under the law, which enables the president to order businesses to produce items necessary for national defense.

States that use their National Guard in the effort would be reimbursed by the federal government, the transition team said.

The coronavirus has killed more than 390,000 people in the United States, and a top Biden adviser said on Friday the death tally could reach 500,000 by February.

Biden has promised to do better than President Donald Trump to curb the virus and get 100 million vaccine shots into the arms of Americans during his first 100 days in office.

“This is a time to set big goals and pursue them with courage and conviction because the health of the nation is literally at stake,” said Biden, who takes office on Wednesday.

EXPANDING VACCINATION SITES

Speaking near his home in Wilmington, Delaware, Biden called for increasing vaccine distribution in lower-income neighborhoods not currently well served by hospitals and pharmacies. Biden also plans a marketing campaign to encourage those skeptical of the vaccine to get inoculated.

His transition team said he will reorganize the vaccine distribution team currently called “Operation Warp Speed” and has asked former Food and Drug Administration chief David Kessler to work with manufacturers to boost vaccine availability.

Biden said his administration will release the vast majority of doses when they become available, rather than holding back a large portion to ensure that recipients can get a second dose, which had been the Trump administration’s approach for much of the rollout. States will get regular updates to know how many doses are coming to ensure they can distribute them efficiently.

He said he will order the Federal Emergency Management Agency to set up 100 vaccine centers within a month, which he said would ultimately serve millions of people. Neighborhood pharmacies would also be enlisted as vaccination sites, he said.

Even with these changes, Biden said it will take time for the United States to beat back the virus. “The honest truth is this: things will get worse before they get better,” he said.

Biden unveiled a $1.9 trillion stimulus plan on Thursday that includes $20 billion for vaccine distribution as well as $50 billion for coronavirus testing, which experts and officials said should help speed the process up.

The stimulus proposal faces an uphill battle in Congress, however. When Biden takes office, Democrats will control both the Senate and the House of Representatives but by narrow margins. Some Republicans have balked at its cost, while liberals have pushed for more spending on direct payments to individuals.

The Trump administration had aimed to give vaccine doses to 20 million Americans by the end of 2020. But only 12.3 million coronavirus shots had been administered as of Friday morning out of more than 31 million doses distributed to states, according to data from the U.S. Centers for Disease Control and Prevention.

Federal officials have largely left states to manage distribution, resulting in big differences in vaccination rates. The Trump administration has said it expects 1 million shots to be delivered per day by the end of next week.

A Trump administration official, speaking on condition of anonymity, said the United States is on track to have 300 million doses available by the end of Biden’s first 100 days in office.

Biden Outlines $1.9 Trillion Spending Package to Combat Virus and Downturn

Biden Outlines $1.9 Trillion Spending Package to Combat Virus and Downturn  - The New York Times

Source: The New York Times, by Jim Tankersley and Michael Crowley

President-elect Joseph R. Biden Jr. on Thursday proposed a $1.9 trillion rescue package to combat the economic downturn and the Covid-19 crisis, outlining the type of sweeping aid that Democrats have demanded for months and signaling the shift in the federal government’s pandemic response as Mr. Biden prepares to take office.

The package includes more than $400 billion to combat the pandemic directly, including money to accelerate vaccine deployment and to safely reopen most schools within 100 days. Another $350 billion would help state and local governments bridge budget shortfalls, while the plan would also include $1,400 direct payments to individuals, more generous unemployment benefits, federally mandated paid leave for workers and large subsidies for child care costs.

“During this pandemic, millions of Americans, through no fault of their own, have lost the dignity and respect that comes with a job and a paycheck,” Mr. Biden said in a speech to the nation. “There is real pain overwhelming the real economy.”

He acknowledged the high price tag but said the nation could not afford to do anything less. “The very health of our nation is at stake,” Mr. Biden said, adding that it “does not come cheaply, but failure to do so will cost us dearly.”

