Updates from your ACE team
Congratulations! We survived the first month of 2021. While we’re still in a pandemic and need to continue to practice social distancing and wearing a mask in public, it seems as though more and more people are ready to put the pandemic behind us. This newsletter examines Kaiser Family Foundation’s (KFF) research and data concerning the attitudes and beliefs Hispanic people over and under 50 years old and those living in rural America have toward the COVID-19 vaccines and how these beliefs and attitudes affect the American people’s future heard immunity. Dr. Fauci estimated that we’ll have herd immunity by the summer, assuming all proper protocols are followed and everyone gets vaccinated.

This newsletter also shares RCM tips and tricks to increasing revenue through retro payment Medicaid, a simple process that tracks self-pay patients that can get you paid up to 5 years after the visit. This newsletter also has an update to the ongoing issue that seems like it’s never going to end (the debate and challenge covered entities are in with big pharma), the US Department of Health and Human Services (HHS) Secretary Alex Azar resigned with plans to stay in office until the Biden Administration takes its place, the Biden Administrations’ health care plans and how Centers for Medicare and Medicaid (CMS) fits into it and finally, COVID-19 vaccine updates. 
Stop writing off revenue from your self-pay patients
You probably frequently encounter a retro payment Medicaid situation and don’t even realize it.

A self-pay patient walks through the door and doesn’t have the ability to cover the cost of their visit at the time of the encounter. The same patient comes back a year later and still doesn’t have the ability to pay for the visit. Most would write the visits off at the end of the fiscal year to keep a manageable A/R. However, self-pay patients may later become a Medicaid beneficiary – up to five years after their initial visit. Tracking these patients and leaving it on the A/R can get you reimbursed by Medicaid for their visit instead of having to write it off. Premature write offs may result in lost revenue.

Most community health centers don’t have the resources to have an entire team analyze the A/R and track the entire self-pay patient population. We’re here to help! We have teams of specialists that work to drive your bottom line by tracking your self-pay patient population and trend your A/R. Our specialized approach and staff will allow you to expand your practice, so you can afford to implement a program, hire a provider and/or implement a new specialty that your patient base needs. Our team also has credentialing specialists that can help ensure a seamless credentialing process when you add a new provider, practice or location under your current operating practice. 
Studies show COVID-19 susceptible areas and people - rural America and Hispanics - are hesitant to get the COVID-19 vaccine
Throughout the pandemic, there has been progressive moves and walk backs as science was included for more data that has made a larger impact and redefined normal. Since the race for a vaccine started last year, vaccines have been developed, approved by the Food and Drug Administration (FDA) and some people – about 3.2 percent – have received their vaccines. KFF shares the different phases and recommendations proposed by the Centers for Disease and Control Prevention (CDC) and how States are choosing to distribute the vaccines to their residents.

KFF has been tracking vaccine hesitancy and the COVID-19 spread in rural areas. Throughout the pandemic, some of the hardest hit places for COVID-19 were rural areas. Rural America has had its own challenges in treating COVID-19, from a smaller number of hospitals and therefore hospital beds, less providers and limited access to telehealth. Additionally, those living in rural areas are more likely to have a chronic health condition and therefore are more susceptible to contracting COVID-19 and having more severe symptoms. “An analysis from Pew Research Center found that sparsely populated rural areas [had] twice the number of [COVID-19-related] deaths as urban areas. With the pandemic’s toll hitting rural communities hard, the findings from the December KFF COVID-19 Vaccine Monitor are [concerning]. Rural residents are among [some of] the most vaccine hesitant groups, along with Republicans, individuals 30-49 years old and [African American] adults. Individuals living in rural areas are significantly less likely to say they will get a COVID-19 vaccine that it is deemed safe and available for free than individuals living in suburban and urban America.
  • 31 percent [of those living in] rural areas say they will ‘definitely get’ the vaccine, compared to 42 percent [of those living] in urban areas and 43 percent in suburban areas.
  • 35 percent of people [living] in rural areas say they will ‘probably get it,’ 15 percent say they will either ‘probably not get it’ or 20 percent say they will ‘definitely not get it.’”
Those living in rural areas “are just as likely as those living in urban and suburban communities to know someone who [either] tested positive for [or died from COVID-19].
  • 39 percent of those living in rural America say they are not worried they or someone in their family will get sick from COVID-19, compared to 23 percent of urban residents and 30 percent of suburban residents.
  • Half of those living in rural America say the seriousness of COVID-19 is ‘generally exaggerated’ compared to 27 percent of those living in urban areas and 37 percent of those living in suburban areas.

