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 PPPForgivenessTool.com.

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.

CMS Extends Special Enrollment Period Qualifications In Latest ACA Rule

Affordable Care Act

Source: Fierce Healthcare, by Robert King

The Biden administration finalized a rule that makes it easier for consumers to qualify for a special enrollment period for Affordable Care Act exchange coverage, in addition to several other major changes.

The Centers for Medicare & Medicaid Services finalized on Friday the second part of the Notice of Benefit and Payment Parameters that outlines regulations on the ACA exchanges for the 2022 coverage year.  A key part of the rule was more flexibility for consumers to sign up for a special enrollment (SEP) period to get coverage outside of open enrollment.

“These [special enrollment period] policies will offer greater flexibility for those who need coverage—particularly those communities hit hardest by COVID-19,” CMS said in a release on Friday.

ACA exchange customers can qualify for an SEP if they meet certain requirements like they lost their job or got a divorce. The rule would now allow an individual to sign up for an SEP if they weren’t aware of such a triggering event or didn’t get a timely notice.

CMS also finalized a policy that codifies a recent law that says individuals with COBRA coverage could qualify for an SEP.

More flexibility for consumers to sign up for an SEP is a departure from the Trump administration, which tightened the qualifications for the special enrollment periods. The Trump administration also shortened the open enrollment period to six weeks.

The agency is also lowering the consumers’ maximum out-of-pocket costs by $400 for the 2022 coverage year.

“The final 2022 reduced annual limitation on cost-sharing for eligible enrollees with incomes between 100% and 200% of the federal poverty level is $2,900 for self-only coverage and $5,800 for other-than-self-only coverage,” the rule said.

The limit for enrollees with an income 200 to 250% above the poverty level is $6,950 for self-coverage and $13,900 for families.

CMS also decided not to finalize several provisions in the proposed version of the rule, for example, a proposal to change web broker display requirements. CMS had proposed an exception to existing requirements that call for non-exchange websites to display certain information on qualified health plans.

“We agreed with commenters that the display of more [qualified health plan] comparative information on the web broker non-exchange websites is in the best interest of consumers to aid them in comparing [QHP] options without having to potentially navigate multiple websites,” CMS said in a fact sheet on the final rule.

The agency is also finalizing a policy that updates website display requirements for direct enrollment entities, which are carriers and web brokers that can directly enroll customers in ACA exchange plans.

Direct enrollment entities must display and market three categories of plans: QHPs, off-exchange plans and “all other products, such as excepted benefits not subject to ACA market-wide rules.”

Another major change focuses on pharmacy benefit management transparency. The rule includes a new requirement for the collection of prescription drug data directly from PBMs.

“The data will be used to enhance our understanding of the true cost of prescription drugs provided in exchange plans and shed light on the role that PBMs play in their cost,” CMS said.

This is the second part of the Notice of Benefit Payment Parameters. The first part was finalized by the Trump administration back in January. That final rule set user fees for the 2022 coverage year and encourages states to team up with private firms to create new exchanges.

Employers, Insurers Push To Make Virtual Visits Regular Care

The Associated Press
Source: Associated Press, by Tom Murphy

Make telemedicine your first choice for most doctor visits. That’s the message some U.S. employers and insurers are sending with a new wave of care options.

Amazon and several insurers have started or expanded virtual-first care plans to get people to use telemedicine routinely, even for planned visits like annual checkups. They’re trying to make it easier for patients to connect with regular help by using remote care that grew explosively during the COVID-19 pandemic.

Advocates say this can keep patients healthy and out of expensive hospitals, which makes insurers and employers that pay most of the bill happy.

But some doctors worry that it might create an over-reliance on virtual visits.

“There is a lot lost when there is no personal touch, at least once in a while,” said Dr. Andrew Carroll, an Arizona-based family doctor and board member of the American Academy of Family Physicians.

Telemedicine involves seeing a doctor or nurse from afar, often through a secure video connection. It has been around for years and was growing even before the pandemic. But patients often had a tough time connecting with a regular doctor who knew them.

Virtual-first primary care attempts to smooth that complication.

The particulars of these programs can vary, but the basic idea is to give people regular access to a care team that knows them. That team may include a doctor, nurse or physician assistant, who may not be in the same state as the patient. Patients can also message or email the caregivers with a quick question in addition to connecting on a video call.

People who choose this option may have to give up a doctor they’ve been seeing in person. They also will need a smartphone, tablet or computer paired with a fast internet hookup.