Mr. Biden took swift action to shape the agenda at a time of national crisis and a day after President Trump’s impeachment in the House. While it reflects the political shift in Washington as Democrats take control of Congress, support for Mr. Biden’s program will immediately run into challenges, starting with the possibility that a Senate trial of Mr. Trump might delay its passage.

It is also unclear how easily Mr. Biden can secure enough votes for a plan of such ambition and expense, especially in the Senate. Democratic victories in two Georgia special elections last week gave Mr. Biden’s party control of the Senate — but only with a 50-50 margin after Vice President-elect Kamala Harris’s tiebreaking vote. Mr. Biden will have to compensate for any defecting moderate Democrats with Republican votes at a time of scarce bipartisanship.

Mr. Biden said that lawmakers would need to come together for the good of the country, and that “unity is not some pie in the sky dream — it’s a practical step to getting the things we have to get done as a country, get done together.”

His speech on Thursday came at an incredibly challenging moment, as virus cases continue to climb, millions of workers remain sidelined and America’s partisan divisions are threatening to tear it apart. A week after a mob stormed the Capitol to disrupt Congress’s certification of Mr. Biden’s win, Washington has come to resemble an armed camp, with steel barricades being erected across the city and armed law enforcement policing the streets.

More than 20,000 National Guardsmen are expected to flood Washington before Mr. Biden’s swearing-in on Jan. 20.

The economic rebound from the pandemic recession has also reeled into reverse amid a winter surge of the virus and new waves of restrictions on economic activity in cities and states.

The Labor Department reported on Thursday that 1.15 million Americans filed new unemployment claims in the first full week of the new year, a 25 percent increase from the previous week. Another 284,000 claims were filed for Pandemic Unemployment Assistance, an emergency federal program for workers like freelancers who do not normally qualify for jobless benefits. The nation shed 140,000 jobs in December, the department reported last week.

Mr. Biden’s aides say the urgency of the moment drove the president-elect to propose a significantly larger economic jolt than what the Obama administration pushed through upon taking office amid a recession in 2009. The Biden proposal is more than 50 percent larger than the Obama-Biden stimulus, after adjusting for inflation, and it comes on top of several trillions of dollars of economic aid that Congress approved last year under Mr. Trump.

The package reflected the scope of the challenge facing the economy and the nation’s health system. In a briefing on Thursday, one Biden official noted that the existing national planning and infrastructure for mass vaccinations and testing was far less developed than the incoming White House team had anticipated.

Mr. Biden detailed his so-called American Rescue Plan in an evening speech in Delaware, effectively kicking off his presidency and placing him in the brightest spotlight since his nomination acceptance speech last summer at the Democratic National Convention.

The president-elect struck an urgent, but optimistic tone, saying the United States could overcome its current challenges.

“Out of all the peril of this moment, I want you to know I see the promise,” Mr. Biden said. “I’m as optimistic as I’ve ever been.”

The plan was lauded by progressive groups as well as by the nation’s leading business lobby, the U.S. Chamber of Commerce, which was often at odds with the Obama administration over spending and regulations. “We applaud the president-elect’s focus on vaccinations and on economic sectors and families that continue to suffer as the pandemic rages on,” the chamber said in a statement.

Republicans were largely silent on the plan, which includes the type of state and local aid that became a sticking point in last year’s stimulus negotiations. Congress was able to agree on a $900 billion package in December only after such aid was excluded. But Mr. Biden outlined his rationale for including such funding, saying it was vital to avoiding cutbacks and layoffs that would set back the fight against the virus and further damage the economy.

“Millions of people putting their lives at risk are the very people now at risk of losing their jobs: police officers, firefighters, all first responders, nurses, educators,” Mr. Biden said.

Mr. Biden’s “rescue” proposal, which would be financed entirely through increased federal borrowing, flows from the idea that the virus and the recovery are intertwined and that the economy cannot rebound without mass vaccine deployment.

