The pandemic virtually shut down elective procedures for much of 2020, but that may not be the case in 2021.
Thanks to the coronavirus pandemic, the use of healthcare services took a nosedive in 2020. But a new analysis suggests that the lull may be over in 2021.
A new analysis from consultants Willis Towers Watson projects that the costs of healthcare benefits in 2021 are likely to increase above and beyond non-pandemic projections as care deferred in 2020 is pushed into the future.
"COVID-19 has played havoc with all previous projections of health care utilization levels," said Trevis Parson, chief actuary, Willis Towers Watson.
"In 2020, we may see a reduction in national healthcare expenditures on a per capita basis for the first time since 1960," Parson said. "However, this reversal in trend is highly likely to be only temporary, despite the continued uncertainty about the virus, as previously deferred care returns in 2021.”
Examining medical claims, Willis Towers Watson looked at four potential future patterns of COVID-19 infection and their impact on the care delivered to COVID-19 and non-COVID-19 patients.
The analysis found employer healthcare costs in 2020 will likely come in between 3.3% and 8.8% lower than originally expected because of the pandemic, as system capacity shifts and a fear of contracting the virus in medical settings continue to depress volumes.
In 2021, however, costs are expected to rise again, between 0.5% and 5.0% above non-pandemic projections due to continued care for COVID-19 patients and delivery of previously deferred non-COVID-19 care, Willis Tower Watson said.
When 2020 and 2021 are combined, the study shows cost reductions of between 2.8% and 3.8% from non-pandemic levels across the four patterns.
Parson said the impact of COVID-19 on employer plans will differ based on geographic factors.
"Employers need to pay special attention to the impact of COVID-19 on their healthcare spend," he said. "The pandemic is driving significant volatility, which demands effective measurement."
Parson said broader changes to the healthcare system are likely to result, which will challenge employers as they look to drive value to employees through their health care plans.
"Employers will need to understand the rapidly changing health care market landscape and the shifting needs and risk profiles of their workforce," he said.
The appointment comes as the pediatric health system contemplates staff cuts and relocating services in the face of the COVID-19 pandemic and declining birth rates.
Veteran healthcare executive Bess Musser has been named vice president of revenue services at Children's Minnesota, the Twin Cities-based pediatric heath system announced Monday.
"I look forward to joining Children's Minnesota and hitting the ground running during a critical time as the organization focuses on growing and enhancing its current revenue cycle performance," Musser said in a media release. "I am thrilled to have the opportunity to put my expertise to work for an organization that is so vital to our community."
Musser duties will include implementing strategies to improve revenue cycle performance, in partnership with leaders and teams across the organization.
In addition, she will manage the system-wide process for the end-to-end revenue cycle functions, including patient access, health information management, patient financial services, billing, coding, regulatory compliance, accounts receivable, and budgeting and reporting.
Musser comes to Children's Minnesota as the state's largest pediatric hospital contemplates major reforms that could include staff cuts and a relocation of services from St. Paul to Minneapolis.
In aninterview this month with the Minneapolis Star Tribune, Children's CEO Marc Gorelick, MD, said the changes were part of a broader plan to transition some services to virtual care, and improve supplies acquisitions and financial services.
"It's been a long time since we've had significant layoffs at Children's," Gorelick told the newspaper, adding that the redesigns are not entirely motivated by COVID-19 but by long term trends.
"One of them is declining birthrates. One of them is increased emphasis on value-based care" contracts that change reimbursements from health insurers," Gorelick said.
Messer joins Children's Minnesota after 20 years at University of Minnesota Physicians, working in various capacities that focused on operational improvement initiatives, including the transition to integrated electronic health-practice management.
Before that, Musser was a senior consultant at McGladrey & Pullen, LLC.
"Beth is known for her ability to innovate across the revenue cycle and for her drive to challenge the status quo to advance the organization," said Brenda McCormick, CFO at Children's.
The Washington State-based health insurer self-reported the breach, which was discovered 2015 and may have affected more than 10.4 million beneficiaries over nearly nine months.