The goal of the virtual-first approach is to make patients feel more connected to their health and less reliant on Google searches for advice or the nearest urgent care center to treat something minor.

“We have a large portion of the population that is avoiding going to a primary care doctor because they don’t have time or they think they can’t afford it, even though its generally covered under their benefits,” said Arielle Trzcinski, a health care analyst with Forrester who works with insurers.

Amazon Care pairs patients with a regular care team and in some markets also sends providers like nurses to them if they need in-person care. The retailer developed the program for its employees but said in March that it would expand it to other employers nationwide.

Insurers like Oscar Health, UnitedHealthcare and Kaiser Permanente also have started or expanded virtual-first care plans this year. Priority Health in Michigan began selling a plan for people without employer-sponsored coverage after the insurer noticed that customers weren’t visiting doctors as much as they expected.

A vice president, Carrie Kincaid, said Priority Health found that some customers didn’t have time to leave work for appointments. Another group, early retirees, travels frequently and isn’t able to make it back to Michigan for in-person visits.

She said the new plan, run with virtual care provider Doctor on Demand, blew past enrollment projections and had more than 5,000 people signed up on the first day.

“When members get exposed to virtual care in general, they really, really like it,” she said.

Wendy Katje signed up for a Priority Health virtual-first primary care plan by accident online, but she plans to stick with it.

The 60-year-old multiple sclerosis patient said the doctor she got through the program has helped adjust her cholesterol medications and made sure she stays connected with a neurologist she usually sees in person.

Katje said the virtual-first approach makes sense during the pandemic, when she wants to avoid waiting rooms.

“It’s not quite as personal as sitting in an office with someone, but for what I’ve needed to have done it was perfectly adequate,” the Otsego, Michigan, resident said.

Walter Woodberry, of Albuquerque, New Mexico, signed up for a virtual-first plan through his employer, ABF Freight, after he tried telehealth and grew used to its convenience.

He said he doesn’t have to leave work early for an appointment, and he feels more comfortable giving medical information to someone who knows him.

“I’m not trying to schedule my life around a doctor’s appointment,” he said.

Consumers have grown used to shopping for clothes, gifts or groceries online. But Carroll, the family physician, noted that patients sometimes need an in-person visit.

He said he once had a patient diagnosed virtually with pink eye. In person, Carroll could see that the patient actually had a form of glaucoma and was in danger of blindness.

Doctors are still sorting out what can be treated virtually and what demands in-person care. These new plans generally reserve those visits for emergencies or if the doctor or patient requests them.

Virtual-first proponents say they aren’t trying to eliminate in-person visits. They are focused on improving health.

Patients are more likely to follow a doctor’s orders, get laboratory tests or take prescribed medicine when they receive care from someone they’ve gotten to know and trust, said Doctor on Demand CEO Hill Ferguson.

“That’s what we need to get back to in this country,” he said.

Stanford University’s Dr. Megan Mahoney estimates that about half of primary care visits can be done virtually, depending on whether insurers and other payers reimburse for the care.

The family physician says her practice still does 30% to 40% of its visits virtually, months after reopening its offices. The pandemic has changed how patients view care, she said.

“We had made assumptions about consumers’ willingness to adopt telehealth, yet we see 89-year-olds who are on video visits with their providers every other week with no problem now,” she said.

Biden Says He Wants to Go Big On Health Care. But He Left Major Reforms Out of His Latest Plan

U.S. President Joe Biden speaks during a joint session of Congress at the U.S. Capitol in Washington, D.C., U.S., on Wednesday, April 28, 2021.

Source: Time, by Abigail Abrams

During President Joe Biden’s speech to Congress on Wednesday, he called for an ambitious health agenda that would allow the federal government to negotiate prescription drug prices, expand Medicare coverage, build on the Affordable Care Act and lower deductibles. All of these ideas would transform the way Americans pay for health care—but most of them are not actually in the legislative plan the President has put forward.

“Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower drug prescription prices. And, by the way, that won’t just help people on Medicare. It will lower prescription drug costs for everyone,” Biden said. “We’ve talked about it long enough. Democrats and Republicans, let’s get it done this year.”

Despite his strong rhetoric, Biden’s American Families Plan, also unveiled on Wednesday, does not include the proposals to cut prescription drug costs or lower the Medicare eligibility age, which congressional Democrats had pressured him to include in recent weeks. His $4 trillion package comprised of the American Families Plan and the American Jobs Plan has been praised by progressives as a huge investment in the country’s economy and social safety net. But the omission of these larger health care policies has raised questions for progressives about the President’s commitment to the ideas in the face of opposition from Republicans, moderate Democrats and pharmaceutical companies.