“What the economy needs is a successful rollout of the vaccines, and reduction in the risks of social and economic activity,” said Aaron Sojourner, a labor economist at the University of Minnesota’s Carlson School of Management who served in the White House Council of Economic Advisers under the Obama and Trump administrations. “That will go a long way toward promoting recovery. It won’t go all the way, but it will go a long way.”

Mr. Biden, who has promised to get “100 million Covid vaccine shots into the arms of the American people” by his 100th day in office, said last week that he intended to release nearly all available coronavirus vaccine vials once he takes office, rather than holding some back as the Trump administration had been doing.

The $20 billion “national vaccine program” he announced on Thursday envisions community vaccination centers around the country. In recent speeches, he has said he would like to see mass vaccination sites in high school gymnasiums, sports stadiums and the like, perhaps staffed by the National Guard or employees of the Federal Emergency Management Agency.

Mr. Biden also called for a “public health jobs program” that would address his goals of bolstering the economy and the Covid-19 response while also rebuilding the nation’s fragile public health infrastructure. The proposal would fund 100,000 public health workers to engage in vaccine outreach and contact tracing.

At the same time, Mr. Biden is keen on addressing the racial disparities that have been so painfully exposed by the coronavirus pandemic, which has disproportionately claimed the lives and jobs of people of color. He pledged to increase funding for community health centers and to fund efforts to mitigate the pandemic in prisons and jails, where Black people and Latinos are overrepresented.

In his remarks, Mr. Biden lamented a “growing hunger crisis,” particularly among minority communities, saying: “More than one in five Black and Latino households in America report that they do not have enough food to eat. It’s wrong. It’s tragic. It’s unacceptable.”

He proposed a wide range of efforts to help those who have suffered the most in the economic pullback. His plan would provide emergency paid leave to 106 million Americans, regardless of the size of their employer, a proposal that many congressional Republicans worked to pare back in a stimulus bill passed last spring. And it would extend tax credits to many families to offset up to $8,000 in annual child care costs.

It provides billions of dollars in rental aid and would give grants to millions of the hardest-hit small businesses. It also temporarily increases the size of two tax credits in a manner that would effectively provide more cash from the government to low-income workers and families. And it would extend expanded unemployment benefits through the end of September, with an extra $400 weekly supplement.

Mr. Biden also called on Congress to raise the federal minimum wage to $15 an hour, a priority he outlined during his campaign.

Mr. Biden plans to unveil another, larger set of spending proposals in February, and he began laying the groundwork to finance those efforts by raising taxes on corporations and the rich. He drew a sharp contrast between the suffering of low-wage workers and those struggling without a paycheck with the wealthiest Americans, saying there is a “growing divide between those few people at the very top who are doing quite well in this economy — and the rest of America.”

“Just since this pandemic began, the wealth of the top 1 percent has grown by roughly $1.5 trillion since the end of last year — four times the amount for the entire bottom 50 percent,” he said.

The second package is expected to be centered on job creation and infrastructure, including hundreds of billions of dollars of spending on clean-energy projects like electric vehicle charging stations, along with health care and education spending.

Mr. Biden has said he will work to build Republican support for his plans, and he will need 10 Republican votes in the Senate to overcome a filibuster. But top Democrats in the House and Senate are preparing to pivot quickly to a parliamentary process known as budget reconciliation in the event they can get only a simple majority in the Senate. Republicans used the procedure to bypass a filibuster and approve Mr. Trump’s signature tax cuts in 2017.

Republicans’ refusal to consider a stimulus package in excess of $1 trillion held down the size of the last congressional relief bill, passed in December. Mr. Biden’s aides said Thursday that they were confident that the nearly $2 trillion package he had proposed would find wide support among Democrats at a time when interest rates remain low and many economists are urging lawmakers to deficit spend in order to promote economic growth.

Analysis Examines the Implications of Price Transparency for Providers and Patients as New Rules Go into Effect

Implications of Price Transparency for Providers and Patients as New Rules  Go into Effect

Source: Kaiser Family Foundation

A new KFF analysis examines how new federal rules on price transparency for health services may affect patient decision-making and market pricing.

