In The News

The Power of Boosters

The Wall Street Journal

The C.D.C. has begun to publish data on Covid outcomes among people who have received booster shots, and the numbers are striking: 

  • Weekly Average Deaths per 100,000 (From Oct. to Nov. 2021)
    • Unvaccinated 7.8 
    • Vaccinated, No Booster .6 
    • With Booster .1

Based on U.S. Jurisdictions / Source C.D.C

This data underscores both the power of the Covid vaccines and their biggest weakness — namely, their gradual fading of effectiveness over time, as is also the case with many other vaccines. If you received two Moderna or Pfizer vaccine shots early last year, the official statistics still count you as “fully vaccinated.” In truth, you are only partially vaccinated. 

Once you get a booster, your risk of getting severely ill from Covid is tiny. It is quite small even if you are older or have health problems.

The average weekly chance that a boosted person died of Covid was about one in a million during October and November (the most recent available C.D.C. data). Since then, the chances have no doubt been higher, because of the Omicron surge. But they will probably be even lower in coming weeks, because the surge is receding and Omicron is milder than earlier versions of the virus. For now, one in a million per week seems like a reasonable estimate.

That risk is not zero, but it is not far from it. The chance that an average American will die in a car crash this week is significantly higher — about 2.4 per million. So is the average weekly death rate from influenza and pneumonia — about three per million

With a booster shot, Covid resembles other respiratory illnesses that have been around for years. It can still be nasty. For the elderly and immunocompromised, it can be debilitating, even fatal — much as the flu can be. The Omicron surge has been so terrible because it effectively subjected tens of millions of Americans to a flu all at once.

For the unvaccinated, of course, Covid remains many times worse than the flu.

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COVID-19 Updates from NAHC

Moderna Announces Full US Approval for its COVID-19 Vaccine

Moderna announced Monday that U.S. health regulators granted full approval to its COVID-19 vaccine, a shot that’s been given to tens of millions of Americans since its emergency authorization over a year ago.

The action by the Food and Drug Administration means the agency has completed the same rigorous, time-consuming review of Moderna’s shot as dozens of other long-established vaccines.

The decision was bolstered by real-world evidence from the more than 200 million doses administered in the U.S. since the FDA cleared the shot in December 2020. The FDA granted full approval of Pfizer’s vaccine last August.

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'Stealth' Omicron Variant BA.2 Circulating in Almost Half of US, but CDC Exercises Caution: Report

Is BA.2 going to be omicron 2.0?

There are now at least 127 known cases of the subvariant BA.2, otherwise known as the "stealth" variant, circulating in almost half of the United States that international experts suggest is more contagious as omicron, according to a recent CNBC report.

But Kristen Nordlund, a CDC spokesperson, in a Monday statement toThe Washington Post, cautions, "Currently, there are insufficient data to determine whether the BA.2 lineage is more transmissible or has a fitness advantage over the BA.1 lineage[omicron]."

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What Causes Long Covid? Scientists are Zeroing in on the Answer.

Even as the number of new Covid-19 cases in the US is dropping, hundreds of thousands of Americans are still testing positive every day. More than 28 million new cases have been reported since Omicron emerged in the US just two months ago, and the variant now drives 99.9 percent of cases, as of January 22, according to the Centers for Disease Control and Prevention.

Thanks to vaccines, boosters, and increasingly available treatments, most people who get infected today won’t end up in the hospital or die. A big question, however, looms over the survivors: What about long Covid?

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Updated Document Getting Started with HQRP CASPER QM Reports Now Available on the HQRP Requirements and Best Practices Webpage.

To assist hospice providers in understanding and using the CASPER QM Reports that now include claims-based measures, CMS has updated this fact sheet to reflect the changes to the HQRP based on the (FY) 2022 Hospice Final Rule. This renamed and revised document, Getting Started with HQRP CASPER QM Reports can be found in the Provider Toolkit section of the HQRP Requirements and Best Practices webpage.


Home Health Notice of Admission Processing Issues Continue (From NAHC)

NAHC Report readers are probably aware that  implementation of the notice of admission (NOA) at the beginning of this year has gotten off to a rocky start. (See January 20, 2022 NAHC Report.) Home health agencies began experiencing problems with the NOA submissions right away due to an issue at the Centers for Medicare & Medicaid Services (CMS) and some MAC-specific systems issues, but most of the issues were fixed at the end of January.

However, there is one issue that was identified after the fix was implemented and this is the reason code U537F is assigning incorrectly on some NOAs when the Common Working File (CWF) does not correctly recognize a discharge (patient status other than 30 on the last HH period). There is no workaround.  A system fix to correct this issue is being created, but an implementation date has not been established.

NOAs are supposed to return to provider (RTP) with reason code U537F if the “From” date of the NOA falls within an existing home health admission period unless condition code 47 is present or the CCN (CMS Certification Number/provider number) on the NOA matches the CCN on the admission period.  In situations where duplicate NOAs were submitted, one or both of the NOAs may RTP with U537F. If only one of the NOAs is returned with U537F, the other should process if there are not additional reasons why it cannot.

Providers do not need to take action with the duplicate NOA that returned for U537F but shall follow the other NOA to ensure it processes/approves.

Providers are reminded to ensure a pending/not finalized (suspended) NOA does not exist before submitting a new NOA for a beneficiary admission and to utilize condition code 47 on the NOA when the beneficiary has been discharged from another HHA, but the period of care claim has not been submitted or processed at the time of the new admission to discharge the beneficiary.


From Facility to Home: How Healthcare Could Shift by 2025

McKinsey Insights | February 1, 2022
When patients enter a healthcare facility, their primary aims are to become well again and to go home. While increasing disease burden and rising healthcare costs in the United States have already contributed to a boost in Care at Home services, the COVID-19 pandemic has created a catalyst to truly reimagine their future.1
Based on a survey of physicians who serve predominantly Medicare fee-for-service (FFS) and Medicare Advantage (MA) patients, we estimate that up to $265 billion worth of care services (representing up to 25 percent of the total cost of care) for Medicare FFS and MA beneficiaries could shift from traditional facilities to the home by 2025 without a reduction in quality or access. 2 That number represents a three- to fourfold increase in the cost of care being delivered at home today for this population, although how the shift will affect reimbursement rates is not yet clear. What’s more, Care at Home could create value for payers, healthcare facilities and physician groups, Care at Home providers, technology companies, and investors. It also could improve patients’ quality of care and experience.
That said, several factors could affect adoption of these services. We outline those factors below, along with actions that stakeholders can take to address them. We also discuss why Care at Home services are rising, how Care at Home could create value for stakeholders and lead to higher-quality care for patients, areas where care could shift from traditional facilities to the home, and strategies for successfully adopting Care at Home.

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