Hospital and nursing home job losses were partially offset by gains in the ambulatory care sector.
The healthcare sector reported 18,000 job losses in September, according to a disappointing employment report issued Friday by the Bureau of Labor Statistics.
Nursing homes accounted for 38,000 job losses, followed by hospitals with 8,000 job losses. Those losses were partially offset by 28,000 job gains in ambulatory care for the month, BLS reported.
The BLS report accounts for employment in mid-September and can be subject to considerable revision.
The healthcare sector has shed 524,000 jobs since the start of the pandemic in February 2020, with hospitals accounting for 93,300 job losses, and nursing homes accounting for 425,700 job losses. Ambulatory services lost 4,700 jobs in that span.
There were 15.9 million people attached to the healthcare sector workforce in September, BLS said.
The larger economy created 194,000 new jobs in September, down from the 235,000 jobs created in August, as the unemployment rate ticked down 0.4 percentage point to 4.8% for the month and the number of unemployed people fell to 7.7 million, BLS reported.
Nonfarm employment has grown by 17.4 million jobs since a April 2020 but is down by 5 million, or 3.3%, from its pre-pandemic level in February 2020.
The bureau also noted that 13.2% of employees teleworked in September because of the coronavirus pandemic, little changed from August.
Mortality was nearly 200 deaths per 100,000 prisoners over a one-year span, versus 80 deaths per 100,000 in the U.S. population.
Inmates in the nation's prisons were more than three times as likely to contract COVID-19 and more than twice as likely to die from it during the first year of the pandemic, when compared with the overall U.S. population, a new research letter shows.
Writing this week in JAMA, University of California at Los Angeles researchers looked at COVID-19 cases and deaths among U.S. federal and state prisoners for 52 weeks from April 5, 2020, to April 3, 2021 and compared these rates with the overall U.S. population.
The findings showed that 394,066 COVID cases and 2,555 deaths had been documented in U.S. prisons in that 52-week span.
The cumulative incidence rate per 100,000 prisoners for the period was 30,780 cases, compared with 9,350 cases for the U.S. population.
The standardized mortality rate per 100,000 prisoners over the same one-year span was 199.6 prisoner deaths versus nearly 80 deaths for the U.S. population.
In December 2020, at the peak of the epidemic inside prisons, prisoners were five times as likely to contract COVID-19, and nearly three times as likely to die from it, the research found.
"While COVID-19 incidence and mortality rates peaked in late 2020 and early 2021 and have since declined, the cumulative toll of COVID-19 has been several times greater among the prison population than the overall US population," the study said.
The funding provides reimbursements for telecommunications services, information services, and connected devices needed for telehealth during the pandemic.
The Federal Communications Commission has approved another 72 applications for funding commitments totaling $41.1 million for its second round of funding for its COVID-19 Telehealth Program.
The funding provides hospitals and other healthcare venues reimbursements for telecommunications services, information services, and connected devices needed for telehealth during the COVID-19 pandemic.
The new money follows the nearly $42 million awarded in August to healthcare providers in each state, territory, and the District of Columbia.
"The FCC has now approved a total of over $83 million in funding applications for Round 2 of its COVID-19 Telehealth Program," said Acting Chairwoman Jessica Rosenworcel. "From community health clinics in urban city centers to hospitals serving rural communities across the country, these funds will support efforts to help our neighbors remain in the care of their doctors, nurses, physician assistants and trusted healthcare providers during this pandemic."
Round 2 is a $250 million federal initiative that builds on the $200 million program established as part of the CARES Act. As outlined in the Round 2 Report, when $150 million has been committed, the FCC's Wireline Competition Bureau will give all remaining applicants a chance to supplement their applications.
For a detailed list of providers who received Round 2 funds, click here.
A new J.D. Power survey suggests that service limitations, access hurdles, and quality-of-care issues dampen consumer enthusiasm.
The telehealth sector has seen broad expansion during the first 18 months of the coronavirus public health emergency, but that surge has been accompanied by growing pains, one survey shows.
