Survey finds 1 in 3 Americans would decline a COVID-19 vaccine: Your WellSky COVID-19 Briefing
In this edition
Use the links listed below to jump between sections.
NEWS
Current cases & maps
Cyber alert from HHS: Beware of fake COVID-19 websites
Is herd immunity easier to achieve than we thought?
Caring for face masks: Don’t hang them from the rearview mirror
Inexpensive and fast COVID-19 tests, with thanks to the NBA
Survey finds 1 in 3 Americans would decline COVID-19 vaccination
Turnover among public health officials
COMPLIANCE
Provider Relief Fund reporting
Nursing home enforcement actions during COVID-19
Resumption of CMS survey activities
Florida urges a delay on Review Choice Demonstration
OIG reports hospital overpayments for patients headed for home health
CLINICAL
ADMINISTRATIVE
Please note
The views, information, and guidance in this resource are provided by the author and do not necessarily reflect those of WellSky. The content provided herein is intended for informational purposes only. The information may be incomplete, and WellSky undertakes no duty to update the information. It is shared with the understanding that WellSky is not rendering medical, legal, financial, accounting, or other professional advice. WellSky disclaims any and all liability to all third parties arising out of or related to this content. WellSky does not make any guarantees or warranties concerning the information contained in this resource. If expert assistance is required, please seek the services of an experienced, competent practitioner in the relevant field. WellSky resources are not substitutes for the official information sources on COVID-19. Providers should continue to track developments on official CMS and CDC pages, including:
Current cases & maps
Next week will be the last weekly version of this briefing before we move to a new monthly schedule. Over the course of 22 weeks, we’ve certainly covered a lot of ground. On March 30, less than five months ago, the WellSky COVID-19 Weekly Briefing reported a total of 140,000 cases of COVID-19 across the United States and 2,400 deaths. As this week begins, we have passed 5.4 million cases and 170,000 deaths — that is an average of nearly 9,000 deaths per week.
Thankfully, this is the second week in a row with no color changes in the map provided by the Centers for Disease Control and Prevention (CDC). The count of states with more than 40,000 cases of COVID-19 is holding steady for the moment. However, as we consider individual states, the news is a little more sobering.
California now leads the nation with more than 633,000 cases, followed by Florida and Texas with 573,000 and 562,000, respectively. These three states now eclipse New York (431,000 cases), Georgia (222,000), and Illinois (208,000) as the former centers of the outbreak.
According to the New York Times database, over the past week the nation has averaged 51,523 cases per day — which represents a decrease of 17% from the same average two weeks earlier. The graph below shows the trend.
Finally, deaths are leveling off, after recent surges in the South and Southwest. But the CDC reports that it expects we will reach 200,000 mortalities by Labor Day (Sept. 7). The looming question for many is how the seasonal flu might impact these numbers in the coming months.
Even though we still see lots of red on the map produced by COVID Exit Strategy, the trends reported here are improving little by little. Two weeks ago, Oregon, Colorado, and Pennsylvania were considered to have uncontrolled spread. Now there’s still reason for caution, but overall improvements are being recorded. Fourteen other states are still red but seem to be improving — Arizona, Utah, Wyoming, South Dakota, Nebraska, Wisconsin, Minnesota, Indiana, Kentucky, Virginia, North Carolina, Maryland, Delaware, and Rhode Island.
A newer New York Times tracking map depicts nursing home deaths. Nursing home residents have accounted for only 8% of cases; yet 41% of deaths have been concentrated in this vulnerable population.
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News
Cyber alert from HHS: Beware of fake COVID-19 websites
On Friday, August 14, the U.S. Department of Health and Human Services (HHS) issued a cyber alert through the Cybersecurity and Infrastructure Security Agency (CISA). The alert warned of a malicious cyber actor spoofing COVID-19 loan websites with phishing emails. The person or persons involved are unknown but are spoofing Small Business Administration (SBA) COVID-19 websites. The emails include a malicious link to the spoofed SBA website that can steal credentials.
The phishing emails contain the subject line, “SBA Application – Review and Proceed” with the sender being identified as disastercustomerservice@sba[.]gov. The text in the email urges the recipient to click on a hyperlink that goes to hxxps:leanproconsulting[.]com.br/gov/covid19relief/sba.gov which resolves to an IP address of 162.214.104[.]246. Below is an image from the alert that shows the page that is reached through the link.
