Gov. Andrew Cuomo, in addressing a potential budget gap, said across-the-board cuts of $550 million to Medicaid funds were needed in his budget proposal. The governor said the revision is necessary to support the state's spending plan for fiscal 2020, which starts April 1. The decision reverses his position in January: that the industry needed support to fend off federal cuts.
Because of the federal matching funds that support Medicaid, the health care industry is projecting the total impact to be $1.1 billion less than they expected after Cuomo's proposal last month.
Cuomo blamed the federal government's changes to the deductibility of state and local taxes for the state's budget gap, saying that the higher tax burden has caused some of the state's wealthy residents to relocate—or at least change their residence for tax purposes.
Cuomo released a three-prong plan to achieve the savings. The state is diverting funds it had earmarked for "health care transformation" toward housing programs, reducing "indigent care" funding, which supports hospitals that provide a large percentage of services to Medicaid and uninsured patients, and levying a 0.8% across-the-board cut to Medicaid payments.
The decision drew swift condemnation from the Greater New York Hospital Association and the state's largest health worker union, 1199SEIU, two of Cuomo's closest political allies.
"As we seek to balance this budget, it cannot be done on the backs of our most vulnerable communities, and the dedicated workers who provide exceptional care," said George Gresham, president of 1199SEIU.
"Many hospitals would curtail vital services—and some would close their doors for good," GNYHA President Kenneth Raske said in a statement. "Tens of thousands of health care workers would lose their jobs. We will take our message to the public that these cuts would spell disaster for health care in New York, and we will do so with every resource at our disposal."
The hospital group and union backed Cuomo's re-election and helped orchestrate political rallies the governor held in 2017 in support of the Affordable Care Act. The two groups, which combine their lobbying efforts through the Healthcare Education Project, cheered last year when Cuomo announced a 2% increase in Medicaid payments to hospitals and 1.5% for nursing homes that went into effect Nov. 1. That support has been eliminated as the state lowers the growth in Medicaid costs to 3%, down from 3.6% in the governor's proposal last month.
Cuomo also said he plans to reconvene the Medicaid Redesign Team, a group created in 2011 to rein in spending. It was made up of leaders from the health care industry and helped save $17.1 billion in a five-year period.
CLARIFICATION: This article has been updated to reflect that the $550 million in cuts are a downward vision from Gov. Andrew Cuomo's fiscal 2020 budget proposal presented in January 2019.
Hidden from view: The complexity of the system comes with costs that aren’t obvious but that we all pay.
By Austin Frakt
It takes only a glance at a hospital bill or at the myriad choices you may have for health care coverage to get a sense of the bewildering complexity of health care financing in the United States. That complexity doesn’t just exact a cognitive cost. It also comes with administrative costs that are largely hidden from view but that we all pay.
Because they’re not directly related to patient care, we rarely think about administrative costs. They’re high.
A widely cited study published in The New England Journal of Medicine used data from 1999 to estimate that about 30 percent of American health care expenditures were the result of administration, about twice what it is in Canada. If the figures hold today, they mean that out of the average of about $19,000 that U.S. workers and their employers pay for family coverage each year, $5,700 goes toward administrative costs.
Such costs aren’t all bad. Some are tied up in things we may want, such as creating a quality improvement program. Others are for things we may dislike — for example, figuring out which of our claims to accept or reject or sending us bills. Others are just necessary, like processing payments; hiring and managing doctors and other employees; or maintaining information systems.
That New England Journal of Medicine study is still the only one on administrative costs that encompasses the entire health system. Many other more recent studies examine important portions of it, however. The story remains the same: Like the overall cost of the U.S. health system, its administrative cost alone is No. 1 in the world.
Using data from 2010 and 2011, one study, published in Health Affairs, compared hospital administrative costs in the United States with those in seven other places: Canada, England, Scotland, Wales, France, Germany and the Netherlands.
At just over 25 percent of total spending on hospital care (or 1.4 percent of total United States economic output), American hospital administrative costs exceed those of all the other places. The Netherlands was second in hospital administrative costs: almost 20 percent of hospital spending and 0.8 percent of that country’s G.D.P.
At the low end were Canada and Scotland, which both spend about 12 percent of hospital expenditures on administration, or about half a percent of G.D.P.
