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Thursday, July 8, 2021
THE REVOLUTION IS IN CYBERSPACE AND MACHINE LEARNING
Thursday, June 17, 2021
Laughing gas shows promise for treatment-resistant depression, small trial finds
Wednesday, May 26, 2021
Digital Health Passes in the Age of COVID-19: Are “Vaccine Passports” Lawful and Ethical? | Law and Medicine | JAMA | JAMA Network
Friday, May 14, 2021
Study: 99.75% of hospitalized COVID-19 patients weren't vaccinated - Axios
Wednesday, May 12, 2021
To Vaccinate Younger Teens, States and Cities Look to Schools, Camps, Even Beaches -
Tuesday, May 4, 2021
Hit by Higher Prices for Gear, Doctors and Dentists Want Insurers to Pay
This story also ran on Los Angeles Times. It can be republished for free.
For instance, the box of 100 gloves that cost $2.39 in February 2020 costs $30 now, said Dr. Judee Tippett-Whyte, president of the California Dental Association, who has a private dental practice in Stockton.
Her practice used to rely on surgical masks that cost 20 cents each but has upgraded to N95 masks at $2.50 a pop. On top of that, her office is scheduling two or three fewer patients each day to accommodate physical distancing and give staff members time to disinfect between patients, she said.
“We’ve sustained a lot of financial costs,” Tippett-Whyte said. “We shouldn’t have to bear the cost of this for ourselves.”
Her argument raises a fundamental covid question: Who should pay for pandemic expenses? Should it be health care providers contending with new pandemic-era protocols or insurance companies, which may pass on their additional costs to customers in the form of higher premiums?
California’s dentist and doctor lobbies say insurance companies are flush with cash after collecting premiums during the pandemic but paying fewer claims than usual — and should foot the bill. The California Medical Association, which represents doctors, has sponsored legislation that would require insurers to reimburse medical and dental practices for pandemic-related expenses like personal protective equipment, disinfectant and the staff time required to screen patients for symptoms before an appointment.
A request by doctors to bill Medicaid and Medicare for supplies and other pandemic-related costs recently failed at the federal level. But in Washington state, a new law sponsored by the state doctors’ lobby requires private health insurers to reimburse a portion of those costs.
Insurance trade groups have opposed both state measures.
Reimbursing the cost of nonmedical supplies isn’t typically the responsibility of insurers, said Mary Ellen Grant, spokesperson for the California Association of Health Plans.
“Here we are with treatment and office levels back at pre-pandemic levels. Now they want additional payment from plans to pay for nonmedical expenses,” Grant said.
The insurance industry also points out that doctors and dentists haven’t had to fend for themselves when it comes to PPE and other pandemic-related expenses. Since April 2020, the U.S. Department of Health and Human Services has distributed $9.9 billion to more than 50,000 California medical providers through the Provider Relief Fund, out of $178 billion available nationally.
And more than 900,000 businesses in the “health care and social assistance” category — including some medical practices and dentists — have gotten Paycheck Protection Program loans from the Small Business Administration since March 2020.
A letter from insurance groups opposing California’s bill points to other assistance, such as advance payments on insurance claims from the federal government and insurance plans, state-based grants and loans, and programs that distributed free PPE to some practices.
“They’ve gotten plenty of help from the feds to cover these costs,” Grant said.
Health insurance companies saw their margins and profits skyrocket at the beginning of the pandemic when they were collecting premiums while patients put off non-urgent medical care. Those tapered off when people started returning to the doctor. Still, the nation’s largest medical insurer, UnitedHealth Group, recently announced its net income for the first quarter of 2021 was 44% higher than in the same quarter last year.
Allison Hoffman, a professor who researches health policy at the University of Pennsylvania’s law school, said she has little sympathy for health insurance companies that “made a fortune over the past year” by collecting premiums without paying for the typical number of treatments and doctors’ visits.
“We’re starting to see a kind of broader definition of what health insurance might pay for in order to keep people healthy,” Hoffman said. “There’s nothing like a public health emergency to shine a light on the fact that sometimes it’s not a prescription drug or surgical procedure that’s going to improve health.”