“While [lowering drug prices and expanding Medicare] is a focused priority of Congress, it’s clear it’s not as much so for the White House,” says Alex Lawson, executive director of Social Security Works, which supports the drug pricing and Medicare reforms.

Biden’s plan does include $200 billion to make permanent the increased premium subsidies for people who buy health coverage on the Affordable Care Act (ACA) marketplace, which were passed in the American Rescue Plan earlier this year. The expanded subsidies mean that millions of Americans are eligible for cheaper or free health coverage. But the Congressional Budget Office has estimated that the subsidies will get just 1.3 million uninsured people to buy coverage over two years, a small portion of the total uninsured. “In terms of federal dollars, subsidizing private insurance is the most expensive way you can go about getting people covered. Whereas doing it through a public option or Medicaid or Medicare is much lower cost on a per person basis,” says Cynthia Cox, a vice president at the nonpartisan Kaiser Family Foundation.

That is a main reason why many congressional Democrats have been pushing Biden to do more than shore up the ACA. Vermont Sen. Bernie Sanders and 16 other Senators sent a letter to Biden on April 25 calling for the President to address drug pricing, lower the Medicare eligibility age, cap out-of-pocket expenses for Medicare and expand Medicare benefits to cover hearing, dental and vision care. Another group of more than 80 House members, including progressives like Washington Rep. Pramila Jayapal and moderates like Rep. Conor Lamb of Pennsylvania and Rep. Jared Golden of Maine, wrote a similar letter advocating for the government to negotiate drug prices and expand Medicare.

A new set of analyses from the Kaiser Family Foundation this week indicate that lowering the Medicare eligibility age from 65 to 60 or even lower could bring down U.S. health spending overall. The foundation’s first analysis showed that when people turn 65, their health care spending drops significantly from the period between age 60 to 64 despite the fact that most people use more health care as they age. The reason? Medicare pays lower prices for health care services than private insurers. Employers also benefit. The foundation’s second analysis showed that if people ages 60-64 were no longer enrolled in employer-sponsored insurance, the cost for employer plans could drop by 15%. Even if Medicare expanded to include dental, vision and hearing coverage as Sanders and some Democrats want, Kaiser Family Foundation’s Cox says health spending could still drop.

Polling has shown that both of these policies are popular, even among Republican voters. And congressional Democrats say that is especially true after the COVID-19 pandemic disproportionately affected older Americans. But by far the most popular item that Democrats are pushing is the proposal to allow the U.S. government to negotiate with manufacturers over drug prices—something that most other developed countries already do. A new government study commissioned by Sanders and released this week shows that the U.S. pays two to four times more for prescription drugs than other wealthy countries, adding to the evidence supporting the Democrats’ position.

Even though these policies are popular among voters, the political reality for Biden is more difficult. Republicans oppose most of Biden’s spending on the social safety net, so the legislation will likely need to pass through the budget reconciliation process, which would allow Democrats to push it through along party lines. But with an evenly-divided Senate, they can’t afford to lose any votes. The ACA subsidies that Biden has included in his plan face no opposition from Democrats or the health insurance industry, but both the drug pricing reform and Medicare changes will face intense pushback from pharmaceutical companies, hospitals and medical providers, as well as more moderate Democrats.

Health care has been a winning topic for Democrats in recent election cycles and bringing down drug prices could be particularly helpful ahead of the next midterms, says Robert Blendon, a Harvard professor of health policy and political analysis who studies public opinion about health care. If Biden isn’t prioritizing that, “it must be because there’s one or two votes in the Senate who have an interest that’s more worried about the pharmaceutical industry than what it’s going to look like in the 2022 election,” he says.

Democrats can still fight to add the drug pricing proposal and Medicare changes into the spending package once it gets to Congress. Sanders told reporters on Tuesday that the provisions would be in the legislation “if I have anything to say about it,” while Senate Finance Committee Chair Ron Wyden of Oregon said he would “look at every possible vehicle” to get drug pricing done. House Energy and Commerce Committee Chair Frank Pallone of New Jersey said drug pricing would be one of his top priorities as the plan makes its way through the House.

House Democrats passed their signature drug pricing legislation, known as H.R. 3, back in 2019, and the bill was recently reintroduced and has a hearing scheduled in Pallone’s committee. Advocates believe that lawmakers can negotiate to put measures like this into the American Families Plan. “We have a container that can fit what we want in there,” said Lawson of Social Security Works.