Hospitals are not the only source of high administrative spending in the United States. Physician practices also devote a large proportion of revenue to administration. By one estimate, for every 10 physicians providing care, almost seven additional people are engaged in billing-related activities.
It is no surprise then that a majority of American doctors say that generating bills and collecting payments is a major problem. Canadian practices spend only 27 percent of what U.S. ones do on dealing with payers like Medicare or private insurers.
Another study in Health Affairs surveyed physicians and physician practice administrators about billing tasks. It found that doctors spend about three hours per week dealing with billing-related matters. For each doctor, a further 19 hours per week are spent by medical support workers. And 36 hours per week of administrators’ time is consumed in this way. Added together, this time costs an additional $68,000 per year per physician (in 2006). Because these are administrative costs, that’s above and beyond the cost associated with direct provision of medical care.
In JAMA, scholars from Harvard and Duke examined the billing-related costs in an academic medical center. Their study essentially followed bills through the system to see how much time different types of medical workers spent in generating and processing them.
At the low end, such activities accounted for only 3 percent of revenue for surgical procedures, perhaps because surgery is itself so expensive. At the high end, 25 percent of emergency department visit revenue went toward billing costs. Primary care visits were in the middle, with billing functions accounting for 15 percent of revenue, or about $100,000 per year per primary care provider.
“The extraordinary costs we see are not because of administrative slack or because health care leaders don’t try to economize,” said Kevin Schulman, a co-author of the study and a professor of medicine at Duke. “The high administrative costs are functions of the system’s complexity.”
Costs related to billing appear to be growing. A literature review by Elsa Pearson, a policy analyst with the Boston University School of Public Health, found that in 2009 they accounted for about 14 percent of total health expenditures. By 2012, the figure was closer to 17 percent.
One obvious source of complexity of the American health system is its multiplicity of payers. A typical hospital has to contend not just with several public health programs, like Medicare and Medicaid, but also with many private insurers, each with its own set of procedures and forms (whether electronic or paper) for billing and collecting payment. By one estimate, 80 percent of the billing-related costs in the United States are because of contending with this added complexity.
“One can have choice without costly complexity,” said Barak Richman, a co-author of the JAMA study and a professor of law at Duke. “Switzerland and Germany, for example, have lower administrative costs than the U.S. but exhibit a robust choice of health insurers.”
An additional source of costs for health care providers is chasing patients for their portion of bills, the part not covered by insurance. With deductibles and co-payments on the rise, more patients are facing cost sharing that they may not be able to pay, possibly leading to rising costs for providers, or the collection agencies they work with, in trying to get them to do so.
Using data from Athenahealth, the Harvard health economist Michael Chernew computed the proportion of doctors’ bills that were paid by patients. For relatively small bills, those under $75, over 90 percent were paid within a year. For larger ones, over $200, that rate fell to 67 percent.
“It’s a mistake to think that billing issues only reflect complex interactions between providers and insurers,” Mr. Chernew said. “As patients are required to pay more money out of pocket, providers devote more resources to collecting it.”
A distinguishing feature of the American health system is that it offers a lot of choice, including among health plans. Because insurers and public programs have not coordinated on a set of standards for pricing, billing and collection — whatever the benefits of choice — one of the consequences is high administrative burden. And that’s another reason for high American health care prices.
Austin Frakt is director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System; associate professor with Boston University’s School of Public Health; and adjunct associate professor with the Harvard T.H. Chan School of Public Health. He blogs at The Incidental Economist. @afrakt
Philadelphia, PA - January 24th, 2019 – vybe urgent care, the leading independent operator of
urgent care centers in greater Philadelphia, announces the opening today of its newest location
in the University City District of Philadelphia. This new center will be located in the heart of
West Philadelphia, nestled between the campuses of Drexel University and the University of
Pennsylvania and positioned amid the expanding commercial and residential development in
The center is located at 3550 Market St. and will be open from 8:00 a.m. to 8:00 p.m. Monday
through Friday and from 8:00 a.m. to 5:00 p.m. on the weekends.
The announcement marks another milestone in vybe’s expansion, as this location joins the
company’s current network of urgent care centers in Center City, South Philadelphia, Port
Richmond, Roxborough, Havertown and Ridley.