Premera Blue Cross will pay the federal government $6.85 million to settle potential violations of the Health Insurance Portability and Accountability Act Privacy and Security Rules for a nearly nine-month-long data breach that may have exposed the personal information of more than 10.4 million people, the Department of Health and Human Services Office of the Inspector General announced.
OCR Director Roger Severino said the settlement is the second-largest payment to resolve a HIPAA investigation in OCR history and should serve as a warning.
"If large health insurance entities don't invest the time and effort to identify their security vulnerabilities, be they technical or human, hackers surely will," Severino said. "This case vividly demonstrates the damage that results when hackers are allowed to roam undetected in a computer system for nearly nine months."
PBC self-reported the breach on March 17, 2015, stating that hackers had accessed its IT system, using a phishing email to install malware that gave them access to PBC’s IT system in May 2014.
The hack went unreported for nearly nine months until January 2015, and resulted in the disclosure of protected health information of more than 10.4 million people, including their names, addresses, dates of birth, email addresses, Social Security numbers, bank account information, and health plan clinical information.
OCR's investigation found systemic noncompliance with HIPAA rules at PBC, including failure to conduct an enterprise-wide risk analysis, and failures to implement risk management, and audit controls.
More than 1,600 Medicare Advantage and Part D prescription plans will cap insulin monthly copays at no more than $35.
Medicare Advantage premiums in 2021 will be 34.2% lower than they were in 2017, with a monthly average that will be the lowest since 2007, the Trump administration announced Thursday.
In addition, Trump officials said that more than 1,600 Medicare Advantage and Part D prescription plans will cap insulin monthly copays at no more than $35.
"Historically low premiums, massive savings on insulin, and more supplemental benefits represent the welcome fruit of the creative, patient-oriented policies that this administration has made its calling card. Medicare beneficiaries will feel the difference – in their health as well as their pocketbook," she said.
The announcement comes weeks before the annual open enrollment period for Medicare. About 26 million people are projected to enroll in Medicare Advantage. The trending lower Medicare Advantage premiums have saved beneficiaries nearly $1.5 billion since 2017, CMS said.
In addition:
The Medicare Advantage average monthly plan premium is expected to decrease 11% to $21 in 2021 from an average of $23.63 in 2020. In some states including Alabama, Nevada, Michigan, and Kentucky, beneficiaries will see average premium decreases of over 50% since 2017.
Beneficiaries will have about 2,100 more Medicare Advantage plans operating in 2021 than in 2017, a 76.6% increase. Beneficiaries can choose from more than 4,800 Medicare Advantage plans during 2021 open enrollment.
The average number of Medicare Advantage plan choices per county will increase from about 39 plans in 2020 to 47 plans in 2021, a 78.5% since 2017. The number of plan options in rural counties has increased to 2,900 in 2021 from about 2,450 in 2020, an 18%.
The projected Medicare Advantage enrollment for 2021 would be a 44% increase since 2017.
Starting in 2021, beneficiaries with End Stage Renal Disease can enroll in a Medicare Advantage plan.
The average basic Part D premium will be approximately $30.50 in 2021. Part D premiums have decreased by 12% since 2017, saving beneficiaries nearly $1.9 billion.
Part D continues to be an extremely popular program, with enrollment increasing by 16.7% since 2017.
Since 2017, beneficiaries have saved approximately $3.4 billion in combined Medicare Advantage and Part D premium costs.
Delaney succeeds Joseph Iannotti, MD, who served as interim CEO and president for the $1.8 billion Florida region since June.
Conor Delaney, MD, has been named president and CEO of the five-hospital Cleveland Clinic Florida region, effective Oct. 15, the health system announced this week.
Delaney succeeds Joseph Iannotti, MD, Ph.D., who served as interim CEO and president for the $1.8 billion Florida region since June. Iannotti will return to his roles as Chief of Staff, and Chief Academic and Innovation Officer for the Cleveland Clinic Florida region.
"I am incredibly excited to join the Cleveland Clinic Florida team and contribute to our mission of providing patients access to Cleveland Clinic care, while helping grow research and education throughout the region," Delaney said in amedia release.
