In The News

Moderna Covid-19 booster may come later than Pfizer and a 3-dose regimen may be best, Fauci says

By John Bonifield, CNN

Updated 10:57 PM ET, Sun September 5, 2021

Booster doses of Moderna's Covid-19 vaccine may be delayed from rolling out the week of September 20 as planned, Dr. Anthony Fauci said Sunday.

Fauci, President Joe Biden's chief medical adviser, said that while the administration's plan had been to roll out booster doses of both Pfizer and Moderna at the same time, that may not happen.

Fauci said vaccine maker Pfizer has submitted its information to the US Food and Drug Administration and "things look like they're ready to go," Fauci told CNN's Jim Acosta.

He said Moderna might be a little bit behind that, and if it is, rather than seeing a simultaneous rollout of both products, Moderna could be rolled out a week or two later.

"I don't think that is a major issue there, but we would have liked to have seen it happen all together, simultaneously. But ultimately the plan will be implemented, as was put forth," Fauci said.

Fauci said the plan is contingent first on the companies submitting the appropriate data to the FDA, and second, getting FDA approval and then a recommendation from the US Centers for Disease Control and Prevention's vaccine advisers.

Fauci said ultimately, it may turn out the proper Covid-19 immunization regimen is three doses.

"What we're observing now -- not only here in the United States but in other countries, including Israel and the UK -- (is) that the durability of the protection tends to wane, particularly in the context of the Delta variant," Fauci told CNN.

He explained how such waning can lead to both breakthrough infections and breakthrough infections that lead to hospitalizations.

"You look at the evidence from the cohorts here in the United States, there's no doubt that there is a diminution in the efficacy of the vaccine against infection, namely symptomatic infection. There's a slight suggestion in a couple of the cohorts that it also is true for a diminution of protection against hospitalization -- not profound, but the suggestion when you look at the data is there," he said.

"However, when you look at the Israeli data, and they are about a month or so ahead of us in every aspect of this -- vaccinations, boosters, etc. -- the data from the Israeli studies are that there's a rather substantial diminution in protection against infection and an unquestionable diminution in the protection against hospitalization."

Fauci said the good news is that data from Israel shows booster doses offer "profound" protection against infection and hospitalization.

"Importantly, their data also show that when you give those boosters you reconstitute, to an even higher level than before, the protection against both infection and hospitalization," Fauci said. "The boosters really jack up the response very, very high, and we hope that that response would be durable."

 

 

FlexforChecks Program Expanded to Communities Across the U.S.

Tim Rowan of “Healthcare at Home: The Rowan Report” recently announced that the HRSA grant that has been distributing funds to providers helping individuals living in minority communities to get vaccinated against COVID-19, is no longer limited to the list of communities originally presented.

Interested home health or home care agencies can register at FlexForChecks.com

As described by Mr. Rowan:

“Every time a patient or client of yours uploads proof of a vaccine shot to the official web site, they receive $50; the nurse or caregiver who connects them with a local vaccination station receives $25, and that person's employer, the agency, receives $25. Tell your unvaccinated workers if they get a shot themselves, they can collect both the $50 and the $25. For the Pfizer or Moderna two-shot vaccines, that would add up to $150.”

View Related Rowan Report Articles

 

Introducing Post-Acute 2.0: New Services Needed To Deliver Care At Home

Forbes / Ashish V. Shah
 
Ashish V. Shah is CEO of Dina, an AI-powered care-at-home platform, that supports the industry's transition to virtual and in-home care.
 
As care continues to move into the home setting, traditional Medicare-approved services like skilled nursing and home health care are no longer enough. Meal delivery, transportation, remote monitoring, in-home care and pest control are just a few examples of the health benefits of the future.
 
In the next five to 10 years, every home will need to be configured to operate as a formalized care setting (e.g., primary care clinic or hospital), and providers — especially those who are part of value-based contracts — need to be ready to deliver care in this setting.
 
A major challenge is replicating acute-level care in the home environment: delivering around-the-clock nursing care, continuously monitoring vital signs, supporting nutrition and social well-being needs, and providing just-in-time testing and imaging when needed.
 
There are other big considerations as well. How do you ensure the home is safe and ready for care? After discharge, what types of modifications are required to help people age in place moving forward? . . .

Read Full Article

 

Hospice Community Responds to Proposed Survey Reforms in CMS Home Health Rule

Hospice News / By Jim Parker
 
The National Hospice & Palliative Care Organization (NHPCO) in consultation with its members have submitted comments to the U.S. Centers for Medicare & Medicaid Services (CMS) on hospice provisions within the proposed 2022 home health rule. If made final the rule would overhaul the survey and regulatory enforcement processes that CMS uses to evaluate hospices.
 
CMS is taking these actions pursuant to the Consolidated Appropriations Act of 2021. Congress included these provisions in response to July 2019 reports on hospice quality from the Office of the Inspector General (OIG) at the Department of Health and Human Services (HHS).
 
“While the intent of the proposed rule is sound, many of the specifics raise concerns,” said NHPCO’s President and CEO Edo Banach. “NHPCO’s recommended revisions to the proposed rule would protect patient interests, bring hospice regulations in line with regulations governing other post-acute care providers, and improve standardization and consistency in hospice accreditation and surveying systems.”
 
If made final, the new regulations would require multidisciplinary survey teams, prohibit surveyor conflicts of interest and update the surveyor training process. The agency expects that implementation of these proposals would cost an estimated $5.5 million annually. The rule would also mandate that surveys be conducted more frequently, no later than 36 months following the providers’ previous survey.
 
Among the numerous elements contained in the proposal is the creation of a Special Focus Program (SFP) with the power to impose enforcement remedies against hospices with poor performance on regulatory or accreditation surveys. The agency also has plans to implement a hospice program complaint hotline through which the public can report issues to CMS.
 
Hospices flagged by the proposed Special Focus Program would be surveyed every six months rather than the current three-year cycle. The SFP would have the authority to impose fines, suspend reimbursement, appoint temporary management to bring the hospice into compliance, or revoke a provider’s Medicare certification altogether.

Read Full Article

 

CMS Resumes Targeted Probe and Educate

As reported previously, CMS has announced the resumption of Targeted Probe and Education (TPE) reviews. Although there is not yet much additional information available, we understand that there may be more detail coming from the MACs in the near future.

Until then, checking claim status codes may help providers identify any claims that might be part of TPE reviews. The following reminder is provided by Palmetto but applies to all MACs including CGS:

  • When a claim is selected for possible Targeted Probe and Educate (TPE) review, it will go into an S B6000 location in Direct Data Entry (DDE). When the claim goes to this location there will be narrative that indicates the claim was selected and documentation is requested. However, you should not respond with medical documentation unless the claim moves to S B6001 location. When a claim goes into S B6001 location, it generates an Additional Document Request (ADR) and it will hold in that location until the records are received.
  • Claims initially suspended into location S B6000 may not advance to S B6001 for review and could be released for processing without review. Only claims that are selected for review will move from S B6000 to S B6001. Do not send in medical documentation unless the claim suspends to location S B6001, when the ADR will be generated.
  • However, when and if the claim moves to SB6001 and you need to send in documentation, please refer to your ADR letter to ensure you provide the MAC with the documents needed to process your claim.
 
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