“We believe that everyone deserves great care – especially when they’re sick or injured,
nervous, and perhaps anxious about the cost of their treatment. vybe’s focus is easing those
concerns through everything we do, and we are pleased to expand our innovative model to
University City” said vybe urgent care President Peter Hotz. “We believe the diversity of West
Philadelphia is one of its greatest strengths, and we look forward to serving the diverse
healthcare needs of this community.”
While consumers typically rely upon urgent care centers for accessible, affordable, and
immediate healthcare service, vybe is committed to creating a truly patient-focused
atmosphere that eases the stress that comes with an illness or injury. vybe urgent care
provides patients with efficient walk-in, extended-hour medical attention with evening and
weekend hours. vybe is fully accredited by the Urgent Care Association (UCA), which is the
highest level of distinction for urgent care centers and ensures high levels of patient safety and
vybe urgent care operates the leading independent network of walk-in urgent care centers in
the greater Philadelphia region, with a focus on high-quality medical care and unparalleled
patient service. The Company’s vision is that everyone deserves great care, which is driving
development across the region and a unique focus on patient experience. Urgent care is rapidly
becoming the new way to be seen for many healthcare consumers. vybe provides a broad
range of injury and illness treatments, physical exams, and occupational health and workers’
compensation treatments. For more information, visit www.vybe.care.
By Sharon Otterman
Jan. 17, 2019
Through the fall, traveler after traveler arrived in the ultra-Orthodox Jewish communities of New York from areas of Israel and Europe where measles was spreading. They then spent time in homes, schools and shops in communities where too many people were unvaccinated.
Within months, New York State was facing its most severe outbreak of the disease in decades, with 177 cases confirmed by Tuesday, almost exclusively among ultra-Orthodox Jews. Health officials in New Jersey have reported 33 measles cases, mostly in Ocean County, driven by similar conditions.
In 2018, New York and New Jersey accounted for more than half the measles cases in the country.
Alarmed, health officials began a systematic effort to bring up vaccination rates and halt the disease’s spread.
But while there has been progress, the outbreak is not yet over. Health officials said part of the problem has been resistance among some people in ultra-Orthodox neighborhoods to fully cooperate with health workers, get vaccinations and promptly report infections.
“Sometimes they hang up and they don’t want to open the door,” said Dr. Patricia Schnabel Ruppert, the health commissioner of Rockland County, northwest of New York City, where the worst of the outbreak has been, with 114 confirmed cases. “It’s hard to break an outbreak if you are not getting cooperation.”
Dr. Ruppert said that health officials discovered that some religious schools, or yeshivas, in ultra-Orthodox communities in Rockland County had vaccination rates as low as 60 percent, far below the state average of 92.5 percent. Audits found that some schools were overreporting vaccination rates, she added.
Delayed vaccination also helped fuel the outbreak in the Orthodox communities of Williamsburg and Borough Park in Brooklyn, which had reported 55 cases as of last week, said Dr. Jane R. Zucker, head of the city health department’s Bureau of Immunization.
There have been no deaths in the outbreak, but there have been a few serious cases in young children that required hospitalization.
Measles is one of the most contagious infections and can live for up to two hours in the airspace where an infected person breathed, coughed or sneezed. It usually affects children, and symptoms include high fever and a rash of red spots all over the body, as well as a cough and runny nose. Some 90 percent of unvaccinated people exposed in proximity to an infected person will get it.
But the vaccine, when given in two doses — typically around age 1 and age 5 — is about 97 percent effective.
Health officials and sociologists say the reasons for low vaccination rates among the ultra-Orthodox are complex.
In part they are tied to the wider anti-vaccination movement globally, including concerns that the measles vaccine, which also protects against mumps and rubella, causes autism or other diseases. The idea has been widely debunked but persists in some circles.
Rabbi Yakov Horowitz, founder of Darchei Noam yeshiva in Monsey in Rockland County, said that some parents considering admission to his school agonized over giving their children vaccines because they had heard they were dangerous. His yeshiva insisted on them, he said, though he knew of others that did not.
“Good people, great parents were terrified,” he said. “They felt that I was asking to give their children something that would harm them.”
