COVID-19 Mutations Impact Testing

As the COVID-19 pandemic continues, there have been reports of new viral mutations, resulting in more strains of the virus. The FDA recently alerted clinical laboratory staff and healthcare providers that genetic variants of COVID-19 may lead to false negative results in certain diagnostic tests, which could result in delayed treatment and/or increased risk of spreading COVID-19.

This alert applies to all molecular tests for COVID-19, but specifically identifies three molecular tests that received emergency use authorizations (EUAs) to test for COVID-19. These tests include:

  • Accula SARS-Cov-2 Test
  • TaqPath COVID-19 Combo Kit
  • Linea COVID-19 Assay Kit

The FDA continues to monitor the effects of different variants on authorized molecular tests for the detection of SARS-CoV-2 and will update clinical laboratory staff and health care providers accordingly.

Molecular tests designed to detect multiple SARS-CoV-2 genetic targets are less susceptible to the effects of genetic variation than tests designed to detect a single genetic target. Negative test results should be considered in combination with clinical observations, patient history, and epidemiological information. Healthcare professionals who encounter patients that test negative but still display symptoms should consider retesting with a different test.

The FDA reminds clinical laboratory staff and healthcare providers about the risk of false negative results with all laboratory tests, including molecular tests.

Tags: FDA, COVID-19, mutation, testing

Mobile Technology Is on Workers’ Comp Experts’ Minds: Here Are 3 Reasons They’re Right

In a recent survey conducted in partnership between Risk & Insurance® and Healthesystems, nearly 1 in 2 workers’ comp experts ranked mobile solutions as the most important technology impacting their organization in 2020.

Kristine Kennedy, SVP of Product Strategy and Innovation at Healthesystems, spoke to Risk & Insurance about how digital solutions can go a long way in improving the claims experience and outcomes.

Pulling insights from a Healthesystems 2020 research study specifically designed to understand more about the workers’ comp claims journey, pain points and opportunities to improve these pain points through digital and mobile solutions, Kennedy speaks to three opportunities for digital and mobile solutions to help improve the workers’ comp journey and outcomes, including:

  1. Outdated forms of communication, such as snail mail, cause delays in injury reporting and resultant claim complexity
  2. Current interactions often don’t match up with injured workers’ preferred channels, which are email and text on their smartphones
  3. Workers’ comp can take a page from the broader healthcare playbook, incorporating well-liked, well-utilized tools such as telehealth services and medication reminders

Read the article in full at Risk & Insurance.

Tags: Healthesystems, Kristine Kennedy, Risk & Insurance, technology, patient engagement, claims management, digital solutions

COVID-19’s Impact on Opioid Prescribing Trends

A new report from the IQVIA Institute for Human Data Science, a multinational health information technology and research company, provides an overview of trends in opioid prescribing, with special consideration paid to the impacts of the COVID-19 pandemic.

Overall, opioid prescribing is expected to decrease for the ninth consecutive year, with opioid prescriptions dropping 40% since 2011, and with the national MME (morphine milligram equivalents) dropping from 246 billion MME in 2011 to 100 billion in 2020 – a 60% decline.

During 2020, healthcare providers prescribed longer opioid prescriptions to mitigate COVID-19 disruptions, with prescriptions in the 20-50 MME per day range reflecting a 17% increase in early April but returned to baseline by June. However, total opioid prescribing declined 16% at the peak of shutdowns in late April, with significant variations across key specialties.

Pain specialists reported a 5% increase in opioid prescribing, while oral and maxillofacial surgery saw a 55% decrease in opioid prescribing. Very little fluctuation was seen in prescribing among family medicine and internal medicine specialists.

It would seem that while providers worked hard to ensure that patients who legitimately needed opioids still received them throughout the pandemic, overall the pandemic reduced opioid prescribing. It is estimated that the number of new patients starting opioid therapy decreased by 44%. MME declined as well, with 120 billion MME reported in 2019, dropping 17.1% in 2020 to 100 billion MME.

However, not all trends are positive. Medication-assisted treatment (MAT) for opioid use disorder (OUD) was also disrupted in 2020 due to the pandemic, with a 22% drop in new patients starting MAT. These numbers rebounded slightly in June and July as facilities reopened, but then faltered again in September and October.

The report included other key points regarding opioid prescribing, beyond the scope of the COVID-19 pandemic. Brief highlights include:

  • The co-prescribing of opioids with benzodiazepines decreased 30% since 2016, but these declines have been less prevalent in patients aged 65+. Over 1.2 million seniors still receive this drug combination
  • Abuse-deterrent opioid formulations had minimal impact on safety, as many showed little clinical differentiation and similar side effect profiles, resulting in a diminishing pipeline
  • Only three products are in Phase III development for OUD and for opioid overdose
  • In 2020 there were 115 products currently in the non-opioid analgesic development pipeline, an increase from only 38 in 2017

For further information, download the report in full.

