Fast Facts
The U.S. Strategic National Stockpile is a multibillion dollar inventory of medical countermeasures — medication, supplies, and more — that can be used in emergencies. COVID-19 underscored its importance.
The Department of Health and Human Services’ inventory planning reports didn’t meet most legal requirements enacted in 2019 or communicate risks associated with not meeting recommended inventory levels. This is partly because HHS hasn’t updated its processes for completing the reports and a key advisory body was inactive.
Our recommendations address this.
HHS’s leadership and coordination of public health emergencies is on our High Risk list.
What GAO Found
The Strategic National Stockpile (SNS) is a multibillion dollar inventory of drugs, vaccines, supplies, and other medical countermeasures that can be used in emergencies. GAO reported in August 2022 that to guide inventory purchases from 2015 through 2019, the Department of Health and Human Services (HHS) used a multi-step process involving interagency experts, resulting in annual SNS reviews with inventory recommendations. This process was suspended when the expert group underwent a reorganization, and annual reviews were not completed to inform inventory decisions for fiscal years 2020 through 2022, resulting in purchases based on past reviews and HHS discretion. HHS has since completed reviews to inform inventory decisions for fiscal years 2023 and 2024. However, these reviews did not meet most statutory requirements — such as by including the amount of additional medical countermeasures procured—because HHS did not update its procedures to account for changes enacted in 2019. Until HHS updates its procedures, the agency risks not meeting the statutory requirements designed to give Congress additional information about the SNS inventory.
From fiscal years 2015 through 2021, HHS obligated nearly $5 billion in non COVID-19 appropriations to purchase medical countermeasures, mostly for anthrax and smallpox.
Obligations from Non COVID-19 Appropriations for Strategic National Stockpile from Fiscal Years 2015 through 2021
GAO’s analysis of SNS reviews shows the SNS contained most medical countermeasure types recommended, but often not in the recommended quantities. HHS officials noted that gaps in quantities are due to budget constraints and acknowledge these gaps present risks. However, the reviews lack key information needed for managing these risks and communicating them to stakeholders, including to Congress. Risk management principles include guidance related to the management and communication of risk. Without an approach for regularly managing risks, HHS and Congress lack assurance the department is most effectively preparing for public health emergencies.
HHS obligated $6.1 billion in COVID-19 relief funds for supplies for the SNS that significantly increased the amount of certain medical countermeasures and expanded the types of countermeasures in the SNS inventory. For example, most of the funding went toward ventilators and personal protective equipment, which resulted in substantial increases in the amount of these medical countermeasures in the SNS relative to what was held prior to the COVID-19 pandemic.
Obligations Using COVID-19 Relief Funds for COVID-19 Supplies Delivered to the Strategic National Stockpile, Fiscal Years 2020 and 2021
Additionally, the SNS inventory now contains additional finished pharmaceutical products, such as sedatives for use with ventilators. In response to recommendations from HHS, ASPR also took steps to add testing supplies to the SNS inventory in late 2020, including nasal swabs and transfer media. Prior to the COVID-19 pandemic, the SNS did not hold these medical countermeasures.
The COVID-19 response has also been a catalyst for HHS to re-examine SNS operations, including the role, responsibilities, expertise, and inventory needed moving forward. As such, HHS is working to develop a strategic plan to guide future SNS efforts.
Why GAO Did This Study
Recent emergencies have highlighted the importance of preparedness. One key component of the nation’s medical response infrastructure is the SNS. The SNS inventory may be deployed to state, local, territorial, tribal, and international governments when needed. GAO placed HHS’s leadership and coordination of public health emergencies on its High Risk List in January 2022 (GAO-22-105291) in part due to deficiencies in HHS’s management of countermeasures.
The Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2019 included a provision for GAO to review the SNS. This report examines: (1) the process used to make inventory decisions; (2) non COVID-19 obligations for countermeasures and their alignment with recommendations; and (3) obligations for countermeasures using COVID-19 relief funds, and inventory and operations changes in response to the COVID-19 pandemic.
To conduct this work, GAO reviewed standard operating procedures, statutory requirements, inventory and obligations data, and other documentation; compared HHS actions to risk management practices; and interviewed HHS officials.
This report is a public version of a sensitive report issued in August 2022.
