$4,000 for Average Covid Hospital Stay

From WDSU Channel 6 News: For Complete Post, Click Here…

Measures to protect patients hospitalized with COVID-19 from financial liability have been rolled back by most insurers in the United States, leaving the vast majority of patients with an average out-of-pocket bill of about $4,000 for each hospital stay, according to research published this week in the journal JAMA Network Open.

Between March 2020 and January 2021, less than 9% of patients with private health care insurance had any cost-sharing associated with COVID-19 hospitalization. By March 2021, more than 84% of patients with private insurance had some financial responsibility for a COVID-19 hospitalization.

A separate analysis by the Kaiser Family Foundation found that cost-sharing waivers have now expired for more than 94% of the largest health insurance plans. The vast majority had rolled them back by August 2021, when COVID-19 vaccines were widely available to the general public.

Patients insured under the Medicare Advantage program saw a similar jump in cost-sharing responsibilities, from less than 3% in the first year of the pandemic up to 66% in March 2021.

From March 2020 through March 2021 – spanning periods when cost-sharing waivers were both widespread and rolled back – the average COVID-19 hospitalization cost privately insured patients an average of $3,998 out-of-pocket. Average costs were highest in the Western region of the U.S. and lowest in the Northeast.

Shortsighted COVID policies are accelerating harm for people with disabilities

BY JAVIER ROBLES: For Complete Post, Click Here…

I used to talk to my college students about all the advances in civil rights and equity that people with disabilities have made over the years. 

Then the COVID-19 pandemic struck. Across the country, countless members of my community were turned away from hospitals, denied lifesaving treatment, forced to remain in dangerous congregate living arrangements, and unable to safely access food, transportation, personal protective equipment, testing and even critical information about how to protect themselves. 

All because of who they were. 

I say “countless” because we have no idea how many people with disabilities have contracted COVID-19, been hospitalized, or died. There is no systematic reporting of COVID-19 testing, infection, mortality or outcomes by disability status. 

Nearly everyone will experience a disability, especially as we age, even if only temporarily. People with disabilities are 26 percent of the population, yet we are invisible — and never more so than during a public health crisis when we are also acutely vulnerable. 

Recently, I served as member of the Robert Wood Johnson Foundation National Commission to Transform Public Health Data Systems. Our job was to make recommendations for modernizing the collection, sharing and use of public health data to advance health equity. While on the commission, I saw that public health data are essential to ensuring that society’s most overlooked members — including not only people with disabilities but people of color, people who are poor and LGBQT people — receive equitable treatment. 

What’s the Deal With Mark Cuban’s Pharmacy?

by Jared Dashevsky: For Complete Post, Click Here…

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Sarah was recently booted off her parents’ family insurance plan after turning 26. She’s on her own now, but is in luck: the software company she works for offers decent health insurance, with an annual premium of $7,739 and a deductible of $1,945.

Sarah is healthy and doesn’t frequently go to the doctor. Her only health condition is ulcerative colitis, but she’s in remission with the help of two medications that control inflammation: mesalamine extended release (Apriso) and mesalamine (Canasa). Since Sarah now pays for her deductible and premium, her out-of-pocket expenses are about to jump: a 3-month supply of Apriso and Canasa cost on average around $370 and $2,820, respectively.

Sarah wonders why her meds are so expensive. Billionaire entrepreneur Mark Cuban wonders the same thing. He is looking for a solution by tackling the drug supply chain head-on. He aims to lower the cost of common medications with the launch of his pharmacy, the Mark Cuban Cost Plus Drug Company (MCCPDC).

How Does MCCPDC Work?

MCCPDC is an online pharmacy offering 100 affordable, life-saving generic drugs. Some of MCCPDC’s drugs are 10 times cheaper than those sold elsewhere. The company achieves such cost savings by removing insurance plans and outside middlemen, known as pharmacy benefit managers (PBMs), from the drug supply chain.

Why Millions on Medicaid Are at Risk of Losing Coverage in the Months Ahead

By Rachana Pradhan: For Complete Post, Click Here…

The Biden administration and state officials are bracing for a great unwinding: millions of people losing their Medicaid benefits when the pandemic health emergency ends. Some might sign up for different insurance. Many others are bound to get lost in the transition.

State Medicaid agencies for months have been preparing for the end of a federal mandate that anyone enrolled in Medicaid cannot lose coverage during the pandemic.

