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Our Take: Hospitals to send COVID-19 data directly to HHS, sidelining CDC

Jul 20, 2020
Last Monday evening, the Department of Health and Human Services (HHS) sent a letter to governors across the country directing the nation’s hospitals to stop reporting certain categories of pandemic-related data to the Centers for Disease Control and Prevention (CDC) and instead, starting July 15, to use a new reporting mechanism developed by a private technology company called TeleTracking.

Hospitals that had been reporting the data to their state health department rather than the CDC were given the option to continue doing so — if they could obtain a written release confirming that the state would relay the data to the new data collection platform.

With only about 48 hours’ notice of the switch, hospitals scrambled to comply. Meanwhile, on Tuesday night, the CDC removed the COVID Data Tracker from its website, which provides real-time data to anyone who accesses the site. The agency also discontinued certain reports it had been providing regularly to states and other government agencies, according to The Washington Post.

News of the abrupt change, along with the disappearance of the CDC’s tracking information, led to widespread criticism from hospital associations, health system executives, public health experts, researchers and other scientists who rely on the data, politicians, former federal health authorities, state health officers, and even CDC employees.

Some of the critics said they believed that diverting the flow of data away from the public-facing CDC was politically motivated — i.e., an attempt by the White House to diminish the CDC’s role and/or conceal data showing the growing numbers of COVID cases, hospitalizations, and deaths.

Others expressed concern that hospitals were being forced to contend with a new reporting system (and, in many instances, new categories of reporting) at a time when health systems in several states are at or near capacity.

By Wednesday, CDC Director Robert Redfield and Michael Caputo, the assistant secretary for public affairs at HHS, were defending the change in reporting protocol.

Dr. Redfield said in a prepared statement that the new database, known as HHS Protect, would streamline the reporting process for hospitals, reduce confusion and duplication of reporting, and assist in the allocation of resources, such as personal protective equipment (PPE), testing supplies, ventilators, and treatments, including remdesivir.

He and Caputo also offered assurances that the CDC would continue to have access to the data.

“No one is taking access or data away from the CDC,” Dr. Redfield said.

“The CDC, an operating division of HHS, will certainly participate in this streamlined all-of-government response,” Caputo said. “They will simply no longer control it.”

By Thursday morning, the dashboard was back on the CDC’s website. That same day, the National Governors Association asked the administration to postpone the change in reporting requirements for 30 days, to give hospitals time to learn the new system.

Our Take:
For the better part of five months, hospitals have been reporting information daily to the CDC’s National Healthcare Safety Network (NHSN) regarding bed occupancy, availability of ventilators, and PPE supplies. The CDC has been using this system to gather and publicly report data on hospital infections for 15 years.

The NHSN was expanded at the outset of the pandemic to track vital COVID-19-related information, The Washington Post reported.

But Michael Caputo, the public affairs official at HHS, said only 85% of hospitals have been reporting and there’s a lag time of at least a week, according to The New York Times. An unnamed CDC official disagreed with Caputo’s numbers, telling the Times that only 60% of hospitals have been reporting, but that most data is collected and reported within two days.

For the sake of argument, let’s concede that the NHSN is less than ideal. Does that justify the administration’s decision to take control of the reporting — and the data — away from the CDC? Why not upgrade the NHSN and let the CDC — an agency that hospitals, health experts, the public, and the research community overwhelmingly trust — continue to be the responsible party?

Dr. Thomas File Jr., president of the Infectious Diseases Society of America, is among those who believe this is the appropriate course of action. In a statement on the organization’s website, he said the change “will undermine our nation’s public health experts.”

He added, “COVID-19 data collection and reporting must be done in a transparent and trustworthy manner and must not be politicized, as these data are the foundation that guide our response to the pandemic. Collecting and reporting public health data is a core function of the CDC, for which the agency has the necessary trained experts and infrastructure. Placing medical data collection outside of the leadership of public health experts could severely weaken the quality and availability of data, add an additional burden to already overwhelmed hospitals, and add a new challenge to the U.S. pandemic response.”

“The administration should provide funding to support data collection and should strengthen the role of CDC to collect and report COVID-19 data by race and ethnicity, hospital and ICU capacity, total number of tests and percent positive, hospitalizations, and deaths,” Dr. File said.

The process of removing the CDC as the federal COVID-19 reporting authority started several weeks ago during a conference call between hospital executives and Dr. Deborah Birx, the administration’s coronavirus response coordinator, according to the Times. She indicated on the call that hospitals were not sufficiently reporting their data and later convened a working group to devise a new plan.