As of January 1, 2021, the United States Department of Health and Human Services requires that hospitals publish payer-negotiated rates for common services on their websites. A second set of rules, which requires insurers to provide rate and cost-sharing estimates for common services, is scheduled to go into effect in 2023.

While the new rules are intended to help patients save money by choosing lower-priced care, the analysis finds that many patients still face significant barriers to shopping for common health services. Many health services, particularly those that treat emergent conditions like heart attacks, cannot be planned for in advance, and awareness of price comparison tools among consumers is limited. The listed rates may not reflect patients’ final out-of-pocket costs if additional services, unaccounted for when the patient used the transparency tool, were received during the course of care.

The brief also presents new analysis of the significant geographic variation in prices for three common services covered under the price transparency rules: hip and knee replacements, MRIs, and cholesterol tests. The average price of a lower back MRI in Oakland, CA is $853 – over 144% higher than the average price in Orlando, FL ($349). Even within the same region, prices for a given service can vary dramatically: for example, a knee or hip joint replacement in the Houston, TX area could cost as little as $28,815 or as much as $45,775.

The analysis is available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

CMS Will Raise Medicare Advantage Plan Payments By 4.08% In 2022

Medicare Advantage plans will get a 1.66% pay bump for 2021

Source: Fyne Fettle, by James Schneider

CMS will raise Medicare Advantage plan payments by 4.08%, the agency announced Friday.

It also signed off on its controversial proposal to complete a multiyear phase-in of a new payment methodology. The new process will adjust plan payments using diagnoses solely from encounter data—information created by healthcare providers about patients’ medical conditions and treatment. The health insurance industry has long railed against the use of encounter data to adjust their payments. They argue that the data is incomplete and often inaccurate and that using it would lead to lower payments to Advantage plans.

“This announcement is being made nearly three months earlier than usual to provide MA organizations and Part D sponsors more time to take this information into consideration as they prepare their bids for 2022,” CMS said in a fact sheet.

CMS also approved a 5.90% coding pattern adjustment for Advantage plans, which is the lowest adjustment allowed under the law. It also cemented previously approved changes to Medicare Part C and D Star Ratings.

Paycheck Protection Program Begins Offering Loans Again

Congress approved $284 billion to restart the Paycheck Protection Program, allowing some who already received loans from the program to get a second round of aid.

Source: Saucon Source, by Jonny Hart

A COVID financial relief program which helps small businesses continue to pay workers resumed offering loans this week, the Small Business Administration (SBA) announced.

The Paycheck Protection Program (PPP) was reopened to businesses that did not receive a first round forgivable PPP loan on Monday. The program expanded to accept applications from certain businesses that did receive funding during the first round (so-called “Second Draw” businesses) on Wednesday.

First Draw PPP loans may be used to fund payroll costs, including benefits. However, the SBA announced that the funds can also be put toward other business expenses, including mortgage interest, rent, utilities, worker protection costs related to COVID-19, uninsured property damage costs caused by looting or vandalism during 2020, and certain supplier costs and expenses for operations.

The SBA will even forgive loans if all employee retention criteria are met, and the funds are used for eligible expenses.

Terms of First Draw PPP loans include:

  • * PPP loans have an interest rate of 1 percent.
  • * Loans issued prior to June 5, 2020 have a maturity of two years. Loans issued after June 5, 2020 have a maturity of five years.
  • * Loan payments will be deferred for borrowers who apply for loan forgiveness until the SBA remits the borrower’s loan forgiveness amount to the lender. If a borrower does not apply for loan forgiveness, payments are deferred 10 months after the end of the covered period for the borrower’s loan forgiveness (either eight or 24 weeks).
  • * No collateral or personal guarantees are required.
  • * Neither the government nor lenders will charge small businesses any fees.

