In The News

Health officials plan major research on COVID-19 long-haulers

Roll Call
By Mary Ellen McIntire
Posted April 30, 2021 at 6:00am
 
The National Institutes of Health is preparing to award grants in the next three weeks to researchers studying the long-term effects of COVID-19 and patients experiencing “long COVID.”
 
NIH Director Francis Collins told the Energy and Commerce Health Subcommittee this week that the agency expects laboratory research and imaging studies to be underway by the summer. The agency received 273 research proposals after Congress provided more than $1 billion for research into the long-term effects of COVID-19. 
 
Many people who have been sick with COVID-19, including some who had mild or no symptoms, reported dealing with additional symptoms long after their acute illness ended. The long-haul COVID-19 symptoms can range from fatigue or headaches to mental health issues or chronic pain. 
 
“Some of you have been suffering for more than a year with no answers, no treatment options, not even a forecast of what your future may hold,” Collins said during his opening statement Wednesday, referring to patients suffering from long COVID-19. “Some of you have even faced skepticism about whether your symptoms are real. I want to assure you that we at NIH hear you and believe you.”

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CMS extends joint replacement model for three years

Modern Healthcare 
Michael Brady
 
CMS' Center for Medicare and Medicaid Innovation on Thursday signed off on a three-year extension of the Comprehensive Care for Joint Replacement model.
 
It will now last through the end of 2024. The final rule changes the definition of an episode to include outpatient hip and knee replacements, modifies how the agency calculates target prices and reduces the number of reconciliation periods from two to one. It also makes changes to beneficiary notice requirements, gainsharing caps and the appeals process. Regulators expect the extension to save the Medicare program about $217 million over three years.
 
In addition to extending the CJR model, the final rule makes permanent a three-month extension of the model's fifth performance year, which will now end March 31. It was initially slated to end at the end of 2020. The rule solidified COVID-19 related flexibilities for the model's fifth performance year and new diagnostic related groupings for hip and knee procedures.
 
CMMI originally planned to continue the model through 2023. But it scuttled those plans in light of the COVID-19 pandemic, which wreaked havoc on the healthcare system. Policymakers waived or delayed several reporting and value-based payment requirements in response, but those exceptions will begin to draw to close alongside the public health emergency.
 
The CJR model is supposed to test if bundled payments and quality measurements for hip and knee replacements cause providers to boost quality and coordinate care from the first hospitalization and throughout the recovery period.
 

The Fragility of the Caregiving Infrastructure

Home Care Magazine

On March 31, 2021, President Joe Biden proposed a sweeping $2 trillion infrastructure package dubbed the American Jobs Plan. The proposal includes funding efforts for highways, bridges, transit systems, water supplies, the electrical grid and more. An unexpected inclusion is $400 billion dollars for home- and community-based care for seniors and people with disabilities; the package would also increase wages for in-home caregivers.
 
During his presidential campaign, Biden had said he would devote $450 billion to allow more older Americans to receive care at home; homecare’s position in the package is described in a White House fact sheet as an administration effort to “solidify the infrastructure of our care economy.”
 
“It’s expanded services for seniors,” Biden said in a news conference about the proposal. “It’s homecare workers, who go in and cook their meal, help them get around and live independently in their home, allowing them to stay in their homes—and I might add, saving Medicaid hundreds of millions of dollars in the process.”
 
Care at Home
 
Fifty-seven percent of Medicaid’s long-term care budget goes to home- and community-based services; this amounted to $92 billion in the 2018 federal budget year. While all states offer some form of this service, 41 have waitlists totaling nearly 820,000 people, with an average wait of 3.2 years. The American Jobs Plan would expand these services in order to eliminate the wait list—and would treat in-home care like institutional care. One way the plan would do this is by expanding the Medicaid Money Follows the Person program, which aims to move seniors back into their homes.
 
“The past year has led to job losses and threatened economic security, eroding more than 30 years of progress in women’s labor force participation,” reads the White House fact sheet. “It has unmasked the fragility of our caregiving infrastructure.”