*Health and Human Services:
GAO Report, Older Households: Comparison of Income, Wealth, and Survival in the United States with Selected Countries
GAO-22-103950, Published: Sep 15, 2022. Publicly Released: Oct 17, 2022.
In recent decades, income and wealth disparities have been increasing among older Americans and exceed those in Canada, Germany, and the United Kingdom. We found:
In 2007, older Americans in a typical low-income household needed to work 12 years to equal what a typical high-income older household earned in 1 year; there were similar gaps in Germany, where they’d need to work 6 years, and 10 years in the U.K.
Higher income and wealth were associated with living longer in the U.S. and the U.K. for those under 80 years old
Homeownership and higher education were generally associated with higher wealth and income, respectively, in each country
What GAO Found
Income and wealth disparities among older households were wider in the United States than in selected countries from 1998 through 2019, according to GAO’s review of households headed by those 55 and older. For example, in 2007, the median, or “typical,” income of high-income older households in the United States was about 12 times greater than that of low-income households, compared to about 6 times in Germany and about 10 times in the United Kingdom (see figure). GAO’s analysis also indicates that income and wealth were more concentrated at the top of high-income and high-wealth older households in the United States, compared to other households in either the United States or selected countries. Further, GAO’s analysis shows that high-wealth older households in the United States and United Kingdom held a greater proportion of their wealth in financial assets, relative to middle-wealth households. Still, homes and other non-financial assets made up the majority of total wealth for all older households GAO reviewed.
Median Income of Older Households in the U.S. and Selected Countries, by Quintile
Note: GAO sorted households into quintiles based on income when the survey respondent, their partner or spouse, or both reported being 55 or older. For each quintile, GAO calculated median income, meaning the income of the “typical” household. GAO converted estimates to 2017 U.S. Dollar purchasing power parities, which were the most recent available at the time. Confidence intervals are reported at either the 99 or 95 percent level based on the availability of Luxembourg Wealth Study data.
Although the wealth data GAO reviewed indicate wider disparities in the United States than in selected countries over the period of review, these data did not include the estimated value of retirement benefits that older households expect to receive from public and private sources. GAO and some researchers have demonstrated how incorporating the value of these expected retirement benefits shows wealth disparities that are somewhat smaller than measures that omit these benefits.
GAO’s analysis indicates that higher income and wealth are associated with living longer among older individuals in the United Kingdom and United States. To compare survival between the United Kingdom and United States, GAO used data from 2002 through 2012, which are the most recent years for which there are reliable mortality data for both countries. The data sets GAO used for this analysis are unique in that they are representative of older individuals in the United Kingdom and United States and follow the same individuals as they age, while tracking their mortality over time, as well as their income, wealth, and other demographic information. As a result, GAO examined survival rates over a 10-year period, as a proxy for longevity.
GAO found that individuals from high-income and high-wealth households in the United States and United Kingdom were generally more likely to survive during the 10-year period compared to lower household income and wealth groups. For example, in the United States, the proportion of individuals in their seventies at the beginning of the study period who were alive at the end of the 10-year period ranged from 68 percent for those from the wealthiest households, to 44 percent for those from the least wealthy households. However, these patterns differed for the oldest individuals, who were in their eighties and nineties at the beginning of the study period. For example, survival rates for those in their nineties did not vary significantly based on wealth.
Educational attainment and homeownership in selected countries and the United States are associated with higher levels of income and wealth according to GAO’s examination of data, review of research, and interviews. For example, in each of the selected countries, older households that have obtained postsecondary education tend to have higher incomes during their working years and subsequently higher levels of wealth during their older years. Homeownership is similarly associated with higher levels of wealth because, in part, a house serves as an asset that can increase in value, as well as a dwelling.
Other factors associated with income and wealth disparities include the cost of long-term care, which can quickly deplete the wealth of older households. However, research indicates that Germany mitigates the high costs of long-term care through nationwide long-term care insurance. Additionally, public retirement programs in selected countries and Social Security in the United States are designed in part to reduce disparities by providing a higher rate of payments to households with lower incomes. Similarly, income taxes in all three selected countries and the United States are designed in a way that can reduce income disparities, with marginal rates that increase by income.
Why GAO Did This Study
Some researchers and policymakers have raised questions about whether differences in income, wealth, and longevity in the United States and other countries may affect older populations’ financial security in retirement.
