August 26, 2021 | Will Pfizer/BioNTech approval raise vaccination rates?

INDUSTRY NEWS

Will Pfizer/BioNTech approval raise vaccination rates?

With Monday’s full approval of the Pfizer/BioNTech vaccine, expect more businesses, colleges and universities to impose vaccine mandates. Federal officials also expressed hope that the approval would allay the fears of some of the vaccine-hesitant. Kaiser Health News provides a roundup of coverage. (Kaiser Health News)

JAMA: Health care dollars disproportionately spent

White Americans received 72% of all health care spending in 2016 while comprising 61% of the population, according to a study published in JAMA. In contrast, Hispanic patients benefited from 11% of spending despite accounting for 18% of the population. “Measuring disparities in healthcare spending and use not only helps us understand the magnitude of inequities, but also provides valuable insights for policymakers to address their underlying causes,” lead author Joseph Dieleman, PhD, said in a prepared statement. (JAMA; announcement)

Chamber sues over transparency rule

In a recent lawsuit, the U.S. Chamber of Commerce contends that the new rules under Transparency in Coverage Rule are both unlawful and overly burdensome, Modern Healthcare reports. Among the many defendants: HHS, CMS and the IRS. The suit specifically targets a provision that requires insurers to post on their websites three machine-readable files: one that shows the in-network rates they've negotiated with providers, one with their allowed out-of-network rates and a third that shows the rates for prescription drugs. (Modern Healthcare*)

INNOVATION & TRANSFORMATION

Feds invest $19M in rural telehealth

The Biden administration announced investments of more than $19 million in grants to expand telehealth in rural and underserved communities. The investments will provide funding to train primary care providers, bolster groups providing virtual care, pilot new telehealth services and research the efficacy of digitally delivered care in rural geographies. The funds will be distributed among 36 grantees. (Healthcare Dive)

Political fortitude required for value-based care

Even if CMS improves its payment policies and information sharing, it probably won’t make much difference as long as it’s easy for providers to make money through fee-for-service reimbursement. Experts tell Modern Healthcare that Congress must make fee-for-service medicine less attractive if value-based care is to succeed. “Lawmakers are punting here because it takes political fortitude to squeeze fee-for-service. CMS has demonstrated that it’s willing to go there, but it gets no political protection. Often, Congress is the one that steps in and undoes payment decreases,” says Mai Pham, MD, MPH, a former CMS chief innovation officer. (Modern Healthcare*)

CONSUMERS & PROVIDERS

Nearly 17% HF patients forgo care

Roughly one in six US heart failure patients skip appointments, don’t take medications as directed, or forgo some other type of care, costing the health care system 20%-30% more per patient, according to research published in JACC: Heart Failure. About half of the patients cite financial reasons. "I think we make a pretty strong case linking forgone care to higher costs. […] This is enough to give us cause to look at the somewhat granular reasons as to why patients are forgoing care," says lead author Alexander Thomas, MD. (Medscape Medical News; JACC: Heart Failure)

Insurers ending COVID OOP waivers

Many health insurers are no longer waiving out-of-pocket expenses for people hospitalized with the coronavirus, the Kaiser Family Foundation reports. Across the two largest health plans in each state and the District of Columbia, 72% are no longer waiving COVID-19 treatment costs; about half ended cost-sharing waivers by April 2021. “As more waivers expire, more people hospitalized for COVID-19 – the vast majority of whom are unvaccinated – will likely receive significant medical bills for their treatment.” (Kaiser Family Foundation)

NEW & NOTED

Liar, liar: School officials, religious figures, and even doctors and government officials are providing resources to help people circumvent masking or vaccine rules. They often instruct people to lie about having a disability. Another tactic is to provide “exemptions.” California’s state medical board is investigating a doctor accused of handing out dozens of one-sentence mask exemptions for children. (AP)

Nursing home mandate: President Joe Biden announced that nursing homes must require their workers to be vaccinated against COVID-19 to continue receiving Medicare and Medicaid funds. CMS is expected to release an emergency rule to that effect in September. Overall, about 60% of nursing home staff are currently vaccinated, but it varies widely by state. (Roll Call)

New certification: The American Board of Telehealth is launching a Teleprimary Care Certificate program. The online program will cover a range of topics and best practices related to virtual primary care, including workflow, regulatory considerations and health equity. (Healthcare IT News)

MULTI-MEDIA

Suicide rates up in communities of color

Kaiser Health News examines the rising suicide rates among Black, Hispanic and other communities of color in a collaboration with Science Friday, a public radio science show. (Science Friday)

MARKETVOICES...QUOTES WORTH READING

“Don’t blame value-based care for not being effective when you keep giving people a sugar high on fee-for-service.” —Mai Pham, MD, MPH, quoted in Modern Healthcare*