CISA recommends using the following best practices to strengthen the security posture of an organization’s systems. (System owners and administrators should review any configuration change prior to implementation to avoid unwanted impacts.) Note CISA’s best practices here:
- Include warning banners for all emails external to the organization.
- Maintain up-to-date antivirus signatures and engines. See Protecting Against Malicious Code.
- Ensure systems have the latest security updates. See Understanding Patches and Software Updates.
- Disable file and printer sharing services. If these services are required, use strong passwords or Active Directory authentication.
- Restrict users’ permissions to install and run unwanted software applications. Do not add users to the local administrators’ group unless required.
- Enforce a strong password policy. See choosing and protecting passwords.
- Exercise caution when opening email attachments, even if the attachment is expected and the sender appears to be known. See Using Caution with Email Attachments.
- Enable a personal firewall on agency workstations that is configured to deny unsolicited connection requests.
- Disable unnecessary services on agency workstations and servers.
- Scan for and remove suspicious email attachments; ensure the scanned attachment is its “true file type” (i.e., the extension matches the file header).
- Monitor users’ web browsing habits; restrict access to sites with unfavorable content.
- Exercise caution when using removable media (e.g., USB thumb drives, external drives, CDs).
- Scan all software downloaded from the internet prior to executing.
- Maintain situational awareness of the latest threats and implement appropriate Access Control Lists (ACLs). Sign up to receive CISA’s alerts on security topics and threats.
- Sign up for CISA’s free vulnerability scanning and testing services to help organizations secure internet-facing systems from weak configuration and known vulnerabilities.
Visit the CISA Cyber Resource Hub for more information about vulnerability scanning and other CISA cybersecurity assessment services.
Is herd immunity easier to achieve than we thought?
Herd immunity is an epidemiological concept that essentially measures the point at which a disease ceases to be widespread because the number of vulnerable humans has dwindled to a level where it can no longer gain a foothold among a large percentage of the population. Herd immunity is calculated using an epidemic’s reproductive value, which shows how many people can be infected by one person who has the disease. It’s also worth noting that herd immunity can vary from one community to the next, depending on demographics and health characteristics of the population. Early in the pandemic, director of the National Institute of Allergy and Infectious Diseases (NIAID) Dr. Anthony Fauci and others suggested that herd immunity for COVID-19 would only happen when 70% or more of a given population became immune. Now some researchers think the percentage could be significantly lower — maybe 50% or even less.
A new article in the New York Times suggests that in parts of New York where the virus was widespread earlier this year, “it is not inconceivable that there is already substantial immunity to the coronavirus.”
According to Tom Britton, a mathematician at Stockholm University, the virus “ferrets out the most outgoing and most susceptible in [its] first wave and immunity following a wave of infection is distributed more efficiently than with a vaccination campaign that seeks to protect everyone.” His model establishes herd immunity at 43% — meaning that after that percentage of people in a community become infected, the virus simply cannot hang on. The downside is that herd immunity comes at a high price. Some scientists are cautioning that these models are flawed, as all models are, and oversimplifying can complicate conditions on the ground. The article is interesting and worth a read, but the clear takeaway is that we still have a long way to go.
Caring for face masks: Don’t hang them from the rearview mirror
These days, face masks are a necessity of daily life. For some, they are also fashion statements or a form of inexpensive advertising. Whatever your relationship with your face mask, there are a few things you need to know about caring for it — and there might be a few things we need to teach our kids about caring for theirs if and when in-person school begins again.
According to the Washington Post’s face mask FAQs daily laundering is a must for cloth masks. If your washer has a sanitizing cycle, even better. Another consideration is the laundry detergent you’re using. For many with sensitive skin prone to the latest COVID-19 spin-off affliction — “maskne” (that is, acne linked to wearing a mask) — it’s best to use a mild detergent, followed by a dryer cycle with warm to hot air. Using a little bleach in the wash cycle isn’t a bad idea either.
There is the question of whether sunlight, by itself, will effectively decontaminate a mask. The answer is generally, no.
Clearly, the laundry is not recommended for surgical and N95 masks. For these masks, it’s recommended that wearers store the mask in a paper or plastic baggie (preferably a clean one) for at least a day before the next use. Even at that, these medical masks do not have long shelf lives.