GAO was asked to compare income, wealth, and longevity trends in the United States and other countries. This report (1) compares trends in distributions of income and wealth, and disparities in survival rates for older households in the United States with those in Canada, Germany, and the United Kingdom; and (2) describes factors that contribute to any disparities in income and wealth distributions for older households in selected countries.
GAO selected countries based on the availability of comparable data and size of their economies. GAO analyzed the countries’ distributions of income and wealth from 1998-2019 using the Luxembourg Wealth Study Database. GAO examined associations with 10-year survival rates in the United States and United Kingdom using data that followed older households from 2002-2012 in the English Longitudinal Study of Ageing and the Health and Retirement Study in the United States. GAO reviewed relevant literature, interviewed researchers and government officials in the selected countries, and sought input from the U.S. Census Bureau, Departments of Labor and the Treasury, Internal Revenue Service, and Social Security Administration.
For more information, contact Tranchau (Kris) T. Nguyen at (202) 512-7215 or NguyenTT@gao.
Full Report
Looking Back: Women’s Congressional Policy Institute, Weekly Legislative Update; September 12-16, 2022, Screening Initiatives by Health Care and Social Service Providers
|
“Henry Ford Innovation Nation”, a Favorite Television Show
Between looking at a post we had started about Nancy Pelosi and the January 6th Committee, we delved into watching our CBS favorite TV program, Henry Ford Innovation Nation:
“In 2014, The Henry Ford premiered its first-ever national television series, The Henry Ford’s Innovation Nation. Hosted by news correspondent and humorist, Mo Rocca, this weekly Emmy®- winning half-hour show airs Saturday mornings on CBS. The Henry Ford’s Innovation Nation showcases present-day change-makers who challenge themselves to think differently and create new, innovative solutions for a better future. In addition, each episode highlights The Henry Ford — its artifacts, unique visitor experiences and its unparalleled expertise. For more information about The Henry Ford, please visit our website, www.thehenryford.org“.
“250 acres of unexpected. 1 awe-inspiring experience. At The Henry Ford, you’ll discover America — its culture, inventions, people and can-do spirit — and hundreds of hands-on ways to explore it, enjoy it and be inspired by it. Prepare to be astounded by our attractions and resources: Henry Ford Museum of American Innovation, Greenfield Village, Ford Rouge Factory Tour and Giant Screen Experience.”
Editor’s Comments:
Although we’ve not been out to the actual site, you can enjoy (if your local CBS station carries this program) the discoveries, experiences and history surrounding this complex.
The Henry Ford’s Innovation Nation is a weekly Saturday morning show on CBS that showcases present-day change-makers from all over the world who are creating solutions to real needs. It is hosted by news correspondent and CBS Sunday Morning regular Mo Rocca. The intent is to stimulate curiosity and to inspire audiences with entertaining yet educational stories about yesterday and today’s visionaries and turning points that changed the course of history, as well as innovations and inventions that are changing the world today. .
Social Security Announces 8.7 Percent Benefit Increase for 2023; On average, Social Security benefits will increase by more than $140 per month starting in January.
Social Security and Supplemental Security Income (SSI) benefits for approximately 70 million Americans will increase 8.7 percent in 2023, the Social Security Administration announced today. On average, Social Security benefits will increase by more than $140 per month starting in January.
The 8.7 percent cost-of-living adjustment (COLA) will begin with benefits payable to more than 65 million Social Security beneficiaries in January 2023. Increased payments to more than 7 million SSI beneficiaries will begin on December 30, 2022. (Note: some people receive both Social Security and SSI benefits). The Social Security Act ties the annual COLA to the increase in the Consumer Price Index as determined by the Department of Labor’s Bureau of Labor Statistics.
“Medicare premiums are going down and Social Security benefits are going up in 2023, which will give seniors more peace of mind and breathing room. This year’s substantial Social Security cost-of-living adjustment is the first time in over a decade that Medicare premiums are not rising and shows that we can provide more support to older Americans who count on the benefits they have earned,” Acting Commissioner Kilolo Kijakazi said.
To view a COLA message from Acting Commissioner Kijakazi, please visit www.youtube.com/watch?v=Vgm5q4YT1AM.