[Furthermore], 62 percent [of rural Americans view being vaccinated] as a personal choice [while] 36 percent [view it as a part] ‘of everyone’s responsibility to protect the health of others.’ 55 percent [of those living in urban areas] say that getting vaccinated is a part of everyone’s responsibility and 47 percent” of those living in suburban areas.
Who do rural American patients trust when receiving information about the COVID-19 vaccine? According to the article:
  • 86 percent trust their own doctor or health care provider
  • 68 percent trust the FDA
  • 66 percent trust the CDC
  • 64 percent trust their local public health department
  • 59 percent trust Dr. Fauci
  • 55 percent trust government officials 
While KFF has been working to research and track the different attitudes toward the COVID-19 vaccinations, the second published report reviews Hispanics’ attitudes and beliefs toward the COVID-19 vaccines.

Some of the hardest hit demographics by the pandemic were American Indians, Alaskan Natives, Hispanics and African Americans. “Hispanics were overrepresented when it came to COVID-19 cases and more likely to suffer worse outcomes than their White counterparts. Hispanic adults [have additionally] been harder hit by the economic impact of the pandemic. 52 percent of Hispanic adults [said] their household has lost a job or income since the [pandemic started] in February 2020, compared to 42 percent [of White adults. Furthermore], 43 percent claim to be essential workers that are required to work outside of their home.” Of all the different subgroups of this demographic, younger Hispanics are less likely to be vaccinated than adults.

 Interestingly, new KFF data shares that:
  • “26 percent of Hispanic adults say they will get a COVID-19 vaccine ‘as soon as possible.’
  • 43 percent say they will ‘wait until it has been available for awhile to see how it is working for others’ before [receiving the vaccine].
  • 11 percent say that will only get a vaccine ‘if required to do so for work, school or other activities.’
  • 18 percent say that they ‘will definitely not’ get the vaccine. Hispanic adults say they will either definitely or probably won’t get the vaccine, [comparable] to the national average of 27 percent.” 
“Among Hispanic adults, differences across age groups are more pronounced than those across gender, education and income levels. Mirroring age differences among White adults, there is a generational divide among Hispanic adults when it comes to vaccine hesitancy.
  • 44 percent of Hispanic adults ages 50 or older say they will definitely [get the vaccine while] 36 percent say they will probably get the COVID-19 vaccine; two thirds of Hispanics under 50 say the same.
  • Moreover, when asked more specifically about when they would like to get vaccinated, 38 percent Hispanic adults over 50 say they would want to get vaccinated ‘as soon as they can,’ compared to one in five younger adults who say the same.
  • 45 percent of younger Hispanics would prefer to ‘wait and see’ before getting” vaccinated.

69 percent of the Hispanics that are essential workers and under the age of 50 say they will either definitely or probably get the vaccine, 23 percent say they want to get the vaccine as soon as possible, 18 percent they will get the vaccine if it’s required and 18 percent say they are definitely not getting the vaccine.
While the research shows that there is a generational age gap of those that are willing to get vaccinated because they trust it, it’s also worth understanding who this group trusts with health care and COVID-19 information.
  • 75 percent of Hispanic adults trust their own doctor
  • 71 percent trust the CDC
  • 66 percent trust the FDA
  • 65 percent trust their local public health department
  • 62 percent trust Dr. Fauci
  • 58 percent trust President Biden.
As COVID-19 vaccine efforts shift and ramp up, Hispanic adults may have additional barriers to getting vaccinated from a lack of health insurance and therefore a routine provider, being undereducated about the cost of the vaccine and logistical issues, such as transportation. Hispanic adults appear to be open to and learning more about the vaccine from public health organizations and individuals and getting vaccinated. Younger Hispanic adults will require additional reassurance about the vaccine’s safety.
Covered entities continue to strike back against pharmaceutical manufacturers in 340B debate
Five hospital associations, the association of hospital pharmacists and three hospitals are suing federal health officials [because of the pharmaceutical] manufacturers’ [that are denying] 340B pricing for the drugs shipped to [a covered entities’ contracted] contract pharmacies” (CVS, Walgreens, etc). “The groups and hospitals said the companies ‘should reimburse 340B entities for the damages they have incurred.’ If the companies persist, the groups and hospitals said they ‘will continue to seek to require HHS to enforce the 340B statue, covered entities are reimbursed for damages caused by the illegal policy, and the matter is referred to the HHS Inspector General for the imposition of civil money penalties.’