There have been more than 200 measles cases in New York and New Jersey in recent months, accounting for half of the cases in the country.CreditSchneyder Mendoza/Agence France-Presse — Getty Images
Alexandra Khorover, general counsel for Refuah Health Center, one of the largest health providers in the Rockland community of Spring Valley, said her health workers had encountered “a small pocket of people who are anti-vaccine who have been peddling this information, fostering confusion and fear.”
Part of the reluctance to vaccinate or allow a government health worker to enter the home, though, is cultural.
Samuel Heilman, a Queens College sociology professor who studies the ultra-Orthodox, said that there is a “fear of interference from the outside” rooted in the community’s origins in pre-World War II Europe. More recently, the ultra-Orthodox have fought back against other health department efforts, such as New York City’s efforts to limit a controversial circumcision practice, metzitzah b’peh, because of warnings from health officials that it causes herpes in infants.
“They have accepted the idea that they live by different rules than others in the outside community,” Mr. Heilman said.
While this insularity allowed the measles to spread, it has also had a protective effect on wider public health, at least so far. In part because ultra-Orthodox Jews tend to attend their own religious schools and patronize their own shops and restaurants, the disease has remained in Orthodox circles, save for several infections among non-Jewish workers linked to their communities, health officials said.
The outbreak in New York and New Jersey can be traced to the rise of measles in Israel, where some 2,700 cases and two deaths were reported in 2018, centered in Jerusalem.
In Europe, which was the source of at least some of the Brooklyn infections, some 65,000 cases were reported in the year ending October 2018, with high concentrations in Balkan countries and Ukraine.
A flier distributed in ultra-Orthodox Jewish communities by the New York City Health Department.
A flier distributed in ultra-Orthodox Jewish communities by the New York City Health Department.CreditNew York City Department of Health & Mental Hygiene
As measles spread in New York, public health officials swung into action. Some 40,000 fliers were printed in English, Yiddish, Spanish and other languages warning of the Israeli outbreak and calling for people to be vaccinated. Health officials met with rabbis and pediatricians, who sounded the alarm to their congregations and patients.
“We are telling people the health department is looking out for your health,” said Rabbi David Niederman, a community leader and executive director of the United Jewish Organizations of Williamsburg. “They are the experts and you should take the vaccinations.”
In Rockland County, which includes the large ultra-Orthodox community of New Square, the authorities put 59 schools under “exclusion orders,” forbidding unvaccinated children to attend even if they had a valid religious or medical exemption to the vaccine. The orders are lifted when a school’s vaccination rate reaches 95 percent, which state authorities consider protective of public health. Eighteen schools have had the orders lifted, officials said.
In Brooklyn, some children have been out of school for months because of similar exclusion orders by health officials, said Rabbi David Zwiebel, the executive director of Agudath Israel, an ultra-Orthodox umbrella organization. Tensions are high, with some parents still refusing to vaccinate because of health fears, and others relenting.
“There has been some harsh language exchanged on both sides,” Rabbi Zwiebel said.
The information campaign has had an impact. In Rockland County alone, more than 13,000 vaccines have been given since October.
While the rate of infection has slowed regionwide, Rockland has recorded an uptick — 18 new cases in January, after a drop in December.
Dr. Ruppert advised caution for all residents of Rockland County, particularly for parents of young infants and others who are not immunized, because just about everyone in the county shops at the same malls and box stores.
“Rockland is a small county, and I consider everyone potentially exposed,” she said.
In New York City, health officials sounded a hopeful note: No new cases in Brooklyn have been confirmed since Jan. 8. Orange County cases have crept up in recent weeks to eight.
“I’m sort of holding my breath,” Dr. Zucker said. “I think we have promising news, but I don’t want to be optimistic too soon.”
Liz Robbins contributed reporting.
“This could become a truly major epidemic,” said one pediatrician.
By Maggie Fox
At Clarkstown Pediatrics in Nanuet, New York, babies are on an accelerated measles vaccination schedule, getting their first shots six months early and their second dose right away.
It’s part of a statewide effort to stop several outbreaks of measles from turning into an epidemic. The state has had 170 cases of the highly infectious virus since September, making it the worst year for measles since the 1990s.
