Measles Cases Surge in Texas and New Mexico
Texas and New Mexico see surge in measles cases, with vaccination exemptions rising. Universities issue warnings after potential exposure to measles.
According to a Feb. 22 article from The New York Times, outbreaks of measles in parts of Texas and New Mexico have increased according to state health officials.
We reported on this outbreak earlier in February.
The article stated, “An outbreak has been spreading through the South Plains region of Texas since late January, the Texas Department of State Health Services said on Friday. Measles vaccination rates in the region lag significantly below federal targets.
“On Friday, the department confirmed 90 cases of measles, with at least 77 of them being children. Sixteen people have been hospitalized, the department said.”
According to an article from BBC, “Health officials in Texas say their figures are likely to be an underestimate, as some parents may not report infections or may not realize their child has the disease.”
Further, the article said, “In Texas, federal data shows that the state achieved a 94.3% vaccination rate among kindergarteners for the 2023-2024 school year, while New Mexico reached 95%.
“But a state survey of Texas schools found that rates of exemptions were ticking upwards for MMR and other required vaccines.
“In Gaines County, where 57 of the Texas cases were reported, exemptions have surged over the last decade. State data shows 17.62% of students had a conscientious exemption to at least one required vaccine during the 2023-2024 school year, up from 7.45% in the 2013-2014 year.”
The neighboring county, Terry, which has 20 cases, saw exemption rates rise from zero to 3.73% over the same period of time.
Texas officials, according to BBC, reported that of the 90 cases in their state, 85 were in people who are unvaccinated or whose vaccination status was unclear.
A Feb. 23 article from CBS News reported that two Texas universities—Texas State and the University of Texas at San Antonio—and their surrounding communities have issued warnings about potential exposure to measles after giving campus tours.
The article stated, “The Hays County Health Department said a Gaines County resident visited San Marcos, where Texas State is located, on Feb. 14. That individual has since tested positive for measles.
“The agency said those who were on the Texas State campus between approximately 3 p.m. and 7 p.m. and/or at Twin Peaks Restaurant from 6 p.m. to 10 p.m. on Feb. 14 may be at risk of developing measles.
“The following day, Feb. 15, a Gaines County resident who has since tested positive for measles, toured the University of Texas at San Antonio.”
Impact of Tariffs on Healthcare: Meet the Trump Trade Team
Tariffs have emerged as a pivotal element in U.S. trade policy. While tariffs aim to protect strategically vital industries and act as a negotiating tool in trade disputes, their impact on healthcare providers has become an area of growing concern. Rising costs attributed to tariffs on medical supplies, equipment, and pharmaceuticals could jeopardize the financial stability of healthcare systems and limit access to critical care for patients.
HIDA is actively monitoring developments in trade policy and educating elected officials on the ways in which tariffs impact the medical supply chain. Tariff Policy Clearinghouse has the latest developments on trade policy. You can access this resource on our website at www.hida.org/tariffs.
Healthcare providers in the United States operate within a tightly regulated, resource-constrained environment. Tariffs on imported medical equipment and pharmaceuticals could lead to price disruptions across the supply chain. A report by the American Hospital Association (AHA) has underscored these challenges, stating that “rising costs tied to tariffs on medical goods risk eroding access to necessary supplies and compromising patient care outcomes.” The AHA emphasizes the need for policymakers to balance trade policy with the essential public service mission of healthcare providers.
The Trump Administration’s Trade Policy Team
President Donald Trump’s trade team has signaled a commitment to advancing a tariff-centered agenda. Each member brings a unique perspective and potential influence on how healthcare providers will navigate the new trade landscape:
- Treasury Secretary Scott Bessent: Bessent has advocated for using tariffs not only as revenue tools, but also as leverage in international negotiations. His emphasis on fiscal discipline – including spending cuts and tax shifts – may influence broader policy decisions that indirectly impact healthcare funding.