Business entities that may be eligible for First Draw PPP loans include:

  • * Sole proprietors, independent contractors and self-employed individuals
  • * Any small business concern that meets SBA’s size standards (either the industry size standard or the alternative size standard)
  • * Any business, 501(c)(3) non-profit organization, 501(c)(19) veterans organization or tribal business concern (sec.31(b)(2)(C) of the Small Business Act) with the greater of:
    • ** 500 employees, or
    • ** That meets the SBA industry size standard if more than 500
  • * Any business with a NAICS code that begins with 72 (Accommodations and Food Services) that has more than one physical location and employs less than 5000 per location

The SBA is accepting applications for First Draw PPP loans until March 31, 2021.

Businesses that previously received a First Draw PPP loan may now apply for Second Draw PPP loans, the SBA also announced this week.

A borrower may be eligible for a Second Draw PPP Loan if they:

  • * Previously received a First Draw PPP Loan and will or have used the full amount only for authorized uses
  • * Have no more than 300 employees; and
  • * Can demonstrate at least a 25 percent reduction in gross receipts between comparable quarters in 2019 and 2020

The SBA has made some alterations to the second iteration of the program to promote access for smaller lenders and their customers.

“SBA will initially only accept Second Draw PPP Loan applications from participating community financial institutions, which include Community Development Financial Institutions, Minority Depository Institutions, Certified Development Companies and Microloan Intermediaries,” they announced.

The program will reopen to all participating lenders “shortly thereafter,” the SBA announced.

The program also targets the smallest businesses, as well as those in less fortunate areas.

“At least $25 billion is being set aside for Second Draw PPP Loans to eligible borrowers with a maximum of 10 employees, or for loans of $250,000 or less to eligible borrowers in low or moderate income neighborhoods,” the administration announced.

The SBA website has more information about PPP loans as well an application available for download.

Those interested in a Paycheck Protection Program loan can use the administration’s lender match tool to get started by being matched with a participating lender.

Pandemic Pushes California Lawmakers Into Fast Action on State Budget

Source: KQED, by Katie Orr

California lawmakers are wasting little time debating the $227 billion budget proposal Gov. Gavin Newsom announced last week.

In a break with the normally slow-moving process that drags out for months, budget committees in both the Assembly and state Senate convened this week to review the governor’s spending plan, which includes immediate financial relief to families and businesses hard hit by the pandemic.

Newsom and lawmakers are aiming to send out immediate relief funding by the end of January, ahead of when the majority of the budget will be implemented in July.

During a meeting of the Assembly Budget Committee on Monday, Chair Phil Ting, D-San Francisco, said much of what Newsom proposed matches up with the Assembly’s budget priorities.

“We also wanted to have an adequate response to COVID-19 to ensure that there were investments in public health infrastructure, vaccine distribution, as well as safe reopening of schools,” Ting said.

Despite the economic downturn, the state finds itself with a one-time budget surplus of about $15 billion. That money primarily comes from California’s wealthiest taxpayers, whose jobs and investments have been largely shielded from pandemic-related losses. Newsom’s proposal calls for using $5 billion of that surplus to take immediate action on several COVID-19 relief items, including a $600 one-time payment to the state’s lowest-income earners.

State Sen. Nancy Skinner, D-Berkeley, chair of her house’s Budget and Fiscal Review Committee, which met Thursday, said the state must keep its most vulnerable residents in mind when making spending decisions. That means looking at the numbers, she said, “with the latest data strongly pointing to women, and women of color especially, being the most hard hit economically.”

But even though state bank accounts are relatively flush, there are still many competing priorities in this year’s budget, with limited funding available.

Several lawmakers, for instance, have questioned whether Newsom’s proposal includes enough spending on wildfire prevention. His plan allocates about $1 billion for prevention and protection, in addition to money for new firefighting crews and equipment.

Some legislators also challenged Newsom’s proposal to direct a sizable amount of funding toward state environmental initiatives.

Assemblyman Jim Wood, D-Santa Rosa, asked if the governor’s proposal to build new electrical vehicle charging stations throughout the state should be a top priority right now.

“We have $1.5 billion in the budget for electric car infrastructure and incentives,” he said. “We have $575 million going to small businesses. I wonder, is that the right number?”