Pockets of unvaccinated children have provided fertile ground for the measles virus to take hold. Although measles was eliminated in the U.S. the virus has been brought back by travelers to Israel, which has been battling an epidemic of measles for months. The victims: mostly members of close-knit Orthodox Jewish communities across the state.
“It’s a clear and present danger right here in our community,” said Dr. Douglas Puder, a pediatrician at Clarkstown Pediatrics. His practice is right in the middle of the biggest outbreak, in New York’s Rockland County. As of Jan. 10, county reported 108 cases of measles since the fall. More than 80 percent on average had not been vaccinated and just three cases had received both recommended doses of measles vaccine.
Europe's measles outbreak sparks concern over what could happen in U.S.
Local, state and federal health officials are battling to fight the outbreaks, which they believe have been fueled by a combination of anti-vaccine propaganda, lax enforcement of school requirements to vaccinate, and a growing trend among some families to turn away from standard medical care. As a result, some private schools in the county reported vaccination rates had fallen to as low as 50 percent. It takes a vaccination rate of 95 percent or higher to prevent outbreaks of disease.
Thus, the full-court press to get children vaccinated. “We have made an incredibly aggressive effort to address this,” said New York state health commissioner Dr. Howard Zucker. “This has been the worst measles outbreak in recent history in New York state.”
More than 13,000 people, mostly young children, have been vaccinated over the past three months at state and county clinics. More than 40,000 educational flyers have been distributed to homes in the hardest-hit communities, and more than two dozen schools and daycare centers closed because of low vaccination rates. Unvaccinated children have been required to stay home for their own protection until they get the shots.
“To date there are more than 30 schools, daycares, and nursery schools in Rockland county that have been required to enact exclusion policies to help stop the spread of measles as permitted by New York State Public Health Law,” the county says on its website.
And individual clinics are making their own efforts.
“We have brought in every child six months and older to give them an MMR (measles, mumps and rubella vaccine),” Puder told NBC News.
A child usually receives the first MMR vaccine at the age of one year, and a second dose by age four. But to protect local kids in the face of a spreading, highly contagious virus, the schedule has been accelerated. “We have been bringing the one-year-olds back at 13 months to get a second dose,” Puder said. “It’s up to us to keep this from spreading. This could become a truly major epidemic.”
It took years for the pile of dry tinder to build. Three things have to happen to before a measles outbreak can take hold in the U.S., where homegrown measles has been eliminated: A population must have substantial numbers of unvaccinated or under-vaccinated people; some of those unvaccinated people must travel to an area where measles is spreading and then must themselves get infected and bring it back.
Health officials have struggled to get a handle on how this happened. Statewide, New York has good vaccination rates. More than 92 percent of children in New York have received at least one dose of the MMR vaccine, according to the Centers for Disease Control and Prevention.
But New York is one of 47 states that still allow parents to refuse to vaccinate their children for religious reasons, and confusion over that may have led some parents to opt out, Zucker said. That’s even though no organized religious group forbids its member to vaccinate children, and Jewish law specifically instructs followers to protect their own health as well as the health of their children and community.
“I have been out to the community many times now and met with the rabbis there,” Zucker said. He said religious leaders have been puzzled by some of the vaccine skepticism and are advising their congregations to vaccinate.
One issue: Private schools don’t necessarily follow state guidelines for vaccinating students as a prerequisite for enrollment, and Rockland County has a large number of private schools, said John Lyon, a spokesman for the county.
“People usually wait until the school or the doctor makes them get vaccinated,” Lyon said. “In many cases, it seems like they didn’t have to do it so they chose not to do it.” Enforcing school vaccination requirements appears to have helped encourage more vaccinations, Lyon said.
“There is also a strong movement by the anti-vaccination community to get into this community,” Zucker said. Some groups have complained that they were targeted for years by an anti-vaccine group called PEACH, or Parents Teaching and Advocating for Children’s Health — including with pamphlets and robo-calls.
Measles is extremely infectious. An unvaccinated person has a 90 percent chance of becoming ill if exposed to the virus and the virus itself is unusually transmissible. It can hang in the air and infect people even hours after an infectious person has left a room.
Puder said parents are often vague about their fears. “Parents will say things ‘like so many vaccines’ or ‘my child is too small to get so many vaccines’,” he said. “When the fear is not put into words ... it’s hard to respond.”