Caregiver Wages
 
The U.S. Bureau of Labor Statistics reports that the median pay for a homecare worker was $12.15 per hour in 2019. Homecare workers are often women and people of color, with immigrants making up nearly one-third of the workforce. Overall, nearly half of the homecare workforce lives in a low-income household, with 43% of workers relying on public health care coverage such as Medicaid. One-third don’t have insurance from their employer. A portion of the $400 billion would help workers receive “a long-overdue raise, stronger benefits and an opportunity to organize or join a union,” according to a statement from the administration. Homecare groups have said that Medicaid reimbursement will need to compensate for any increased wages, which the plan addresses.

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What you Need to Know About Vaccines and Vaccine Safety

At least 20% of adults have consistently said that they would not get vaccinated or would do so only if required, and a lack of accurate information continues to be a concern among those who are not ready to get a COVID-19 vaccination. To address these fears, it's important to emphasize the facts, including how the accelerated timeline for the COVID-19 vaccine does not translate to compromises on safety.
 
In a new Healthcare Triage YouTube series, funded by NIHCM Foundation, Dr. Aaron Carroll explains the history of vaccines and vaccine development–one of the greatest public health achievements of all time–in six short, consumer-friendly videos covering:

  • · the timeline of COVID-19 vaccine development and the mRNA vaccine approach
  • · the history of anti-vaccine sentiments, vaccine legislation, and societal backlash (Part 1, Part 2) 
  • · how vaccines work with the immune system
  • · the history of vaccine development (Part 1, Part 2)

Dr. Carroll is a Professor of Pediatrics at Indiana University School of Medicine and the host of the award-winning Healthcare Triage series on YouTube.

 

COVID-19 Updates

CDC: You Don't Need to Mask Outdoors if You Are Vaccinated

As reported by The Washington Post, “Federal health officials said Tuesday [04/27/2021] that fully vaccinated people can go without masks outdoors when walking, jogging or biking, or dining with friends at outdoor restaurants. Officials said the changed guidance was aimed at helping those who are fully inoculated return safely to old routines, while encouraging others to get their shots to counter highly contagious new variants.”

In general, people are considered to be fully vaccinated 2 weeks after their second dose of a 2-dose vaccine series (e.g., Pfizer or Moderna), or 2 weeks after a single-dose vaccine such as Johnson & Johnson’s Janssen vaccine. If someone does not meet these requirements, they are not fully vaccinated and should continue to take full precautions. Additinoally, those who have a medical condition or are taking medications that weaken your immune system, may not be fully protected even after vaccination. The new recommendations are for personal consideration and are not intended for healthcare settings.

Even after full vaccination, CDC general guidelines should still be followed by everyone, to avoid the spread (e.g., wear a mask, social distance 6’ apart, avoid crowds and poorly ventilated spaces) until more is known. See full set of new guidelines for those who have been fully vaccinated at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html

Fauci Says U.S. Should See Turning Point in the Pandemic ‘within a few weeks’  

If the U.S. continues its vaccination pace, “literally within a few weeks, we’re going to start to see a turning around of the dynamics,” Fauci said on Monday. “Not down to no infections,” he said. “If you’re waiting for classic measles-like herd immunity, that’s going to be a while before we get there. But that doesn’t mean we’re not going to have a significant diminution in the number of infections per day and a significant diminution in all of the parameters, namely hospitalizations and deaths.” Visit the CNBC website for more details from the interview.

NBC News reports that, “After a worrisome uptick in Covid-19 cases in the United States in recent weeks, there are encouraging signs that the situation is beginning to stabilize, according to the Centers for Disease Control and Prevention. New reported infections fell by 21 percent over the past week, with the most recent seven-day average coming in at just over 54,400 cases per day.”

New At-home Pill to Treat Covid Could be Available by Year End

CNBC reports, “Pfizer’s experimental oral drug to treat Covid-19 at the first sign of illness could be available by the end of the year. Health experts say the drug, taken by mouth, could be a game changer because people newly infected with the virus could use it outside of hospitals. Researchers hope the medication will keep the disease from progressing and prevent hospital trips.”

 
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