Delaney is a colorectal surgeon and professor of surgery with more than 30 years of experience in healthcare. He joined Cleveland Clinic in 1999 as a fellow and began his career at Cleveland Clinic in 2000 on the clinical associate staff.
Delaney now serves as chairman of Cleveland Clinic's Digestive Disease and Surgery Institute, with oversight of the departments of Colorectal Surgery, Gastroenterology, Hepatology, Nutrition and General Surgery throughout Cleveland Clinic.
The institute has more than 240 staff physicians, more than 80 advanced practice providers, and 140 residents and fellows, who perform 48,000 surgical cases and 90,000 endoscopic procedures each year.
Delaney earned his medical degree from University College Dublin Medical School. In 1992. He became a fellow of the Royal College of Surgeons in Ireland and earned his master’s degree in surgery in 1994.
His doctorate degree is from the University of Pittsburgh. He holds the Victor W. Fazio, M.D., Endowed Chair in Colorectal Surgery.
Weston-based Cleveland Clinic Florida includes five hospitals across the southeastern corner of Florida, outpatient venues, and a newly opened Cleveland Clinic Florida Research and Innovation in Port St. Lucie, north of Palm Beach.
"Dr. Delaney's accomplishments and leadership experience will further advance our mission and expand our capabilities throughout Florida," said Cleveland Clinic CEO and President Tom Mihaljevic, M.D. "He brings a remarkable dedication and commitment to providing the highest level of quality and safe care for our patients."
Iannotti has been serving as interim CEO since the departure in late June of Wael Barsoum, MD, an orthopedic surgeon, who left the health system he led for six years to become president and chief transformation officer at privately held HOPCo, which operates orthopedic practices, specialty hospitals, ambulatory surgery centers, medical risk management.
At the time of Barsoum's departure, Cleveland Clinic was hemorrhaging red ink and cutting staff and services because of the COVID-19 lockdown, but Barsoum told local media that was not why he stepped aside.
"I am choosing to leave for another job," he told the South Florida SunSentinel in June. "It has nothing to do with Cleveland Clinic cutting costs. I’m just ready for a change."
Baroum, an orthopedic reconstruction specialist, remains on staff at Cleveland Clinic Florida Professor of Surgery in the Cleveland Clinic Lerner College of Medicine.
University of South Florida researchers estimate COVID-19 has caused "2 million years of lost life."
The United States recorded 200,000 deaths from COVID-19 this week, but a new study this week suggests that the grim milestone does not fully reflect the effect of the disease.
A study by researchers at the University of South Florida and published in the Journal of Public Health suggests that measuring "years of life lost" is a better metric than deaths, because it accounts for the range of ages of the people who've died from COVID-19.
"While death counts are a vital initial measure of the extent of COVID-19 mortality, they do not provide information regarding the age profile of those who died," said lead author Troy Quast, professor of health economics in the USF College of Public Health.
"By contrast, years of life lost tell us the extent to which deaths are occurring across age groups and can potentially help healthcare providers and policymakers better target clinical and governmental responses to reduce the number of deaths," he said.
Using a tool is often used to determine the effects of non-communicable disease, drug misuse and suicide, the researchers found that for every U.S. COVID-19 death, an average of nearly 10 years of life had been lost.
The USF researchers obtained data from the Centers for Disease Control and Prevention that report COVID-19 death counts by sex, age and state from Feb. 1 to July 11, during which there had been roughly 130,000 COVID-19 deaths reported.
They compared the ages at death to life expectancies by age and gender from the U.S. Social Security Administration and to population data from the U.S. Census Bureau and calculated that COVID-19 had caused 1.2 million years of life lost during that timeframe.
While the analysis only covered the period through mid-July, if past trends were to have continued, that figure at this point would approach 2 million, Quast said.
Researchers adjusted for the higher rate of pre-existing conditions among COVID-19 deaths by reducing expected life expectancy by 25%.
Close to 80% of U.S. COVID-19 deaths are among people ages 65 and older. Another significant factor is pre-existing medical conditions. Men have more pre-existing medical conditions than women and accounted for 55% of deaths attributed to COVID-19
Measuring COVID-19 deaths has been difficult due to evolving diagnostic criteria, testing supply constraints and the uncertainties that occur in over-burdened intensive care units. Quast says it's vital to continue monitoring years of life lost due to COVID-19 to help policy makers and health care providers better understand the extent of the outbreak.