Some other adjustments that take effect in January of each year are based on the increase in average wages. Based on that increase, the maximum amount of earnings subject to the Social Security tax (taxable maximum) will increase to $160,200 from $147,000.
Social Security and SSI beneficiaries are normally notified by mail starting in early December about their new benefit amount. The fastest way to find out their new benefit amount is to access their personal my Social Security account to view the COLA notice online. It’s secure, easy, and people find out before the mail arrives. People can also opt to receive a text or email alert when there is a new message from Social Security — such as their COLA notice — waiting for them, rather than receiving a letter in the mail. People may create or access their my Social Security account online at www.ssa.gov/myaccount.
Information about Medicare changes for 2023 is available at www.medicare.gov. For Social Security beneficiaries enrolled in Medicare, their new higher 2023 benefit amount will be available in December through the mailed COLA notice and my Social Security’s Message Center.
The Social Security Act provides for how the COLA is calculated. To read more, please visit www.ssa.gov/cola.
Impaired Driving and Excessive Speeding: The National Transportation Safety Board and Alcohol Impairment Detection Systems
Horrific crash highlights need for technology solutions to eliminate impaired driving and speeding
An investigation into a California crash that killed nine – including seven children – has led the National Transportation Safety Board to call for alcohol impairment detection systems to be included in all new vehicles, according to new recommendations released Tuesday.
The crash, on New Year’s Day 2021 in Avenal, California, was caused by an impaired driver who was speeding, the NTSB found.
“Technology could’ve prevented this heartbreaking crash — just as it can prevent the tens of thousands of fatalities from impaired-driving and speeding-related crashes we see in the U.S. annually,” said NTSB Chair Jennifer Homendy. “We need to implement the technologies we have right here, right now to save lives.”
Above, Collision Between a Car Operating With Automated Vehicle Control Systems and a Tractor-Semitrailer Truck Near Williston, Florida, 2016, NTSB, NTSB Chair Jennifer Homendy
As a result of the investigation, the NTSB is recommending measures leveraging new in-vehicle technologies that can limit or prohibit impaired drivers from operating their vehicles as well as technologies to prevent speeding. These include:
- Requiring passive vehicle-integrated alcohol impairment detection systems, advanced driver monitoring systems or a combination of the two that would be capable of preventing or limiting vehicle operation if it detects driver impairment by alcohol. The NTSB recommends that the National Highway Traffic Safety Administration require all new vehicles to be equipped with such systems.
- Incentivizing vehicle manufacturers and consumers to adopt intelligent speed adaptation systems that would prevent speed-related crashes. This is a reiteration of a previous NTSB recommendation to NHTSA.We have to remember that technology is only part of the solution. To save lives on our roads, we need to look more broadly at the entire transportation system, which includes everything that can prevent a crash,” said Homendy, a strong supporter of the comprehensive Safe System Approach to reducing roadway deaths.
On Friday, Jan. 1, 2021, a sport utility vehicle was traveling south on State Route 33 near Avenal, Calif. Meanwhile, a pickup truck — occupied by a driver and seven passengers, ranging in age from 6 to 15 years old — was traveling north on State Route 33. The SUV had traveled less than 3,000 feet on SR-33, during which it accelerated to a speed between 88 and 98 mph, when it ran off the shoulder to the right. The driver overcorrected to the left and the SUV crossed the centerline into the other lane, directly in front of the oncoming pickup truck. The SUV and pickup truck collided head-on and the truck immediately caught fire. The SUV driver and all eight pickup truck occupants died.
NTSB investigators found that the SUV driver had a high level of alcohol intoxication and was operating at an excessive speed. These factors contributed to a loss of vehicle control. The excessive speed of the SUV also prevented the oncoming pickup truck from having enough time to take evasive action. The NTSB determined that it is unlikely this crash was survivable due to the severity of the head-on collision, the significant vehicle intrusion and the rapid spread of the post-crash fire.
Findings Suggest COVID-19 Rebound Not Caused by Impaired Immune Response: Robust Cellular Immune Response to Residual Viral RNA?
Detailed analysis of eight patients published.
Colorized scanning electron micrograph of a cell infected with the Omicron strain of SARS-CoV-2 virus particles (purple), isolated from a patient sample. NIAIDhat the five-day course of Paxlovid is too short for the body to develop a strong immune response to SARS-CoV-2, the virus that causes COVID-19.