Lawmakers also discussed the right approach to reopening schools, weighing Newsom’s plan, which calls for increased testing and safety measures.

Assemblyman James Gallagher, R-Yuba City, said the state’s focus should be on vaccinating teachers.

“We all say we want to get our schools open,” he said. “Well, the biggest thing we can do to get our schools open is to get our teachers and support staff vaccinated.”

California Hospitals Prepping For Grim COVID-19 Choices

Source: Modern Healthcare

California hospitals struggling with a skyrocketing coronavirus surge are trying to prepare for the possibility that they may have to ration care for lack of staff and beds — and hoping they don’t have to make that choice.

The state avoided surging cases for months, but now the virus is raging out of control there and across the nation in the wake of Thanksgiving holiday gatherings that authorities say vastly spread infections. Only Arizona tops California in cases per resident.

The state this week ordered hospitals in the hardest-hit areas to delay many elective surgeries in order to free up space.

In Los Angeles County, Methodist Hospital of Southern California convened an in-house triage team that makes daily evaluations “about the severity of critically ill patients that allows us to distribute resources to those who need it the most,” chief strategy officer Cliff Daniels said.

The hospital isn’t rationing care “and we hope we don’t get there,” Daniels said.

However, guidelines posted on the hospital’s website warn: “If a patient becomes extremely ill and very unlikely to survive their illness (even with life-saving treatment), then certain resources … may be allocated to another patient who is more likely to survive.”

Los Angeles County, the nation’s most populous with 10 million residents, is one of nearly two dozen in Southern California and the agricultural Central Valley that have essentially run out of intensive care unit beds for COVID-19 patients.

Health officials warned Wednesday that hospitalizations will continue for at least the next three weeks as people who ignored social distancing rules to gather for Christmas and New Year’s Eve fall ill.

Hospitals statewide with room have been told to accept patients from others that have exhausted their ICU beds but in fact most of the state is reporting struggling to provide ICU beds, with non-COVID-19 patients spilling into corridors, tents and cafeterias.

To the north, officials in Santa Clara County, with about 2 million residents, say 100 infected people a day are winding up in hospitals.

“And as awful as it is, it could get worse,” said Dr. Ahmad Kamal, the county’s director of Healthcare System Preparedness. “We haven’t had a situation where two people are out of breath and one person gets a ventilator. We could get there.”

California reported its second-highest number of daily coronavirus deaths Wednesday with 459 lives lost, bringing the death toll to 2,504 in the last week as more than a quarter-million new weekly cases portended a continued overwhelming crush.

Vaccinations being administered at what Gov. Gavin Newsom has said is too slow a pace will take weeks or months to slow the spread.

About 12% of people who test positive for COVID-19 eventually are likely to need hospital care, authorities have estimated.

“The numbers are extraordinary,” said Carmela Coyle, president and CEO of the California Hospital Association. “We’re not going to dodge this math. We need the state’s help.”

State officials also should override decisions by many county health officers that prevent recovering coronavirus patients from being released to skilled nursing facilities, despite fears that they could spread the virus, Coyle said.

“Focus on nothing other than saving lives for the next few weeks,” Coyle said.

L.A. County, which is recording more than 200 deaths a day, has seen a rate of new COVID-19 cases nearly double that of December, health officials said.

More than 8,000 people are hospitalized with COVID-19 — with a fifth of them in intensive care — and more than a third of adult hospital beds are occupied by virus patients, said Barbara Ferrer, the county public health director.

“This is a health crisis of epic proportions,” Ferrer said.

COVID-19 Still A Big Uncertainty For Insurers In 2021

Finance earnings stock ticker graph

Source: Nimbus-T PPE, by Nona Tepper

Given the continuation of the pandemic, health insurers are steeling themselves for a possible bumpy ride. Industry analysts said they expect 2021 to be a volatile year for insurers, although nothing can compare to the dramatic peaks and valleys in profits publicly traded companies reported in the first half of 2020.

