MRCS Weekly Recap 5 (2.27.22-3.5.22)

1. COVID

In his State of the Union address, Biden expressed optimism about returning to "normal life" and how the virus will "no longer control our lives." Biden's new COVID-19 strategy focuses on continued public health measures to expand access to coronavirus therapies and improve ventilation in indoor spaces. The plan represents a move toward a world where the government allows life to proceed as usual while keeping a watchful eye for new outbreaks of viral variants. The plan involves initiating programs to help families deal with the costs of treating long Covid symptoms. Also, paying for funerals and bereavement support and funding programs to help address the country's ongoing mental health crisis. Many are worried about COVID restrictions being lifted, while others are worried about keeping them in place. Most Republicans and unvaccinated adults think it's safe to resume normal activities, while fewer Democrats and vaccinated adults would agree. About 2/3 of people say they were worried about restrictions hurting the mental health of school-aged children.

The CDC released a new mask guide saying that those who live in medium or high-risk counties should continue to wear masks indoors. Under the new framework, the CDC recommends people wear masks indoors in counties with a high COVID-19 community level, meaning there is a high level of severe disease and a high potential for the area's healthcare system to become strained. At this point, nearly 90% of the U.S. lives in communities that no longer require masks, with the CDC stating, "if you are more comfortable wearing a mask, feel free to do so." While the new guidelines indicate COVID-19's effect on a community is minimal enough that people do not need to wear masks in the two lower categories, agency Director Rochelle Walensky, MD, said, "We should all keep in mind that some people may choose to wear a mask based on personal preference."

The FDA has warned people against using specific COVID-19 tests. Acon Laboratories, Celltrion and S.D. Biosensors all run the risk of false results even though all have received emergency use authorizations from the FDA. All companies are now recalling their unauthorized tests, including Celltrion's over 160,000 tests across Europe and the U.S. Similarly, a new CDC report from 10 states show that the Pfizer vaccine, for children aged 5-11, is not very protective against Omicron but that it does protect against severe illness. Due to reports like this, there is a significant divide on COVID vaccinations between urban and rural America. A new CDC report shows that 59% of rural people and 75% of urban people are vaccinated, with the most significant gap in children. Among 12–17-year-olds, only 39% of rural people are vaccinated, while 65% of people in urban areas are. This could stem from 40% of rural parents saying their pediatrician did not recommend the vaccine. In comparison, just 8% of urban parents reported this.

The highly transmissible omicron subvariant cases appear to be doubling every week in the U.S. Still, there isn't clear evidence BA.2 will cause another significant surge. According to CDC estimates, the subvariant accounted for an estimated 8.3 percent of COVID-19 cases ending Feb 26, up from 4.4 percent a week prior. Overall, the cases are trending down in the U.S. This, coupled with evolving societal expectations, indicates a hopeful turn for the pandemic!

2. IT Updates

Infusion pumps used to deliver medications and fluids to patients are reported to have cybersecurity flaws. Around 75% of infusion pumps are believed to be vulnerable to cyber-attacks. With Russia's invasion of Ukraine, the federal government warned about the potential of Russian cyberattacks on the healthcare sector and many other industries. The Cybersecurity and Infrastructure Security Agency said there are no "specific or credible cyber threats" but that every organization "must be prepared to respond to disruptive cyber activity." The 2021 HIMSS Healthcare Cybersecurity Survey found healthcare cyber-attacks most frequently targeted financial information. Aging systems that are out-of-date with tight budgets are at threat to security challenges.

Here are the top trends impacting healthcare decision-making around the world:

i. Real-World Health Data Evidence: RWE in healthcare decision-making remains the top trend as its use and impact grow in importance. Also, infrastructure and interoperability of health data becomes integral to its practical use.

ii. Value Assessment and Patient Engagement: Interest in infusing the "patient voice" in healthcare research remains high along with the shift to value-driven healthcare, strengthening the need for value assessment.

iii. Public Health and Health Equity: Illuminated by the pandemic, interest in researching and addressing healthcare disparities intensifies along with the significance of critical priorities in public health.

iv. Healthcare Financing: As new and innovative technologies come to market, healthcare financing remains in the spotlight. Additionally, the need for price transparency in healthcare continues.

v. Artificial Intelligence and Technology Assessments: The potential grows for A.I. and advanced analytics to profoundly impact healthcare. Additionally, the benefits and challenges of cross-country cooperation bring HTA back to the trends list.