Late last year, the American Medical Association lobbied the federal Centers for Medicare & Medicaid Services to approve a procedure code doctors could use to bill those public insurance programs for PPE, disinfecting materials, office modifications to keep people apart, and staff time spent instructing patients before their visits and checking their symptoms. Often, when federal regulators approve a new billing code for Medicare and Medicaid, private insurers start reimbursing for the corresponding costs as well.
Allowing doctors to bill for that code would help them follow infection control protocols without further cutting into revenues, the association wrote to the federal agency.
But CMS denied the request, saying it considers payment for those costs as part of the payment for the rest of the appointment, according to an agency spokesperson.
In the wake of that decision, two state medical associations took up the cause themselves.
The Washington State Medical Association backed a law, which took effect April 16, that allows health care providers to bill state-regulated private insurance companies $6.57 when they see a patient in person — on top of billing for whatever services they provide — to cover the cost of extra PPE, staff time and materials to conduct and transport covid tests. The new rules last through the rest of the federally declared public health emergency.
For a law that put the state’s medical association and insurance association on opposite sides of the bargaining table, it was remarkably uncontentious, said state Sen. David Frockt (D-Seattle), who introduced the bill.
California’s legislation, which is still being debated, is more open-ended than Washington’s.
SB 242 doesn’t specify a dollar amount but would require private health plans regulated by the state to reimburse dental and medical practices for the “medically necessary” business expenses associated with a public health emergency.
The California Medical Association said physician practice revenues fell by one-third while PPE costs rose by 14% in the first six months of the pandemic, according to an October 2020 survey of its members. Of the survey respondents, 87% said they were worried about their financial viability.
“When you look at the record profits on some of these publicly traded companies and what they’re showing their shareholders, this would be a drop in the bucket,” association spokesperson Anthony York said of health insurers. “We’re not surprised plans don’t want to pay more, but ultimately this is a fight we’ll have in the legislature.”
The bill is intended to keep small and medium-sized practices from closing their doors in the face of rising costs, said its author, state Sen. Josh Newman (D-Fullerton). The state medical and dental associations warn that anything that adds costs and cuts into revenues could force smaller practices to close or consolidate, exacerbating physician and dentist shortages around the state.
“What I’m doing, as a legislator, is to deliberately offset some of these burdensome costs so we don’t lose physicians and practices,” Newman said. “It would be a shame if those communities lost access to health care.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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CVS and Walgreens Have Wasted More Vaccine Doses Than Most States Combined
Two national pharmacy chains that the federal government entrusted to inoculate people against covid-19 account for the lion’s share of wasted vaccine doses, according to government data obtained by KHN.
This story also ran on NBC News. It can be republished for free.
The Centers for Disease Control and Prevention recorded 182,874 wasted doses as of late March, three months into the country’s effort to vaccinate the masses against the coronavirus. Of those, CVS was responsible for nearly half, and Walgreens for 21%, or nearly 128,500 wasted shots combined.
CDC data suggests that the companies have wasted more doses than states, U.S. territories and federal agencies combined. Pfizer’s vaccine, which in December was the first to be deployed and initially required storage at ultracold temperatures, represented nearly 60% of tossed doses.
It’s not completely clear from the CDC data why the two chains wasted so much more vaccine than states and federal agencies. Some critics have pointed to poor planning early in the rollout, when the Trump administration leaned heavily on CVS and Walgreens to vaccinate residents and staff members of long-term care facilities. In response to questions, CVS said “nearly all” of its reported vaccine waste occurred during that effort. Walgreens did not specify how many wasted doses were from the long-term care program.
One thing is clear: Months into the nation’s vaccination drive, the CDC has a limited view of how much vaccine is going to waste, where it’s wasted and who is wasting it, potentially complicating efforts to direct doses to where they are needed most. Public health experts say having a good handle on waste is crucial for detecting problems that could derail progress and risk lives.
The Pfizer-BioNTech and Moderna vaccines, which come in multidose vials, are fragile and have limited shelf lives. Overall, waste has been minuscule: As of March 30, the U.S. had delivered roughly 189.5 million vaccine doses and administered 147.6 million, including 7.7 million in long-term care facilities, according to the CDC.
