Healthcare costs – Medic Buzz Fri, 17 Sep 2021 22:32:17 +0000 en-US hourly 1 Healthcare costs – Medic Buzz 32 32 Clover Health uses MedArrive to vaccinate home-confined AH members Fri, 17 Sep 2021 20:03:10 +0000

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Clover Health partners with MedArrive to deliver COVID-19 in-home vaccines to its Medicare Advantage members.

MedArrive’s platform serves payers and providers who can use it to send emergency medical service (EMS) providers to patients’ homes to perform basic clinical services. If necessary, home providers can virtually call on the patient’s physician for additional monitoring.

As an insurance provider for the elderly, some of Clover’s members are housebound and may find it difficult to get vaccinated themselves. The company has partnered with MedArrive to begin sending its network of EMS providers to members’ homes for immunization.

The program kicks off in New Jersey, according to the announcement.


Even now, as more than 75% of adults in the United States have received their first dose of a COVID-19 vaccine, new cases are on the rise. In fact, the United States is reporting the highest rate of new COVID-19 cases since the peak of last winter, according to data from the Centers for Disease Control and Prevention.

This creates problems for unvaccinated seniors, who are at increased risk of serious illness, hospitalization and death, according to the CDC.

But beyond the risk that unvaccinated seniors could put themselves at risk by delaying getting the vaccine, there is the burden they would place on the U.S. health care system if they got sick and needed care. For example, between June and August, $ 5.7 billion was spent on hospital care for unvaccinated COVID-19 patients, according to the Kaiser Family Foundation.

The KFF says that despite the high cost of developing and administering vaccines, the injections will ultimately save the health care system money by avoiding costly hospitalizations.

The partnership between Clover Health and MedArrive aims to combat these risks by providing patients with the care they need at home.

“Many Clover members have disabilities or face other challenges that may prevent them from leaving their homes, even to obtain life-saving medical care like the COVID-19 vaccine,” said Kumar Dharmarajan, deputy chief medical officer. of Clover Health, said in a report.

“This service allows our most vulnerable members to get essential care in the fastest and most convenient way possible, which we believe will ultimately improve their quality of life, reduce hospitalizations and reduce costs. health care costs. “


Clover manages care for Medicare beneficiaries in 11 states, including Arizona, Georgia, Kansas, Mississippi, New Jersey, New York, Pennsylvania, South Carolina, Tennessee, Texas and Vermont .

Last year, the company went public after completing a merger with specialist acquisition firm Social Capital Hedosophia Holdings Corp. III.

Around the same time it hit public markets, Clover announced it was teaming up with Walmart to bring MA plans to Georgia. The deal marked Walmart’s first foray into insurance.

But this summer, when Clover announced plans to expand its geographic footprint, the company also announced it was ending its partnership with the retail giant. In its announcement, Clover said there would be no material change in the benefits of these plans or any disruption in service.

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Healthcare providers to receive $ 25.5 billion in relief funds – Food, medicine, healthcare, life sciences Fri, 17 Sep 2021 07:30:00 +0000

United States: Healthcare providers to receive $ 25.5 billion in relief funds

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On September 10, the Biden-Harris administration, in conjunction with the Department of Health and Human Services (HHS), announced that $ 25.5 billion in relief funds will be distributed to healthcare providers by the through the Health Resources and Services Administration (HRSA). The American Rescue Plan (ARP) will provide $ 8.5 billion in funding and an additional $ 17 billion will be distributed as Phase 4 Provider Relief (PRF) funds.

HHS Secretary Xavier Becerra said “funding will be distributed on an equitable basis, to ensure that providers who serve our most vulnerable communities receive the support they need.” The distribution of funds will follow the guidelines of the Coronavirus Response and Relief Supplemental Appropriations Act of 2020 (CARES Act) on the distribution of lost income and expenses of providers between July 1, 2020 and March 31, 2021. Smaller providers that serving rural and vulnerable populations will be the key target group for these additional Phase 4 funds and will include bonuses for those serving Medicaid, CHIP and / or Medicare patients. All Phase 4 ARP and PRF distributions received between July 1, 2021 and December 31, 2021 must be used by December 31, 2022.

Request for ARP and PRF funds

ARP and PRF applicants will begin the application process through the same application and attestation portal used in the previous PRF distribution phases. Rural ARP providers can use the HRSA Rural Health Grant Eligibility Analyzer to determine their qualification as a rural provider. The application portal opens on September 29, and HRSA will use existing Medicaid, CHIP, and Medicare claim data to calculate payments in addition to bonus payments.

Phase 4 of the PRF distribution methodology

The Phase 4 distribution will allocate lost revenue and expenses related to COVID based on the following guidelines:

  • 75% of the phase 4 allocation will be based on lost income and expenses related to COVID.
  • Large vendors will receive a minimum payout amount based on a percentage of their lost revenue and COVID-related expenses.
  • Medium and small providers will receive a base payment plus a supplement, with smaller providers receiving the highest supplement, as smaller providers tend to operate on low margins and often serve vulnerable or isolated communities.
  • HHS will determine the exact amount of base payments and supplements after analyzing data from all claims received to ensure that we are on budget and that funds are distributed fairly.
  • No supplier will receive a Phase 4 payment in excess of 100% of their losses and expenses.
  • HHS will continue to use risk mitigation and cost containment measures during Phase 4 to protect program integrity and preserve taxpayer dollars.
  • 25% of the Phase 4 allocation will be used for bonus payments based on the amount and type of services provided to Medicaid, CHIP and Medicare patients.
  • HHS will rate Medicaid and CHIP claim data at Medicare rates, with some exceptions for certain services provided primarily in Medicaid and CHIP.