Participants were selected from adults enrolled in an ongoing COVID-19 study at the NIH Clinical Center in Bethesda, Maryland, and other local hospitals. The study aims to better understand how SARS-CoV-2 affects white blood cells. Participants provide blood and other samples as well as access to their COVID-19 medical records as part of the study. The study to evaluate COVID-19 rebound included six participants (three men and three women with a median age of 42 years) who took Paxlovid within four days of initial symptom onset and then experienced recurrent symptoms; two participants (a 54-year-old man and 35-year-old woman) who experienced recurrent symptoms who did not take Paxlovid; and a control group of six people who had COVID-19 but did not experience symptom rebound. All participants were previously vaccinated and boosted against COVID-19, and none developed severe disease requiring hospitalization during acute infection or rebound. Investigators collected data on each participant’s clinical course and performed laboratory tests on blood and nasal swab samples.
Investigators found no evidence of genetic mutations that would suggest participants who experienced COVID-19 rebound were infected with a strain of SARS-CoV-2 that was resistant to Paxlovid. They also found no evidence of delayed development of antibodies in participants experiencing rebound after taking Paxlovid. Investigators detected robust SARS-CoV-2 T-cell responses in rebound patients. Overall, the level of T-cell responses was greater in rebound patients than in patients with early acute COVID-19 who did not experience rebound. Infectious SARS-CoV-2 was detected by viral culture in one out of eight rebound participants.
The findings suggest that rebound symptoms could be partially driven by the robust cellular immune response to residual viral RNA throughout the respiratory tract, rather than an impaired immune response allowing viral replication, according to the authors. Larger, more detailed epidemiologic studies are needed to further understand the clinical importance and epidemiologic consequences of COVID-19 rebound, the authors write. The authors note that the current data support the need for isolation in symptomatic rebound persons and the need to evaluate, in a clinical trial, longer courses of Paxlovid in immunocompromised individuals where the immune response may be ineffective.
Gender and Labor Markets by Diego Mendez-Carbajo* : “Sure [Fred Astaire] was great, but don’t forget that Ginger Rogers did everything he did…backwards and in high heels.” — Robert Thaves1
Introduction
In economics, labor is the human effort directed toward producing goods and services. Along with the other factors of production—land, capital, and entrepreneurship — it is a building block of the economy.
Employees exchange their labor with employers for wages, salaries, and other benefits such as health insurance and retirement benefits. These transactions take place in what is called the labor market and are worth more than half the total value of all the final goods and services produced in the economy during a given year.2
The labor market is so important that the U.S. Congress made promoting maximum employment part of the Federal Reserve’s mandate, along with promoting stable prices and moderate long-term interest rates. Monitoring how the labor market is doing is important to fulfilling that mandate. However, it is also valuable for the Fed to understand how various characteristics of individuals affect their participation in the market.
For example, workers’ gender affects their experiences in the labor market. These include their decisions to participate in the market, the types of jobs they hold, their decisions to exit the market, and ultimately their earnings. The following sections discuss these aspects of men’s and women’s experiences in the labor market.
How Many Men and Women Participate in the Labor Market?
To answer that question, the U.S. Bureau of Labor Statistics (BLS) uses data collected through its monthly Current Population Survey (CPS). This survey is administered by the U.S. Census, and it involves interviewing about 60,000 people who either live alone or as part of a household.3 Survey respondents identify as either employed (holding a job) or unemployed (being out of work and actively looking for work). The sum of the employed and unemployed workers is called the labor force. Because the size of the labor force is related to the overall size of the population, it is helpful to calculate the labor force participation rate by dividing the number of people in the labor force by the number of people in the population. Multiplying that rate by 100 expresses the rate as a percentage.