J.D. Power's newly released 2021 U.S. Telehealth Satisfaction Study identified service limitations, access hurdles, and quality-of-care issues have dampened consumer enthusiasm for telehealth.
The survey showed that while 36% of the more than 4,600 respondents said they'd used telehealth in the past year – up from 9% in 2020 and 7% in 2010 -- overall satisfaction with both direct-to-consumer and payer-sponsored telehealth services decline in 2021 from 2020.
The top annoyances among consumers included limited services (24%); lack of awareness of costs (15%); confusing technology requirements (15%); and lack of information about providers (15%).
"It's impossible to ignore that 36% of the healthcare customers we measure within our research have used telehealth services this year—which is four times higher than a year ago," said James Beem, managing director of global healthcare intelligence at the Troy, Michigan-based consumer data analytics firm.
"However, digging deeper into the research, it's clear that customer satisfaction has declined during the same period, with many users citing limited access to the services they need and inconsistencies in the care they receive," he said. "As the industry grows, it is critical to address these challenges."
Among the findings in the new survey:
Telehealth adoption spikes across all generations in 2021: Overall, 36% of patients have accessed telehealth services during the past year, up from just 9% in 2020 and 7% in 2019. Usage is consistent across all generational groups, with the highest usage among members of Generation Y and Pre-Boomers.
Convenience, speed and safety drive utilization: The top reasons for telehealth utilization are convenience (57%); ability to receive care quickly (47%); and safety (36%).
Patient satisfaction declines as pain points emerge: Overall satisfaction with both direct-to-consumer and payer-sponsored telehealth services decline in 2021 from 2020. The most frequently cited barriers encountered by patients are limited services (24%); lack of awareness of costs (15%); confusing technology requirements (15%); and lack of information about providers (15%).
Uneven care for higher-risk patients: Overall satisfaction is 85 points lower (on a 1,000-point scale) among patients with the lowest self-reported health status than among patients who consider themselves to be in excellent health. Similarly, healthier patients are more likely than less healthy patients to understand the information provided during the visit; say they receive clear explanations; perceive that their visits are highly personalized; and obtain high-quality diagnoses.
Telehealth Providers Ranked
Among the major providers of telehealth, Teladoc was ranked highest in customer satisfaction among direct-to-consumer brands, with a score of 874. MDLIVE (868) ranks second and MyTelemedicine (859) ranks third.
UnitedHealthcare ranks highest among payers of health plan-provided telehealth services with a score of 868. Humana (865) and Kaiser Foundation Health Plan (865) rank second in a tie.
The survey, now in its third year, measures customer service, consultation, enrollment, and billing and payment, and is based on responses of 4,676 consumers in July and June who used a telehealth service within the past year.
The new plan -- Align powered by Sanford Health Plan – covers Medicare Advantage enrollees in South Dakota, North Dakota and western Minnesota.
Sanford Health Plan announced Monday that it has launched a Medicare Advantage health insurance plan for beneficiaries in three states.
Enrollment runs from October 15 – December 7, 2021, and coverage starts on January 1, 2022.
Described by the Sioux Falls, South Dakota-based payer as an "all-in-one bundled health insurance option,Align powered by Sanford Health combines Medicare Part A and Part B "with more tailored, comprehensive health benefits and prescription drug coverage."
"What makes our offering stand out from other options on the market is that seniors will be able to join a Medicare Advantage plan that is backed by a network of Sanford Health providers working together to deliver personalized care," said John Snyder, president of Sanford Health Plan.
"As a health plan that is part of Sanford Health's comprehensive system of care, we provide members with innovative services and supplemental benefits to improve health and manage chronic conditions," Snyder said.
The plan -- offered in North Dakota, South Dakota, and western Minnesota – is touted by Sanford as meeting the comprehensive needs of beneficiaries while remaining affordable and, in some cases, offer $0 premiums and copays.