Rural health fund under the ARP

The Health Resources and Services Administration (HRSA) will facilitate PRF and ARP distributions. The $ 8.5 billion ARP funds will be available to rural Medicaid providers, CHIP and / or Medicare patients. Rural ARP distributions will be made to all providers serving patients who live in rural areas, as defined by the Federal Office of Rural Health Policy at HHS. The language of the ARP generally follows the PRF, which provides funding to providers for health care-related expenses and lost income attributable to COVID-19 but not reimbursed from another source.

FRP Phase 3 Compliance and Reviews

Any FRP beneficiary that has been the subject of a merger or acquisition must report to the Secretary of HHS and will likely need to be audited to confirm the proper use of funds for COVID-related costs. -19 which are compatible with an overall risk-based audit strategy. PRF Phase 3 suppliers who believe their Phase 3 payments were incorrect will now have the option to file a review. HRS provided a detailed methodology on how the Phase 3 payments were calculated.

Finally, HHS announced a 60 day final grace period (expiring 9/30/21) for any PRF vendor who must comply with PRF reporting requirements. This grace period does not affect reporting of PRF use or reporting requirements, but will remain any HHS enforcement or collection activity for non-compliant suppliers.

What it means for you

All providers who received PRF distributions in any of the other phases may be eligible to receive additional funding as part of the last phase 4 distributions. In addition, providers only need to serve patients. rural areas to be eligible for ARP payments. Husch Blackwell can help you determine your qualification and guide you through the PRF and ARP application process. Suppliers who have received Phase 3 PRF distributions and have questions about how they were reimbursed under the Phase 3 methodology or who believe their payment should be reconsidered can also contact Husch Blackwell for further assistance. help in solving these complex problems.

The content of this article is intended to provide a general guide on the subject. Specialist advice should be sought regarding your particular situation.

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Vermont hospital spending outpaces economic growth for second year in a row Thu, 16 Sep 2021 22:10:55 +0000

On the heels of approving a major increase in hospital budgets for fiscal 2022, the chairman of the Vermont healthcare regulatory board said executives should expect cuts in future cycles budgetary.

The Green Mountain Care Board oversees health care costs and has set a cap for annual increases at 3.5%, in line with the state’s economic growth. In recent budget cycles, the board has allowed Vermont’s 14 hospitals to exceed that number due to pressures from the pandemic.

That approach has run its course, said board chairman Kevin Mullin. Over the past two years, the board has given hospitals leeway to get their finances back on track, “but that’s not something that’s going to continue to happen,” said Mullin.

Hospitals have requested a median growth rate of 6.1% for the current budget cycle. The board reduced that figure to 5.86% during its recent deliberations on fiscal 2022. For comparison, the average growth rate over the five budget cycles before the pandemic was 3.3. %. The new fiscal year begins on October 1.

Individual hospitalization rates varied considerably.

At a rate of 13.4%, Copley Hospital in Morrisville offered the highest rate hike from last year’s budget. The board of directors reduced this target to 12.4%. Springfield hospital officials initially asked for a 7.8% increase. The council ultimately denied that request and set Springfield’s rate at zero.

The board also slashed the prices that individual hospitals can charge to Vermonters who are either self-insured or have insurance coverage through small employers by $ 10 million. Insurance costs, which total $ 66 million in final hospital budgets, are low compared to revenues from other private insurance plans. But for Vermonters in the employer insurance group, the cuts could represent significant savings.

Mullin acknowledged that it was difficult to straddle the line between raising costs enough to support hospitals and making it unaffordable for Vermonters to see a doctor. The board has erred on the side of hospitals for the past two years, he said, and it is time to reverse that trend.

Several hospital administrators openly disagreed with this assessment.

John Brumsted, president and CEO of the University of Vermont Health Network, said in a statement Monday that the three hospitals in the network need all the resources they can get “to meet the needs of our communities and to make real progress in improving access to needed services. “

He wrote that the board cuts would make it “even more difficult to achieve these goals.”

In a recent interview, Brumsted did not answer questions about a payment of more than $ 140 million the network received from state and federal agencies to cover the costs of Covid – he also did not address a reservation. network-wide of nearly $ 66 million in fiscal 2020, according to an audited budget statement from that year. Despite all the difficulties in 2021 at the network’s flagship hospital, the University of Vermont Medical Center in Burlington – a cyberattack, the closure of an outpatient surgery center, staff shortages and the pandemic – the network is preparing to end the year in the dark.

UVM Health Network’s three Vermont hospitals – UVM Medical Center, Central Vermont Medical Center in Barre, and Porter Medical Center in Middlebury – are expected to generate $ 1.8 billion in collective patient revenue over the course of the year. fiscal year 2022, accounting for roughly two-thirds of health spending in Vermont. With around 700 beds in Vermont, the network, which also has three hospitals in New York City, is the region’s largest provider.

The board has been cautious in estimating Brattleboro Memorial Hospital’s fiscal year 2022 budget growth, based on current patient traffic. The hospital requested a 3% increase over last year’s budget, but the board reduced that request to 0.3%. Steven R. Gordon, president and CEO of the 61-bed hospital in southern Vermont, asked the board to reconsider the decision.

In a Sept. 10 appeal to the board, Gordon said the decision was “short-sighted” as increasing numbers of patients sought care there in the spring and summer, a trend he said , should continue.

The council dismissed Brattleboro’s appeal on Wednesday. Representatives from the Windham County Hospital were not immediately available for comment.

Mullin said on Wednesday that hospital executives could return for a mid-year readjustment if patient volumes continue to grow next year. He explained that growth goals determine a hospital’s spending in a given year. A missed one-year growth target, he added, could result in losses that endanger the longevity of a hospital system.

