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Health insurers are starting to roll back coverage for telehealth – even though demand is way up due to COVID-19

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Associate Professor of Nursing, West Virginia University
Associate Professor of Health Policy, Management and Leadership, West Virginia University
Jennifer A. Mallow receives funding from the US DHHS-Centers for Medicare & Medicaid Services & National Institutes of Health/National Cancer Institute.
Steve Davis receives funding from the WV DHHR-Bureau for Medical Services & the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services.

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In less than a year, telehealth has gone from a niche rarity to a common practice. Its ability to ensure physical distance, preserve personal protective equipment and prevent the spread of infection among health care workers and patients has been invaluable during the COVID-19 pandemic.
As health care specialists and researchers, we have long seen the potential of telehealth, providing health care remotely with technology, which has been around for several decades. Despite evidence it could safely treat and manage a range of health conditions in a cost-effective manner, widespread adoption of the practice had been limited by issues including insurance coverage, restrictions on prescribing and technology access.
On March 27, 2020, The Coronavirus Aid, Relief and Economic Security Act, or CARES Act, removed many of the barriers to widespread telehealth use. Soon after, the Centers for Medicare & Medicaid released a toolkit encouraging state Medicaid agencies to adopt CARES policy changes to promote the expansion of telehealth. Many private insurers followed suit. Collectively, these policy changes facilitated the explosion of telehealth. Now, due to the financial strain on health care systems and insurers, the increase in telehealth use may be forced to shrink even though the public health crisis remains.
At the very beginning of the pandemic, the use of telehealth went from 13,000 to 1.7 million visits per week among Medicare recipients. Between mid-March and mid-June 2020, during the height of the national lockdown, over 9 million telehealth visits were conducted for Medicare recipients. Private insurers, who mimicked the CARES Act policy changes, also reported exponential increases – with telehealth claims increasing over 4,000% from the previous year.
Telehealth is typically used for new health concerns like a sore throat, psychotherapy and in-home monitoring with mobile devices for chronic conditions like diabetes, high blood pressure or heart failure. Telehealth is convenient because it can be done from anywhere and more frequently than in-person visits.
The changes triggered by the CARES Act were intended to last only until the public health emergency was considered over. Making telehealth coverage expansions permanent could lead people to use their insurance coverage more often by making care more convenient, thus costing private insurance companies more money.
Provider compensation is traditionally based on the amount of time spent with the patient and how complicated and risky the exam and procedures are to perform. Historically, telehealth was reimbursed at a lower rate than in-person care. The CARES Act had addressed this payment disparity by mandating the same rate for telehealth visits as in-person visits for those insured by Medicare, with more than 80 new telehealth services being reimbursed at the same rate as in-person services.
Many private insurers followed suit and paid providers who conducted telehealth visits at the same rate as office visits. Now, that’s all changing due to financial loss by insurance companies. As of Oct. 1, telehealth visits are not always paid at the same rate as in-person visits by these private insures.
Several big private insurers are pulling back some of their coverage of telehealth for non-COVID issues. Companies including UnitedHealthcare have already rolled back policies that waived co-pays and other fees for non-COVID-related appointments. Other plans such as Anthem BlueCross BlueShield have extended their coverage through the end of the year, but only the first two sessions are free for the consumer.
Further complicating matters is that every private insurance plan and many state-funded Medicaid plans have different sets of rules and dates for what telehealth treatments they cover. This means some patients are paying more. Costs are getting confusing. Patients may end up with a surprise bill – or they may delay care due to cost.
Health care providers and hospital systems are also in limbo. They don’t know whether they’ll lose telehealth payments when the federal public health emergency for the pandemic lapses or what to expect from private health insurance companies.
Hospitals and health systems have had to meet unprecedented challenges in 2020 – increasing testing, treating infected patients, expanding intensive care unit capacity, safeguarding staff and non-COVID-19 patients, procuring personal protective equipment and canceling nonemergency procedures. These challenges have created historic financial pressures for health care offices and hospitals. The American Hospital Association estimates that the country’s health care systems are losing an average of US$50.7 billion per month.
This financial crisis puts telehealth in jeopardy. Providers and health systems still have to pay salaries and purchase expensive technological equipment, making it difficult to accept a reduced rate for telehealth visits. Without payment parity, in the current financial crisis, health care systems will not be able to continue to offer telehealth services.
A continued increase in COVID-19 cases is expected this fall, just as insurance providers are starting to diminish coverage for telehealth visits.
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Our team – and teams across every state – will undertake rigorous evaluation of each of the CARES Act policy changes (and similar Medicaid and private insurer changes) and their impact. These evaluations will provide information on how telehealth affects cost and cost effectiveness in the future.
Clearly, telehealth is in jeopardy now as patients are paying more, health care practices are receiving less and the risk of infections increases. While the diminished risk of infection through the use of telehealth seems positive, it is clear to us that insurers are trying to drive patients back to the in-person care model. How will vulnerable populations and the fragile health care system respond? Will patients and providers still have a choice in how they receive and provide care, or will we lose the innovation gained during this period?
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Your corner pharmacy – joining the front lines of the COVID-19 fight