Still, Biden’s speech Wednesday hinted at how difficult these big health care changes can be. “We know how to do this. The last president had that as an objective,” he said, referencing former President Donald Trump’s failed push to lower prescription drug prices.

Now Biden has left it up to Democratic lawmakers to get their own colleagues on board and make the changes happen.

Here’s How California’s New Mask Guidelines Differ From The CDC’s

Source: The Mercury News, by Nico Savidge

Let’s say you’re walking down a busy street, or hiking on a popular trail, and see people coming the other way. The path you’re sharing is narrow and you’ll have to pass less than six feet from the other group.

Do you need to put on a mask?

According to the state of California, if you aren’t fully vaccinated, you do.

That differs from new guidelines that the Centers for Disease Control released last week — and what epidemiologists who study how coronavirus spreads advise. Even if you aren’t vaccinated, the CDC suggested, the risk of transmitting the virus through that kind of fleeting contact in an outdoor setting is pretty much nonexistent.

On Monday the California Department of Public Health put out its own new set of mask guidelines, which were meant to bring the state’s rules in line with the CDC’s latest advice.

For the most part the two sets of guidance line up — but on a couple of key points, California’s guidelines are stricter than those advanced by the CDC.

Both the state and federal guidelines differentiate between those who are vaccinated and those who are not yet protected, saying those whose shots have taken full effect don’t need to wear masks outdoors unless they’re in large crowded events like a parade.

People are considered fully vaccinated two weeks after their second Pfizer or Moderna shot, or a single dose of the Johnson & Johnson vaccine.

State and federal health officials also agree that everyone needs to keep wearing masks indoors, where the virus spreads more easily, regardless of their vaccination status.

Where the state differed from the CDC was on the question of when unvaccinated people need to wear masks in outdoor settings.

The CDC last week said that while the unvaccinated should keep wearing face coverings during most outdoor activities when they can’t maintain distance, there were a couple of cases when they could drop their masks: One was going for walks, jogs or bike rides, and another was taking part in small gatherings where everyone else is fully vaccinated.

California’s rules, on the other hand, state that unvaccinated people must wear face coverings “any time physical distancing cannot be maintained” outdoors, with no exceptions for exercise or gatherings with fully vaccinated people. That provision is essentially unchanged from earlier versions of the mask guidance.

The updated state guidance is significant because it’s what many Bay Area counties said they would use to set local mask requirements for residents and businesses. Gov. Gavin Newsom has said the state will keep mask mandates in place beyond the June 15 date he set for lifting most pandemic restrictions.

A spokesperson for the California Department of Public Health did not respond Monday or Tuesday afternoon to an inquiry about the difference between the new state and federal guidelines.

In new guidance released last week, public health officials in Los Angeles also continued to require unvaccinated people to wear masks outdoors any time they can’t keep their distance.

In a statement about its own updated rules late Monday, San Francisco’s public health officials said both vaccinated and unvaccinated people can safely walk or run outdoors without masks, writing, “You will no longer need to pull up your mask when simply passing others by on a sidewalk or trail.” But they also recommended people continue masking when they walk on “crowded sidewalks” or are frequently passing people.

Dr. Monica Gandhi, a professor of medicine at UC-San Francisco who has criticized the CDC’s updated guidelines as confusing and overly strict given how rare outdoor transmission is, said California’s guidelines appeared to be going even further in that wrong direction.

“Passing someone on the street,” even if neither of you are vaccinated or wearing masks, Gandhi said, “is a safe activity.”

Making rules too complex and onerous can backfire, Gandhi said: More cautious people will default to wearing their masks all the time, even in situations that don’t pose a risk, while those who are skeptical of restrictions become more likely to tune them out altogether.

“We are in this very strange mixed period right now,” she said, with a large percentage of the population fully or partially vaccinated. “This mixed period becomes more confusing when our public health guidelines aren’t strictly based on biology and data and science.”

Work In Progress: Price Transparency Efforts Need To Go Further

Work in progress: Price transparency efforts need to go further |  BenefitsPRO

Source: BenefitsPRO, by Scott Wooldridge

Efforts to increase health care price transparency are moving forward, but problems remain with the current reforms, raising questions on whether additional steps are needed, a new Rand Corporation study has found.

The report, “Barriers to Price and Quality Transparency in Health Care Markets,” noted that recent legislative and regulatory efforts to increase transparency are being implemented: a 2018 federal rule requires hospitals to release price data, another 2019 rule requires disclosure of standard health care charges in a machine-readable format. Hospitals, health systems, and insurers are generally complying with these rules, but the information can be confusing and difficult to access in a consumer-friendly way.