Before the public health crisis, states regularly reviewed whether people still qualified for the safety-net program, based on their income or perhaps their age or disability status. While those routines have been suspended for the past two years, enrollment climbed to record highs. As of July, 76.7 million people, or nearly 1 in 4 Americans, were enrolled, according to the Centers for Medicare & Medicaid Services.

When the public health emergency ends, state Medicaid officials face a huge job of reevaluating each person’s eligibility and connecting with people whose jobs, income, and housing might have been upended in the pandemic. People could lose their coverage if they earn too much or don’t provide the information their state needs to verify their income or residency.

Medicaid provides coverage to a vast population, including seniors, the disabled, pregnant women, children, and adults who are not disabled. However, income limits vary by state and eligibility group. For example, in 2021 a single adult without children in Virginia, a state that expanded Medicaid under the Affordable Care Act, had to earn less than $1,482 a month to qualify. In Texas, which has not expanded its program, adults without children don’t qualify for Medicaid.

State Medicaid agencies often send renewal documents by mail, and in the best of times letters go unreturned or end up at the wrong address. As this tsunami of work approaches, many state and local offices are short-staffed.

Extend the Interval Between COVID Vaccine Doses

by Michael Daignault, MD, and Monica Gandhi, MD, MPH: For Complete Post, Click Here…

The safety and effectiveness data should prompt CDC to update its policy.

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On Friday, February 4, the Advisory Committee on Immunization Practices (ACIP) quietly acknowledged the rapidly accumulating body of evidence supporting an extended interval between the first and second dose of a two-dose COVID-19 vaccine series. ACIP members weighed the benefits of extending the interval between doses of the two mRNA vaccines — currently 3 weeks for Pfizer (Comirnaty) and 4 weeks for Moderna (Spikevax) — to 8 weeks, based on both effectiveness and safety data. Updating the guidelines would represent a seismic policy shift in this country.

We welcome the long-overdue recognition of this evidence-based approach already endorsed by multiple other countries including Canada, India, the U.K., and other countries in Europe. Although the two-dose series of the Pfizer vaccine was studied at an interval of 3 weeks and the Moderna vaccine at an interval of 4 weeks, the companies were aware of the urgent global need for an effective COVID-19 vaccine while designing these interval strategies. Except for rabies, no other vaccine is given at a dosing interval of 3 weeks. In fact, a principle of vaccinology is that priming the immune system with the first dose generates good responses to second doses of most vaccines for at least 6 months or more.

There are three main lines of evidence for extending the COVID-19 vaccine dosing interval: 1) immunologic; 2) vaccine effectiveness studies; and 3) safety studies regarding the low risk of myocarditis with mRNA vaccines.

He Donated His Kidney and Received a $13,064 Bill in Return

by Anjeanette Damon: For Complete Post, Click Here…

Living organ donors are never supposed to be billed for transplant-related care. NorthStar Anesthesia charged one donor over $13,000 and nearly sent his bill to collections.

The email arrived in Elliot Malin’s inbox from his cousin’s mom.

“Scott needs a kidney,” the subject line read.

The message matter-of-factly described Scott’s situation: At 28 years old, Scott Kline was in end-stage renal failure. He wasn’t on dialysis yet. But he probably should have been.

His mom was reaching out to as many people as she could, asking them to be screened as a potential donation match.

“Thank you for considering it, but please don’t feel any pressure to do it,” she wrote. “Sorry I have to share this burden, but the best potential match is family.”

Living organ donors are never supposed to receive a bill for care related to a transplant surgery. The recipient’s insurance covers all of those costs. This rule is key to a system built on encouraging such a selfless act. And for most uninsured patients in end-stage kidney failure, Medicare would pick up the tab. But in Malin’s case, he would end up facing a $13,000 billing mistake and the threat of having his bill sent to collections.

Doctors Overlook a Curable Cause of High Blood Pressure

BY MARY CHRIS JAKLEVIC: For Complete Post, Click Here…

A hormonal abnormality is gaining recognition as a common cause of hypertension, but few patients are screened for it.

IN EARLY 2013, after Erin Consuegra gave birth to her second child at age 28, her health nosedived. She developed worrying symptoms, including extreme fatigue, fluttery heart beats, and high blood pressure. She said her doctor prescribed blood pressure medication and chalked it up to stress.

But Consuegra, an elementary school teacher by training, didn’t buy it. “It’s like, you think staying home all day with two kids is causing these real medical issues?” she said. “It was offensive to just write it all off to stress and anxiety.”