- Commerce Secretary Howard Lutnick: Lutnick has endorsed tariffs as a means to “protect the American worker” – aligning himself with President Trump’s philosophy that prioritizes domestic manufacturing. His leadership in driving the Office of the U.S. Trade Representative’s agenda suggests an aggressive approach to applying tariffs on goods that could include healthcare-related products.
- U.S. Trade Representative Jamieson Greer: Greer has been an outspoken advocate of using tariffs to address trade imbalances, particularly with China. His recent support of tariffs on medical products exemplifies the potential impact on healthcare providers.
- Senior Counselor for Trade and Manufacturing Peter Navarro: Known for his pivotal role in shaping U.S. trade policy during Trump’s first administration, Navarro remains committed to bolstering American manufacturing through tariffs. His influence ensures that healthcare providers will likely remain a focus area as medical products are vital components of U.S.-China trade tensions.
As the Trump administration’s trade policy evolves, healthcare providers and policymakers alike must engage in collaborative discussions to ensure the stability of the healthcare sector and preserve the health of the American public. In an era where trade policy and healthcare intersect, prioritizing patient outcomes must remain paramount.
Impact of Tariffs on Healthcare: Meet the Trump Trade Team – The Journal of Healthcare Contracting
Kennedy HHS Nomination Clears Key Committee Vote
The Trump White House’s nomination of Robert F. Kennedy Jr. to become Secretary of Health and Human Services on Feb. 4 cleared a key hurdle, passing out of the Senate Finance Committee on a party-line vote, with all 14 Republicans voting to support Kennedy’s nomination and all 13 Democrats opposing it. Senate Majority Leader John Thune (R-S.D.) will determine the timing of the full Senate vote on the nomination, but most observers believe that the final vote will take place next week.
Baxter Announces Full Restart of Manufacturing Operations Jan. 31, 2025
Jan. 31, 2025
Baxter has successfully restarted all 10 manufacturing lines post-hurricane, with production expected to reach pre-hurricane levels early in 2025.
According to a Jan. 28 update from Baxter, the organization has now restarted all of the site’s 10 manufacturing lines.
The announcement said, “While some lines require additional time to ramp up production, we currently expect to be producing at pre-hurricane levels across the plant early in the first quarter of 2025.”
Baxter attributes this success to the resilience of its teams and coordinating with the FDA.
FDA Issues Early Alert on Medline Fluid Delivery Sets
Certain lots of Fluid Delivery Sets with Drip Chamber within Medline custom kits should be removed from use due to a potential high-risk issue.
January 3, 2025
On Dec. 30, the FDA posted an announcement that it is aware that Medline has issued a letter to affected healthcare providers recommending certain lots of Fluid Delivery Sets with Drip Chamber within Medline custom kits be removed from use related to a potentially high-risk device issue.
The announcement said, “On December 16, 2024, Medline sent all affected customers a Medical Device Recall letter recommending the following actions:
- Immediately check your stock for the affected item number and the affected lot numbers listed above.
- Confirm whether you received product with the incorrect white macro drip chamber. Fluid Delivery Sets with white macro drip chambers should be discarded. The image below shows the difference in drip chamber colors and should help in identifying impacted devices.
- If you have received the correct Fluid Delivery Set with a grey micro drip chamber, the product can be safely used.
- Check this web page for updates. The FDA is currently collecting information about this potentially high-risk device issue and will keep the public informed as significant new information becomes available.”
According to the FDA, the reason for the early alert is Medline’s identification of Fluid Delivery Sets that were not assembled correctly with a white macro dip chamber vs. the required gray micro drip chamber.
“The macro drip chamber delivers three times more fluid per drop than the micro drip chamber,” the announcement added. “As a result, using a Fluid Delivery Set with this incorrect component increases the risk of over-administration of fluids, which may result in swelling (edema), shortness of breath, increased blood pressure, and/or death.”
Medline has not reported any injuries associated with this issue.
These fluid delivery sets with drip chambers are provided as components convenience kits. Fluid delivery sets prevent air from entering into the IV tubing and regulate the solution’s flow rate.