More data, but not more clarity?

The study noted that hospitals, providers, and pharmaceutical companies negotiate with payers such as governmental bodies or commercial insurers. Payments for Medicare and Medicaid services tend to be lower, and among commercial payers prices are generally higher in areas with a higher concentration of providers.

Recent federal efforts to increase price transparency have resulted in more data being released; states are also attempting to increase transparency through state All-Payer Claims Databases (APCDs).

But such efforts still have a way to go, the Rand analysis said. One major problem is that releasing data on charges or negotiated prices does not actually reflect what consumers would pay for services out of pocket (OOP). The complexity of health plans, the various options available to consumers, and the lack of standardization in what providers charge for services, all contribute to a system where the data can be overwhelming, and means of interpreting the data are not available to the average consumer.

In on example, the Rand study notes, “OOP price transparency would be difficult to convey accurately, because any tool would need to know not only negotiated prices between plans and providers but also the specific plan benefit design information of each consumer’s insurance plan and where the consumer falls in their benefit (for example, whether the deductible has been met).”

This level of complexity threatens to undermine the usefulness of the transparency efforts now underway. Because of this, the Rand analysts list a number of additional steps that they recommend to improve both transparency and usefulness of the data to consumers.

Recommended improvements

The report recommends a number of changes, including:

Improvement of transparency tools for consumers.

The study said an increased emphasis on OOP price transparency would be more relevant to consumers. In addition, measurements such as the current Care Compare tools (which provide quality information on providers) should include more detail and do more to link quality and price data.

Require more disclosure on contracts and data.

This would include requiring data from self-funded health plans. Self-funded plans have ERISA exemptions allowing them to avoid disclosure to APCDs. The report suggests setting up a federal APCD, although it acknowledges this would be a big task. In addition, many insurer-provider contracts currently do not allow negotiated prices to disclosed. Legislation requiring disclosure of these prices would give consumers more useful information.

Promote tools such as APCDs.

The analysts said that states that have not yet established APCDs should do so, and those that have them should make sure that online price and quality tools have the depth and clarity of information needed by consumers.

“The barriers to consumer price and quality transparency identified through this work generally represented limitations of existing tools,” the study concluded. “Efforts to achieve price and quality transparency have the potential to allow consumers to make better-informed decisions about their health care.”

Biden Administration Advances Emergency COVID Workplace Safety Rules After Weeks Of Delay

Biden administration advances emergency Covid workplace safety rules after  weeks of delay - POLITICOSource: Politico, by Rebecca Rainery

The Biden administration is advancing emergency workplace safety rules to prevent the spread of the coronavirus after weeks of delay and growing pressure from Democrats and safety advocates.

The Labor Department sent the safety standards to the Office of Management and Budget for review Monday night, according to a DOL spokesperson, the first step before they are released publicly and go into effect.

“OSHA has been working diligently on its proposal and has taken the appropriate time to work with its science-agency partners, economic agencies, and others in the U.S. government to get this proposed emergency standard right,” the spokesperson said.

Shortly after taking office, Biden gave the Labor Department a March 15 deadline to decide whether mandatory workplaces safety rules were necessary to protect workers from Covid-19.

But after the deadline passed, the agency said Labor Secretary Marty Walsh requested additional layers of review of the rules “based on CDC analysis and the latest information regarding the state of vaccinations and the variants.”

On Monday, Michigan Democratic Reps. Debbie Dingell, Rashida Tlaib and Andy Levin pressed Biden for an explanation on the status of the rules, as Covid-19 infections and ICU capacity have surged in the state in recent weeks.

House Democrats have also summoned DOL officials and occupational health experts to testify before Congress Friday on the status of coronavirus workplace safety rules promised by Biden.

OMB’S Office of Information and Regulatory Affairs is expected to take roughly two weeks before it publishes the requirements, which are then likely to take effect immediately.

The rules are expected to require employers to supply their workers with masks, have a written plan to avert exposure in the workplace and take other precautions that could kick up complaints from businesses over costs as more states relax pandemic restrictions.

The new mandates, which will be laid out in the emergency temporary standards by the Occupational Safety and Health Administration, mark the first time since 1983 that the workplace safety watchdog has used its emergency powers to swiftly require employers to provide certain protections to their workers. And the rules mark a significant departure from the Trump administration’s business-friendly approach of providing optional safety guidelines to employers.