He pointed to Springfield Hospital, the only hospital in Vermont to file for bankruptcy in fiscal 2020. Windsor County Hospital ran a deficit for years before the pandemic and entered budget season. this year with less than a month’s reserve for hospital operations. Green Mountain Care’s board of directors voted to maintain the hospital’s growth target in 2022, a move that CEO Robert Adcock said would reduce its reserve to 11 days.

Adcock said in an email Wednesday evening that the hospital was awaiting the final written decision from the Green Mountain Care Board. In the meantime, the hospital has considered joining a larger network as a viable solution to the financial difficulties. The hospital administration has already taken steps in this direction, adding representatives to the board of directors of two major regional players – Dartmouth-Hitchcock Health and UVM Health Network – ahead of a possible partnership agreement.

Mullin said given the coronavirus help Springfield has received from state and federal governments throughout the pandemic, he has had every chance of surviving.

“We want people to be more realistic in the way they look at their budgets and not come up with an expectation of pie in the sky,” he added.

Senior Springfield executives are expected to submit a revised strategic plan at a later date.

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As pandemic rocks economy, more and more American workers are calling it a day Wed, 15 Sep 2021 01:57:21 +0000

Prior to the coronavirus pandemic, Antonio Fernandez, 64, had considered staying at his job at Chevron in Houston for perhaps another five years.

“I probably think I had at least five more years to work,” Fernandez said of his role with the oil giant. “I wasn’t looking forward to retirement.”

But as with so many other things, the pandemic is redoing the playbook for when to retire in the United States.

Retiring earlier was a clear trend in the pre-pandemic era of the world’s largest economy, sometimes out of preference, but often out of necessity.

Some have chosen to remain employed until the age of 70 to keep their benefits in a country where health care costs are noticeably high. In other cases, people were forced to continue working after their savings were hit by the 2008 financial crisis.

But since spring 2020, millions of people over 65 have left the workforce, often earlier than expected.

In June alone, more than 1.7 million more older than expected workers retired, said Teresa Ghilarducci, work and retirement specialist at the New School For Social Research in New York.

After being fired last fall, Fernandez applied for other jobs, but was unsuccessful.

“I have mixed feelings,” he told AFP, adding that the company mainly kept lower paid staff, a change from its approach to previous downsizing.

“In the end, while this may not seem fair, it is not a bad outcome for those like me who are fortunate enough to have enough years of service and to be relatively close to retirement to receive a lump sum pension increased by low interest rates. “

– Not ready to go –

Starting early was also difficult for Brenda Bates.

After 43 years working at a nursing facility in Florida, her job became much more taxing during the pandemic when she had to wear a mask and goggles.

Bates suffered a transient ischemic attack, a stroke-like incident with lingering effects. After struggling to breathe during a swim, Bates discussed options with her husband.

“We made the decision to do it for my health,” Bates said.

“Before the pandemic, I thought I would work at least until the age of 65 to qualify for health insurance,” she told AFP. “I love my job, so I expected to stay as long as I really wanted.”

Bates is far from the only one leaving sooner than she expected.

Whether due to fear of a dangerous workplace or job loss amid economic upheaval, “millions of older workers are simply retiring and often sooner than they are ready”, said Ghilarducci.

“It’s scary,” said Bates, who now works as an independent contractor for a company that does job placements for seniors.

“You give up a very good salary and all your benefits. One day you have nothing left.”

While most departures are among workers aged 65 and over, more workers over 55 without a university degree are also leaving their jobs, Ghilarducci said.

The retirements of black workers without a college degree rose 9.2 percent, while white workers with the same education profile saw an increase of 7.5 percent, she said.

One of the risks associated with early retirement is an increase in poverty among the elderly population.

At the same time, some older workers are in fact in a relatively good position to retire, at least compared to previous crises.

“During the global financial crisis, there were obviously a huge number of people who had lost all of their retirement savings, and 10 years later they couldn’t retire,” said Jacob Kirkegaard, researcher at Peterson Institute for International Economics.

“At the moment, the situation is exactly the opposite,” Kirkegaard said, noting that the stock market rose during the pandemic, as did house prices, which fell after the 2008 stock market crash.

But the exodus of workers exacerbates bottlenecks in some cases, as some of those who have left are “very experienced and highly skilled people,” Kirkegaard said. “They are no longer available.”

Dt-jmb / cs

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Sera Prognostics announces post – Tue, 14 Sep 2021 13:02:30 +0000

The publication illustrates the clinical benefit of the combination of PreTRM® tests with evidence-based interventions to improve neonatal health and reduce total health costs

Positive impact on preterm births, neonatal intensive care admissions, overall length of hospital stay and a net reduction of $ 54 million in total costs in the analyzed population

SALT LAKE CITY, September 14, 2021 (GLOBE NEWSWIRE) – Serum prognosis Inc., The Pregnancy Company ™, focused on improving maternal and newborn health by providing innovative information on pregnancy biomarkers to physicians and patients, today announced the publication of a rigorous clinical and economic review using actual data from claims from a large population of Anthem-affiliated health plans. to assess the potential value of PreTRM® testing and treatment strategy.

The study conservatively modeled the PreTRM® strategy, consisting of proactive, evidence-based testing and interventions, within Anthem claims data from individual and employer-sponsored plans, and has shown both improved neonatal outcomes and reduced costs immediate and long-term treatment associated with preterm birth, compared to routine care. These results were published in the peer-reviewed journal ClinicoEconomics and Outcome Research in an article entitled “Cost-effectiveness of a proteomic test for the prediction of preterm birth”.