Many of the cases are among people who have skipped regular medical visits, Puder said. “I know in our group, it’s the kids you don’t see that don’t get vaccinated,” he said. "It's the group that is interested in alternative medicine."
And some pediatricians have enabled the vaccine-shy. “There are a few pediatricians who are more tolerant of vaccine-refusing parents,” he said. “I know who they are and I am not going to say their names.”
Although some people consider measles a benign childhood illness, it can kill. Measles causes encephalitis and pneumonia and before mass vaccination began in the 1980s, measles killed nearly 2.6 million people a year, according to the World Health Organization. It still kills more than 100,000 people a year, mostly children under five.
So every time a case is identified, public health workers must track down everyone else that patient was in contact with over the preceding days and weeks and check to make sure they do not become infected. “Whenever you get a confirmed case of measles, you have to interview the person and find out everywhere they have been and every person they met during the communicable period,” Lyon said.
But efforts are slowly working.
“It’s a clear and present danger right here in our community."
“I think we are on top of the outbreaks. The issue is to get all these kids vaccinated and to get a very strong campaign to raise public awareness,” Zucker said.
According to the CDC, 2018 was not worst recent year on record for measles in the U.S. As of Dec. 1, 292 cases were reported nationwide. In 2014, 667 cases were reported, fueled in large part by an outbreak traced to travelers returning from the Philippines and linked to Disneyland, as well as unvaccinated Amish communities in Ohio.
And anti-vaccine propagandists helped set the stage for an outbreak of measles among Somali immigrants in Minnesota in 2017.
CityMD, the fast-growing urgent care chain, has reached a contract to remain in the network of UnitedHealthcare, the country's largest health insurer, just before the companies' agreement was set to expire at the end of the year, CityMD said.
If a deal had not been reached, members of United and its subsidiary Oxford Health Plans, would have faced higher charges when seeking care at one of CityMD's locations. A letter dated Nov. 26 warned members that they might need to seek out other providers.
"Utilizing an out-of-network provider may result in higher costs for you," United wrote.
CityMD has more than 120 locations in New York, New Jersey and Washington. In Manhattan, the urgent-care chain dots the map like subway stops, with 22 clinics. Private-equity firm Warburg Pincus acquired a majority stake in CityMD for an undisclosed price in 2017.
Crain's New York
By News Desk on December 29, 2018
A New York resident sickened with Brucellosis by raw milk from Pennsylvania has state agricultural officials warning residents in a three-state region about the threat. Importing unpasteurized, raw milk from state to state is a violation of federal law.
The New Yorker has an RB51 infection, from a strain of the Brucella abortus bacteria, that has been traced to Miller’s Biodiversity Farm in Quarryville, PA. The farm is now under quarantine.
New York, New Jersey, and Pennsylvania consumers were warned not drink raw milk or consume other dairy products from the Miller’s dairy.
Anyone with raw milk or other dairy products from Miller’s is urged to discard them and contact their healthcare provider to discuss preventive treatment, according to the New York Department of Health.
“The New Jersey Department of Agriculture is working with surrounding states to determine the extent to which raw milk from the farm in question has been received by New Jersey residents and consumers at the New Jersey locations listed on the farm’s website,” said New Jersey Secretary of Agriculture Douglas Fisher.
Miller’s Biodiversity Farm lists several “group pickup locations” for its raw milk products. Those locations can be found here. The website shows raw milk priced at more than $15 per gallon.
The Pennsylvania dairy farm claims to be a “private buying club,” or membership organization, providing food from local farms to members who must pay a fee to become eligible to make purchases.
The New York resident with the bacterial infection is being treated and, according to the New York Department of Agriculture, is recovering. Brucellosis can cause fever, sweats, chills, weight loss, headache, fatigue and muscle and joint pain and symptoms may appear up to six months after exposure.
More severe cases include infections of the bones, central nervous system and reproductive organs and fetal loss in pregnant women.
The New York resident infected by drinking raw milk is the third Brucellosis case confirmed in the U.S. in the past two years, with the other incidents occurring in 2017 in New Jersey and Texas. Those patients had also consumed raw milk before becoming ill.
