The cost of complex hospitalizations for COVID-19 ranged from about $49,000 in Maryland to $129,000 in New Jersey, according to a new report by FAIR Health. [MedPage Today 12.15.2021]

In an analysis of private insurance claims spanning March 2020 through July 2021, New Jersey ($128,650) had the highest average allowed amount for complex hospitalizations, while Alaska ($44,239) was the highest for non-complex hospitalizations, and Nevada ($1,538) the highest for outpatient treatment.

Maryland had the lowest average allowed amounts for complex ($49,127) and non-complex ($12,531) hospitalizations as well as outpatients ($580).

Regionally, the west ($117,316) bore the highest average allowed amount for complex cases, and the south ($84,324) had the lowest, according to the report. The west ($38,135) also had the highest average for non-complex hospitalizations, while the south ($20,013) again had the lowest.

Among outpatients, the west ($1,187) was again the highest, while the northeast was the lowest ($937).

The report also looked at other patient characteristics, concluding that among those with complex hospitalizations, 48.4% had five or more comorbidities and 20.6% had no comorbidities.

The most common comorbidity for patients with complex hospitalization was hyperlipidemia and/or hypertension (14.7%), it found.

The median length of complex hospitalization declined from a peak of 13 days in April 2020 to 7 days in July of this year.

While the percentage of COVID patents who died in April 2020 was 1.9%, that figure declined to about 0.5% each month from February to July this year, the report found.

Gender showed varying trends: In non-complex hospitalizations, 57% of patients were female, while 57% of patients with complex hospitalizations were male.

More details here> 

###

Genomic surveillance data indicates the omicron COVID-19 variant accounts for about 3 percent of new U.S. cases, CDC Director Rochelle Walensky, MD, told NBC's Today on Dec. 14. [Becker's Hospital Review] 

The strain has been detected in at least 33 states and accounts for 13 percent of new cases in New Jersey and New York. 

"We're starting to see some early data that is demonstrating some decreased severity — shorter lengths of stay, fewer people on oxygen, fewer people in the intensive care unit  — but I also want to emphasize if you have more and more people who have disease, even if you have fewer people that get sick from it, you still have a lot of people who are getting sick, so really we want to make sure we keep all those keep prevention measures — vaccination, boosters — in place," Dr. Walensky said. 

Preliminary findings suggest omicron causes less severe illness than earlier variants. It is more transmissible, however, and a new study published Dec. 14 based on information from 211,000 COVID-19 cases in South Africa also supports that indication. The risk of hospitalization among people who contracted COVID-19 during a surge in omicron cases was 29 percent lower relative to the initial wave in March 2020. 

The same study also found omicron was more resistant to Pfizer-BioNTech's vaccine, which provided about 33 percent protection against infection. Still, the vaccine offered 70 percent protection against hospitalization.

###

The vast majority of the nation’s 54 million adults ages 65 and over participate in Social Security (86%) and Medicare (93%) — social insurance programs designed to provide nearly-universal coverage of the older population.

But what happens when these social insurance benefits, along with retirement payments and savings, are not enough? What about those not eligible for Social Security or Medicare?

They rely on needs-based assistance that support people with limited resources.

Prior to the COVID-19 pandemic, 1 in 6 older adults participated in a wide range of needs-based assistance programs, according to an analysis of recently released data from the Census Bureau’s Survey of Income and Program Participation (SIPP).

These numbers reveal the importance of the social safety net for economically vulnerable older adults, a need that may be amplified by the economic fallout of the pandemic.

These findings provide context about the experiences of adults ages 65 and over prior to the pandemic and will serve as a baseline for comparisons as additional data become available.

Read more> 

###

As the winter approaches, U.S. COVID-19 cases and hospitalizations are on the rise, and with the emergence of the new omicron variant, the state of the pandemic could rapidly evolve. 

Health officials have warned for months about the potential of a winter surge, with the current uptick largely driven by the delta variant, which remains the dominant strain in the U.S. It's not yet clear whether omicron will outpace delta or how it could change the pandemic's course. 