“The publication of this data adds to the growing body of evidence supporting the effectiveness of Sera’s testing and treatment strategy in identifying women at risk for bPST and enabling evidence-based interventions to reduce the risk.” , thereby improving pregnancy outcomes while reducing the economic burden on payers and health care systems, ”said Gregory C. Critchfield, MD, MS, president and CEO of Sera Prognostics. “We look forward to discussing the implications of this data as we engage with employers and payers in our efforts to improve pregnancy outcomes and reduce healthcare costs through expanded access to PreTRM.® test.”

Study analysis was conducted by Sera in partnership with HealthCore, using claims data from more than 40,000 pregnant women and infants who were members of individual and employer-sponsored Anthem health plans. The analysis assessed the PreTRM® test and treatment strategy by modeling the application of PreTRM® test during weeks 19 or 20 of pregnancy, and evaluated the benefit of proactive interventions consisting of more intensive case management and monitoring, as well as pharmacological interventions for women identified as at highest risk by the test, whereas usual care was assumed for all women without higher PreTRM® risk.

The main conclusions of the analysis include:

  • 20% reduction in preterm births less than 37 weeks gestation
  • 33% reduction in births under 32 weeks gestation
  • 10% reduction in neonatal intensive care admissions
  • 7% reduction in overall length of hospital stay
  • Net savings of $ 863 ($ 1,608 in gross savings) per pregnant woman, a reduction of $ 54 million in total costs compared to the study population

“The pre-MRT® The testing and treatment strategy is associated with both better outcomes and lower total costs, which is rare among modern medical interventions, said Michael Grabner, senior scientist for HealthCore. “The results were consistent across a wide variety of possible scenarios in terms of test participation, treatment adherence, treatment effectiveness, and accumulated costs.”

Based on the study’s estimated net cost savings for the health care system of $ 863 saved per pregnant woman, the authors estimate that more than $ 850 million could be saved each year in individual-sponsored health plans. and employers in the United States, assuming full use of the test-and-treatment strategy. This is based on an assumption of around 4 million births per year, of which around 50% occur to women with such commercial health insurance, and further assuming that at least half have no risk factors. obvious premature labor.

About Sera Prognostics, Inc.

Sera Prognostics is a leading health diagnostics company dedicated to improving the lives of women and babies through precision pregnancy care. Sera’s mission is to provide physicians with essential and early information about pregnancy, enabling them to improve the health of their patients, which translates into reduced health care delivery costs. Sera has a strong portfolio of innovative diagnostic tests focused on early prediction of the risk of preterm birth and other pregnancy complications. Precision medicine from Sera PreTRM® The test reports the individualized risk of spontaneous preterm delivery during pregnancy to a doctor, allowing for earlier proactive interventions in women at higher risk. Sera Prognostics is located in Salt Lake City, Utah.

About premature birth

Premature birth is defined as any birth before 37 weeks gestation and is the leading cause of illness and death in newborns. The March of Dimes 2020 report shows that of about 3.8 million babies born each year in the United States, more than one in ten are born prematurely. Prematurity is associated with a significantly increased risk of major long-term medical complications, including learning disabilities, cerebral palsy, chronic respiratory disease, intellectual disability, seizures, and vision and hearing loss, and can generate significant costs throughout the life of the children concerned. The annual health care costs for managing the short- and long-term complications of prematurity in the United States have been estimated at around $ 25 billion for 2016.

About PreTRM® Test

The pre-MRT® is the only commercially available widely clinically validated blood biomarker test that provides early, accurate and individualized prediction of the risk of spontaneous preterm delivery in asymptomatic single pregnancies. The pre-MRT® test measures and analyzes proteins in the blood that are highly predictive of preterm birth. The pre-MRT® The test allows doctors to identify, in the 19th or 20th week of pregnancy, which women are at increased risk of preterm delivery, allowing for more informed and personalized clinical decisions based on each woman’s individual risk. . The pre-MRT® the test is ordered by a healthcare professional.

Sera Prognostics, the Sera Prognostics logo, The Pregnancy Company, and PreTRM are trademarks or registered trademarks of Sera Prognostics, Inc in the United States and / or other countries.

Safe Harbor Declaration

This press release contains “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995, including statements relating to engagement with employers and payers to potentially expand access to PreTRM.® test; estimates of over $ 850 million to be saved each year assuming full adoption of the risk detection and treatment strategy; and the company’s strategic guidelines under the heading “About Sera Prognostics, Inc.” These “forward-looking statements” are based on management’s current expectations regarding future events and are subject to a number of risks and considerations. ‘uncertainties that could cause actual results to differ materially and adversely from those stated or implied by forward-looking statements. These risks and uncertainties include, but are not limited to: net losses, cash generation and the potential need to raise more capital; income from the PreTRM test representing almost all of the Company’s income to date; the need for broad scientific and commercial acceptance of the PreTRM test; a concentrated number of hardware customers; our ability to introduce new products; potential competition; our exclusive biobank; critical suppliers; the ongoing COVID-19 pandemic and its impact on our operations, as well as the activities or operations of third parties with whom we do business; estimates of the total addressable market opportunity and market growth forecasts; potential coverage and reimbursement by a third party payment; the new reimbursement methodologies applicable to the PreTRM test, including the new CPT codes and the payment rates for these codes; changes in FDA regulations on lab-developed tests; intellectual property rights protecting our tests and our market position; and other factors discussed under the heading “Risk Factors” contained in our final prospectus on Form S-1, which was filed with the Securities and Exchange Commission on July 14, 2021, as well as any updates to these factors from time to time. in our quarterly reports on Form 10-Q, annual reports on Form 10-K or routine reports on Form 8-K. All information contained in this press release is as of the date of publication, and the Company does not undertake to update this information, except as required by law.