Study Tests Benefits of Designated CPR Coaches in Pediatric ICUs | Healthcare Purchasing News
Biden proposes Medicare, Medicaid cover anti-obesity drugs
By Noah Tong Nov 26, 2024
The Centers for Medicare & Medicaid Services is attempting to cover anti-obesity medications under Medicare Part D and Medicaid, the agency announced Nov. 26.
Under the Contract Year 2026 MA and Part D proposed rule (PDF), CMS is choosing to follow conventional medical thinking that obesity is a disease. As such, the agency is then able to reinterpret a statute that excludes weight loss drugs from coverage.
“During my time as CMS administrator, I heard from countless people about how this coverage exclusion is a barrier preventing people from treating obesity living healthier lives,” said CMS Administrator Chiquita Brooks-LaSure during a press conference.
Medicare has long claimed it does not have the authority to cover anti-obesity medications, which is why the agency is attempting to reinterpret the statute. They say this new approach is better aligned with existing policies, like covering drugs used to treat AIDS wasting and cachexia. In Medicaid, the reinterpretation would allow states to determine whether to cover GLP-1 drugs.
For individuals that are considered overweight but not obese, the drugs would not be covered.
Critics, meanwhile, say radical uptake of GLP-1 drugs for weight loss would be far too costly on the healthcare system. Officials declined to say if semaglutide would be a selected drug under the drug price negotiation program through the Inflation Reduction Act.
CMS projects that 7% of the Part D population, or approximately 3.4 million Americans, would be newly eligible for coverage of anti-obesity medications, increasing by 1% each year.
The agency expects Part D coverage will increase costs by $24.8 billion in Part D and $14.8 billion in Medicaid. Though the policy could create savings in the long-term, CMS did not assume downstream savings in the proposed rule.
Because of Inflation Reduction Act’s $2,000 out-of-pocket cap and the premium stabilization demonstration, officials downplayed fears of surging premiums. The total HHS budget sits at $2.1 trillion.
“We do not expect any short term impact on premiums from this proposal, and in fact, this proposal provides a significant savings for people who currently may be paying out of pocket for these medications,” said CMS Deputy Administrator and Director for the Center for Medicare Meena Seshamani, M.D
“This action will not only save money but will more critically save lives by significantly driving down obesity rates and improving health outcomes for millions — including the millions of Black and Brown Americans who are disproportionately and unfairly shouldering the burden of the obesity epidemic,” said the Health Equity Coalition for Chronic Disease following the announcement.
The proposed rule also reworks prior authorization and utilization management, guardrails for AI safety, provider directories through the Medicare Plan Finder and new requirements of brokers.
The new regulation may be one of the last major efforts of the Biden administration to revamp healthcare before leaving office.
After the comment period concludes, the rule would need to be finalized in Trump’s next term, said a CMS senior official, hinting the current administration would not try to rush to rubber stamp the rule. If the rule was finalized before Trump takes office, it would be subject to rescission under the Congressional Review Act, which could threaten the policy’s implementation permanently.
It wouldn’t be surprising to see Trump scuttle the plan to cover weight loss drugs, given the incoming administration’s desire to slash the federal budget and regulations, as well as potential HHS Secretary Robert F. Kennedy Jr.’s aversion to the drugs. That might be a welcome development for insuresrs footing the bill.
“The excessive prices drugmakers command for GLP-1s have enormous cost consequences for consumers, taxpayers and employers, said the Alliance of Community Health Plans in a statement. “There are limited long-term studies of these drugs on patients with obesity, particularly those who do not have diabetes or other related chronic conditions.”
A host of new actions addressing prior auth is proposed in the rule. They include prohibiting a MA plan from reopening an approved authorization for inpatient hospital admission and other clarifications of existing enrollee liabilities.
The rule codifies the benefits MA plans must cover and better determines the guardrails these plans must follow when determining internal coverage. These changes are designed to simplify coverage criteria for medically necessary determinations. Also codified is a provision mandating MA plans enact a utilization management committee for plan policies.