The seven-day average for new daily cases nationwide on Dec. 9 was 119,788, a 30 percent jump over the last two weeks, according to data from The New York Times. Hospitalizations have also risen about 21 percent across the last 14 days, with a daily average of 62,971 on Dec. 9. 

The omicron variant had been detected in at least 22 states as of Dec. 9, and while nearly everything health officials know about its transmissibility, illness severity, and vaccines' and treatments' efficacy against it is preliminary, more concrete data is expected to emerge soon. 

As the healthcare industry awaits more definite information, Becker's compiled five updates about early omicron findings and the nation's response: 

1. President Joe Biden unveiled Dec. 2 a new federal strategy to combat the pandemic, aiming to protect against both omicron and delta variants during the winter months. Efforts include encouraging booster shots and expanding free at-home testing for Americans. 

2. As part of the new federal strategy, the CDC tightened COVID-19 testing protocols for air travelers. As of Dec. 6, air travelers entering the U.S. must show proof of a negative COVID-19 test within 24 hours of their flight to help prevent the omicron variant's spread. The rule applies to all air travelers, regardless of vaccination status or citizenship.  

3. New data from South Africa suggests the omicron variant may cause less severe infections than delta, though more research is needed to confirm this finding. In a Dec. 4 report, the South African Medical Research Council outlined the early experience of 42 COVID-19 patients treated at several hospitals and found 70 percent of patients didn't need supplemental oxygen, and few developed COVID-19 pneumonia. Four patients required a high level of care, and one patient was placed in intensive care. Overall, the average length of stay was 2.8 days compared to the 8.5-day average seen in COVID-19 patients in the last 18 months. 

4. The omicron variant appears to spread more than twice as quickly as delta, according to preliminary findings released by Scientists with the South African COVID-19 Modelling Consortium on Dec. 3. The researchers believe omicron's ability to rapidly spread results from both its contagiousness and ability to dodge the body's immune defenses, though it's unclear how large of a role each factor plays. The findings have yet to be peer reviewed. 

5. Pfizer's COVID-19 booster provided significant protection against the omicron variant during a lab study, the drugmaker said Dec. 8. On average, blood samples from people who received only two doses of Pfizer's vaccine saw a 25-fold drop in antibodies against the variant. Blood samples from people who received three doses saw similar neutralization against the omicron variant as the two-dose series provided against the original coronavirus strain. Following the announcement, the FDA authorized the vaccine booster for emergency use for teens ages 16 and 17, a move the CDC endorsed Dec. 9. 

###

A bipartisan group of lawmakers grilled state officials Wednesday for not doing more to address the rise in mental health issues among Illinois children. [Health News Illinois 12.9..2021]

 

Speaking during a joint legislative hearing on the issue, Rep. Deb Conroy, a Villa Park Democrat and chair of the House’s Mental Health and Addiction Committee, said the COVID-19 pandemic has exacerbated the long-simmering issue of behavioral healthcare for children.

“I would consider this to be a crisis, and a crisis that we needed to act on yesterday,” she said.

Dr. Frank Belmonte, chief medical officer at Advocate Children's Hospital, echoed Conroy’s concern. He said some are calling the situation the “fourth wave of the pandemic,” marked by record incidents of depression, anxiety and suicidal thoughts in children and families.

“Unfortunately, this crisis rests upon an already under-resourced behavioral health infrastructure that is simply unable to handle the massive tsunami of children and adolescents who need help now,” Belmonte said. “The inadequacy of resources is felt at every level of the care continuum, including outpatient partial hospitalization, inpatient, acute psychiatry and residential treatment.”

Dr. David Gomel, CEO of Rosecrance Health Network, told lawmakers that many children either wait in emergency rooms or have to be sent out of their communities - and sometimes out of state - to receive mental health services.

“Alternatively, in far too many cases, kids simply don't receive the care they need,” Gomel said. “When kids don't get treatment, they cycle through hospitalizations and crisis services, their behaviors escalate, they lose time in school or they become involved with the legal system. All these options are bad for kids and their families, are clinically inappropriate and are expensive for the state.”

He added the crisis has disproportionately impacted minorities.