The Biden administration rules — which will stay in effect for the next six months — land at the same time many states have started to roll back restrictions on businesses, including mask mandates.

Employers in states that have relaxed their own Covid-19 rules — like Texas and Mississippi — will now have to provide their workers with masks and other protective equipment under the federal OSHA rules, a requirement they did not face until now.

The rules will act as a floor for the 14 states that have instituted their own coronavirus-specific workplace protections.

OSHA has the authority to issue such emergency temporary standards when it determines that “workers are in grave danger due to exposure to toxic substances or agents determined to be toxic or physically harmful or to new hazards.”

The standards are open for public input and the Labor Department is required to adopt permanent safety standards within six months.

The emergency temporary standards can be challenged by affected parties in federal court.

The Biden administration’s stricter enforcement posture during the pandemic comes after a year of a far more lenient approach from the Trump administration.

The Trump-led OSHA declined to issue a workplace safety standard, instead providing optional guidelines that it said would give employers flexibility as more information about the virus was released by the Centers for Disease Control and Prevention.

But an audit of the Trump OSHA’s enforcement during the pandemic by the Labor Department’s independent watchdog found that the agency did not provide the level of protection workers needed during the crisis and left workers’ safety at increased risk.

The report, released in March, noted that while OSHA has received an influx of safety complaints during the pandemic, the agency suspended most of its on-site safety inspections last year, instead opting for informal inspections that typically result in a phone call to the facility, putting employee’s safety at greater risk.

Biden and Democrats now in control of both chambers of Congress have vowed to step up enforcement.

Lawmakers set aside $75 million for OSHA in the massive stimulus package Biden signed into law in March.

During his confirmation hearing before the Senate Health, Education, Labor and Pensions Committee, Labor Secretary Walsh said safety standards should not be seen as “terrible” for businesses. “This is about protecting their workforce, it’s about protecting their companies,” he said.

Biden Prodded to ‘Go Big’ on Drug Pricing

Biden Administration's Methodical Approach To Drug Price ReformSource: Bloomberg Government, by Brandon Lee

Democrats are urging the White House to include their health policy ideas in the next phase of President Joe Biden’s infrastructure push, with hopes of gaining an edge over colleagues with competing plans.

Congressional leaders, top senators, and rank-and-file Democrats say they’ve put in calls or made trips to the White House this week plugging legislation to broaden health insurance, expand Medicare, or lower drug prices. But Biden has kept quiet on whether he intends to include health care as part of the next phase of his infrastructure plan, which has left some lawmakers fearful it’s being left out.

“I’ve talked with folks at the White House and I know other colleagues have as well because we’d love very much to see something on Medicare” in a new Biden infrastructure proposal, Sen. Debbie Stabenow (D-Mich.) told reporters.

The next piece of Biden’s massive infrastructure and economic proposal, called the American FamiliesPlan, isn’t expected to include boosting health coverage or reduce prescription drug costs, The New York Times reported yesterday. White House press secretary, Jen Psaki, didn’t mentioning any health care policies while outlining what would be included in that plan.

Sens. Stabenow, Tammy Baldwin (D-Wis.) and Sherrod Brown (D-Ohio) introduced a bill this week that would let Americans beginning at age 50 buy into Medicare. Stabenow said the White House hasn’t indicated if Biden would support their measure.

Their measure shares the same goal as Sen. Bernie Sanders’s (I-Vt.) drive to expand Medicare eligibility broadly to Americans starting at age 55. Rep. Pramila Jayapal (D-Wash.), who helped to lead a unity task force between progressive Democrats like herself and the Biden team, said she’s also pushing to include a Medicare expansion.

In addition, House leaders yesterday reintroduced their signature drug-pricing measure that would direct the government to negotiate with drugmakers for lower prices on certain drugs, hoping it will become part of the infrastructure plan. “Lowering health costs and prescription drug prices will be a top priority for House Democrats to be included in the American Families Plan,” Speaker Nancy Pelosi (D-Calif.) said. Alex Ruoff has more.

Drug Pricing Group to Launch Ads: A drug pricing group will launch ads in response to the report that Biden’s next plan will exclude drug cost reduction initiatives, Alex Ruoff reports. The Patients for Affordable Drugs Now is launching ads to run on broadcast and cable news in the Washington D.C. TV market, and on multiple digital platforms, Alex Ruoff reports. The campaign launches today with a new ad highlighting Biden’s promise to allow Medicare to negotiate for lower prices. It will also include patient mobilization and other activities.

Last Updated 05/05/2021

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