The COVID-19 Public Health Emergency is blamed for dramatic year-over-year reductions in healthcare services for children.
Health screenings and vaccinations fell dramatically for children enrolled in the Children's Health Insurance Program during the early months of the COVID-19 Public Health Emergency, the Centers for Medicare & Medicaid Services reported Wednesday.
When compared to data from March through May 2019, with the same three-month span in 2020, there were 1.7 million (22%) fewer vaccinations for beneficiaries up to age 2, 3.2 million (44%) fewer child screening services, 6.9 million (44%) fewer outpatient mental health services even after accounting for increased telehealth services, and 7.6 million (69%) fewer dental services, according to CHIP data released by CMS.
In a telehone call with media on Wednesday, CMS Administrator Seema Verma raised concerns that the drop in preventive and primary care services could have a long-term effect on the health outcomes for the 40 million children enrolled in CHIP, 75% of whom live in poverty.
"Today's analysis gives us a much better understanding of how children have been affected by the pandemic and we're releasing it today to raise awareness about this critical public health issue," Verma said.
The problem is further exacerbated by the limited in-person instruction at many schools, which normally would provide a venue for these physical, dental, and mental health screenings and other services such as speech, physical, and occupational therapy.
"The absence of these vital healthcare services may have lifelong consequences for these vulnerable children, and I call on states, pediatric providers, families, and schools to ensure children catch-up on overdue medical, behavioral health and dental appointments as well as childhood immunizations," Verma said.
Verma told reporters that the solution would not come solely from the federal government.
"From our perspective, we've provided a lot of flexibility to states around telehealth services. We've provided over 500 waivers to state Medicaid programs across the country," she said. "This is going to require state and local leadership on this is going to require local communities to put together a system of care for children. So we need to see collaboration between schools and health care providers, and also outreach to families."
CMS said that, for children to catch up on missed vaccinations, vaccination rates must not only approach those of 2019, but to be much higher, in order to mitigate the 22% dip during the early part of the COVID-19 Public Health Emergency.
"This has not begun to happen, and increases the risk of transmission of vaccine-preventable illnesses, such as measles, mumps, and Haemophilus influenza," CMS said.
Newer preliminary data cited by CMS also show a strong uptick in the use of telemedicine for children, but "it is still not enough to offset this decline in care for vulnerable children."
"Further, although telehealth remains an important part of care delivery for children, some services, such as vaccinations, cannot be provided through this vehicle, which contributes to the current gap in their healthcare," CMS said.
Providers also complain that the delayed release of the final rule cuts into the time ACOs and other APMs would have to implement the changes.
Citing concerns about mandating sweeping new reporting requirements in the middle of a pandemic, some of the nation's largest physician and hospital associations on Wednesday asked the federal government to drop changes on how Medicare accountable care organizations are assessed for quality.
"The ACO quality changes proposed are significant and come at a time when ACOs are continuing to deal with challenges and uncertainty caused by the COVID-19 pandemic," the American Medical Association, and nine other stakeholder groupswrote in a joint letter to Centers for Medicare & Medicaid Services Administrator Seema Verma.
"Just as CMS has proposed to delay moving forward with the MIPS Value Pathways approach due to concerns with COVID-19, CMS should also postpone such a drastic and significant change to the way ACO quality is measured, assessed, reported and scored for purposes of both the MSSP and MIPS programs," the letter said.
"The proposed rule, set to take effect in 20201, mandates of how ACOs and other alternative payment models are assessed on quality in the Medicare Shared Savings Program and Merit-Based Incentive Payment System.
The stakeholders also complain that the delayed release of the final rule cuts into the time ACOs and other APMs would have to implement the changes.
Specifically, the stakeholders urged Verma to reconsider:
Ending the use of the Web Interface reporting mechanism, which has been used since the MSSP's inception.
Removing the pay-for-reporting year currently provided to ACOs beginning an initial MSSP contract as well as individual measures that are newly introduced to the measure set.