For those of us who have the bad habit of taking our masks off and jamming them in a pocket or, in my case, a purse, we need to develop better habits. “You have to remember that the outside [of your mask] is contaminated” once it has been worn. You want to remove the mask from the ear loops, fold it, keep the inner parts touching, and then store it in a clean bag until it can be cleaned or discarded.
And, as with most other things, face masks have a shelf life. When they are irreparably soiled or begin to smell, it’s time for them to go. Teach your kids — ideally, let them learn by example.
One last thing on the subject of masks. It turns out that wearing a neck gaiter could be worse than not bothering to wear a mask at all. Here is another Washington Post treatise on that.
Inexpensive and fast COVID-19 tests, with thanks to the NBA
SalivaDirect is a new product that was approved for emergency use by the U.S. Food and Drug Administration (FDA) on Saturday, August 15. If you haven’t heard of it yet, you soon will. It is a COVID-19 test that relies on saliva instead of nasal swabs for testing. The tests are very inexpensive at less than $5 apiece and can produce 90 results in less than three hours in a lab. There are no reagents or special collection devices required.
The origin story of SalivaDirect includes an interesting combination of circumstances, timing, and innovation. Anne Wyllie, PhD is a microbiologist at Yale who was working on another study involving the use of spit tests when she realized that saliva could also be an effective weapon in COVID-19 testing. Like many researchers, her initial findings were publicized in a news report earlier this year. After reading news coverage of the testing research, enter Dr. Robby Sikka, the Minnesota Timberwolves’ new vice president of basketball performance and technology. An anesthesiologist by training, Dr. Sikka was intrigued, and he contacted the Yale team, after which the collaboration began in earnest. Anne Wyllie needed test subjects — the National Basketball Association (NBA) had them. The players, while residing in their Walt Disney World bubble, have been regularly tested using SalivaDirect for several weeks. The good news is that no players have tested positive for the virus since entering the bubble. However, that also makes evaluating the efficacy of the tests a bit more obscure. Watch for more on this.
Survey finds 1 in 3 Americans would decline COVID-19 vaccination
A recent Gallup Survey found that as many as 1 in 3 Americans would choose to not get a free vaccination — even if it was approved by the FDA. A total of 7,632 adults were surveyed by the Gallup organization between July 20 and August 2. Here are the main findings:
- Just over a third (35%) of the respondents said they would not accept a free, FDA-approved vaccination for COVID-19.
- 81% of Democrats said they’d get the vaccine. Lesser numbers of Republicans and Independent voters would take advantage of such an offer (47% and 59%, respectively).
- Those most willing to receive a vaccine right now were between 18 and 29 (76%). Those between 50 and 64 were least willing (59%).
- 56% of those living in rural areas would not get vaccinated now. 65% of respondents living in cities would accept the vaccine as would 69% of those living in the suburbs.
And, speaking of vaccinations, experts are urgently pushing us to get flu shots this year. In connection with that effort, we have a “new” word of the day — “twindemic” — which is a flu season punctuated by high or rising levels of COVID-19. The CDC has been talking up the need for flu shots and suggesting that employers should be considering covering the cost of inoculations for their employees. The CDC usually purchases 500,000 doses of flu vaccinations for uninsured adults. This year it ordered 9.3 million based on estimates that there will be between 39 million and 56 million cases that will result in up to 740,000 hospitalizations with between 24,000 and 62,000 flu-related mortalities. To be forewarned is to be forearmed — be sure to ask patients about whether they have had their shots this fall.
Turnover among public health officials
According to an article published by Kaiser Health News (KHN), dozens of state and local public health officials around the U.S. have left their positions as the pandemic has gained momentum in “a testament to how politically combustible masks, lockdowns and infection data have become.” At least 49 state and local leaders have resigned, retired, or been relieved of their responsibilities across 23 states since the pandemic began. Some of the departures have come amid news reports about data discrepancies, outmoded technology issues, and some measure of politics. According to Dr. Tom Frieden, former director of the CDC, the numbers reflect burnout, along with unfortunate attacks on public health experts from “the highest levels of government” with a “tone toward public health in the U.S. [that is] so hostile it has emboldened people to make these attacks.” Adding to the problem is the fact that since 2010, public health spending has dropped by 16% per capita. At least 38,000 public health jobs have disappeared, leaving what the KHN article describes as a “skeletal workforce for what was once viewed as one of the world’s top public health systems.”
