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Following confusion, the White House has clearly defined which contraceptive methods are to be covered at no cost to patients. Additionally, are EHR prompts the answer to timely completion of HPV vaccines? How are very premature infants surviving?
In a FAQ issued on May 11, the Administration made clear that all 18 methods of contraception included in the Food and Drug Administration’s (FDA) Birth Control Guide must be covered without cost under the Affordable Care Act (ACA). Aimed squarely at insurers and group health plans that were denying coverage for some methods, the document was issued jointly by the Departments of Health and Human Services, Labor, and Treasury.
In its blog about the FAQ, Health Affairs cited reports from the Kaiser Family Foundation and the National Women’s Law Center, which found gaps in contraceptive coverage under the ACA. In at least 5 and as many as 15 states, numerous plans were not covering all forms of birth control and had no process for waivers for provision of contraceptives to patients with a medical need but who were not otherwise eligible to receive them.
Forms of birth control identified by the FDA and referenced in the FAQ include sterilization, implantable rods, intrauterine devices, oral contraceptives, patches, rings, the diaphragm, the sponge, cervical cap, female condom, spermicide, and emergency contraception. The document also makes clear that coverage “must also include the clinical services, including patient education and counseling, needed for provision of the contraceptive method.”
Plans and insurers can impose cost sharing for contraception to encourage use of certain methods and they must have an “easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or a provider.” If a provider recommends a particular type of birth control because of medical necessity, the plan or issue must cover that method without cost sharing. Coverage of some forms of contraception without cost sharing while excluding other forms entirely from coverage is not in compliance with the terms of ACA.
In its statement regarding the FAQ, the American College of Obstetricians and Gynecologists said the organization hopes the clarification “will help ensure that all FDA-approved methods of birth control are covered by insurance companies, as mandated by the Affordable Care Act, so that every woman is able to get the contraceptive that is right for her.” The Association of Reproductive Health Professionals called the guidance “an essential next step toward securing the right to quality reproductive health care for all.”
EHR prompts may increase HPV vaccination rates
Electronic reminders during a health care visit may be a key to getting patients-particularly those who are African American-to initiate and complete human papillomavirus (HPV) vaccinations, according to results of a new retrospective study.
More than 15,000 female patients aged 9 to 26 from five family medicine practices in the Midwest were included in the analysis by researchers at the University of Michigan. All had been seen by their doctor between March 1, 2007 and January 25, 2010 and received either a prompt about HPV vaccination from an electronic health record (EHR) during an appointment or no such prompt.
The patients in the prompted cohort (5,994) were younger on average (17.8 vs 18.5 years; P<.001) than those who were not prompted. The average age at initiation of vaccination was 17.3 years in the prompted cohort versus 18.1 in the unprompted cohort. A significantly larger portion of those prompted (34.9%) initiated the vaccine than those who were not prompted. African Americans aged 9 to 18 with ≥3 visits during the observation period in the prompted cohort were significantly more likely to start the vaccination series (P<.001). In addition, the prompted cohort was much more likely to finish the vaccine series in a timely fashion than those who didn’t receive a prompt.
The “reminder” to providers from the EHR consisted of “HPV” followed by the vaccine in the series that was needed. Providers were required to reply with one of the following options: done, ordered, patient declined patient not eligible, discussed, or not addressed. Patients received a note about “services your provider will recommend for you today.” Unprompted patients were seen in practices with EHRs but those tools had no systematic form of alerts.
The researchers concluded that sending prompts via EHR led to greater initiation of the HPV vaccine series and a higher likelihood of completing the series on the recommended schedule. They said that implementing prompts could help get HPV vaccination rates up to the rates that physicians would like to see.
Why are some very premature babies surviving?
According a new study funded by the National Institutes of Health, very premature babies born between 22 and 26 weeks’ gestation are surviving, in part, because of active treatment following delivery.
Researchers evaluated infants born between April 2006 and March 2011 at the 2 hospitals that comprise the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, collecting data on 4987 infants who were born before 27 weeks’ gestation and had no congenital abnormalities. For the purpose of the study, active treatment was defined as any potentially lifesaving intervention performed after delivery. Survival and neurodevelopment impairment at 18 and 22 months of corrected age were assessed in 4704 children (94.3%).
The rates of active treatment ranged from 22.1% (interquartile range [IQR], 7.7 to 100) for babies born at 22 weeks’ gestation to 99.8% (IQR, 100 to 100) among those born at 26 weeks’ gestation. Rates of survival and survival without a severe impairment were 5.1% (IQR, 0 to 10.6) and 3.4% (IQR, 0 to 6.9), respectively, among children born at 22 weeks’ gestation; among those born at 26 weeks, the rates were 81.4% (IQR, 78.2 to 84.0) and 75.6% (IQR, 69.5 to 80.0), respectively. The rate of active treatment accounted for 78% and 75% of the variation between hospitals for survival and survival without a severe impairment among infants born at 22 and 23 weeks; among those born at 24 weeks, it accounted for 22% and 16%. No variation in outcomes linked to administration of active treatment was seen in babies born at 25 and 26 weeks.
The investigators concluded that use of active treatment may explain somewhat why levels of survival and survival without severe impairment are higher for babies born at 22, 23, and 24 weeks in some hospitals than in others.