Epidemiologists from the federal Centers for Disease Control and Prevention and state health officials across the country, including those in Pennsylvania, say the only way to avoid Brucella exposure via milk is to drink pasteurized milk. In 2017 the CDC reported people in at least seven states were sick with brucellosis symptoms after drinking raw milk. At least one person in Texas and another in New Jersey were confirmed with infections linked to raw milk.
(To sign up for a free subscription to Food Safety News, click here.)
With flu season starting to peak, doctors on Long Island and across New York State are encouraging anyone still unvaccinated to roll up their sleeves for a shot.
Since the season started in October, 3,283 laboratory-confirmed cases of the flu have been reported statewide to the State Department of Health. One child died of the illness, and 923 people of all ages have been hospitalized, according to numbers compiled by the state from physicians and hospitals. The peak flu period runs from this month into February.
The majority of the cases, reported from New York City, have been caused by the dominant A-strain of influenza, called A/Singapore H3N2, which is one strain the flu shot protects against, according to the Centers for Disease Control and Prevention.
"It's not too late to get vaccinated," Dr. Susan Donelan, medical director of health care epidemiology and assistant professor of infectious diseases at Stony Brook University's Renaissance School of Medicine, wrote in an email.
Mary Ellen Laurain, a spokeswoman for the Nassau County Department of Health, urged residents 6 months of age and older to get their flu shot.
Donelan also advised anyone who isn’t feeling well to be mindful about possibly exposing others.
"Stay home if you are sick, regardless of whether you ‘think’ you may or may not have the flu," Donelan added in the email. "There are a number of viruses out there circulating and any one of these may make someone else sick enough to be hospitalized, even if you are only mildly ill."
Dr. Bruce Farber, chief of infectious diseases for the Northwell Health system, also stressed the importance of getting the vaccine, which if it doesn't completely prevent the illness, will modify its severity. The vaccine protects against four strains of influenza.
"I think the mistake many people make is that they think that if they get the flu after getting a flu shot that it was a failure," Farber said. "But many times, although it didn't prevent it, it made the flu less severe and can prevent hospitalization or complications."
Health officials underscore that state figures are lower than the actual number of flu cases because most people do not seek medical attention.
Other seasonal respiratory viruses in circulation include respiratory syncytial virus — RSV — coronavirus, rhinovirus, enterovirus, human meta-pneumovirus and parainfluenza virus, which despite its name, does not cause the flu.
The flu remains an ongoing health concern not only because of its contagiousness, but also because of its capacity to morph into pneumonia, which can be deadly.
Unvaccinated health care workers must wear "surgical" or "procedure" masks in the presence of patients, according to a state law in effect since the 2013-14 flu season.
“Health care personnel are routinely exposed to sick patients and are also in close contact with vulnerable patients,” State Health Commissioner Dr. Howard Zucker said in a statement. “The requirement that unvaccinated health care personnel wear a mask when patients are nearby protects both our critical health care workforce and at-risk New Yorkers."
An estimated 80,000 people died nationwide during the 2017-18 flu season, a total that included 200 children, according to the CDC. It was the highest flu-death toll in 40 years.
The high number of deaths arrived in the 100th anniversary year of the 1918 flu, the worst flu season in human history. An estimated 675,000 people died in the United States and 50 million worldwide. Within months, the pandemic killed more people than any other infectious illness in recorded history.
Simple measures can help limit influenza's spread.
"Cover your coughs and sneezes," Donelan said, "and perform hand-hygiene with either soap and water or alcohol-based hand rubs after blowing your nose. Avoid touching mucous membranes such as your eyes, nose and mouth."
Importance of vaccinations
SOURCE: State Health Department/Centers for Disease Control and Prevention
How to limit spread of influenza
SOURCE: Dr. Susan Donelan, Stony Brook University Renaissance School of Medicine
ALBANY — Influenza is officially prevalent in New York, with 1,230 cases confirmed statewide as of Saturday.
State Health Commissioner Howard Zucker announced the news Thursday, triggering a regulation to go into effect that requires all unvaccinated health care workers to wear surgical masks in areas where patients are typically present. Influenza and its complications have led to 923 hospitalizations across the state so far, and one child's death.