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Director of Skills Education and Clinical Assistant Professor of Pharmacy Practice, Binghamton University, State University of New York
Assistant Professor, Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University
The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

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The new year has brought the deadliest weeks of the U.S. COVID-19 epidemic thus far, with thousands of deaths every day. It’s been several weeks since the U.S. Food and Drug Administration issued the first of two emergency use authorizations for COVID-19 vaccines, but getting one isn’t easy.
There are no available appointments to get a vaccine in many communities. Wait times at California’s Dodger Stadium, the nation’s largest distribution site, reached five hours earlier this month. At the current rate, it could take until 2022 for all adult Americans to be vaccinated, according to some estimates.
The Biden administration is trying to change that. The national strategy President Biden rolled out in his first week in office includes a target of injecting 100 million vaccines during his first 100 days as president and strengthening distribution to high-risk communities.
A key component of the president’s five-step vaccine plan, he said, is to “fully activate the pharmacies across the country.” This will greatly expand the number of providers to administer vaccines – and expand the role of pharmacists in the pandemic in the weeks and months ahead.
As pharmacists who work in both rural and urban settings, we are among those who are preparing to meet this challenge.
With the slow rollout, community pharmacies are being brought on board much sooner than anticipated. They’ve been an underutilized resource: U.S. pharmacies have experience storing and administering many types of vaccines. In 2018, they gave about one-third of all flu shots, up from 18% in 2012. They are now preparing to handle the new Pfizer-BioNTech and Moderna COVID-19 vaccines.
These messenger RNA (mRNA) vaccines have a new, but not unknown, mechanism. The Moderna vaccine can be kept in a traditional freezer, but the Pfizer vaccine requires ultra-cold storage at -112 to -76 F before being thawed and administered. Health systems and federal partner pharmacies equipped with these specialized freezers are key hubs for distribution.
It’s not just the vaccine that needs to be protected. Pharmacies are stockpiling personal protective equipment to keep staff safe. They have also established safety protocols for patients – social distancing, disinfection and observation for 15 to 30 minutes after vaccination.
There are also administrative requirements, issuing immunization cards to those who have been immunized and reporting the number of administered doses to state and federal officials.
Pharmacies are registering with the searchable Vaccine Finder website – where people will be able to search for participating pharmacies. The vaccine is free: Insurance companies will be billed an administration fee, though a national relief fund covers that cost for the uninsured.
Under a U.S. Department of Health and Human Services mandate, pharmacists and pharmacist interns who have completed a minimum of 20 hours of accredited training are authorized to administer COVID-19 vaccines.
While health departments and local officials are working to share information, many people are calling their local pharmacies with questions. Because the vaccine was produced, tested and approved in record time, some are questioning its safety. It was produced quickly because government funding fast-tracked various phases of development, allowing them to be conducted simultaneously rather than sequentially. Thousands of volunteers signed up for clinical trials, speeding the process, and emergency FDA approval allowed for rollout while some phase 3 studies are completed.
People are also concerned about contracting coronavirus from the vaccine, which is impossible. Neither mRNA vaccine contains live virus; they simply teach the body to recognize the unique spike protein on the outside of the COVID-19 virus to create a faster immune response to the invader if exposed. Two doses must be spaced 21 to 28 days apart, and it takes another few weeks after the second dose to reach full immunity.
Some who have called us are worried about possible side effects. The most commonly reported aftereffect is pain and swelling at the injection site; some individuals have also reported chills, fever, headache or fatigue. While this may be uncomfortable, it’s not alarming: These are all signs that the immune system is doing its job.
We have also helped explain to people why all are monitored after their shot. A few people have had serious allergic reactions – anaphylactic shock, which is why there is an established observation period after the vaccine that is longer for anyone with a history of allergies. Pharmacists are trained to respond to these rare reactions should they occur.
There have also been reports of individuals who have died within days or weeks of receiving the vaccine. Researchers are investigating these rare events, but so far, there is no evidence that the vaccine is responsible. Unrelated or “incidental” illness seems to be the culprit, which is unsurprising given the demographics – many of those vaccinated in the early rollout are elderly people who are in frail health.
Vaccines have the power to bring this pandemic under control. They could possibly even end it, but only after some 70% of humanity is inoculated. Almost 90% of Americans live within five miles of a local pharmacy where, starting in February, many will be able to get vaccinated against this virus.
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How to stay safe with a fast-spreading new coronavirus variant on the loose