Figure 1
Labor Force Participation Rates for Men and Women
SOURCE: U.S. BLS via FRED®, Federal Reserve Bank of St. Louis; https://fred.stlouisfed.org/graph/?g=Im2s, accessed October 20, 2021. Update from SeniorWomen.com : https://www.dol.gov/agencies/wb/data/widget: Labor Force Status of Women and Men, August 202
Figure 1 shows the different labor force participation rates for men (blue line) and women (red line) in the United States. A larger percentage of men than women participate in the labor force. Between 1960 and the late 1990s, the number of women in the labor force steadily increased, when more married women started to work outside the home. Factors that helped facilitate this change include delaying having children and using time-saving household technology, such as washing machines, vacuums, and dishwashers.4
Nonetheless, since 2000, the labor force participation rate for U.S. women has declined. Researchers have not identified a single reason for this decline, however. In other countries, such as Canada, the labor force participation rate for women continues to increase. More generous parental leave policies and tax incentives may play a role there.5
Do Economic Shocks Impact Working Women and Men Differently?
The labor market is affected by the expansions and contractions in economic activity known as business cycles. Figure 1 shows that the participation rates of both men and women decreased during the COVID-19-induced recession in 2020. At the time of this writing, those rates haven’t fully bounced back. During contractions, known as recessions, there is less activity in the labor market (less hiring and moving from job to job) and more workers become unemployed. Recessions, however, can affect the employment status of men and women differently.
Figure 2
Unemployment Rates for Women and Men
SOURCE: U.S. BLS via FRED®, Federal Reserve Bank of St. Louis; https://fred.stlouisfed.org/graph/?g=HvNK, accessed October 20, 2021.
Figure 2 shows the unemployment rate for men (blue line), for women (red line), and across genders (black line). The BLS reports the unemployment rate in the CPS survey by dividing the number of people unemployed by the number of people in the labor force. Because there are different numbers of men and women in the labor force, calculating a rate for each allows us to compare their unemployment experiences. Multiplying that rate by 100 expresses it as a percentage.
During the 2007-09 recession, men experienced higher unemployment rates than women because more jobs were lost in occupations and industries that traditionally employ more men: namely, goods-producing manufacturing and construction.6 (See the boxed insert for examples of jobs in each industry).
During the COVID-19-induced recession in 2020, women made up the majority of those who became unemployed and the majority of those who left the labor force. An unequal distribution of household responsibilities between men and women could explain this phenomenon. In fact, during the first few months of the pandemic, mothers decreased their work hours outside the home four to five times more than fathers did.7 And research shows that women living with children under the age of six left the labor force in larger proportions than women with older children, suggesting that regular, reliable, and available childcare plays an important role in supporting women’s continued participation in the labor force.8
However, recent research indicates that the unequal effects of the COVID-19 pandemic on the labor market experience of men and women were mostly temporary and that lingering differences are associated with age, race, ethnicity, and occupation.9 The type of jobs men and women tend to hold can either shelter them from or expose them to an economy-wide shock.
Ferida Wolff’s Backyard: Dandelion Landing
Dandelion Landing
It was a pleasant afternoon, sunny but not too hot. Just right for being out back on the patio reading a book.
But then something took my attention away from what I was reading, a puffy seed flipping over my legs. I reached out for it but it slipped off my palm and hurried off. Then I noticed other seeds frolicking over the lawn, all determined to be on their way.
I scooped one up as it was flying over me and brought it inside where I could examine it more closely. How delicate it was and yet I knew it wasn’t fragile. It was a dandelion seed that would plant itself with the others and they would overtake the lawn if allowed to land.
I heard of someone who was considering planting dandelion seeds instead of grass. No doubt it would be lovely to look out but not consistent with what is considered a proper lawn. Maybe it will start a fad and change our perspective about lawns.
After all, there are many positives to dandelions, including vitamins.
Check this out:
https://www.medicalnewstoday.com/articles/324083#what-is-dandelion
©2022 By Ferida Wolff for SeniorWomen.com
Editor’s note: White-flowered Japanese dandelion, https://en.wikipedia.org/wiki/Taraxacum_albidum
For more on the dandelion, we refer you to: https://fohn.net/dandelion-pictures/literature.html
Dandelion Literature Table of Contents:
GAO, Medicare Telehealth: Actions Needed to Strengthen Oversight and Help Providers Educate Patients on Privacy and Security Risks
GAO-22-104454,
Published:
To help patients access care during the pandemic, Medicare temporarily waived restrictions on telehealth — health care services delivered via phone or video. The use of telehealth services rose tenfold: 53 million telehealth visits in Apr.-Dec. 2020 vs. 5 million during the same period in 2019.