Investor contact
Peter DeNardo, CapComm Partners
[email protected]
+1 (415) 389-6400

Media contact
Erich Sandoval, Lazar FINN
[email protected]
+1 (917) 497-2867

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North Texas Employers, Congressional Delegation Respond to Vaccination Mandate – NBC 5 Dallas-Fort Worth Sat, 11 Sep 2021 01:12:20 +0000

There is praise and criticism following President Joe Biden’s executive orders requiring COVID-19 vaccinations for approximately 100 million American workers.

Large employers in North Texas are considering their next steps and how they will implement mandates for workers who do not wish to be vaccinated.

At El Rancho de Garland supermarket, safety comes with sacrifices.

They offered employees $ 200 incentives to get vaccinated against the virus.

“We do it because we care about the community. We want the community to be open and we want it to be safe and we want to work in a safe environment, ”said Vice President of Operations Guillermo Washington.

The large North Texas employer with multiple locations welcomes President Biden’s directive.

Private employers with 100 or more workers are soon to require that employees receive a COVID-19 vaccine or be tested weekly.

The mandate led the discussion at a congressional panel hosted by the Dallas Regional Chamber on Friday.

Members of the North Texas congressional delegation discussed several topics, including budget, infrastructure, health and workforce issues.

Representatives Eddie Bernice Johnson, Marc Veasey, Colin Allred and Beth Van Duyne were in attendance.

“I don’t think the president wanted to do this,” Rep. Allred said of the sweep warrants. “I think it was something that was forced on him.”

The delegation was asked to weigh in on the fact that the American Hospital Association said that the president’s policy “could exacerbate the serious problems of labor shortages that currently exist.”

“I don’t see this as a problem because you don’t have to get vaccinated with this order,” Allred said. “You can also do weekly tests. It is a matter of public health. “

The Texas Restaurant Association is also voicing concerns, releasing a statement saying:

“Texas restaurants share President Biden’s goal of increasing the number of fully vaccinated Americans to fight the spread of COVID-19. At the same time, we need to recognize the burden the new mandate places on an industry that is already seeing its strenuous recovery reversed due to a severe labor shortage, with food costs rising at their pace. faster in seven years and declining income. To make matters worse, the announcement comes in the same month as a tax credit that helps restaurants and other small businesses grant paid time off to employees getting a COVID-19 vaccine is currently on the verge of being released. expire.

“Adding additional taxes and regulations now at a time when you’re already struggling to hire people to keep your doors open, I think that’s exactly the opposite direction we need to go,” said representative Van Duyne.

Healthcare consulting firm PCS Advisors helps medium and large businesses across the country manage healthcare costs.

“You have 28% of American employees who say they are ready to lose their jobs before they get vaccinated. I don’t think that has changed as a result of the president’s speech yesterday, ”said Paul Seegert, Managing Partner at PCS Advisors.

Seegert told NBC 5 that his clients in North Texas are “not thrilled” with the warrants.

There are still many unresolved issues with implementing the policy, including additional costs such as weekly testing.

“Who’s paying for it,” Seegert asks.

PCS warns its customers of their additional liability if they defy the decree.

“The advertised penalties of $ 14,000 per offense are so severe that I think most [employers] will go reluctantly if they are not in favor of it for fear of this massive penalty, ”he said. “It’s something employers should take seriously. We’ve seen companies that haven’t taken the Affordable Care Act and the reporting requirements that go with it seriously. They thought they would never reach me and they are getting notices today. The government collects billions of dollars in ACA fines.

It is a risk that some are not prepared to take.

“When the law requires it, we will follow the law,” Washington said.

The president also issued vaccination warrants for other workers. It includes most federal government employees, such as the 17 million nursing home and hospital workers who receive Medicare and Medicaid funds. Federal Head Start and Early Head Start program staff are also included in the mandate.

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As Valley Hospitals Face Soaring COVID Costs, Federal Authorities Sit On Help – GV Wire Tue, 07 Sep 2021 22:10:53 +0000

State hospitals lost more than $ 8 billion last year in dealing with the COVID-19 pandemic, according to a report commissioned by the California Hospital Association.

Additionally, financial challenges are expected to continue in California, with projected losses of $ 600-2 billion, said KaufmanHall, a Chicago-based healthcare consultant.

The report tells a story from the hospitals in the valley.

For example, Kaweah Health lost $ 23.1 million in 2020 – and that was after receiving massive relief from federal funding.

But now, with the upsurge in COVID cases and the Biden administration in charge, hospital officials are asking when they will receive the next round of help.

The answer to this $ 52.5 billion question is unclear.

According to the Washington Post, $ 44 billion from the Provider Relief Fund created last year remains intact, as does an additional $ 8.5 billion that Congress set aside in March for medical care in rural areas.

Big losses for California hospitals

Jan Emerson-Shea, vice president of external affairs for the California Hospital Association, said hospitals across the state suffered huge losses last year and will continue to suffer financial setbacks due to staff shortages and the increase in COVID cases among the unvaccinated.

KaufmanHall found that California hospitals lost more than $ 14 billion in 2020, although funding for COVID relief through CARES made up for these losses of $ 6 billion.

The study noted that community hospitals were among the hardest hit.

The blow to the results of hospitals is not weakening.

“More than 200 California hospitals could lose money from their operations in 2021, and more than 250 could struggle to break even, more than before the pandemic,” KaufmanHall said.

Hospitals in the valley particularly affected

Laura Florez-McCusker, director of media relations for Visalia-based Kaweah Health, said the healthcare system suffered a cumulative operating loss of $ 68.7 million in fiscal year 2020-2021 .

The only bright spot, said Kaweah Health CEO Gary Herbst, getting $ 47.4 million from the CARES Act.