"The importance of getting vaccinated against influenza to protect yourself, as well as your family and friends, cannot be overstated," Zucker said. "Healthcare personnel are routinely exposed to sick patients and are also in close contact with vulnerable patients. The requirement...protects both our critical healthcare workforce and at-risk New Yorkers. I encourage all New Yorkers older than six months to get their influenza vaccine as soon as possible."
Flu season occurs primarily from October through May, often peaking in February.
The number of cases confirmed at labs in New York so far this season outpaces cases from the same time last year, when there were 891 cases confirmed as of Dec. 15. Last year's season, which was unusually vicious, peaked at 18,258 cases statewide as of Feb. 17. For comparison, previous seasons in New York peaked at 6,076 cases as of Feb. 11, 2017 and 6,422 cases as of March 12, 2016.
It was one of the deadliest in four decades. More than 80,000 Americans died of flu in the 2017-18 season, the Centers for Disease Control and Prevention said.
Saratoga County appears the hardest hit of all upstate counties this season with 28 cases confirmed. The Capital Region as a whole has had 77 cases confirmed.
New Yorkers can see just how prevalent the flu is near them using a new flu tracking platform published on the NYS Health Connector website. It includes a breakdown of confirmed cases by county, week and year dating back to 2015-16, making year-over-year comparisons possible.
It also shows which type of flu is prevalent (A, B or unspecified). So far this year, 1,140 of the 1,230 confirmed cases around New York are Type A.
State health officials are reminding New Yorkers that it's not too late to get vaccinated, noting that there's plenty of vaccine still available. While the vaccine is not always effective at preventing flu, studies have shown it can lessen the symptoms and duration of the illness.
By Bethany Bump
The state Department of Financial Services approved CVS Health's $69 billion acquisition of insurer Aetna on Monday morning, lifting the final barrier to the deal's closure.
Aetna said in a Securities and Exchange Commission filing the companies expect the deal to close on Wednesday.
The U.S. Department of Justice approved the purchase in October and the companies have already received all other necessary approvals from other states. Bloomberg News reported that 28 states, including New York, weighed in on the combination of the nation's largest drugstore chain and one of the nation's largest health insurers.
DFS said it received commitments that the costs of CVS' acquisition will not be passed on to Aetna customers in New York in the form of higher premiums. CVS also agreed to provide $40 million to the state to support health insurance education and enrollment, including payments to the state's Health Care Transformation Fund. That fund has been used previously by the Cuomo administration to support struggling hospitals.
"DFS listened to the concerns of the public and has obtained significant commitments from CVS and Aetna to address those concerns, ensuring that the companies hold to their promises of reduced costs and improved health care for New Yorkers," DFS Superintendent Maria Vullo said in a statement.
The department held a public hearing on Oct. 18 with local trade groups representing pharmacists and physicians who opposed the transaction. CVS Caremark is one of the three biggest pharmacy benefit managers, which negotiate drug prices on behalf of insurers, employers and union benefit funds. Opponents said the deal would limit competition.
CVS and Aetna have said their combination will lead to lower costs for consumers and greater access to care through a network of health clinics at CVS stores. The chain and its subsidiaries own 573 pharmacies in the state. Aetna received about $3.5 billion in premiums from New York customers last year, according to DFS.
To win approval from New York, CVS also agreed not to offer any preferential pricing to Aetna-affiliated insurers in the state and to continue to include non-chain pharmacies in its local networks for at least three years.
The health plan will maintain its current set of insurance products for three years, add an additional product in the small- or large-group market and document the "synergies" it said it would create by combining with CVS.
The Cuomo administration has previously supported legislation that would require that pharmacy benefit managers, including CVS Caremark, are licensed and regulated by the Department of Financial Services. A previous bill was not ultimately approved by the state Legislature but DFS said Monday that CVS Health has agreed to "take no action to oppose such future legislation."
Dr. Thomas Madejski, president of the Medical Society of the State of New York, said he supported the Cuomo administration’s push for legislation to more closely monitor pharmacy benefit managers. He said the "enormous power" of the combined company would marginalize physicians.
"Physicians fully expect that the merger will further reduce competition in New York’s health insurance market," he said in a statement. "This is one more reason why physicians deserve the right to collectively."
JONATHAN LAMANTIA CRAIN'S NEW YORK BUSINESS
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