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Bayard D. Clarkson Distinguished Professor of Mechanical and Aeronautical Engineering, Clarkson University
Associate Professor of Mechanical Engineering, Clarkson University
Suresh Dhaniyala receives funding from National Science Foundation and NY State Energy Research and Development Authority.
Byron Erath receives funding from the National Institutes of Health, the National Science Foundation, and the Empire State Development's Division of Science, Technology and Innovation (NYSTAR)

Clarkson University provides funding as a member of The Conversation US.
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A fast-spreading variant of the coronavirus that causes COVID-19 has been found in at least 20 states, and people are wondering: How do I protect myself now?
We saw what the new variant, known as B.1.1.7, can do as it spread quickly through southeastern England in December, causing case numbers to spike and triggering stricter lockdown measures.
The new variant has been estimated to be 50% more easily transmitted than common variants, though it appears to affect people’s health in the same way. The increased transmissibility is believed to arise from a change in the virus’s spike protein that can allow the virus to more easily enter cells. These and other studies on the new variant were released before peer review to share their findings quickly.
Additionally, there is some evidence that patients infected with the new B.1.1.7 variant may have a higher viral load. That means they may expel more virus-containing particles when they breathe, talk or sneeze.
As professors who study fluid dynamics and aerosols, we investigate how airborne particles carrying viruses spread. There is still a lot that scientists and doctors don’t know about the coronavirus and its mutations, but there are some clear strategies people can use to protect themselves.

The SARS-CoV-2 variants are believed to spread primarily through the air rather than on surfaces.
When someone with the coronavirus in their respiratory tract coughs, talks, sings or even just breathes, infectious respiratory droplets can be expelled into the air. These droplets are tiny, predominantly in the range of 1-100 micrometers. For comparison, a human hair is about 70 micrometers in diameter.
The larger droplets fall to the ground quickly, rarely traveling farther than 6 feet from the source. The bigger problem for disease transmission is the tiniest droplets – those less than 10 micrometers in diameter – which can remain suspended in the air as aerosols for hours at a time.
With people possibly having more virus in their bodies and the virus being more infectious, everyone should take extra care and precautions. Wearing face masks and social distancing are essential.
Spaces and activities that were previously deemed “safe,” such as some indoor work environments, may present an elevated infection risk as the variant spreads.
The concentration of aerosol particles is usually highest right next to the individual emitting the particles and decreases with distance from the source. However, in indoor environments, aerosol concentration levels can quickly build up, similar to how cigarette smoke accumulates within enclosed spaces. This is particularly problematic in spaces that have poor ventilation.
With the new variant, aerosol concentration levels that might not have previously posed a risk could now lead to infection.

1) Pay attention to the type of face mask you use, and how it fits.
Most off-the-shelf face coverings are not 100% effective at preventing droplet emission. With the new variant spreading more easily and likely infectious at lower concentrations, it’s important to select coverings with materials that are most effective at stopping droplet spread.
When available, N95 and surgical masks consistently perform the best. Otherwise, face coverings that use multiple layers of material are preferable. Ideally, the material should be a tight weave. High thread count cotton sheets are an example. Proper fit is also crucial, as gaps around the nose and mouth can decrease the effectiveness by 50%.
2) Follow social distancing guidelines.
While the current social distancing guidelines are not perfect – 6 feet isn’t always enough – they do offer a useful starting point. Because aerosol concentrations levels and infectivity are highest in the space immediately surrounding anyone with the virus, increasing physical distancing can help reduce risk. Remember that people are infectious before they start showing symptoms, and they many never show symptoms, so don’t count on seeing signs of illness.
3) Think carefully about the environment when entering an enclosed area, both the ventilation and how people interact.
Limiting the size of gatherings helps reduce the potential for exposure. Controlling indoor environments in other ways can also be a highly effective strategy for reducing risk. This includes increasing ventilation rates to bring in fresh air and filtering existing air to dilute aerosol concentrations.
On a personal level, it is helpful to pay attention to the types of interactions that are taking place. For example, many individuals shouting can create a higher risk than one individual speaking. In all cases, it’s important to minimize the amount of time spent indoors with others.
The CDC has warned that B.1.1.7 could become the dominant SARS-CoV-2 variant in the U.S. by March. Other fast-spreading variants have also been found in Brazil and South Africa. Increased vigilance and complying with health guidelines should continue to be of highest priority.
[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]
This story was updated Jan. 18 with latest CDC count and map showing B.1.1.7 cases now found in 20 states.
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Coronavirus