“So going from $ 15 million to $ 18 million of positive margin to a loss of $ 68 million over a 13-month period – it had an absolutely devastating effect,” Herbst said.

To cut costs, the hospital had to freeze salary increases for 5,100 employees and forgo contributions to funds for 401,000 employees.

Valley Children spokeswoman Zara Arboleda acknowledged the pressure hospitals are feeling from the pandemic.

“Hospitals across the country have suffered revenue losses in the tens or even hundreds of millions since March of last year, including Valley Children,” Arboleda said.

As hospitals struggle, federal government clings to funding

Meanwhile, critics say the Biden administration is sitting on approved funding that U.S. hospitals desperately need.

“There has not been a single penny of state money made available to hospitals or other health care providers. California Hospital Association. “$ 44 billion is currently in the Treasury Department that was supposed to be allocated to hospitals and nursing homes across the country to help cover the costs of COVID. These funds were never allocated, so they stay there. “

According to the Washington Post, health officials, lobbyists and lawmakers have complained to senior health officials in the Biden administration about the delay in aid.

US Secretary of Health Xavier Becerra has been asked several times about providers’ funds. He replied that during the Trump administration there was not enough transparency to show how the money was being used. When this issue is resolved, the funds will be released, Becerra said.

“We continue to work quickly to release these funds and will be announcing another fund distribution soon – plans are being finalized,” HHS said in a statement.

Could staff shortages add to the financial pressure on hospitals?

Employees of hospitals, nursing homes, doctor’s offices, clinics and other medical facilities will have until September 30 to get vaccinated unless they have a medical exemption – a prescription issued by California Public Health Officer Dr Tomás J. Aragón.

Hospitals in need of vaccinations could see an unexpected number of nurses leave the profession, creating new headaches for hospitals facing staffing and financial shortages.

As of July 23, according to CalMatters, “23% of the nearly 500,000 hospital workers in more than 350 California hospitals (had) not received a single dose of vaccine.

Fresno County interim health worker Dr Rais Vohra does not see the vaccination mandate amplifying the nursing shortage. He noted that the vast majority of healthcare workers have said they will comply with the deadline.

“I don’t think the hospitals are worried that this is a huge sum,” Vohra said. “We hear that 60-80% are vaccinated, and that’s the ballpark figure for most hospitals in terms of the number of vaccinations for their staff. “

Emerson-Shea says there is no way to know this will play out.

“We support the demand that all healthcare workers be immunized – healthcare workers have a special role in our society and in hospitals,” said Emerson-Shea. “So we support this requirement for vaccination, but how is it actually going to play out? I don’t think anyone really knows.

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In Wisconsin, a $ 100 vaccine incentive appears to be working. Nationally, incentive results are a tossup. Fri, 03 Sep 2021 23:59:00 +0000

MADISON, Wisconsin – A week after Governor Tony Evers promised a $ 100 debit card to anyone in Wisconsin receiving their first COVID-19 vaccine, the 7-day average of vaccines administered reached its highest level since late June.

From free beer to cash prizes, COVID-19 vaccine incentives have emerged across the country as part of a nationwide campaign to get more Americans vaccinated, with mixed results. For the people of Wisconsin, the promise of a $ 100 gift card likely helped more than 65,000 Wisconsin residents receive their first dose within 13 days of the Get Vaccine, Get 100 announcement. $ “from Evers.

The results had state officials happy enough to maintain the incentive beyond the originally announced end date of September 6 to the new September 19 deadline.

“This is for sure the highlight of the last few weeks,” Wisconsin Department of Health Services secretary-designate Karen Timberlake told News 3 Investigates. “We are very satisfied with the results obtained so far.

The increase in vaccine incentives follows President Biden’s recommendation that states, territories and local authorities should use US bailout dollars to encourage citizens to take the vaccine with $ 100 incentives. With the current number of first doses in Wisconsin equivalent to about $ 6.5 million in incentive payments, the $ 100 cards will come from the state’s ARPA fund pool. Incentives are partly targeted for those hesitant to vaccinate, but also for those who may face additional barriers to getting vaccinated.

“They have to hire a babysitter, or they have transportation issues, or they have to take time off work because they don’t work in a place that gives them sick time,” said Timberlake.

Yet, with Evers extending the incentive program to run for another two weeks, the effectiveness of vaccine incentives from a national perspective remains uncertain. Additionally, health policy experts point to the pros and cons, and sometimes ethical concerns associated with health incentives.

Justin Sydnor, professor at UW-Madison School of Business with expertise in economic behaviorals and health care, these incentives could cause people who are already hesitant to receive the vaccine to increase their concerns.

“There is reason to fear that the incentives will backfire on some of these situations,” Sydnor said. “Sometimes when you offer an incentive, it indicates that the thing you are trying to encourage might not be that appealing, so that’s a slight concern.”

Nationally, the effectiveness of incentives varies

An analysis of data from various types of incentives from other states shows mixed results, especially depending on the type of incentive. Examples are plentiful in Wisconsin: A chance to win Bucks tickets for Game 5 of the NBA Finals only prompted 19 people to get shot; later, hundreds of people got one in exchange for a free cream puff at the Wisconsin State Fair.

In Minnesota, the state offered a $ 100 gift card vaccination incentive that served as a model for the Wisconsin program. The program has also been extended due to its apparent success, with Minnesota’s 7-day average dropping from 2,675 last month to around 4,955 at the end of August. This caused an old-fashioned rivalry between the states.

“We looked carefully at Minnesota which had a similar incentive program,” said Timberlake. Are we beating their results? “There’s still that Wisconsin-Minnesota rivalry so we’d love to be ahead of them on that point.”