Prior auth changes were informed by utilization management audits conducted by CMS this year. The agency found that Medicare Advantage plans overturn 80% of denials on appeal, but only 4% of claims decisions are appealed.
Following up on an executive order last month requiring the feds to make sure AI tools don’t result in inequity in health care organizations, today’s rule mandates MA plans cover services equitably and does not discriminate, no matter if a decision spawns from an AI system or not.
The rule also overhauls provider directories.
Right now, the Medicare Plan Finder, which allows beneficiaries to shop for MA and Part D plans, does not include any information on provider directories, though it can be found on a MA plan’s website.
“This can be cumbersome for individuals when they must search the Medicare Plan Finder, as well as a plan’s website, to find provider network information,” said CMS in a fact sheet.
Under the proposed rule, searchable provider information must be given from MA plans to CMS for the Medicare Plan Finder.
But wait, there’s more.
Biden addresses behavioral health in this rule, too, by limiting cost sharing to be equal or less than traditional Medicare. They are pushing for 20% coinsurance for mental health, psychiatric and outpatient substance abuse services. There would also be zero cost sharing for opioid treatment program services. CMS is asking for public comment on how to best implement these policies with minimal upheaval.
“In response to concerns that cost sharing in other service categories will be raised in response to this movement in behavioral health, we also emphasize that the extent to which organizations may shift costs to services utilized by certain groups of enrollees is limited by statutory and regulatory requirements that ensure beneficiaries can access needed health services regardless of their health condition,” CMS added.
The agency also wants to expand its definition of broker “marketing”, as CMS continues to receive complaints of shady tactics meant to deceive consumers, even as CMS has denied more than 1,500 TV ad submissions. This allows CMS to review more ads before they go to air.
Agent and brokers would also be required to discuss a consumer’s eligibility for the low-income subsidy and Medicare savings program, as well as provide more information on Medigap.
CMS is hoping to make a series of technical changes to the medical loss ratio calculation. Part of that incentive, it appears, is to crack down on unhealthy consolidation in the MA market.
“In addition to the proposed changes, we are issuing a request for information on potential policies that CMS could adopt regarding how the MA and Part D MLRs are calculated in order to enable policymakers to address concerns surrounding vertical integration in MA and Part D,” the proposed rule says.
CMS is concerned MLR reporting is less transparent when these organizations are involved.
In response to backlash from the FTC and media outlets that pharmacy benefit managers allegedly push patients toward expensive brand drugs, the rule reinforces language mandating formularies include access to generics and biosimilars. The rule includes several transparency measures for Part D plans and sponsors.
https://www.fiercehealthcare.com/payers/biden-proposes-medicare-medicaid-cover-anti-obesity-drugs
HIRC: “High level” of provider concern over IV solutions supply
October 9, 2024- Jesse Schafer, executive director of the Healthcare Industry Resilience Collaborative, said he believes the impact of the IV solutions shortage will be similar to what healthcare experienced during Hurricane Maria. “Recovery may take months, and market supply will be highly constrained. Conservation and use of alternatives will be essential.”
HIRC member sentiment in early October suggested a high level of provider concern, an expectation of 4-6 months for recovery, and constrained alternative sources.
“My opinion is that the recovery time frame will exceed existing inventory if demand remains unchanged,” Schafer said. “Users of all IV fluids must conserve. Less use by all means more product for the patients that need it most.”
“In my experience, Baxter has been transparent and forthcoming,” said Schafer. “At the same time, the situation is serious and hospitals must activate their incident response teams and conservation measures.”
B Braun, another leading IV fluids supplier, is manufacturing 24/7 to help meet the need. Other alternative suppliers include Fresenius Kabi and ICU Medical.
A majority of surveyed providers indicated stockpiling. “This is instinctive and understandable,” Schafer said. “However, any excess in the form of hoarding will only exacerbate anticipated shortages.”