Moody’s Investors Service forecasts mid- to single-digit earnings growth among insurers in 2021. “The need to control health costs has been a huge problem for the industry and for the country,” said Dean Ungar, vice president and senior credit officer at Moody’s. “The health insurers know that their future in a way depends on helping keep costs under control without government intervention and government meddling. The insurers are investing in things like value-based care and digital, remote monitoring.”

During the first two quarters of 2020, hospitals deferred elective procedures and health plan members put off routine doctor appointments. Those care deferrals are expected to continue at insurance giant UnitedHealth Group, John Rex, chief financial officer at the Minnetonka, Minn.-based health insurer, said at an investors conference in December.

Rex said he expects the deferral of care to continue into 2021, with the spike in COVID-19 cases this winter keeping members out of hospital waiting rooms, although not at the levels seen in 2020.

He said the missed preventive tests and procedures people delayed would result in more severe illness when they’re diagnosed, plus COVID-19 could also have long-term health effects on patients’ health that may be expensive for insurers.

UnitedHealth expects COVID-19 testing, treatment and other pandemic-related costs to reach $2 billion in 2021, with about 75% of that total coming from its insurance subsidiary UnitedHealthcare’s bottom line.

“Certain populations, particularly seniors, have deferred care,” Rex said. “Some have not seen a doctor at all in 2020, which impacts their health, and our ability to close gaps in care and properly document conditions that surely still exist. This could affect final risk scores in 2021.”

Some insurers expect a lower amount of traditional claims to offset the high costs of COVID-19 treatment. Mary Anne Jones, chief financial officer at Priority Health, said she expects the Grand Rapids, Mich.-based insurer’s finances in 2021 to mirror the third and fourth quarters of the previous years for the company, which is a subsidiary of Spectrum Health.

“Accidents aren’t happening like they had happened in the past,” Jones said. Sports-related injuries and contagious conditions beside COVID-19 are down because people are doing so much mask wearing and social distancing, which is offsetting the added costs of treating the coronavirus.

California Oks Expansion Of Who Can Get COVID-19 Vaccine To Avoid Doses Going To Waste

Nurse Cherry Costales prepares Pfizer-BioNTech COVID-19 vaccine at St. John's Well Child & Family Center in Los Angeles.

Source: Los Angeles Times, by Colleen Shalby

In an effort to avoid wasting COVID-19 vaccine and help speed up the vaccine rollout, the state is instructing local health departments and providers to expand vaccine prioritization to community healthcare workers, public health field staff, primary care clinics, specialty clinics, laboratory workers, dental clinics and pharmacy staff.

The state has also told officials that if a surplus remains even after all those eligible to receive the Pfizer-BioNTech and Moderna vaccine under expanded criteria have been granted access, they should move to Tier 1 of the next phase of distribution, which has not yet officially taken effect.

That group includes individuals who work in education, child care, emergency services, food and agriculture, as well as those 75 and older.

The announcement comes amid a slower than anticipated vaccine rollout throughout the state. The slowdown has been blamed on a variety of issues including the fact that some frontline workers have declined the vaccine and the state has lacked a regimented plan when it comes to leftover doses.

On Monday, Gov. Gavin Newsom said that distribution rules would be eased to prevent vaccine from going to waste.

“We want to see 100% of what’s received immediately administered in people’s arms, and so that’s a challenge,” he said during a briefing. “It’s a challenge across this country — it’s a challenge, for that matter, around the rest of the world. But that’s not an excuse.”

Last month, the state health department released guidance that said vaccine doses may be offered to people in lower priority groups when demand eases and doses are about to expire.

“Health Departments may temporarily adjust prioritization based on other resource constraints while continuing efforts to immunize higher priority groups as soon as feasible,” the guidelines state.

To date, a total of 586,379 vaccine doses have been administered throughout the state. A total of 2,052,025 doses, which includes the first and second dose, have been shipped to local health departments and facilities, CDPH said.

Last Updated 01/20/2021

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