Lawmakers questioned representatives of the Department of Healthcare and Family Services on concerns raised by advocates, while also calling on the agency to do more now to help families in crisis.

Kristine Herman, chief of HFS' Bureau of Behavioral Health, told lawmakers they have worked on interim relief for parents to access psychiatric residential treatment facilities services for their children. Additionally, the agency continues the planning of its behavioral health model, known as the Pathways to Success Program.

“HFS’ Pathways to Success Program focuses on the importance of building community-based services first, and introducing residential treatment services at a time in a way that's going to ensure quality and appropriate oversight,” Herman said.

She said they are still working with the Centers for Medicare and Medicaid Services to gain federal approval for the program, with the hope it can be implemented in the coming months.

Conroy said that was not enough.

“In the meantime, families are falling apart and children are dying,” she said. “So we need to put a crisis plan in place until a few months from now.”

Herman shared concerns raised by lawmakers about the workforce necessary to implement the program, though she said many providers have submitted their applications to become care coordination and support organizations to support staffing.

Lawmakers also called on Gov. JB Pritzker’s administration to take the mental health crisis as seriously as it has taken the COVID-19 pandemic. Conroy said Wednesday’s meeting reinforced the need for Pritzker to appoint a mental health czar in Illinois to help address the issue. 

She filed legislation earlier this year to establish a mental health and substance use disorder oversight officer within the Department of Human Services to make policy recommendations and encourage, promote, suggest and report best practices for treating mental health and substance use disorders in Illinois.

“I just want to take this moment yet again, and it will not be a surprise to anyone, to beg our governor to please - we have a marijuana czar - we need a mental health czar,” Conroy said.

Pritzker's office did not return a request for comment.

Laura Fine, a Democrat from Glenview and chair of the Senate’s Behavioral and Mental Health Committee, said she hoped the passions shown during the roughly three-and-a-half-hour meeting would help lead to change down the road.

 “Let's use that anger and frustration to drive us forward and get this issue solved,” she said. “It's been going on too long, and lives are hanging in the balance. We need to get it done."

###

COVID-19 dropped out of the top five telehealth diagnoses nationally in September 2021, according to FAIR Health's Monthly Telehealth Regional Tracker. In August, COVID-19 had been among the top five telehealth diagnoses nationally and in every US census region except the Northeast. In September, the only region in which COVID-19 ranked in the top five was the Midwest. The data represent the privately insured population, including Medicare Advantage and excluding Medicare Fee-for-Service and Medicaid. 

For the second straight month, national telehealth utilization, measured as a percentage of all medical claim lines,1 grew by about two percent. Telehealth utilization rose nationally in September by 2.3 percent, increasing from 4.3 percent of medical claim lines in August to 4.4 percent in September, following a national rise of 2.4 percent in August. Telehealth utilization also grew in September in the Midwest and West, though there was no change in the South and a decrease in the Northeast.

From August to September 2021, mental health conditions, which remained the top-ranking telehealth diagnosis nationally and in every region, increased in percentage share of all telehealth claim lines nationally and in every region. This was a change from July to August 2021, when this diagnosis declined in percentage share of all telehealth claim lines nationally and in every region.

From August to September 2021, substance use disorders joined the top five telehealth diagnoses nationally, while rising from the fourth to third most common telehealth diagnosis in the Northeast. From August to September 2021, developmental disorders rose from fourth to third place in the top five telehealth diagnoses nationally. Similarly, this diagnosis rose in the rankings in every region except the South, where it was not among the top five in either August or September.

CPT®2 90833, psychotherapy performed with evaluation and management visit, 30 minutes, joined the top five telehealth procedure codes by utilization nationally in September 2021. Ranking at number five, it displaced CPT 99441, physician telephone patient service, five to ten minutes of medical discussion. This was a reversal of August 2021, when CPT 99441 displaced CPT 90833 in the rankings.