It’s not clear to us precisely what advantages the new reporting system has over the NHSN. Both systems require hospitals to enter their data manually. The new system requires hospitals to input more information than the CDC required, which eventually could be a positive. But right now, as Dr. File noted, that would seem to increase hospitals’ reporting burden rather than easing it, as Dr. Redfield suggested.

Regardless, we were relieved to find that TeleTracking has a 16-year history with the federal government and has been awarded 29 contracts in that time; for the most part, the company has been managing the location and use of hospital beds for the Department of Veterans Affairs. But the $10.2 million, “sole source” contract for the new reporting system is “by far” the firm’s largest, the Pittsburgh Post-Gazette reported. It could be that expediency was the reason no other bids were sought. Still, if that were the case, wouldn’t it have been more expedient to build out the existing system?

It’s an understatement to say that we’re living in a hyper-political environment. In the larger picture, choosing one database over another for reporting public health data might seem relatively inconsequential, and if this had happened some other time, maybe no one would care. But these days, nearly anything can become a political football.

The Washington Post published an op-ed piece by four former heads of the CDC last Tuesday in which they said the “sound science” of the CDC’s experts “is being challenged with partisan potshots, sowing confusion and mistrust at a time when the American people need leadership, expertise, and clarity.”

We don’t know whether making HHS Protect the official COVID-19 database was a political maneuver or purely an attempt to improve the flow of information, but it’s clear from news reports that the White House and the CDC haven’t been in complete agreement lately.

It’s also clear that public health experts, state government officials, and researchers need access to reliable, real-time data they can use to track the course of the pandemic and make decisions about how and when to safely reopen schools and other public places.

What else you need to know

Moderna’s COVID-19 vaccine candidate induces a “robust” immune response, according to an interim analysis of data from a Phase I study that evaluated three dose levels, the company announced last Tuesday. Forty-five healthy adults received two doses of the vaccine 28 days apart. The results, published Tuesday in The New England Journal of Medicine, showed that — after the second vaccination — the study participants produced neutralizing antibody titers similar to those observed in convalescent sera from people who had recovered from COVID-19. More than half of the study participants experienced mostly mild or moderate adverse events; no serious adverse events were reported. A Phase II, placebo-controlled trial with 600 participants is underway, and Moderna anticipates that a Phase III trial with approximately 30,000 participants will begin later this month.

In the company’s press statement, Moderna said it “remains on track to be able to deliver approximately 500 million doses per year, and possibly up to 1 billion doses per year, beginning in 2021” in collaboration with Lonza. CEO Stephane Bancel said during a conference call that the company has already begun commercial production of the vaccine in preparation for quick shipment if it is approved, FiercePharma reported Wednesday. On Monday, before the trial results were published, Jefferies analysts wrote that they believe the vaccine could generate about $2 billion for Moderna next year if it is approved, and possibly $5 billion or more over the next few years, according to FiercePharma. Those estimates were based on a price of $50 per dose and 50 million people being vaccinated in 2021.

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Blue Cross Blue Shield of Massachusetts will offer a value-based payment model to a limited number of independent, privately owned primary care practices next year. Instead of traditional fee-for-service payments, practices participating in the pilot program will receive a “global” pool of money for patients, along with flexibility in how to use the funds, the insurer said in an article on its website. Practices that achieve targets for quality care with lower costs can earn incentive payments, whereas those that do not meet predetermined outcomes will earn less. The article noted that this type of value-based model was previously available only to practices that treat more than 10,000 Blue Cross members annually; the company has limited the amount of financial risk to make the model stable for smaller practices.

Amazon is opening Neighborhood Health Centers for employees near some of its fulfillment centers and operations facilities, the company announced Tuesday in a news release. Crossover Health will operate and staff the centers, which will be available only to Amazon employees and their families and will offer acute, chronic, and preventive primary care services, including behavioral health, physical therapy, and specialty referral services. In the pilot program, Amazon plans to open 20 centers in five cities. The first will be in the Dallas-Fort Worth area, followed “in months ahead” by centers in Phoenix, Louisville, Ky., Detroit, and San Bernardino/Moreno Valley, Calif. If the pilot is successful, Amazon said it may open centers in other cities. San Clemente, Calif.-based Crossover works with self-insured employers to offer primary care to their workforce. Instead of a fee-for-service payment arrangement, employers pay the company a fixed monthly fee for each employee.

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