Hospitals will likely need to implement firm conservation strategies and alternate therapies where possible. “Unfortunately, this is not a new experience where nature struck the IV fluids market,” Schafer said. “As such, most hospitals have existing plans and experience.”
Schafer said one-third of surveyed provider members have already implemented conservation strategies. “In my opinion, all providers should be doing this now to reduce the risk of future shortages.”
Some of the most common mitigation strategies included:
General:
- Deliver IV fluid based on patient need
- Regularly assess patients receiving IV infusions
- Consider clinical alternatives (e.g. IV push, intramuscular, subcutaneous or intra nasal doses)
- Convert all possible medications from IV to oral (PO) form
- Use premixed antimicrobials, if available
- Limit utilization of parenteral nutrition (PN)
- Use the smallest possible indicated volume
- Use smaller bag sizes for slower rate infusions where practical
- Use sterile water vials or saline vials for reconstituting IV medicines instead of using large volume fluid bags
- Do not use IV fluids for non-IV administration
- Avoid practice changes that require additional fluids
- Avoid spiking bags or opening overwrap until you are certain that IV fluid will be administered
Surgical
- Minimize fasting to reduce need for fluid replacement
- Avoid priming of IV giving sets until certain of IV fluid requirements
Pharmacy
- Consider premixed and ready to use IV products
- Leverage 503B sources when available
Supply Chain
- Ensure backorders are registered and allocations are filled
- Explore all alternative sources to maximize inventory
- Consider signage at point of use to alert clinicians for the supply disruption
Hospital leaders can prioritize mitigation efforts to ensure minimal disruption to patient care through frequent cross-functional communication internal and external, patient-centric conservation strategies, and maximizing available inventories without hoarding. “Stand up a cross-functional response team that bridges clinicians, pharmacy, and supply chain,” Schafer said. Near real-time analytics and periodic status updates to inform decision makers will be important, as will opening all available communication channels.
Hospitals and health systems can use this as an opportunity to strengthen their supply chain resilience by prioritizing resiliency in their sourcing decisions,” Schafer said. “Consider implementing the HIRC resiliency badging program as a specific strategy to measure and elevate resiliency in sourcing strategy. This program rigorously assesses supplier operational and resiliency maturity. Suppliers with this badge have proven the capacity to more often predict, resist, and recover from disruption. We encourage all strategic suppliers to pursue this badge and for all providers to inquire if their trading partners have this designation. Having a badge does not eliminate disruption. Disruptions are inevitable, which is why resilient partnerships are key.”
AHA letter to president urges Administration to take immediate action to address IV solution supply shortage as a result of Helene
AHA President and CEO Rick Pollack Oct. 7 sent a letter to President Biden urging the Administration to take immediate actions to increase the supply of IV solutions for hospitals and other health care providers that are struggling with shortages following the closure of a Baxter manufacturing plant as a result of Hurricane Helene.
“Our members are already reporting substantial shortages of these lifesaving and life-supporting products,” Pollack wrote. “Patients across America are already feeling this impact, which will only deepen in the coming days and weeks unless much more is done to alleviate the situation and minimize the impact on patient care.”
The letter includes a number of specific actions the AHA is asking the Administration to take to support hospitals’ ability to care for patients and communities. In addition, the AHA invited the White House and agency experts to join the association in a forum to communicate directly with hospitals and health systems to “inform each other in real time on the status of the situation while we work together to mitigate the impact on patients.”
Port strike likely to disrupt supply chain, could cause inflation
Retailers import a significant amount through ports paralyzed by the strike of longshoremen who walked off their jobs at 14 ports from Maine to Houston on Tuesday (Oct. 1). A strike won’t hurt holiday sales, but could be a broader supply chain problem if it continues.
Steve Lamar, CEO of the American Apparel & Footwear Association, said the ports are critical for the retailing industry. Last year, the East and Gulf Coast ports accounted for 53% of all U.S. apparel, footwear and accessories imports amounting to more than $92 billion in value, he said.
