Jeffrey Bendix

In another sign of concern over the rapid spread of monkeypox, the American Medical Association (AMA) has developed three new billing codes for testing and vaccinating for the disease.

In a July 26 statement, the AMA said it has added one laboratory testing and two product codes for monkeypox vaccines to the Current Procedural Terminology (CPT) code set, effective immediately. The announcement follows the World Health Organization’s July 23rd declaration of monkeypox as a global health emergency,

“In the wake of the World Health Organization declaring monkeypox a global health emergency, and with case numbers increasing in the United States, these CPT updates are timely,” AMA President Jack Resneck Jr., M.D. said in the statement.

The new codes “are designed to clinically distinguish the diagnostic test and vaccinations for monkeypox to support data-driven tracking, reporting and analysis necessary for resource planning and allocation during the public health response to the outbreak,” the statement adds.

According to the Centers for Disease Control and Prevention, as of July 26 there were more than 19,000 confirmed monkeypox/orthopox cases worldwide, including about 3,600 in the U.S. The U.S. recorded its highest daily case count—439—on July 25.

The new vaccine codes are designed for the two available smallpox and monkeypox virus products, the AMA says. Code 90622 describes ACAM2000, an FDA-approved vaccine manufactured by Sanofi Pastuer Biologics Co. for active immunization against smallpox for persons determined to be at high risk for smallpox infection.

Code 90611 describes the FDA-approved JYNNEOS vaccine manufactured by Bavarian Nordic for prevention of smallpox and monkeypox disease in adults 18 years of age and older at high risk for smallpox or monkeypox infection. The new laboratory test CPT code (87593) is for molecular diagnostic testing that detects the nucleic signature of an orthopox virus, including the monkeypox virus.

“The daily increase in cases in the U.S. shows community spread occurring; however we are relieved to see access to testing has increased to 80,000 specimens per week with commercial labs now online and vaccine supply is increasing,” Resneck said.

This article was published by our sister publication Medical Economics.

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Codes enable billing for lab tests, administering vaccines.

New billing codes for monkeypox testing, vaccines unveiled

Childcare-related stress has worsened among people working in health care since the start of the COVID-19 pandemic, according to a new study. For those experiencing it, the result has been higher rates of depression, anxiety and burnout, and increased likelihood that they will reduce work hours or leave their job.

In a survey conducted from April to December 2020, the study’s authors asked about 58,000 health care workers—including 15,766 physicians--to rate their concerns about childcare due to COVID on a scale of 1 to 4, with 4 being the highest. Those scoring a 3 or 4 were considered to have childcare stress (CCS).

They found that just over 12,000, or about 21%, of all workers experienced CCS, and that the prevalence of burnout was substantially higher among those with high levels of CCS. For example, 39% of men reporting low CCS had burnout, while 53% with high CCS had burnout. Among women, the 49% reporting low CCS had burnout, compared with 63% of those with high CCS. Overall, respondents with CCS had 115% greater odds of experiencing anxiety or depression and 80% greater odds of burnout compared with those without CCS.

Broken down by race and ethnicity, the highest rate of CCS, 27.6%, was among those who preferred not to identify their category. That was followed by Hispanics/Latinos (26.3%,), Asian or Pacific Islanders and Native Americans (both at 25%), and African Americans (24.7%). The rate for white respondents was 18.8%.

Elevated feelings of CCS were also associated with greater likelihood of reducing work hours or quitting, the report found. Among all workers experiencing CCS, had 91% greater odds of intending to reduce work hours, and 28% greater odds of intending to leave their job, than those without CCS. Similarly, workers experiencing CCS had 115% greater odds of anxiety and depression than those with low CCS.

The authors propose addressing the problem of CCS through “a more intentional approach in the health care workplace to assessing and addressing childcare concerns” when making workplace assignments. Employers that can provide on-site care for ill children or on-site schools, and are aware of employees childcare concerns “will be better positioned to show workers they are a caring environment,“ and are thus likely to experience less turnover and fewer employees reducing their work hours.

The study, “Childcare Stress, Burnout, and Intent to Reduce Hour or Leave the Job During the COVID-19 Pandemic Among US Health Care Workers” was published July 18 on 

Study finds more depression, burnout as worries over childcare increase

Childcare concerns stress health care workers during pandemic

The first half of 2022 saw some gains in the battle to safeguard health care records, a 

According to cybersecurity firm Fortified Health Security, the number of 

 reported to the U.S. Department of Health and Human Services Office for Civil Rights affecting at least 500 health records dropped by 8.4% compared to the same period in 2021, from 368 to 337.