Tags: opioid, opioid prescribing, IQVIA, COVID-19, benzodiazepine, MAT, medication assisted treatment

Worker Classification Debate Continues Across the Country

Across the nation the debate continues whether or not workers in the gig economy should be classified as independent contractors or employees.

Classifying workers as employees or independent contractors greatly impacts the benefits these workers are entitled to; employees are entitled to workers’ comp, disability, and other traditional benefits, while independent contractors are not.

The Department of Labor announced a final rule clarifying the standard for employee versus independent contractor status under the Fair Labor Standards Act (FLSA). To summarize the rule, the Department establishes that independent contractors are in business for themselves and are not economically dependent on a potential employer for work. This means that a contractor has a degree of control over work and that the worker’s opportunity for profit or loss is based on initiative and/or investment.

This federal ruling comes only months after a key ballot initiative passed in California, greatly impacting the gig economy.

A few years ago, the California Supreme Court established the “ABC Rule,” a series of three criteria that must be met for workers to qualify as independent contractors, essentially reclassifying millions of independent contractors as employees.

This was swiftly followed with the passage of affirming state legislation, but then in a twist of events, Proposition 22 was passed during the 2020 election, creating an exception in California for app-based transportation and delivery companies from providing employee benefits to certain drivers. In essence, rideshare drivers were initially reclassified as employees entitled to benefits, but the passage of this ballot averted that.

Proposition 22 was backed by organizations including Uber, Lyft, DoorDash, and Instacart, and recently these same companies have helped to form the App-Based Work Alliance, an organization that is now working to introduce similar initiatives in other states.

Other states have worked to duplicate California’s ABC rule, which could reclassify millions of workers across the country as employees entitled to benefits. However, with special interest groups now pushing to create more exemptions across the country, the future of the gig economy is still uncertain.

The Department of Labor’s recent ruling is scheduled to go into effect March 8, 2021, and it is uncertain how this federal ruling will conflict with future exemptions created by states.

Tags: gig economy, worker classification, independent contractor, employee, benefits, Uber, Lyft

The Department of Justice Sues Walmart Over Role in Opioid Crisis

The Department of Justice filed a nationwide suit against Walmart, Inc. for violations of the Controlled Substances Act (CSA), alleging that the company unlawfully dispensed and distributed prescription opioids.

Citing Walmart’s role as one of the largest pharmacy chains and wholesale drug distributors in the country, the Justice Department alleges Walmart had the responsibility and means to prevent opioid diversion, instead choosing to fill thousands of invalid prescriptions without legitimate medical purposes, and failing to report hundreds of thousands of suspicious prescriptions, contributing to the opioid epidemic.

The Justice Department seeks civil penalties. If Walmart is found liable for violating the CSA, it could face civil penalties of up to $67,627 for each unlawful prescription filled and $15,691 for each suspicious order not reported, potentially totaling billions of dollars. The court also may award injunctive relief to prevent Walmart from committing further CSA violations.

This lawsuit is the result of a multi-year investigation by the Department’s Prescription Interdiction & Litigation Task Force.

Tags: Department of Justice, Walmart, Opioid, epidemic, CSA, Controlled Substances Act

Top 10 Disruptors of 2020 for the Workers’ Comp Industry

For the past three years, Healthesystems has surveyed professionals across the workers’ compensation spectrum to get a sense of their greatest perceived challenges. Normally, those professionals are recruited from the Risk & Insurance® booth at the National Workers’ Compensation and Disability Conference & Expo (NWCDC). This year, the survey was disseminated entirely online, for reasons we understand all too well.

This year, 602 industry respondents ranked the top 10 disruptors that have had the most significant impact on their organization in 2020, recognizing not just the significant impact of COVID-19, but also longer-term, systemic challenges within the industry that will continue to disrupt operations until solutions are developed or fine-tuned.

The top 10 disruptors of 2020 for the workers’ comp industry are:

  1. COVID-19
  2. Psychosocial Factors
  3. Mental/Behavioral Health
  4. Access to Care
  5. Telehealth
  6. Interoperability Between Disparate Systems
  7. Mobile Technology
  8. New and Expensive Medical Treatment
  9. Opioids
  10. Artificial Intelligence

The COVID-19 pandemic is a unifying theme across many of these disruptors, presenting new safety threats, roadblocks to the recovery of injured workers, and operational challenges for workers’ comp organizations.

But this enormous disruptor could yield some positive long-term changes. On the technology side, the pandemic has illuminated what works and what doesn’t in the context of remote work, and could drive the increased investment in technology that many organizations need in order to move past the disruptive phase of new tools, and start reaping their benefits.

Visit Risk & Insurance® for the full article and a more in-depth discussion of these disruptors, including the insights of Healthe leaders Robert Goldberg, MD, FACOEM, Chief Medical Officer, and Kristine Kennedy, SVP, Product Strategy and Innovation.

Tags: Healthesystems, Risk & Insurance, industry survey, survey, insights, Robert Goldberg, Kristine Kennedy, COVID-19, disruptors