Among other things, tracking wasted doses helps to identify bottlenecks where distribution adjustments might be needed, said Dr. Bruce Y. Lee, a professor of health policy and management at the City University of New York. Because the federal government is footing the bill for the country’s doses, any waste amounts to “basically throwing [taxpayer] money down the chute,” he said. CVS, Walgreens and other retailers don’t pay for the vaccine. The government provides it. And under the Medicare program, it pays providers roughly $40 for each dose administered.
Particularly early on, officials didn’t adequately assess where there would be demand and set up sites in response, Lee said — something that’s especially important when trying to jab as many people as possible as quickly as possible.
“If you think of any business, they’re going to determine where the customers are first,” he said. “It’s not just a matter of loading up vaccine and going to a place.”
KHN’s survey of vaccine waste is based on public records requests to the CDC and all 50 states, five major cities, Puerto Rico and Washington, D.C. Combined, the records document more than 200,000 wasted doses. However, the data has clear shortcomings. Data from 15 states, the District of Columbia and multiple U.S. territories are not included in the CDC’s records. And, in general, waste reporting has been inconsistent.
In addition to the CDC, 33 states and D.C. provided at least some data to KHN in response to those records requests. They reported at least 18,675 additional doses that have been wasted across 10 jurisdictions not represented in the CDC figures. They include 9,229 doses wasted in Texas as of March 26 and 2,384 in New Hampshire as of March 10.
An additional eight states told KHN of more wasted doses than they reported to the CDC.
But no city or state comes close to the waste reported by CVS and Walgreens, whose long-term care vaccination drive was criticized by some officials as slow and ineffective. Among nursing home staffers, a median of 37.5% reported they got a shot in the first month, according to a February CDC study.
“To me, this ultimately correlates with just poor planning,” said Dr. Michael Wasserman, immediate past president of the California Association of Long Term Care Medicine and a critic of the corporate effort.
Wasserman said the companies’ approach was too restrictive and their unfamiliarity with long-term facilities’ needs harmed the effort.
“CVS and Walgreens didn’t have a clue when it came to interacting with nursing homes,” he said. “Missed opportunities for vaccination in long-term care invariably results in deaths.”
A CVS spokesperson, Michael DeAngelis, in an email blamed wasted doses on “issues with transportation restrictions, limitations on redirecting unused doses, and other factors.”
“Despite the inherent challenges, our teams were able to limit waste to approximately one dose per onsite vaccination clinic,” he added.
Walgreens said its wastage amounted to less than 0.5% of vaccines the company administered through March 29, which totaled 3 million shots in long-term care facilities and 5.2 million more through the federal government’s retail pharmacy partnership.
“Our goal has always been ensuring every dose of vaccine is used,” company spokesperson Kris Lathan said in an email. Before scheduled clinics, she said, Walgreens would base doses it would need on registrations, “which minimized excess and reduced overestimations.”
CDC spokesperson Kate Fowlie said that because the retail pharmacy giants were tasked with administering a large number of doses, “a higher percentage of the overall wastage would not be unexpected, particularly in an early vaccination effort that spanned thousands of locations.” Since President Joe Biden took office in January, his administration has directed pharmacies to prioritize vaccinations for teachers and school personnel.
Overall, pharmacies accounted for almost 75% of wasted doses reported to the CDC. States and some large cities accounted for 23.3% of vaccine waste reported, and federal agencies, including the Bureau of Prisons and the Indian Health Service, for just 1.54%. The Virgin Islands — the only U.S. territory in the federal data — was 0.19%.
“Though every effort is made to reduce the volume of wastage in a vaccination program, sometimes it’s necessary to identify doses as ‘waste’ to ensure anyone wanting a vaccine can receive it, as well as to ensure patient safety and vaccine effectiveness,” Fowlie said. Even still, the CDC has provided guidance and worked with health departments to train staff members to reduce wastage, and clinic staffers should do “everything possible” to avoid wasting shots, she added.
Vaccine waste could increase in the coming weeks as officials shift tactics to inoculate harder-to-reach populations, public health experts say.