How to stay safe with a new fast-spreading coronavirus variant on the loose

Avatar

Published

on

Bayard D. Clarkson Distinguished Professor of Mechanical and Aeronautical Engineering, Clarkson University
Associate Professor of Mechanical Engineering, Clarkson University
Suresh Dhaniyala receives funding from National Science Foundation and NY State Energy Research and Development Authority.
Byron Erath receives funding from the National Institutes of Health, the National Science Foundation, and the Empire State Development's Division of Science, Technology and Innovation (NYSTAR)

Clarkson University provides funding as a member of The Conversation US.
View all partners
A fast-spreading variant of the coronavirus that causes COVID-19 has been found in at least 10 states, and people are wondering: How do I protect myself now?
We saw what the new variant, known as B.1.1.7, can do as it spread quickly through southeastern England in December, causing case numbers to spike and triggering stricter lockdown measures.
The new variant has been estimated to be 50% more easily transmitted than common variants, though it appears to affect people’s health in the same way. The increased transmissibility is believed to arise from a change in the virus’s spike protein that can allow the virus to more easily enter cells. These and other studies on the new variant were released before peer review to share their findings quickly.
Additionally, there is some evidence that patients infected with the new B.1.1.7 variant may have a higher viral load. That means they may expel more virus-containing particles when they breathe, talk or sneeze.
As professors who study fluid dynamics and aerosols, we investigate how airborne particles carrying viruses spread. There is still a lot that scientists and doctors don’t know about the coronavirus and its mutations, but there are some clear strategies people can use to protect themselves.
The SARS-CoV-2 variants are believed to spread primarily through the air rather than on surfaces.
When someone with the coronavirus in their respiratory tract coughs, talks, sings or even just breathes, infectious respiratory droplets can be expelled into the air. These droplets are tiny, predominantly in the range of 1-100 micrometers. For comparison, a human hair is about 70 micrometers in diameter.
The larger droplets fall to the ground quickly, rarely traveling farther than 6 feet from the source. The bigger problem for disease transmission is the tiniest droplets – those less than 10 micrometers in diameter – which can remain suspended in the air as aerosols for hours at a time.
With people possibly having more virus in their bodies and the virus being more infectious, everyone should take extra care and precautions. Wearing face masks and social distancing are essential.
Spaces and activities that were previously deemed “safe,” such as some indoor work environments, may present an elevated infection risk as the variant spreads.
The concentration of aerosol particles is usually highest right next to the individual emitting the particles and decreases with distance from the source. However, in indoor environments, aerosol concentration levels can quickly build up, similar to how cigarette smoke accumulates within enclosed spaces. This is particularly problematic in spaces that have poor ventilation.
With the new variant, aerosol concentration levels that might not have previously posed a risk could now lead to infection.

1) Pay attention to the type of face mask you use, and how it fits.
Most off-the-shelf face coverings are not 100% effective at preventing droplet emission. With the new variant spreading more easily and likely infectious at lower concentrations, it’s important to select coverings with materials that are most effective at stopping droplet spread.
When available, N95 and surgical masks consistently perform the best. Otherwise, face coverings that use multiple layers of material are preferable. Ideally, the material should be a tight weave. High thread count cotton sheets are an example. Proper fit is also crucial, as gaps around the nose and mouth can decrease the effectiveness by 50%.
2) Follow social distancing guidelines.
While the current social distancing guidelines are not perfect – 6 feet isn’t always enough – they do offer a useful starting point. Because aerosol concentrations levels and infectivity are highest in the space immediately surrounding anyone with the virus, increasing physical distancing can help reduce risk. Remember that people are infectious before they start showing symptoms, and they many never show symptoms, so don’t count on seeing signs of illness.
3) Think carefully about the environment when entering an enclosed area, both the ventilation and how people interact.
Limiting the size of gatherings helps reduce the potential for exposure. Controlling indoor environments in other ways can also be a highly effective strategy for reducing risk. This includes increasing ventilation rates to bring in fresh air and filtering existing air to dilute aerosol concentrations.
On a personal level, it is helpful to pay attention to the types of interactions that are taking place. For example, many individuals shouting can create a higher risk than one individual speaking. In all cases, it’s important to minimize the amount of time spent indoors with others.
The CDC has warned that B.1.1.7 could become the dominant SARS-CoV-2 variant in the U.S. by March. Other fast-spreading variants have also been found in Brazil and South Africa. Increased vigilance and complying with health guidelines should continue to be of highest priority.
[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]
Write an article and join a growing community of more than 119,500 academics and researchers from 3,844 institutions.
Register now
Copyright © 2010–2021, The Conversation US, Inc.

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