Community health centers and HIV/AIDS clinics and hospital groups separately sued HHS over the pharmaceutical manufacturers’ position. The “National Association of Community Health Centers (NACHC) sued HHS in October [2020] to force it to implement a long-delayed 340B program mandatory and binding administrative dispute resolution (ADR) process. HHS published a final rule to implement the ADR system, which took effect 1/13/2021. NACHC and HHS agreed to stay proceedings in the lawsuit through 2/15/2021 to let the rule establishing the ADR system take effect and let NACHC or its members ‘avail themselves of that process.’”

We’ll continue to keep you updated on this unfolding issue.

No matter where you are in your journey to having a 340B Pharmacy Program, we can help! We can help you implement, manage or oversee it and ensure you maintain status and compliance through our 340B Pharmacy services that help you achieve financial independence. Health Resources and Services Administration (HRSA) is allowing covered entities to enroll in the program on a weekly basis to better serve patients throughout the pandemic. 
From the Hill and other useful info
HHS Secretary Alex Azar resigned and is planning “to stay in his role [through] January 20, 2021 when” the Biden Administration transitions into the White House.

There is a lot of uncertainty when it comes to what’s going to happen following the inauguration of the Biden Administration, including what it will focus on in the first 90 days of office. The American Hospital Association (AHA) has already asked the administration to work to protect the 340B Program. One thing that some people are expecting, since the beginning of major use of executive orders, is that the Biden Administration will be using several executive orders to push a lot of health care reform and undoing a lot of the Trump Administration’s policies that go against the Democratic Party. Such health care reform that the Biden Administration may focus on is:
  • Expanding COVID-19 testing, “eliminating out-of-pocket costs for treatment and providing additional pay and personal protective equipment (PPE) for essential workers.
  • Increasing premium subsidies under the Affordable Care Act (ACA), capping premiums for all enrollees at 8.5 percent of income.
  • Creating a public option health plan administered by Medicare that would be available to anyone, including free coverage for people with low income in states that have not expanded Medicaid under the ACA.
  • Lowering [Medicare’s eligibility age] to 60.
  • Giving the federal government the authority to negotiate drug prices for public programs and private payers.
  • Eliminating the 5-year waiting period before lawfully present immigrants can enroll in Medicaid or the Children’s Health Insurance Program.  
Click here for the full article.

COVID-19 vaccine updates
A question of whether or not it’s possible to cut the Moderna COVID-19 vaccine dose in half to vaccinate more people has been posed. Moderna has cautioned against it because there isn’t data showing whether or not the vaccine is or is as effective as having the full dose of the vaccine.
Read the synopsis here and the full article here.

“Pfizer and BioNTech SE [are planning] to produce 2 billion doses of their COVID-19 vaccine this year, bosting [the] previously expected output by more than 50 percent in response to the global demand. The United States [has] locked in a total 200 million doses” of the vaccine.
Read the full article here

The Biden Administration has plans to expand community health centers to increase access to COVID-19 vaccines. In the Administration’s first the month, Biden said it has plans to “’deploy mobile clinics, moving from community to community, that will partner with community health centers and local primary care doctors to offer vaccines to hard-hit and hard-to-reach communities.’ Other key highlights of the plan include:
  • Launching a new program with health centers so they can directly access vaccines where they are needed. The Administration will also encourage jurisdictions to engage and work closely with health centers in community vaccination planning.
  • Ensuring that health centers have the resources they need to successfully launch vaccination programs.
  • Calling on Congress for additional funds to support health centers and HHS to start new programs to provide guidance and technical assistance to providers nationwide.
  • Mobilize a public health jobs program to support the COVID-19 response and funding 100,000 public health workers to nearly triple the public health workforce for community health tasks such as vaccine outreach and contact tracing. These individuals would eventually transition into community health roles to build long-term public health capacity and improve quality of care and reduce hospitalizations for underserved and low-income communities.

Last month’s newsletter mentioned HHS’ goal and action plan to reduce the number of maternal deaths and disparities that put women at risk pre, during and post pregnancy.

CMS launched “the next phase of the Maternal and Infant Health Initiative (MIHI) [on December 22, 2020] to support state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to improve maternal and infant health outcomes.”