But Medicare hasn’t comprehensively assessed the quality of care patients received, and lacks data on telehealth services delivered in patients’ homes or via phone. Patients may also be unaware that their private health information could be overheard or inappropriately disclosed during their video appointment.
Our recommendations address these issues.
What GAO Found
In response to the COVID-19 pandemic, the Department of Health and Human Services (HHS) temporarily waived certain Medicare restrictions on telehealth—the delivery of some services via audio-only or video technology. Use of telehealth services increased from about 5 million services pre-waiver (April to December 2019) to more than 53 million services post-waiver (April to December 2020). Total utilization of all Medicare services declined by about 14 percent post-waiver due to a 25 percent drop in in-person service use. GAO also found that, post-waiver, telehealth services increased across all provider specialties, and 5 percent of providers delivered over 40 percent of services. Urban providers delivered a greater percentage of their services via telehealth compared to rural providers; office visits and psychotherapy were the most common services.
Telehealth and In-Person Utilization, by Month, April 2019 – December 2020
The Centers for Medicare & Medicaid Services (CMS) within HHS took actions to monitor some program integrity risks related to the telehealth waivers. However, CMS lacks complete data on the use of audio-only technology and telehealth visits furnished in beneficiaries’ homes. This is because there is no billing mechanism for providers to identify all instances of audio-only visits. Moreover, providers are not required to use available codes to identify visits furnished in beneficiaries’ homes. Complete data are important, as the quality of these services may not be equivalent to that of in-person services. Also, CMS has not comprehensively assessed the quality of telehealth services delivered under the waivers and has no plans to do so, which is inconsistent with CMS’ quality strategy. Without an assessment of the quality of telehealth services, CMS may not be able to fully ensure that services lead to improved health outcomes.
In March 2020, HHS’s Office for Civil Rights (OCR) announced that it would not impose penalties against providers for noncompliance with privacy and security requirements in connection with the good faith provision of telehealth during the COVID-19 public health emergency. OCR encouraged covered providers to notify patients of potential privacy and security risks. However, it did not advise providers of specific language to use or give direction to help them explain these risks to their patients. Providing such information to providers could help ensure that patients understand potential effects on their protected health information in light of the privacy and security risks associated with telehealth technology.
Why GAO Did This Study
By law, Medicare pays for telehealth services under limited circumstances—such as only in certain (mostly rural) geographic locations. The waivers and other flexibilities that HHS issued in March 2020 (including under its own regulatory authority) have allowed services to be safely delivered and received during the pandemic. There is stakeholder interest in making these changes permanent. GAO and others have noted that extending them may increase spending and pose new risks of fraud, waste, and abuse.
GAO was asked to review telehealth services under the waivers. This report describes, among other issues, (1) the utilization of telehealth services, (2) CMS efforts to identify and monitor risks posed by Medicare telehealth waivers, and (3) a change OCR made to its enforcement of regulations governing patients’ protected health information during the COVID-19 public health emergency.
GAO analyzed Medicare claims data from 2019 through 2020 (the most recently available data at the time); reviewed federal statutes, CMS documents (including its assessment of risks posed by telehealth waivers), and OCR guidance; and interviewed agency officials.
Recommendations
GAO is making three recommendations for CMS to strengthen its telehealth oversight, and one for OCR to provide additional direction to providers to explain privacy and security risks to patients. HHS neither agreed nor disagreed with the three CMS recommendations and concurred with the OCR recommendation.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Centers for Medicare & Medicaid Services | The Administrator of CMS should develop an additional billing modifier or clarify its guidance regarding billing of audio-only office visits to allow the agency to fully track these visits. (Recommendation 1) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Centers for Medicare & Medicaid Services | The Administrator of CMS should require providers to use available site of service codes to indicate when Medicare telehealth services are delivered to beneficiaries in their homes. (Recommendation 2) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Centers for Medicare & Medicaid Services | The Administrator of CMS should comprehensively assess the quality of Medicare services, including audio-only services, delivered using telehealth during the public health emergency. Such an assessment could include leveraging evidence from related efforts led by other HHS agencies. (Recommendation 3) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Office for Civil Rights for the Department of Education | OCR should provide additional education, outreach, or other assistance to providers to help them explain the privacy and security risks to patients in plain language when using video telehealth platforms to provide telehealth services. (Recommendation 4) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
Full Report