In addition, the number of records affected by breaches was down by about 40% from the first half of 2021, although was still 138% higher than 2020. Health care providers accounted for the great majority of the breaches with 72%, followed by 

“While the trendline from mid-year 2021 to today is down, overall breach numbers and affected records remain stubbornly high,” the report states. “The potential attack surface for hospitals and health systems continues to grow as employees work remotely and more medical, financial, and operational technologies move to the cloud.”

While it’s too soon to know, this year’s dropoff in reported data breaches may be an anomaly. According to the report, it was only the second time since 2010 that the number of reported breaches saw a year-over-year decline.

In terms of causes of breaches, those the report calls “malicious attacks” increased to 80% from 73% in the first six months of 2021. The rest were attributed to unauthorized access, theft, loss or improper disposal. It marked the sixth consecutive year malicious attacks was the leading cause of breaches.

The report found that breaches were heavily concentrated among a relatively small number of health care organizations, with seven entities accounting for 31% of 2022’s total to-date. Among these have been an imaging provider (two million records), a California health plan (854,000), a billing company (510,000) and a business service provider (500,000).

“The continued prevalence of healthcare cyberattacks should serve as a wakeup call for all healthcare leaders to assess their current security postures and take action to decrease risk and increase visibility and capabilities,” the report says.

This article was published by our sister company Medical Economics.

Growth in remote work, cloud data storage present opportunities for hackers.

Health care data breaches decline, but threats remain

 among doctors it must find ways to help medical students who are poor and/or members of marginalized groups stay in school and graduate.

, analyzing medical school attrition rates according to socioeconomic factors in students’ lives and backgrounds.

The authors looked at attrition, which they define as withdrawal or dismissal from medical school for any reason, among about 33,000 allopathic medical students during the academic years 2014-2015 and 2015-2016. They compared attrition rates among students across three groups: those who belonged to a race and/or ethnicity underrepresented in medicine (URiM), were low income, or grew up in an underresourced neighborhood (defined as one that is 

). They also compare rates between these groups and students identifying as non-Hispanic white.

The results show higher attrition rates among students from all three groups compared to their counterparts and to the overall attrition rate. The rate for URiM students was 5.6%, compared with 2.3% for non-Hispanic whites. For low-income students versus those without low income the rates were 4.2% and 2.3%, respectively. And students who grew up in underresourced areas had an attrition rate of 4.6%, versus 2.4% for those who did not. The overall rate during the two academic years was 2.8%.

The study also reveals that attrition rates increase along with a student’s number of coexisting marginalized identities. The rate among students who were neither URiM, low income or from underresourced neighborhoods was 1.9%. In contrast, those who identified with all three identities had an attrition rate of 7.3%.

In addition, the authors note an association between race/ethnicity and attrition. Regardless of socioeconomic status, students belonging to URiM groups had attrition rates comparable to those of non-Hispanic white students who were low income and grew up in underresourced neighborhoods.

The authors say that while the reasons for higher attrition rates between students URiM students and non-Hispanic whites are “multifactorial,” these students “experience interpersonal and structural barriers that impact their experience during medical school.” Among these are a lack of mentors and role models, microaggressions and 

 in the form of bigotry from patients and faculty, biased evaluations, and inequities in academic rewards.

“These experiences of social isolation, racism, and discrimination have been associated with burnout, depression, and attritionand highlight the need for medical schools to adopt a more proactive antiracism strategy,” the authors say. Such a strategy would include financial and administrative support for diversity, equity and inclusion offices, and requiring the Liaison Committee on Medical Education to monitor and attrition or early signs of it, such as leaves of absence.

They also recommend shifting retention efforts “away from deficit-based to strength-based models that emphasize recognition of individual students’ talents.” Such models, they say, have helped college students recognize their value and been associated with “higher engagement, retention, and sense of professional identity formation.”

The study, “Association of Sociodemographic Characteristics With US Medical School Attrition” was published online July 11 in 

Study finds higher attrition rates among those with low incomes or from groups underrepresented in medicine

Medical schools must do more to help poor and marginalized students graduate

 vaccine (BNT162b2) prevented about 110,000 deaths and 700,000 hospitalizations in the U.S. and saved more than $70 billion in health care costs and lost productivity in 2021, a 

The vaccine, which first became available in December 2020, was the only one with FDA approval in 2021. The Centers for Disease Control and Prevention estimates that fifty-seven percent of fully vaccinated individuals in 2021 received the 

, the highest proportion of the vaccinated population.