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Compliance highlights
Provider Relief Fund reporting
The Centers for Medicare & Medicaid Services (CMS) issued the anticipated guidelines for reporting related to receipt of Provider Relief Funds on August 17. We expected to see the reporting format and content requirements, but that is apparently still under development. In the meantime, here is the latest on what providers need to know:
- Providers that received one or more payments amounting to $10,000 or more related to any of the provider relief initiatives must report on the use of funds.
- The reporting system will be up and running October 1, 2020.
- All recipients must report within 45 days of the end of calendar year 2020 on their expenditures through the period ending December 31, 2020.
- Recipients who have expended funds in full prior to December 31, 2020 may submit a single final report at any time during the window that begins October 1, 2020, but no later than February 15, 2021.
- Recipients with funds unexpended after December 31, 2020, must submit a second and final report no later than July 31, 2021.
- Detailed Provider Relief Fund reporting instructions and a data collection template with the necessary data elements will soon be made available through the Health Resources and Services Administration (HRSA) website.
Nursing home enforcement actions during COVID-19
On Friday, August 14, the Trump administration announced that CMS has imposed more than $15 million in civil monetary penalties (CMPs) for more than 3,400 nursing homes related to failure to comply with infection control guidelines and failure to report COVID-19 data. The average CMP was $55,000. This is a big jump from earlier reporting in June that suggested very few findings of deficiencies in recent infection control surveys.
According to CMS, since March 4, 15,276 nursing home surveys have been completed as of early August, with more than 180 immediate jeopardy findings for infection control that amounted to $10 million in fines. That’s triple the 2019 rate of immediate jeopardy citations. More than 3,300 facilities were also cited for COVID-19 data reporting deficiencies, which added another $5.5 million to the CMP tab. Notably, through the third week of June, a mere 2% of nursing homes had received any infection control citations based on an earlier analysis that was prepared by CMS.
In the meantime, on Thursday, August 13, CMS Administrator Seema Verma said that federal data is showing about 12,000 new nursing home cases every week — exceeding an earlier peak of 11,000 cases and significantly passing the low of 6,300 cases at the end of June. Since mid-May, CMS has reported nearly 46,000 nursing home deaths, with more than 177,000 confirmed COVID-19 cases and another 109,000 suspected cases originating in nursing facilities. Verma acknowledged in a call that the availability of testing devices and personal protective equipment (PPE) shortages have created hurdles for nursing homes, but also pointed out that Quality Improvement Organizations (QIOs) have reported significant departures from accepted infection control measures — including hand washing, availability of hand sanitizers, and donning/doffing of PPE. Verma said that CMS is seeing “significant deficiencies in infection control practices,” especially among frontline staff.
On August 14, the Wall Street Journal ran a related story about nursing home surveyors not being tested for COVID-19 before entering facilities to complete survey activities. According to the article, more than half the states — including Texas, Pennsylvania, and Ohio — do not require that surveyors be tested before entering a facility, despite CMS’s stated concerns regarding infection control and disease mitigation as the precipitating factors for nursing home lockdowns. Other states like California, Tennessee, and Colorado are adding testing mandates for survey staff, and other states are working on testing programs for surveyors because “it is the responsible thing to do” — especially when states are aware of surveyors who have tested positive for the virus.
Resumption of CMS survey activities
Late in the day on August 17, CMS announced that it will be resuming regular survey activities for all types of providers as soon as resources become available. The surveys to be resumed include:
- Onsite visits, as specified in the policies related to revisits;
- Complaint investigations; and
- Annual recertification surveys required within 15 months of a provider’s last recertification survey.
CMS is also focusing on resolution of suspended enforcement cases. According to Monday’s release, the process will focus on:
- Expansion of desk reviews for Plans of Correction.
- Processing enforcement cases put on hold in mid-March when the public health emergency was declared.
- Processing new enforcement cases begun on or after June 1, 2020.
Florida urges a delay on Review Choice Demonstration
According to the National Association for Home Care and Hospice (NAHC), three representatives from Florida have sent a letter to CMS expressing concerns with the decision to move forward with Review Choice Demonstration (RCD) as the pandemic continues. The letter, authored by Representatives Gus Bilirakis, Kathy Castor, and Darren Soto, suggested that Florida agencies are concerned about meeting the demands of RCD while still dealing with significant challenges brought on by the pandemic, including time and expense associated with acquisition of PPE, infection control, and limited availability of physicians for routine tasks like signing orders. NAHC President Bill Dombi noted that “the expansion of Review Choice Demonstration at this time of a surge in the pandemic just does not fit with previous CMS actions to relieve providers of paperwork burdens.”