Vaccination incentive efforts have appeared to be effective in New Jersey thus, where people receiving a first dose also received a free bear in May. A week after the start of the incentive program, the state recorded an average of 7 days go from about 66,000 on May 4 to about 75,000 hits a day a week later.

But an inducement similar to free beer in Connecticut had a much different result, where the 7-day average of new vaccine doses fell from over 40,000 on the day of the announcement, April 26, to about 33,000 on May 11.

It can be difficult to determine whether immunization incentives are working because states don’t know what immunization rates would have looked like without them. In addition, other variables can also skew the data.

For example, Governor Gavin Newsom in California offered a series of incentives, including free Six Flags tickets, $ 50 gift cards, and the chance to win big bucks. After the announcement of his “Vax for the Win” lottery program, he claimed a 22% increase in doses week after week. But health experts in California say the results are not so clear; a drop in immunizations over Memorial Day weekend and another wave of vaccines after Pfizer’s emergency clearance for children ages 12 to 15 could also have resulted in a 22% increase, rather than be exclusively an incentive result.

In a press conference Two weeks ago, Evers said he was initially skeptical about the success rate of incentive programs, but decided to move forward with the program after witnessing the success of the efforts of the incentive program. Michigan Vaccine Lottery. However, the effectiveness of this particular lottery program has also offered mixed results.

When the Michigan Million Dollar Lottery incentive was announced, millions of residents signed up. At the time, the state’s vaccination rate was 61.82%. However, the state indicated that the vaccination rate only increased to 62% for people aged 16 or over the following week.

This number indicates that most of the roughly 1.4 million Michigan residents who signed up for the lottery had already been vaccinated before the announcement, suggesting that the announcement did not encourage many unvaccinated people to get vaccinated, according to WOOD-TV.

Health policy experts: there are pros and cons

While the success rate of vaccination incentives can be difficult to determine, health experts say government officials should use all available tools to encourage people to get vaccinated.

According to Thomas Oliver, professor of population health sciences at UW-Madison and expert in health policy, the social costs of an unvaccinated population represent a greater risk than the financial cost of a program. vaccination incentive.

“The cost we face socially and individually if we get sick – all the costs of health care, all the stress on all of our other services, people can’t go to work, they lose income… there’s a lot of costs that are lost there to the disease, ”Oliver said.

“I think the government is very responsible in adding this as one more thing to try to tip the scales in favor of immunizing people who have had trouble justifying themselves or taking the time to go and do it. “

Still, Oliver explained that vaccine incentives can cause ethical problems.

“The problem with the financial reward is that it sends a very strange message that we have to bribe you rather than people who feel good about themselves,” Oliver said. “If you take the $ 100 bribe, you probably won’t feel as good as if you’ve done something for others.”

It can also cause those who received the vaccine before vaccination incentive programs to feel wronged in some ways, according to Oliver.

“It brings to mind the rest of us who voluntarily went for the vaccine,” Why should anyone else get $ 100 for waiting so long, creating a more dangerous situation for ourselves and for them. others, now being rewarded for procrastinating, blowing it up, or fundamentally opposing it? And now all of a sudden they’re going to get a reward? Said Olivier. “So I think it hurts the social fabric. “

The state had its own answer for fully immunized people who didn’t like their exclusion from the $ 100 card program.

“The good news for them is that they have been protected from COVID-19 this entire time,” Timberlake said. “We want to say a big ‘thank you’ to the 3 million people across Wisconsin who are fully vaccinated against COVID-19.”

How to register

In order to receive the award, residents will need to register by completing an online form or by calling 844-684-1064. The information will be used to verify that residents received their first dose between August 20 and September 19.

Payments will be in the form of a $ 100 Visa gift card. Cards will be mailed to participants’ addresses and may take up to six weeks to arrive.

Proof of insurance, identity or citizenship is not required. Residents of Wisconsin aged 12 and older are eligible.

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Patient cost of COVID treatments set to rise for some Wed, 01 Sep 2021 02:03:45 +0000

SALT LAKE CITY – As of August 31, 2021, 485 people are currently hospitalized to fight against COVID-19.

Not all of those hospital stays come cheap.

As of September 1, some patients may have to pay more than expected as insurance companies stop paying 100% of the cost of COVID treatments.

“I received invoice after invoice after invoice”

Cass Ho was hospitalized with COVID-19 in May 2020, when the pandemic was still new and hospitals were not yet overcapacity of intensive care patients.

“It was really tough,” Ho said. “I was in critical condition and ended up on a ventilator and probably very close to death.”

Ho said she was in intensive care for two weeks, including nine days of which she was intubated and in a coma.

“Luckily I was able to get through it, one way or another,” she said.

As she began to heal at home, the bills started rolling in.

“I received bill after bill after bill,” she exclaimed. “They came by pages and by pages.”

Overall, Ho estimates that his stay in intensive care cost around $ 125,000.

“I know my doctor was $ 550 a day, and then there was all the meds, all the nursing care that came in,” she said. “They charge everything. Every pill, every injection … all the oxygen. I was on a ventilator. Fans are extremely expensive.

Good news for Ho, she didn’t have to fork out a penny out of her pocket. What his health insurance plan did not cover, his supplemental insurance covered.

Ho said it was a relief to have this burden on her shoulders as she recovers from the effects of COVID-19.

“It plays a huge role in your recovery,” she said. “Because if you have a financial obligation and you’re insured, even if it’s 80%, you’re still stuck with that bill. And if you’re in bad shape, on a ventilator, and in intensive care, you’ve got a six-figure bill. “

The costs of COVID hospitalizations

Other Americans have also found that large bills do not follow them home.

In Utah, KSL investigators found that two major insurance companies have 100% covered the costs of COVID treatment for its members: SelectHealth and Regence Blue Cross Blue Shield.