About the Monthly Telehealth Regional Tracker
Launched in May 2020 as a free service, the Monthly Telehealth Regional Tracker uses FAIR Health data to track how telehealth is evolving from month to month. An interactive map of the four US census regions allows the user to view an infographic on telehealth in a specific month in the nation as a whole or in individual regions. Each infographic shows month-to-month changes in volume of telehealth claim lines, top five telehealth procedure codes and top five telehealth diagnoses (or diagnostic categories), along with that month's top five granular diagnoses within the most common diagnostic category.

FAIR Health President Robin Gelburd stated: "As the COVID-19 pandemic and telehealth utilization continue to evolve, FAIR Health's Monthly Telehealth Regional Tracker serves as a window into that evolution. This is one of the many ways we pursue our healthcare transparency mission."

For the Monthly Telehealth Regional Tracker, click here.

###

As part of the Call to Action, the Department of Health and Human Services (HHS) releases new report estimating that 720,000 more people would gain Medicaid postpartum coverage if states act; the Centers for Medicare & Medicaid Services (CMS) proposes establishment of “Birthing-Friendly” hospital designation and issues guidance to states on how to provide Medicaid coverage for a full year postpartum

...Today marks the first-ever White House Maternal Health Day of Action. In addition to substantial investments proposed in the Build Back Better Act, the Biden-Harris Administration is announcing new commitments to support safe pregnancies and childbirth, and reduce complications and mortality in the year following birth.

Today's program here.

Fact Sheet and more details here>

###

Hospitalizations for COVID-19 in Illinois have hit their highest level since last winter’s surge. There were 2,582 individuals in Illinois hospitals with COVID-19 on Thursday, up 45 from Wednesday and an increase of 595 from the prior week. It’s the highest number of hospitalizations since 2,600 were reported on Jan. 29. [Health News Illinois 12.26.2021] Of those patients in the hospital with COVID-19, 534 patients were in the ICU, up 153 from the prior week, and 221 patients with COVID-19 were on ventilators, up 54 from the prior week. The Illinois Department of Public Health reported 42,559 new confirmed and probable cases of COVID-19 over last week. The seven-day average for new daily cases on Friday was 6,080, up 1,987 from the prior week. There have now been 1,835,076 cases in the state. Illinois has yet to report any cases of the omicron variant. Chicago Department of Public Health Commissioner Dr. Allison Arwady said during a Sunday morning press conference she expected the first omicron case to be reported "within a number of days." "There are multiple examples of case investigation going on right now where we know that there are people who have been exposed to the omicron variant that we are doing aggressive case investigation, testing and contact tracing on," Arwady said. The death toll reached 26,535 after 182 COVID-related deaths were reported last week. The preliminary seven-day statewide positivity for cases as a percent of total test is 4.7 percent. The preliminary seven-day statewide test positivity is 5.6 percent. Approximately 69 percent of Illinoisans have received at least one COVID-19 vaccine dose and 61 percent are fully vaccinated, according to data from the Centers for Disease Control and Prevention. Thirty-six percent of eligible Illinoisans have received a booster dose. A total of 17,508,319 vaccines have been administered as of Thursday night. The seven-day average for doses administered is 54,387 doses. ###

HHS is appealing a federal court's decision to temporarily block the start of its vaccination mandate for healthcare workers, according to Bloomberg Law.  [Beckers Hospital Review 12.2.2021] 

U.S. District Judge Terry Doughty in Louisiana granted a preliminary injunction Nov. 30 halting the vaccination rule for healthcare workers until legal challenges are resolved. 

"There is no question that mandating a vaccine to 10.3 million health care workers is something that should be done by Congress, not a government agency," Mr. Doughty, of the U.S. District Court for the Western District of Louisiana, wrote. "It is not clear that even an act of Congress mandating a vaccine would be constitutional."

HHS Secretary Xavier Becerra and other defendants filed an appeal Dec. 1. The U.S. Court of Appeals for the 5th Circuit will hear the appeal. 

The preliminary injunction at issue effectively expanded a separate order issued Nov. 29 by a federal court in Missouri that temporarily halted the vaccine rules for healthcare workers in 10 states. The mandate requires hospital and nursing home workers to be fully vaccinated by Jan. 4. The regulation allows exemptions based on religious beliefs or recognized medical conditions.

###