OIG reports hospital overpayments for patients headed for home health
In early August, the HHS Office of the Inspector General (OIG) issued its latest report about post-acute care. The report — titled Inadequate Edits and Oversight Caused Medicare to Overpay More Than $267 Million For Hospital Inpatient Claims With Post-Acute-Care Transfers to Home Health Services — found that improperly coded hospital claims contributed to “hundreds of millions of dollars in overpayments” for hospital inpatient services where patients were transferred to home health without an indication of that fact on the hospital claim. This is a repeat of a similar report that was issued about five years ago with similar findings.
Many home health agencies may not realize that CMS rules for hospital billing include claim coding directives related to transfers. Patients who are transferred to home health, for example, would receive a patient status (aka a discharge status) code of 06. When that happens and when the patient has been treated in connection with one of about 280 “transfer” diagnosis-related groups (DRGs), the hospital payment is reduced if and as the patient is admitted to home health within three days of their hospital departure. Here’s how it works: When patients receive inpatient care in connection with one of the affected transfer DRGs and their length of stay is less than the mean length of stay for that DRG, there will be a payment adjustment if and when the patient is discharged to a post-acute setting such as home health or a skilled nursing facility (SNF). This is often referred to as a post-acute care transfer (PACT) policy and in these circumstances, the hospital is paid a per diem rate rather than the full rate associated with the DRG.
What the OIG found is that hospital billing departments have frequently failed to correctly code the claim when patients were discharged as the result of a prior home health transfer and resumed or discharged without an indication that the patient was being referred for post-acute care, especially home health.
The OIG identified a little over 89,000 claims that amounted to $948 million in hospital reimbursement. It reviewed 150 claims and concluded that only three were correctly paid. Many of the improper payments were the result of the hospitals applying condition codes that resulted in full payment including condition code 42 which would be indicative of home health that is not related to the reason for the inpatient stay or 43 which indicates that home health services were not received by the patient within three days of their hospital discharge.
There is nothing for post-acute providers to do about this, but it is interesting to know, especially when we consider the new discharge planning rules in place for hospitals since last November.
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Clinical highlights
COVID-19 “long haulers” and symptom research
A recent article in the MIT Technology Review reports on a group of COVID-19 patients with prolonged symptoms who created their own research group to explore and explain why some patients still feel ill for sometimes weeks or months after first being diagnosed with the virus. These folks call themselves “long haulers,” and they are part of a Slack group known as Patient-Led Research for COVID-19. A team of six scientists led a 23-person research team, and they recently released their first report that includes these findings:
- Nearly 6 in 10 survey respondents had at least one pre-existing condition. The most common were asthma and vitamin D deficiency.
- Most patients reported fluctuations in the type and intensity of their symptoms since first becoming ill. About 70% reported changes in types of symptoms and nearly 90% in their intensity.
- Nine out of 10 of the survey respondents did not feel fully recovered when they initially completed the survey, reporting an average symptom duration of about 40 days. Among the 10% of survey respondents who had recovered, the average length of continuing symptoms was 27 days.
This has interesting implications for post-acute providers who end up treating COVID-19 patients either with or without a preceding hospital stay.
New study on COVID-19 and chronic kidney disease
As I’ve reported previously, the array of acquired conditions associated with COVID-19 has been surprising to many. Originally, it was thought that exacerbations of cardiac and respiratory issues were the conditions most often associated with COVID-19 among Medicare beneficiaries. However, more recent information seems to suggest the involvement of another serious problem: acute kidney injury.
RenalytixAI, a London diagnostic firm, is working with teams at Yale, the University of Michigan Medical School, Johns Hopkins, and Rutgers to predict long-term kidney disease risk in recovering COVID-19 patients. According to an August 11 article in Modern Healthcare, a new trial is being conducted using a multiplex electrochemiluminescence assay to identify biomarkers that will be used in conjunction with patients’ medical history to generate a risk score related to progressive kidney decline. The trial will involve patients who developed acute kidney injury (AKI) while hospitalized with a diagnosis of COVID-19.