3. Telehealth

Teladoc and Amazon are partnering to offer voice-activated virtual care services. Their goal "with this launch is to make healthcare access even easier for customers." The partnership makes 24/7 non-emergency general medical care available to Amazon customers. Customers should typically get a call back on their Echo device from a Teladoc physician within 15 minutes, depending on call volume and queue length. This comes at an exciting time when less than 26% of Americans have used telehealth in the past two years since the pandemic began. There is a misassumption that everyone is interested in telehealth. People who only received in-person care increased from 70% in 2020 to 80% in 2021. Although, the report indicates that women aged 21 - 40 have increased use rates of telehealth.

Mark Hallman, the Chief Innovation and Transformation Officer at JPS Health Network, believes that Amazon Care has the potential to be a true disrupter and further facilitate healthcare consumerism. The extent of services that Amazon Care can bundle together that further separate the patient from traditional care models is something that, as a healthcare executive, you could only dream of — in essence, how do you reinvent care delivery? The extent of services aligned with a reputable and identifiable brand will further facilitate consumer/patient association. Hallman believes the concerns are the same as those stirred up when any competitor achieves hype — "can it create stickiness?"

4. Practice Management

Despite declining COVID-19 cases, hospitals' margins, outpatient volumes, and revenues dropped while expenses rose. In January, hospital margins were negative for the first time in 11 months due to the omicron headwinds. Ongoing expense increases and abrupt volume shifts led the median change in operating margin without accounting for relief funds to drop more than 70% from December to January. Meanwhile, outpatient care delays from December to January led outpatient revenue to fall 7.5%. In terms of paying, hospital and urgent care clinics' cash rates for the uninsured can be cheaper than paying high deductibles. MedCity News shows that paying with cash can be more economical than paying with insurance.

Despite there being more registered nurses than before the pandemic. Nurse shortages are still occurring. This is primarily due to poor working conditions, scheduling errors, and unjust wages. One emergency medicine nurse with 25 years of experience left the field in November 2021. She recounted a shift where she had eight patients and could not care for and clean a soiled, older woman on a gurney in the hallway for hours. She now roasts coffee beans and hopes "to open a cafe where she can look people in the eye, ask about their lives and offer comfort, things she loved in earlier years as a nurse." It is estimated that the youngest American workers are experiencing the most significant wage gains as employers compete to fill staffing gaps in a tight labor market. Workers ages 16 to 24 saw a 10.6 percent increase in median hourly wages in January 2022 compared to January 2021. This increase in wages across the labor market is a trend we can expect to continue to maintain younger nurses in the industry. Before the pandemic, about half of U.S. states had given NPs full practice authority. Since then, even more, states have issued executive orders to allow NPs to take on more responsibility during the pandemic – an emergency response to help address new challenges. A report outlining what to expect from nurse practitioners in 2022 states that the primary care physician shortage will become more pronounced with the spotlight on health disparities intensifying. We should also anticipate full practice authority for NPs to continue to expand.

Simple-to-use integrated scheduling and two-way engagement are critical in equipping healthcare providers to deliver a better patient experience in the digital future. Optimized calendars increase revenues. Bidirectional experiences are the new standard. These are a few common trends we've seen through the first two months of 2022. For health systems to meet growing consumer demand, providers should create virtual care, service-based, provider scheduling. Also, there should be patient-centered digital access beyond the website.

5. Coding Updates

The CMS published a new Level II Healthcare Common Procedure Coding System (HCPCS) code for "prescription digital behavioral therapy," making it easier for commercial and Medicaid plans to cover these therapies. Going into effect in April, this new CMS code is seen as a significant step toward reimbursement for digital therapeutics companies to get reimbursed for software-based treatments.

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