The plan will include personal health "navigators" who can help members schedule appointments, set up transportation, arrange for a trusted partner to attend appointments alongside members, and coordinate follow-up care.
Other benefits include: PPO plans; In-network and out-of-network benefits; access to an integrated network of local Sanford Health providers; visitor and travel benefits; virtual care; pharmacy; dental; vision; hearing; OTC allowance; gym memberships; and meals.
The rule lays out how payers and providers will resolve billing disputes under the No Surprises Act.
The Centers for Medicare & Medicaid Services on Thursday released its interim final rule on surprise medical billing, and payers and providers gave the long-awaited provisions decidedly different receptions.
In short: Hospitals Hate it. Payers are delighted.
The key point of contention in the final rule – which take effect on January 1, 2022 -- is the independent dispute resolution process for some out-of-network billing, which presumes that the payer's out-of-network reimbursement is the starting point for negotiations.
The disputing stakeholders will have a 30-day "open negotiation" to determine a payment. If they're still at loggerheads, they can open the dispute resolution process, which is conducted by a jointly select a "certified independent dispute resolution entity" that's been authorized by CMS.
CMS says the dispute resolution process – mandated by the No Surprises Act -- creates a process "that will take patients out of the middle of payment disputes, provides a transparent process to settle out-of-network rates between providers and payers, and outlines requirements for healthcare cost estimates for uninsured (or self-pay) individuals."
CMS Administrator Chiquita Brooks-LaSure said the final rule requires "healthcare providers and healthcare facilities to provide uninsured patients with clear, understandable estimates of the charges they can expect for their scheduled healthcare services."
Stacey Hughes, executive vice president of the American Hospital Association, called the rule "a windfall for insurers."
"The rule unfairly favors insurers to the detriment of hospitals and physicians who actually care for patients," Hughes said in prepared remarks. "These consumer protections need to be implemented in the right way, and this misses the mark."
Federation of American Hospitals President and CEO Chip Kahn called the final rule "a total miscue" that goes against the intent of Congress when it passed the law.
"It inserts a government standard pricing scheme arbitrarily favoring insurers," Kahn said. "For two years, hospitals and other stakeholders stood shoulder to shoulder with lawmakers to develop legislation that would protect patients from surprise medical bills and last December, Congress passed a bill with a fair and balanced payment dispute resolution process. This regulation discards all of that hard work, misreads Congressional intent, and essentially puts a thumb on the scale benefiting insurers against providers and will over time reduce patient access."
Matt Eyles, president and CEO of America's Health Insurance Plans, said the final rule "signals a strong commitment to consumer affordability and lower healthcare spending through an independent dispute resolution process that should encourage more providers to join health plan networks."
"We are particularly encouraged to see the rules conform to the intent of the No Surprises Act and direct that arbitration awards must begin with a presumption that the appropriate out-of-network reimbursement is the qualified payment amount," Eyles said.
"This is the right approach to encourage hospitals, health care providers, and health insurance providers to work together and negotiate in good faith. It will also ensure that arbitration does not result in unnecessary premium increases for businesses and hardworking American families."
Justine Handelman, senior vice president of policy and representation for the Blue Cross Blue Shield Association, called the IFR "a win for patients and a step toward building a more affordable and equitable healthcare system.
"We commend the administration for protecting patients and using an independent resolution process that focuses on affordability. This was Congress’ intent, and we will continue to work with Congress and the administration to create a more transparent, affordable and equitable health system," Handelman said.
Docs hate it too
The IFR is also getting panned by the American Medical Association, which called it "a surprise gift to the insurance industry."
Like the hospital associations, the AMA says the IFR "ignores congressional intent and flies in the face of the Biden Administration's stated concerns about consolidation in the health care marketplace."
"It disregards the insurance industry's role in creating the problem of surprise billing at the expense of independent physician practices whose ability to negotiate provider network contracts continues to erode,” said AMA President Gerald A. Harmon, M.D.
"Congress appreciated the negative consequences of national price setting for healthcare services and spent considerable time and effort developing a robust independent dispute resolution process to maintain market balance and preserve access to care, which the Administration apparently ignored,” Harmon said.