Steven Coca, founder of RenalytixAI, noted that 46% of patients recently studied in an initial trial acquired AKI and just under a fifth of them required dialysis during their hospital stays. Patient mortality was 50% and the research team found that about a third of the patients with AKI did not recover their kidney function by the time they were discharged from the hospital. Coca noted, “Severity and duration of AKI in the setting of COVID appears to be more severe than ‘standard’ AKI. Thus, we believe the risk for chronic kidney disease (CKD) after surviving COVID-AKI will be higher than routine AKI and risk stratification will be needed to determine who will need to be seen by nephrologists and who will require more aggressive care.”
Because so many post-acute patients already have CKD, this will be a population worth watching as they work through their recovery, and test results will be interesting to see in the future.
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Administrative highlights
New MLN Matters guidance on infusion billing
On August 7, CMS released a new MLN Matters article addressing Billing for Home Infusion Therapy Services on or After January 2021.
The Medicare Home Infusion Therapy (HIT) services benefit covers the professional services — including nursing services — furnished in accordance with the plan of care; patient training and education (not otherwise covered under the durable medical equipment benefit); remote monitoring; and monitoring services for the provision of home infusion drugs furnished by a qualified supplier.
Home infusion drugs are defined as a parenteral drug or biological administered intravenously, or subcutaneously for an administration period of 15 minutes or more, in the home of an individual through a pump that is an item of durable medical equipment. Insulin pump systems and/or self-administered drugs or biologicals are specifically excluded.
There are six G Codes that will be used in connection with HIT services:
- G0068: Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual’s home, each 15 minutes. Short Descriptor: Adm IV infusion drug in home.
- G0069: Professional services for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes. Short Descriptor: Adm SQ infusion drug in home.
- G0070: Professional services for the administration of intravenous chemotherapy or other intravenous highly complex drug or biological infusion for each infusion drug administration calendar day in the individual’s home, each 15 minutes. Short Descriptor: Adm of IV chemo drug in home.
- G0088: Professional services, initial visit, for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy or other highly complex drug or biological) for each infusion drug administration calendar day in the individual’s home, each 15 minutes. Short Descriptor: Adm IV drug 1st home visit.
- G0089: Professional services, initial visit, for the administration of subcutaneous immunotherapy or other subcutaneous infusion drug or biological for each infusion drug administration calendar day in the individual’s home, each 15 minutes. Short Descriptor: Adm SubQ drug 1st home visit.
- G0090: Professional services, initial visit, for the administration of intravenous chemotherapy or other highly complex infusion drug or biological for each infusion drug MLN Matters MM11880 Related CR 11880 Page 4 of 9 administration calendar day in the individual’s home, each 15 minutes. Short Descriptor: Adm IV chemo 1st home visit.
The rates associated with the G Codes above are being added to the physician fee schedule. The article notes that qualified HIT suppliers must be enrolled as Medicare Part B providers but do not have to enroll as durable medical equipment (DME) providers. The G Codes above will be billed through the A/B Medicare Administrative Contractors (MACs) and Multi-Carrier System (MCS) for Medicare Part B claims.
Time increments are shown in Table 1 (below) from the MLN Matters article.
Likewise, payment categories are also shown below based on the G Code being used for billing.
Home infusion drugs are assigned to three payment categories, as determined by the HCPCS J-code:
- Payment category 1 includes certain intravenous antifungals and antivirals, uninterrupted long-term infusions, pain management, inotropic, and chelation drugs.
- Payment category 2 includes subcutaneous immunotherapy and other certain subcutaneous infusion drugs.
- Payment category 3 includes certain chemotherapy drugs and other certain highly complex intravenous drugs.
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In closing
Once again, I leave readers with a couple of thoughts for momentary diversions as the pandemic rages on. According to the Wall Street Journal there is a new hobby for many — gazing at the stars. You can read about stargazing and the Dark Sky Association, which boasts 145 destinations in 21 countries — many of them in the U.S., including 15 in Texas and many more in the west, generally. Use the interactive map to find a site near you and take the kids — it will be a fun night out if one of these areas is close to you.
And, finally, this week we have Curbside Larry, a librarian like none you have ever seen before, pitching the services of the Barbara Bush library in Houston. My best friend in college went on to be a librarian, but she was nothing quite like Larry at hawking the library’s wares. Take a moment to watch the video — it’s inspiring to see so much enthusiasm!
And, while we get through another week — be safe out there and be well.