Walmart reportedly imported 47,700 containers through the impacted ports from September 2023 through September 2024. Home Depot imported 21,200 containers, Dollar General’s container imports totaled 11,000 and Amazon imported 9,000 containers in the same period through the ports now under strike.
Dana Telsey, CEO of Telsey Advisors, said apparel retailers and big box operators brought in goods early in anticipation of the strike. She said lessons learned from 2020 pushed them to be proactive. Telsey said if the strike is resolved soon there would be little impact on consumer prices and inventory levels. But if the strike drags on for several weeks, it will be a major headwind for retailers in rising shipping costs and eventually higher prices for consumers, perhaps pushing inflation back up.
She said supply chain disruptions raise the cost of doing business at a time when many retailers are already treading water.
Kevin Williamson, CEO of RJW, which moves goods in the retail sector, estimates most packaged foods and consumable companies have anywhere from 8 to 16 weeks of inventory, but if the strike drags on their manufacturing operations would be disrupted without key ingredients from Europe. Williamson said grocery is is impacted because ingredients like olive oil and fruit are sourced from Europe through the East Coast ports.
‘SELF-INFLICTED WOUND’
Matthew Shay, CEO of the National Retail Federation, said there will be a ripple effect for retailers and holiday sales, and the shutdown could take the supply chain months to recover
“Though many retailers have worked months in advance to mitigate the impact of any slowdown through measures such as rerouting goods toward West Coast ports, NRF has urged the White House to use all available options to limit the impact of the strike. We’re finally turning the corner on inflation, we know that the job market and the overall economic activity have moderated from the highs over the last several years, and this is the last thing we need as a self-inflicted wound as we go into the fourth quarter of the year,” Shay said.
Costco CEO Ron Vachris said a limited amount of food and sundries arrive via cargo shipments, and its imports are primarily non-food items. He said Costco has contingency plans in place and ordered holiday items in advance. The retailer also could look at moving goods to different ports. Costco said contracts have locked in freight rates for now, but if a disruption does take place those prices could go up.
Walmart echoed that sentiment.
“We prepare for unforeseen disruptions in our supply chain and maintain additional sources of supply to ensure we have key products available for our customers when and how they want them,” Walmart spokeswoman Blair Crowell noted in an email.
AUTO, PHARMA ISSUES
Adam Kamins, an economist at Moody’s Analytics, estimated the strike could have a financial impact of approximately $2 billion a day. He based that analysis on the number of goods flowing through their ports daily. He said the longer the ports stay closed the more dire the implications for the overall U.S. economy.
He said the most significant issues will be in the food and automobile industries that rely heavily on the impacted ports. If the strike drags on, Kamins expects prices will increase, feeding inflationary pressures again. Another industry that could be impacted by a lengthy strike is pharmaceutical who largely use the East Coast ports to ship generic drugs and active pharma ingredients to the U.S. from India. He said without the active pharma ingredients the drugs can not be produced in the U.S.
Analysts at Sea Intelligence estimate the East Coast ports would handle 2.3 million containers in October. That translates to 74,000 shipping per day. The value of that daily freight is around $3.7 billion based on a MDS Transmodal estimate of $50,000 per container. The analysts estimate a one-day strike would take five days to clear. A week-long strike cause disruptions until mid-November.
The strike comes on the heels of Hurricane Helene that delayed port operations in Charleston and Savanah, as well as power losses at intermodal facilities across the southeast. This event created ocean, trucking and rail carrier congestion across the Southeast and Gulf ports.
The Conference Board estimates a week-long strike could cost the U.S. economy $3.78 billion. The shuttered ports handle $3 trillion annually in U.S. international trade. An analysis by J.P. Morgan estimated the daily cost of a port strike by East and Gulf Coast port workers would cost the U.S. economy between $3.8 billion and $4.5 billion per day as operations slow.
BusinessManufacturingRetail by Kim Souza (ksouza@talkbusiness.net)
Port strike likely to disrupt supply chain, could cause inflation – Talk Business & Politics