"It also is apparent that the Administration failed to appreciate the importance of creating an accessible and impartial dispute resolution processes as a backstop against even greater insurer abuses," he said.
Thursday's final rule is the third in a series of implementations of the No Surprises Act put forward by the Departments of Health and Human Services, Labor, Treasury and the Office of Personnel Managment.
The letter notes that 20% of rural Americans experience mental illness, and that rural America is disproportionally adversely affected by the opioid epidemic.
Twenty advocacy groups have called upon the Centers for Medicare & Medicaid Services to extend and make permanent billing for tele-behavioral health outpatient service after the COVID-19 Public Health Emergency expires.
In a letter to CMS Administrator Chiquita Brooks-LaSure, the stakeholders lauded CMS's efforts to bolster telehealth in its CY 2022 Medicare Physician Fee Schedule, which extends through the end of 2023 some of the temporary telehealth regulations that were imposed at the start of the pandemic.
"Given the enormity of the challenge ahead of us, we must leverage our entire rural safety net to address these surging behavioral health needs," the letter said. "We strongly believe that CMS should ensure critical access hospitals, rural health clinics, federally qualified health centers, and other providers are all equipped to fully leverage telehealth and that they are able to bill for clinically equivalent services the same way they would an in-person service."
The letter signers include the American Physciatric Association, Gundersen Health System, the National Association for Rural Mental Health, and the National Rural Health Association.
Among the provisions of the CY2020 fee schedule, it would allow for RHCs and FQHCs to bill and get paid for tele-behavioral mental health visits, including audio-only visits, the same as in-person
"We agree that telehealth payment should be addressed for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), and also believe outpatient behavioral therapy services offered by Critical Access Hospitals (CAHs) are a key component of a comprehensive rural behavioral health strategy," the letter stated. "Without action to ensure these hospitals can bill tele-behavioral health as they do in-person services, access to CAH-provided outpatient will be lost for thousands of Americans in rural areas."
The letter notes that 20% of rural Americans experience mental illness, and that rural America is disproportionally adversely affected by the opioid epidemic. In addition, suicide rates are 40% higher in rural areas than in large urban areas (and are increasing at a faster rate).
"This is only made worse by the fact that there is a severe shortage of mental health professionals in rural areas. Over 80% of rural counties do not have a psychiatrist, compared to 27% of counties in metropolitan areas," the letter said, adding that the challenges "are particularly acute for Medicare beneficiaries."
"Approximately 33% of widowers become depressed – and while elderly adults represent only 13% of the population, they represent approximately 20% of all suicide deaths. At the same time, approximately 68% of elderly adults have little awareness about how to recognize and be treated for depression."
"These are exactly the issues that Congress intended CAHs to address when designating them providers of essential services in rural communities," they wrote. "As you know COVID has only exacerbated these challenges."
The executive order, set to expire on September 30, relaxes regulations on telehealth, including waivers on privacy and security protection laws.
California Gov. Gavin Newsom this week signed an executive order extending relaxed telehealth security and privacy provisions through the remainder of the COVID-19 emergency.
The original executive order was issued in April 2020 and was set to expire on September 30. The new order extends the order through the end of the public health emergency, or until the original order is rescinded or modified.
Newsom said that the extension was needed because "surges in COVID-19 cases in some regions have caused increased wait times for healthcare services, and seasonal influenza is likely to increase further the usage of healthcare facilities across the state."
California has recorded more than 4.7 million COVID cases, and nearly 69,000 COVID-related deaths. Nationally, the virus has claimed 687,000 lives, according to the Centers for Disease Control and Prevention.
However, CDC data also show that California has the nation's lowest level of "community transmission," which measures the number of cases and the number of positive tests in the past week per 100,000 population.
The extended provisions of the prior order will continue to allow providers to conduct routine and non-emergency medical appointments through telehealth without the risk of being penalized.