Researching her symptoms online and through family members in the medical field, Consuegra learned of a little-known syndrome called primary aldosteronism, in which one or both adrenal glands, small structures that sit atop the kidneys, overproduce a hormone called aldosterone. Aldosterone increases blood pressure by sending sodium and water into the bloodstream, increasing blood volume. It also lowers potassium, a mineral that Consuegra was deficient in.

Her primary care physician agreed to run a blood test to screen for the condition but insisted that the result was normal and balked at Consuegra’s request to see a specialist. “She took it as me questioning her,” Consuegra said. Getting a referral, she added, “took a lot of fighting, a lot of tears, a lot of advocacy on my part.”

Consuegra’s story has a relatively happy ending. Doctors at Vanderbilt University Medical Center eventually diagnosed her with primary aldosteronism and found a small noncancerous tumor, or adenoma, in one of her adrenal glands — known to often be a cause of the condition. After doctors removed the gland in July 2014, her symptoms disappeared.

Most vulnerable still in jeopardy as COVID precautions ease

By LAURAN NEERGAARD: For Complete Post, Click Here…

Two years into the pandemic Jackie Hansen still left home only for doctor visits, her immune system so wrecked by cancer and lupus that COVID-19 vaccinations couldn’t take hold.

Then Hansen got a reprieve — scarce doses of the first drug that promises six months of protection for people with no other way to fend off the virus.

“This is a shot of life,” Hansen said after getting injections of Evusheld at a University of Pittsburgh Medical Center clinic. She can’t wait to “hug my grandkids without fear.”

Up to 7 million immune-compromised Americans have been left behind in the nation’s wobbly efforts to get back to normal. A weak immune system simply can’t rev up to fight the virus after vaccination like a healthy one does. Not only do these fragile patients remain at high risk of severe illness and death from COVID-19, they can harbor lengthy infections that can help spark still more variants.

CDC Proposes New Opioid Prescribing Guidelines

by Judy George: For Complete Post, Click Here…

Hard thresholds for pain medication doses, duration no longer promoted.

New draft guidelines for primary care and other clinicians proposed by the CDC Thursday no longer promote hard thresholds on opioid prescribing.

The draft guidance for acute, subacute, and chronic pain is part of a proposed update to the controversial 2016 CDC opioid guideline for chronic pain. The 2016 guideline was interpreted as setting medication dose and duration limits and was misapplied by some organizations, leading CDC researchers to attempt to clarify the document in 2019.

The new guideline isn’t designed to replace clinical judgment, but is a tool to help providers and patients make safe, effective pain care decisions and provides “voluntary recommendations on the use of opioids to treat pain,” the CDC noted.

It is not intended to be applied as an inflexible standard, the agency added. It’s also not intended to lead to rapid opioid tapering or discontinuation, and does not apply to sickle cell disease-related pain, cancer pain, and palliative or end-of-life care.

“I was very pleased to see clear language that the proposed guideline is not a replacement for clinical judgment or individualized, person-centered care,” noted pain specialist Beth Darnall, PhD, of Stanford University School of Medicine.

“This is crucial, as misapplications of the 2016 guideline centered around a reductive focus on dose-based limits and tapering that was associated with patient harms,” Darnall told MedPage Today.

FDA Warns of Strangulation Risk for Kids on Feeding Tubes

by Lei Lei Wu: For Complete Post, Click Here…

Two toddlers died after being found with enteral feeding systems’ tubing around their necks.

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The FDA is warning on the potential risk of strangulation among children using enteral feeding systems.

In a safety alert issued on Tuesday, the agency said two toddlers died last year after becoming entangled in the systems’ feeding tubes. Both children were younger than 2 years old and were found with tubing around their necks by their caregivers — after about a 10-minute period of not being monitored, in one report.

“While the FDA believes that death or serious injury from strangulation with enteral feeding set tubing in children is rare, healthcare providers and caregivers should be aware that these events can and do occur,” the agency stated. “It is also possible that some cases have not been reported to the FDA.”

Enteral feeding delivery sets are used to provide nutrition to people who have difficulty eating or swallowing, via a feeding tube that passes through the nose, mouth, or an artificial opening directly to the stomach or small intestine.

Healthcare providers who work with pediatric patients should ensure that care teams and caregivers are aware of the risk of strangulation when using enteral feeding tubes. Steps should be taken to prevent feeding tubes from getting wrapped around a patient’s neck and enteral feeding tubes should be kept away from children as much as possible, the FDA said.