It’s changing. As of September 1, SelectHealth will apply the normal “plan benefits” to its members receiving COVID treatment.

His spokesperson sent this statement to KSL-TV:

“SelectHealth carefully reviewed the claims data and considered what other carriers were doing with regards to removing COVID coverage before making this decision. We also took into account the availability of vaccines and their ability to reduce the impacts of COVID. We continue to cover 100% testing and vaccinations for COVID and COVID treatment according to plan benefits, and we will continue to encourage individuals to get vaccinated. “

Regence Blue Cross Blue Shield of Utah will change its policy from “no reimbursable fees to members” to normal plan benefits effective January 1, 2022.

KSL investigators looked at other major Utah insurance providers and found that the United Healthcare, PEHP, and University of Utah health plans currently cover COVID treatments under the normal cost-sharing of coinsurance, in accordance with contracts of their members. Medicare also treats COVID treatment like regular billing.

This means that patients can expect bills for things like co-payments, deductibles, and maximum amounts.

With severe cases of COVID, you can probably expect to pay your maximum out-of-pocket expenses if you are hospitalized.

According to independent, nonprofit healthcare cost estimator FAIR Health, the average price for COVID ICU patients in Utah with complexities was $ 223,462, with eligible charges for health insurance at $ 112,808.

Nationally, COVID hospitalizations without complexities cost patients an average of $ 59,536. That’s higher in Utah, with an average bill of $ 82,155.

COVID-19 vaccines remain free.

The Utah Department of Health reports that the vast majority of people currently hospitalized with COVID have not received any of the available COVID-19 vaccines.

The Kaiser Family Foundation has so far found that unvaccinated COVID patients have cost hospitals $ 2 billion nationwide.

Have you had COVID-19 and received medical treatment for it? We would like to see the bills to get a better idea of ​​what COVID is costing the Utah community. Send them to

Have you been through something that you think is wrong? KSL investigators want to help. Send your tip to or 385-707-6153 so we can work for you.

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Reducing Sugar in Packaged Foods Could Generate Significant Health and Economy Gains Sat, 28 Aug 2021 01:47:00 +0000

Removing 20% ​​of Sugar from Packaged Foods and 40% from Drinks Could Prevent 2.48 Million Cardiovascular Events (Such as Stroke, Heart Attack, Cardiac Arrest), 490,000 Cardiovascular Deaths, and 750,000 Cases of Diabetes in the United States during the lifetime of the adult population, reports a study published in Circulation.

A team of researchers from Massachusetts General Hospital (MGH), Friedman School of Nutrition Science & Policy at Tufts University, Harvard TH Chan School of Public Health, and New York City Department of Health and Mental Hygiene (NYC DOH ) created a model to simulate and quantify the health, economic and equity impacts of a pragmatic sugar reduction policy proposed by the United States National Salt and Sugar Reduction Initiative (NSSRI). A partnership of more than 100 local, state and national health organizations convened by the NYC DOH, the NSSRI released draft sugar reduction targets for packaged foods and beverages in 15 categories in 2018. In February, the NSSRI finalized the policy with the aim of the industry voluntarily committing to gradually reformulate their sweet products.

Implementing a national policy, however, will require government support to monitor companies as they strive to meet targets and to publicly report on their progress. The researchers hope their model will build consensus on the need for a national sugar reformulation policy in the United States.

We hope that this study will help advance the reformulation initiative in the coming years. Reducing the sugar content of commercially prepared foods and beverages will have a greater impact on the health of Americans than other initiatives to reduce sugar, such as imposing a sugar tax, labeling of added sugar content or ban on sugary drinks in schools. “

Siyi Shangguan, MD, MPH, senior author and attending physician at MGH

Ten years after the NSSRI policy took effect, the United States could expect to save $ 4.28 billion in total net health costs and $ 118.04 billion over the lifespan of the population. current adult (aged 35 to 79), depending on the model. Adding in the societal costs of the lost productivity of Americans developing illnesses from excessive sugar consumption, the total cost savings of the NSSRI policy amount to $ 160.88 billion over the lifetime of the population. adult. These benefits are probably underestimated because the calculations were conservative. The study also showed that even partial industry compliance with the policy could generate significant health and economic gains.

The researchers found that the INSS policy became profitable at six years and economical at nine. The policy could also narrow disparities, with the largest estimated health gains among black and Hispanic adults, and low-income, less-educated Americans – the populations that consume the most sugar as a historical consequence of inequitable systems.

Product reformulation efforts have been shown to be effective in reducing other harmful nutrients, such as trans fats and sodium. The United States, however, lags behind other countries in implementing strict sugar reduction policies, with countries like the United Kingdom, Norway and Singapore leading the reformulation efforts. sugar. The United States could yet become a leader in protecting its people from the dangers of excessive sugar consumption if the sugar reduction targets proposed by the NSSRI are met.

“The NSSRI policy is by far the most carefully designed and comprehensive, yet achievable, sugar reformulation initiative in the world,” Shangguan said.

Consumption of sugary foods and drinks is strongly linked to obesity and diseases such as type 2 diabetes and cardiovascular disease, the leading cause of death in the United States. More than two in five American adults are obese, one in two have diabetes or prediabetes, and nearly one in two have cardiovascular disease, with people in low-income groups disproportionately affected.

“Sugar is one of the most obvious additives in the food supply to be reduced to reasonable amounts,” says Dariush Mozaffarian, MD, DrPH, senior co-author and dean of the Friedman School of Nutrition Science and Policy. ‘Tufts University. “Our results suggest that it is time to implement a national program with voluntary sugar reduction targets, which can generate major health improvements, health disparities and health spending in less time. a decade.”


Massachusetts General Hospital

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