|THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
The vaccine offensive gets underway
On Monday, at Long Island Jewish Medical Center in New York City, critical care nurse Sandra Lindsay rolled up her sleeve and became the first American to receive Pfizer and BioNTech’s newly approved COVID vaccine, opening a new front in the nation’s battle with the coronavirus pandemic. By Friday, nearly 50,000 doses of the vaccine had been administered nationwide, with millions more expected before year’s end. Amid a complex rollout that has already raised questions about the timely distribution of doses, the Food and Drug Administration (FDA) confirmed that it was safe to use every last drop of the Pfizer vaccine, including the excess amount used to fill the five-dose vials of the precious medicine—meaning many vials may have enough to immunize a sixth person. Based on Thursday’s recommendation from a key panel of experts, the FDA is expected to approve a similar vaccine from Moderna as soon as Friday evening, with doses of that vaccine beginning to be administered by next week. The Moderna vaccine comes in smaller packages with less-demanding storage requirements, making it suitable for a wider distribution across smaller settings and remote areas. Pharmacy chains CVS and Walgreens were set to begin administering shots to nursing home residents in Ohio, Connecticut, and Florida on Friday, as part of an agreement with the US government to vaccinate staff and residents in 75,000 long-term care facilities nationwide. In an interview this week, Secretary of Health and Human Services (HHS) Alex Azar said that the vaccine could be widely available to the general public as soon as late February or early March. While it’s surely tempting to fixate on every setback, second guess every decision about prioritization and distribution, and fret over every isolated report of an adverse vaccine reaction, it will be important in the coming weeks to keep the big picture in mind: we are on the way to beating back the coronavirus. The end is nigh.
It will be darkest before dawn
But first, we have a difficult period to get through. This week again saw record-breaking numbers of cases, hospitalizations, and deaths from COVID-19, with Thursday alone bringing more than 238,000 new cases—and a staggering 3,293 fatalities. Nearly 115,000 Americans are currently hospitalized with COVID, a rise of 16 percent from just two weeks ago, and in many places a precarious capacity situation has turned perilous. Conditions have worsened precipitously in California, with only Tennessee, Oklahoma, and Rhode Island registering more daily COVID cases per 100,000 population than the Golden State, although cases are still on the rise across 80 percent of states and territories. Intensive care availability in Southern California hit zero, with ICU volume there expected to double or triple by this time next month. The same stresses are playing out in dozens of markets across the country, leading to a staffing sustainability crisis that can’t be solved through paying overtime, cancelling vacations or looking to travel nurses to fill the gaps in a now nationwide crisis. With the Christmas and New Year’s holidays still ahead, experts predict COVID cases won’t peak until sometime in mid-January, with a peak in hospitalizations and deaths following several weeks after. Several states and cities tightened restrictions on gatherings and issued new stay-at-home orders, in an effort to keep new cases at a level that allows hospitals to manage through the next several weeks and maintain care quality and access for COVID and non-COVID patients alike. The coming weeks will require every American to take greater precautions than at any time during the course of this pandemic.
Will Congress finally address surprise billing?
As Congress works toward a deadline of Friday at midnight to pass an omnibus spending bill that avoids a government shutdown—expected to include a compromise, $900B coronavirus stimulus package—the legislation is likely to include measures to address the “surprise billing” of patients for unexpected, out-of-network care. Despite failing to agree on such a solution last year, four House and Senate committees recently reached a bipartisan compromise, which seems poised to make its way into the end-of-year spending deal. The compromise measure bans surprise billing for out-of-network emergency care, out-of-network care at in-network facilities, and out-of-network billing for air ambulance services. Resolution of claims for out-of-network care would be conducted via arbitration between hospitals and insurers, based on average in-network charges for the services billed. The deal would be the final legislative accomplishment for retiring Senator Lamar Alexander (R-TN), who chairs the Senate health committee, and is supported by House and Senate leaders of both parties, and by the White House. Still unclear is whether Senate Majority Leader Mitch McConnell (R-KY) will allow the measure to be included in the final omnibus legislation, although the fact that it would generate up to $18B in savings for the federal budget could make it an attractive offset to new stimulus spending. The American Hospital Association has expressed concerns about the legislation, and the American Medical Association has voiced its opposition. Nevertheless, we’re hopeful that the compromise legislation will pass—it’s long past time for Congress to address the terrible predicament that surprise billing poses for so many patients, particularly in the midst of the COVID pandemic. Solving this problem should not wait another year.