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Some states, notably North and South Dakota, are doing better than others to promote nursing home vaccine uptake, and some facilities have taken matters into their own hands to achieve remarkable vaccination numbers. The low national rate, though, suggests that there are systemic challenges requiring policy changes.
The federal government can take the following four steps:
Allow pharmacists to bill Medicare for all vaccine administration in nursing homes. The end of the covid-19 public health emergency in May brought about an end to the waiver that enabled pharmacists to bill Medicare for all coronavirus vaccines administered in long-term care facilities. Now, the process is more complicated.
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Elizabeth Sobczyk, a project director with the Society for Post-Acute and Long-Term Care Medicine, known as AMDA, explained to me that pharmacists can now bill for coronavirus shots delivered during some periods of a resident’s nursing home stay but not others. The facilities themselves can bill for the latter periods, but “the administrative barriers to doing so are very high.” Simplifying the process would make vaccines more readily accessible.
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Enable single-dose vaccine orders for long-term care facilities. Now that vaccines are no longer free of charge, providers have to pay upfront and then seek reimbursement. This presents a new challenge in matching supply with demand to avoid wastage, according to David Gifford, chief medical officer at the American Health Care Association/National Center for Assisted Living.
I understand Gifford’s point. Coronavirus vaccines are currently delivered in multidose vials. Once opened, they need to be used quickly or be discarded. And they are expensive: “The cost of the covid-19 vaccine is about $130 per dose, which is significantly higher than the influenza vaccine, which is about $20 per dose,” Gifford said.
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Many nursing homes are already operating on tight budgets. They won’t want to open an entire vial to give a couple of vaccines, knowing they can’t recoup the significant cost of the unused doses. That could result in a resident waiting weeks for enough other residents to sign up for the shot — an unnecessary delay that would be alleviated with single-dose vials.
Encourage vaccinations before admission. “One of the challenges we face is that many new admissions have not yet received the vaccine from either their primary-care physician or the hospital,” Gifford said. “A common response nursing home staff hear when they recommend the vaccine to a new resident is that their doctor or hospital said they did not need it.”
Because, according to Gifford, about 85 percent of nursing home admissions come directly from a hospital, those hospitals need to emphasize vaccination before discharge. The federal government should launch a national educational campaign that also includes directing primary-care providers whose patients are entering nursing homes to ensure that shots are up to date before arrival.
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Incentivize nursing homes. A spokesperson from the Centers for Medicare and Medicaid Services, the federal agency that oversees long-term care facilities, told me that “CMS requires that nursing homes educate their residents and staff on the importance of the vaccine and to offer them covid-19 vaccines.” Facilities found not to be compliant are “cited for deficient practice and required to implement a plan of correction.”
I don’t think this goes far enough, given the critical importance of the vaccines to this highly susceptible population. “Educating residents and staff” can range from a posted sign and a cursory mention to in-depth conversations with each resident and their family. Similarly, an “offer” of vaccines is not the same as doggedly overcoming administrative barriers to bring shots directly to residents. Facilities that prioritize vaccination should be rewarded for their commitment and persistence.
The federal government can set the expectation that nursing home vaccinations are of great importance by publishing the names of facilities that meet a certain threshold and providing them a financial reward. Conversely, those that have poor rates could face penalties.
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Notably, there is one solution I did not mention, even though it proved to be effective in the past. Federal mandates for vaccinating nursing home residents and staff helped achieve the nearly 87 percent uptake of the primary vaccine series, and instituting the same requirement for boosters would dramatically increase rates now.
However, years of top-down requirements have taken a toll on Americans’ tolerance of covid-related government intervention, and, as Sobczyk said, “the appetite for mandates and further regulation in the nursing home setting is very low.” In the face of that reality, the government should consider these other practical policy measures that can boost protection as covid rates rise this winter.