The study’s authors all received funding from Pfizer, either as employees, consultants or employed of companies paid by Pfizer. To carry out the study, the authors first developed a combined Markov and decision tree model. Then they entered both real-world and trial data into the model to estimate the one-year public health impact of the Pfizer-BioNTech vaccine compared with no vaccine.

The data they used included the number of vaccines administered, and the vaccine’s efficacy in different age groups, as well as the probability of catching COVID-19, developing symptoms and being hospitalized. They also accounted for the effects of 

 and the number of working days likely to have been lost due to short-term illness and the economic cost of premature deaths.

They found that compared to no vaccination, the two-dose series of the Pfizer-BioNTech vaccine prevented almost 8.7 million symptomatic cases of the disease, averted approximately 690,000 hospitalizations, and saved over 110,000 lives.

In addition, the reductions in COVID-19 symptomatic cases were associated with $43.7 billion in productivity gains. Around 36% of the gain came from preventing productivity loss due to early death, with the remainder due to avoiding workdays lost to illness.

The authors note their findings didn’t include the vaccine’s potential to reduce transmission of COVID-19 or its severity, and thus may underestimate the full impact of the vaccine.

“The analyses show that the Pfizer-BioNTech COVID-19 vaccine contributed substantial public health impact in the U.S. in 2021, and had a deep effect on the trajectory of the pandemic,” Manuela Di Fusco, senior director, health economics and outcomes research at Pfizer and one of the study’s authors, said in an accompanying press release. She added that the results “highlight the opportunity to continue widespread vaccination uptake to prevent COVID-19 related disease and generate societal benefits.”

The study, “Public health impact of the Pfizer-BioNTech COVID-19 vaccine (BNT162b2) in the first year of rollout in the United States,” appears in the 

Originally published on our sister brand, 

Nearly 9 million symptomatic cases also avoided.

Pfizer-BioNTech vaccine prevented more than 100,000 US deaths in 2021

Deaths among most racial and ethnic minority groups in the U.S. increased faster than deaths among Whites during the first year of the 

. But not all the differences resulted from the disease itself, a 

The study, published as a Research Letter in 

, examines race- and ethnic-based disparities in excess deaths—the difference between forecasted and observed deaths—from “external causes” (causes other than COVID-19) between March and December, 2020. These included 

, homicides, suicides, and deaths from transportation-related causes.

The racial/ethnic groups included in the study were American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic or Latino, and White.

The authors applied regression models to monthly death count data from the Centers for Disease Control and Prevention from January 2015 to February 2020 to forecast deaths during the study period. Then they subtracted the number of forecast deaths from the number of observed deaths to arrive at excess deaths.

The total of excess external deaths for the period, they estimate, was 17,251 (241,566 observed versus 224,315 predicted deaths), or 5.24 per 100,000 population. Among racial/ethnic groups, the highest rate—17.66 per 100,000—was among American Indians/Alaskan Natives. That was followed by Blacks/African-Americans (15.41), Whites, Hispanics/Latinos (3.81), Whites (3.77), and Asians/Pacific Islanders (0.27).

Broken down by category, the largest proportion of excess eternal deaths resulted from drug overdoses, which occurred at an overall rate of 3.92 per 100,000 population. American Indians/Alaska natives experienced the highest rate of overdose deaths, 11.21 per 100,000, followed by Blacks/African Americans (5.59) and Whites (3.66).

In the homicide category, Blacks/African Americans experienced the highest rate at 6.7 per 100,000, followed by American Indians/Alaskan Natives (3.02), and Hispanics/Latinos (0.97). The overall rate was 1.31.

For suicides, American Indians/Alaska natives was the only group to experience excess deaths, which occurred at a rate of 1.88 per 100,000. The overall rate was 0.74 (38,268 observed versus 40,690 forecasted.)

The highest rate of transportation-related deaths, 2.92 per 100,000, was among Blacks/African-Americans, followed by Hispanics/Latinos (0.76) and Whites (0.31), with an overall rate of 0.67.

The authors attribute the disparities in excess deaths to structural racism, noting that “discrimination against Black and American Indian or Alaska Native populations has left these communities especially vulnerable to the consequences of the pandemic” in areas such as unemployment, housing and food instability, and access to health care.

The study, “Racial and Ethnic Disparities in Estimated Excess Mortality From External Causes in the U.S., March to December 2020,” was published online May 9.

Drug overdoses, suicide, and homicide also have been significant causes of death during this time.

