Read today’s Kaiser Health News
In other news:
FDA’s new expert panels are rife with financial conflicts and fringe views: When the Food and Drug Administration needs outside guidance, it normally turns to a trusted source: a large roster of expert advisers who are carefully vetted for their independence, credentials and judgment. But increasingly, the agency isn’t calling them.
Instead, FDA Commissioner Marty Makary has launched a series of ad hoc “expert panels” to discuss antidepressants, menopause drugs and other topics with physicians and researchers who often have contrarian views and financial interests in the subjects.
Surgical Outcomes and Medicare Advantage Payer-Hospital Integration:
Question Is hospital-owned Medicare Advantage plan coverage associated with improved postsurgical outcomes?
Findings In this cross-sectional study of 560 499 surgical admissions, fully integrated admissions had significantly lower rates of any complications, serious complications, and any ICU use and shorter length of stay, with no difference in any complication or readmission rate between fully and partially integrated admissions.
Meaning These findings suggest aligning care through payer-hospital integration is associated with better postsurgical outcomes.
About health insurance/insurers
Trump administration bans gender-affirming care coverage under federal health plans: The U.S. Office of Personnel Management will end coverage of gender transition-related surgeries and hormone treatments under the Federal Employees Health Benefits and Postal Service Health Benefits programs, beginning in 2026.
In an Aug. 15 letter to carriers, OPM said medical interventions for the chemical and surgical modification of sex traits, including gender transition services, will be excluded from coverage regardless of age.
Counseling services for possible or diagnosed gender dysphoria will remain covered when provided by licensed mental health professionals. Health plans must create an exceptions process for enrollees who are mid-treatment with surgical or hormonal regimens.
Judge rules against Medicare Advantage broker pay restrictions: A federal judge in Texas has struck down portions of a rule governing Medicare Advantage broker and marketing payments, siding with agent groups that challenged the regulation put into place last year.
On Aug. 18, U.S. District Judge Reed O’Connor vacated provisions of a CMS rule that had capped administrative payments at $100 and restricted certain contract terms between MA plans and third-party marketing organizations.
Medicare Advantage Plan Spending and Payments Under the Hospice Carve-Out:
Question Do Medicare Advantage (MA) plans receive excess payments for beneficiaries enrolled in hospice under the hospice carve-out model?
Findings In this cross-sectional study, with 314 087 MA enrollees, MA plan payments exceeded plan spending for most beneficiaries following hospice election from 2017 to 2019, equating to an estimated $23 million to $58 million in excess payments to MA plans per year.
Meaning In this study, MA plans continued to receive high premiums and rebate payments for beneficiaries enrolled in hospice despite low MA health care spending following hospice election.
CMS Announces Plan to Disenroll Noncitizens From Medicaid and CHIP: The Trump administration announced a new initiative Tuesday aimed at getting noncitizens disenrolled from the Medicaid program and the Children's Health Insurance Program (CHIP).
"CMS will begin providing states with monthly enrollment reports identifying individuals whose citizenship or immigration status could not be confirmed through federal databases," the agency said in a press release . "States are responsible for reviewing cases, verifying the citizenship or immigration status of identified individuals, requesting additional documentation if needed, and taking appropriate actions when necessary, including adjusting coverage or enforcing noncitizen eligibility rules."
About hospitals and healthcare systems
28 statistics on hospital financials by state: Moody’s: Hospitals nationwide are showing signs of stronger financial footing, though the pace of recovery varies by region, according to a report from Moody’s.
Rising revenues and moderating expenses are contributing to healthier margins, while liquidity and leverage trends highlight both opportunities and ongoing pressures. At the same time, reliance on government payers continues to shape hospital financial strategies, underscoring the complex environment leaders are navigating in 2024.
About pharma
VantAI, Halda ink $1B AI-powered discovery deal for next-gen TACs: Continuing its streak of signing discovery deals focused on hijacking protein interactions for therapeutic benefits, VantAI on Tuesday linked up with Halda Therapeutics to develop compounds classified as "proximity-based therapies" for both oncology and immunology.
Under the research collaboration, VantAI is eligible for over $1 billion across an upfront payment, research support, and development and commercial milestones, plus tiered royalties.
Generic-Drug Makers To Pay $71M To End Price-Fixing Claims: Glenmark Pharmaceuticals Inc. USA has offered to pay approximately $38 million, and Pfizer Inc. and its generic-drug unit Greenstone LLC have promised to pay roughly $33 million, to settle price-fixing claims by the direct purchasers of generic drugs.
About healthcare IT
The Effect of Misinformation and Disinformation on Physicians’ Ability to Provide Quality Care: Misinformation: false or inaccurate information. Disinformation: false or inaccurate information deliberately intended to mislead.
More than 6 in 10 (61%) physicians reported their patients were influenced by misinformation and/or disinformation at least a moderate amount over the past year.
Rural physicians appear to experience a higher frequency of patients influenced by misinformation and/or disinformation.
About healthcare personnel
The next ‘major workforce crisis’ systems are tackling: Health systems are taking on what one leader has called the “next major workforce crisis”: a shortage of nurse educators.
In 2024, U.S. nursing schools turned away 80,162 qualified applications. Within that total, 65,398 applications from entry-level baccalaureate were turned away, 1,530 from RN-to-BSN, 7,603 from master’s, 5,366 from DNP and 265 from PhD nursing programs
About health technology
FDA approves first-ever glucose monitoring system for weight loss from Signos: KEY POINTS
The Food and Drug Administration approved the first-ever glucose monitoring system specifically for weight loss from the startup Signos, a new option for Americans to manage their weight.
Any patient can now purchase a Signos membership to access its system, which uses an AI platform and an off-the-shelf continuous glucose monitor, or CGM, from Dexcom to offer personalized, real-time data and lifestyle recommendations for healthy weight management.
The system can be used in combination with or after other existing weight loss treatments such as GLP-1s or bariatric surgery.