Changes to the quality measure set ACOs must report under the APM Performance Pathway.
Replacing the existing MIPS APM Scoring Standard, which the stakeholders claim "allows each APM to have its own set of unique quality measures and scoring approaches that best fit the particular model."
The letter was signed by the AMA, American College of Physicians, America's Essential Hospitals, America's Physician Groups, AMGA, Association of American Medical Colleges, Federation of American Hospitals, Medical Group Management Association, National Association of ACOs, and Premier.
"Today we mark a somber milestone as more than 200,000 people in the United States have died of COVID-19 over the course of the pandemic," the American Hospital Association, American Medical Association and American Nurses Association wrote.
The scale and raw numbers of deaths has had a devasting impact on the nation, the three associations wrote, "affecting Americans at a rate that represents a nearly worst-case scenario."
"Those lost include mothers and fathers, grandparents, children, teachers, and frontline workers. The steps required to stop the spread of this virus should be well known by now, but with more than 6 million COVID-positive Americans, we say again: wear your mask, wash your hands, and practice physical distancing," they wrote.
With the flu season approaching, the three associations urged the public to get a flu shot.
"With no end to COVID-19 in sight, a bad flu season has potential to cause additional strain on our health system that is still battling the pandemic. America’s physicians, nurses, and hospitals and health systems thank you for doing your part," they said.
NYU Langone's Center for Diabetes and Metabolic Health was among the nation's first outpatient diabetes practices to switch primarily to remote visits as the pandemic accelerated.
When government and private insurers this spring eased restrictions on telemedicine coverage in response to the pandemic, NYU Langone jumped to expand telemedicine access for the health system's diabetes patients.
"With diabetes emerging as a major risk factor for COVID-19, we felt it was crucial to spare our patients the potential exposures that in-person visits would entail," said Lauren H. Golden, MD, director of Langone's Center for Diabetes and Metabolic Health.
Pre-pandemic, Langone's outpatient diabetes practice had the technical infrastructure for video visits and was training patients to monitor their blood sugar and insulin dosing from personal devices to reduce office visits.
Because of that prearrangement, Golden said, the transition to virtual visits went smoothly.
"We sent patients links to software downloads, and most of them were able to figure out how to transmit readings to us online," she said. "We emailed logs to the others, so that they could fill them out and send them back."
The transition to virtual care came as many of the center's clinicians were working in the health system's "COVID Army," The video visits allowed the remaining clinicians to manage the outpatient services of their colleagues.
A small crew of clinicians and support staff stayed in the office part-time for occasional in-person visits, but by the last week of March, the vast majority of visits were taking place via video.
Langone's use of telemedicine for diabetes management relies on a multidisciplinary approach, Golden said, with endocrinologists, nurse practitioners, diabetes educators, and nutritionists focused on treating the whole patient. In fact, Golden said, video visits are a better access point for diabetes management because much of the regimen centers around lifestyle coaching.
"Because visits don't require travel, patients can check in more frequently than they would have before. Many have told us they're thankful for that enhanced access to care," Golden said.
The video visits also allowed Langone clinicians to support patients’ evolving needs and help them cope with emotional turmoil prompted by the pandemic and social isolation.
"One of the greatest stressors during the pandemic has been dealing with the unknown," Golden said. "We've found that patients benefit from focusing on what they can control, including their own role in staying healthy. It's empowering for them to understand that regulating their blood sugars not only mitigates their diabetes, but also puts them in a better position if they do become infected with the coronavirus."
"If people need a new exercise routine, we’ll send links to workout videos tailored to their age and fitness level," Golden said. "We talk to them about yoga, meditation, and other stress-relieving techniques, and help them find resources online. If they have unmet mental health needs, we try to arrange treatment for those issues as well."
The pandemic is waning in New York City – for now – but Golden said the lessons learned will not be forgotten. In-person visits are returning, but Golden expect telemedicine to remain a popular option with patients post-pandemic.
"The pandemic has shone a spotlight on the things that were or weren't working for people previously," she said. "We want every person we care for to take something positive from this crisis and use it to improve things when we return to whatever the new normal is going to be."