"I find that strict compliance with various statutes, regulations, and certain local ordinances specified or referenced herein would prevent, hinder, or delay appropriate actions to prevent and mitigate the effects of the COVID-19 pandemic," Newsom said in the order.
Newsom's order said the executive order "is necessary to continue to facilitate the use of telehealth services, where appropriate, to minimize the threat of COVID-19 to Californians and healthcare workers alike, to expedite access to healthcare services, and to reduce strain on the healthcare delivery system."
A CMS audit found that Sacramento-based InnovAge was out of compliance in several areas.
The federal government has suspended the InnovAge California PACE program from enrolling new members after a May audit determined that the Sacramento-based Medicare provider repeatedly failed to provide its enrollees with medically necessary equipment and services.
"CMS has determined that the seriousness of these deficiencies requires the suspension of any new enrollments of Medicare beneficiaries into InnovAge Sacramento," John A. Scott, director, Medicaid Parts C and D Oversight and Enforcement Group, said in a September 17 letter to Innovage California PACE COO Maureen Hewitt.
"The enrollment sanction will remain in effect until CMS is satisfied that InnovAge Sacramento has corrected the causes of the violations and the violations are not likely to recur," Scott said. "This enrollment suspension will apply to the enrollment of all Medicare beneficiaries regardless of their Medicaid eligibility status."
The CMS audit found that InnovAge was out of compliance in several areas, including: a failure to ensure participants received necessary services from certain specialists; a failure to coordinate care, review specialists' diagnoses, and provide services recommended by specialists; unwarranted delays in care delivery; and a failure to provide specialists services, including ophthalmology, optometry, dermatology, and nephrology.
The audit noted that even though InnovAge Sacramento was not contracted for these services, the provider "is still responsible for furnishing all services covered under the PACE benefit, which includes all Medicare-covered items and services, all Medicaid-covered items and services, and all other services determined necessary by the IDT to improve and maintain the participant’s overall health status."
InnovAge issued a statement acknowledging the audit and said it was "focused on working closely with CMS to expeditiously address and resolve the points they've identified."
"As a healthcare provider in a highly regulated industry, InnovAge has established protocols to cooperate with and fully support regulatory measures," the company said. "Our primary concern is always the health and safety of our participants in every market we serve."
The hurdles to broadening tele-behavioral health services for Medicaid enrollees come as the nation "confronts the psychological and emotional impact of COVID-19," OIG said.
The COVID-19 pandemic has prompted an increased reliance among states for virtual delivery of behavioral healthcare services for their Medicaid populations, particularly in rural and underserved areas and at-risk communities.
However, a new federal audit, based on interviews with Medicaid directors and other stakeholders in the 37 states that offer tele-behavioral health services, has identified multiple challenges that are hamstringing expansion and adoption efforts.
"Most states reported multiple challenges with using telehealth," said the audit, compiled by the Department of Health and Human Services' Office of the Inspector General, "including a lack of training for providers and enrollees, limited internet connectivity for providers and enrollees, difficulties with providers' protecting the privacy and security of enrollees' personal information, and the cost of telehealth infrastructure and interoperability issues for providers."
"Some states also reported other challenges, including a lack of licensing reciprocity and difficulties with providers obtaining informed consent from enrollees," the audit said. "These challenges limit states' ability to use telehealth to meet the behavioral health needs of Medicaid enrollees.
The hurdles to broadening tele-behavioral health services for Medicaid enrollees come as the nation "confronts the psychological and emotional impact of COVID-19," OIG said.
The auditors noted that the federal Centers for Medicare & Medicaid Service "has an important role to play in facilitating the exchange of information among states to improve the use of telehealth for behavioral health services."
"We recommend that CMS share information to help states address the challenges they face with using telehealth," OIG said.
"This information could include examples from states that describe how they have responded to these challenges. It could also include best practices from states and information about working with other state and federal partners. Further, CMS could collect information from states detailing their experiences and lessons learned in response to the COVID-19 pandemic that address these challenges."