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Only 33 percent of nursing home residents have received the updated coronavirus vaccine, according to data released last week by the Centers for Disease Control and Prevention. This dismal number is particularly concerning as covid-19 hospitalizations are rising around the country, putting this vulnerable group at risk for preventable tragedy.
Some states, notably North and South Dakota, are doing better than others to promote nursing home vaccine uptake, and some facilities have taken matters into their own hands to achieve remarkable vaccination numbers. The low national rate, though, suggests that there are systemic challenges requiring policy changes.
The federal government can take the following four steps:
Allow pharmacists to bill Medicare for all vaccine administration in nursing homes. The end of the covid-19 public health emergency in May brought about an end to the waiver that enabled pharmacists to bill Medicare for all coronavirus vaccines administered in long-term care facilities. Now, the process is more complicated.
Elizabeth Sobczyk, a project director with the Society for Post-Acute and Long-Term Care Medicine, known as AMDA, explained to me that pharmacists can now bill for coronavirus shots delivered during some periods of a resident’s nursing home stay but not others. The facilities themselves can bill for the latter periods, but “the administrative barriers to doing so are very high.” Simplifying the process would make vaccines more readily accessible.
Enable single-dose vaccine orders for long-term care facilities. Now that vaccines are no longer free of charge, providers have to pay upfront and then seek reimbursement. This presents a new challenge in matching supply with demand to avoid wastage, according to David Gifford, chief medical officer at the American Health Care Association/National Center for Assisted Living.
I understand Gifford’s point. Coronavirus vaccines are currently delivered in multidose vials. Once opened, they need to be used quickly or be discarded. And they are expensive: “The cost of the covid-19 vaccine is about $130 per dose, which is significantly higher than the influenza vaccine, which is about $20 per dose,” Gifford said.
Many nursing homes are already operating on tight budgets. They won’t want to open an entire vial to give a couple of vaccines, knowing they can’t recoup the significant cost of the unused doses. That could result in a resident waiting weeks for enough other residents to sign up for the shot — an unnecessary delay that would be alleviated with single-dose vials.
Encourage vaccinations before admission. “One of the challenges we face is that many new admissions have not yet received the vaccine from either their primary-care physician or the hospital,” Gifford said. “A common response nursing home staff hear when they recommend the vaccine to a new resident is that their doctor or hospital said they did not need it.”
Because, according to Gifford, about 85 percent of nursing home admissions come directly from a hospital, those hospitals need to emphasize vaccination before discharge. The federal government should launch a national educational campaign that also includes directing primary-care providers whose patients are entering nursing homes to ensure that shots are up to date before arrival.
Incentivize nursing homes. A spokesperson from the Centers for Medicare and Medicaid Services, the federal agency that oversees long-term care facilities, told me that “CMS requires that nursing homes educate their residents and staff on the importance of the vaccine and to offer them covid-19 vaccines.” Facilities found not to be compliant are “cited for deficient practice and required to implement a plan of correction.”
I don’t think this goes far enough, given the critical importance of the vaccines to this highly susceptible population. “Educating residents and staff” can range from a posted sign and a cursory mention to in-depth conversations with each resident and their family. Similarly, an “offer” of vaccines is not the same as doggedly overcoming administrative barriers to bring shots directly to residents. Facilities that prioritize vaccination should be rewarded for their commitment and persistence.
The federal government can set the expectation that nursing home vaccinations are of great importance by publishing the names of facilities that meet a certain threshold and providing them a financial reward. Conversely, those that have poor rates could face penalties.
Notably, there is one solution I did not mention, even though it proved to be effective in the past. Federal mandates for vaccinating nursing home residents and staff helped achieve the nearly 87 percent uptake of the primary vaccine series, and instituting the same requirement for boosters would dramatically increase rates now.
However, years of top-down requirements have taken a toll on Americans’ tolerance of covid-related government intervention, and, as Sobczyk said, “the appetite for mandates and further regulation in the nursing home setting is very low.” In the face of that reality, the government should consider these other practical policy measures that can boost protection as covid rates rise this winter.
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