“I think we are getting to a place where, to continue to be successful with vaccination, we’re going to have to tolerate some waste,” said Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. People unwilling to travel to a mass-vaccination site might go to a primary care physician or smaller rural pharmacy that might not be able to use every dose in an open vial, he said.
Claire Hannan, executive director of the Association of Immunization Managers, said concerns about waste should not trump getting shots into arms.
“If someone’s there, you need to vaccinate them,” she said. “In our efforts not to waste a dose, we may be missing opportunities to vaccinate because we don’t have 15 people lined up or 10 people lined up.”
CDC Numbers Don’t Match State Data
The federal government collects information about vaccine waste through federal systems called VTrckS, which manages ordering and shipments, and Tiberius, a platform run by the Department of Health and Human Services that monitors distribution. VTrckS can exchange data with state and local immunization registries that track who has received a shot, but some states rely on manual data entry, Hannan said.
The 15 states not included in the CDC’s data are Alaska, California, Colorado, Kansas, Louisiana, Maine, Maryland, Michigan, Nebraska, Nevada, New Hampshire, Ohio, Oklahoma, Oregon and Texas. The District of Columbia is also missing.
Of those jurisdictions, 11 provided data to KHN: Alaska, Colorado, Kansas, Maryland, Nebraska, Nevada, New Hampshire, Ohio, Oregon, Texas and D.C.
Most of those reported minimal waste to KHN: Colorado, Kansas, Nebraska and D.C. together registered just 1,090 wasted doses.
In others, the numbers are more significant. On March 19, the Maryland Department of Health said it knew of 3,175 wasted doses.
Texas had the most wasted doses of any state in either the CDC’s data or the data states provided to KHN. Its records showed 9,229 wasted doses as of March 26, putting it third in overall waste behind CVS and Walgreens.
Fowlie, the CDC spokesperson, said the agency is “working closely” with states that have technical issues to ensure accurate reporting.
Broken Freezers, Bent Needles, No-Shows
The reasons states gave for waste varied, from broken vials and syringes, to provider storage errors, to leftover doses from open vials that couldn’t be used.
The largest waste incidents, in which hundreds of doses were lost at a time, tended to be due to freezer malfunctions or workers leaving doses at room temperature too long.
But state records also register the little things that can go wrong.
On Dec. 16, the public health department in Gunnison County, Colorado, lost a single dose of the Pfizer vaccine when someone bumped into a table and a vial spilled. On Jan. 5, the Tri-County Health Department in Westminster, Colorado, reported that it wasted a Moderna dose because a hypodermic needle bent.
Remi Graber is a registered nurse who has vaccinated people at mass sites and community health clinics in Rhode Island. They said it’s not uncommon for a vial to have one too many or one too few doses, which can lead to a dose being counted as wasted. There are also sometimes syringe problems that result in waste.
But Graber said the biggest problem is people not showing up. Once a vial is punctured, Pfizer’s vaccine must be used within six hours. On April 1, Moderna announced that an opened vaccine vial was good for 12 hours — double what it had been previously.
“What could happen is you get people who just decide, ‘You know what? I don’t need my vaccine today. I’m not going to show up,’” they said. “Well, now we’re scrambling to find somebody to take the vaccine, because we don’t want to waste it.”
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Saturday, April 24, 2021
Haven -- the joint health care venture by Amazon, Berkshire and JPMorgan -- is shutting down - CNN
Haven, an ambitious health care company formed just three years ago as a partnership between Amazon, Warren Buffett's Berkshire Hathaway and JPMorgan Chase is shutting down. The only thing the investors did correctly was to hire Atul Gwande M.D, a well-respected medical writer, researcher and surgeon. Always willing to have additional income he accepted the position as COO. However after 12 months, he recognized the perverse incentives and lack of forethought forming Haven, he bailed out. His reputation remains only slightly blemished the brush with entrepreneurs.
The original three partners did not have a focused goal for the new entity. Operationally it was established as a tool for their own enterprises, and their own employees. The plan was to throw money at the wall, and see if stuck, and go on from there. 