Because of the hiatus since last Tuesday, today’s posting has highlights from last week.
Biden isn't shying away from big new health-related spending: A really good summary of the health content from last week’s Presidential address. For example, Biden proposed permanent ACA premium subsidies and “called on Congress to pass legislation allowing the federal government to directly negotiate lower prices for some drugs in Medicare – a proposal the White House backed away from including in the American Families Plan.” Nothing was mentioned bout Medicare eligibility expansion.
About Covid-19
How Pfizer Makes Its Covid-19 Vaccine: A really good explanation of the science behind the manufacturing.
Reaching ‘Herd Immunity’ Is Unlikely in the U.S., Experts Now Believe: “Now, more than half of adults in the United States have been inoculated with at least one dose of a vaccine. But daily vaccination rates are slipping, and there is widespread consensus among scientists and public health experts that the herd immunity threshold is not attainable — at least not in the foreseeable future, and perhaps not ever.
Instead, they are coming to the conclusion that rather than making a long-promised exit, the virus will most likely become a manageable threat that will continue to circulate in the United States for years to come, still causing hospitalizations and deaths but in much smaller numbers.”
CVS and Walgreens Have Wasted More Vaccine Doses Than Most States Combined: “The Centers for Disease Control and Prevention recorded 182,874 wasted doses as of late March, three months into the country’s effort to vaccinate the masses against the coronavirus. Of those, CVS was responsible for nearly half, and Walgreens for 21%, or nearly 128,500 wasted shots combined.
CDC data suggests that the companies have wasted more doses than states, U.S. territories and federal agencies combined. Pfizer’s vaccine, which in December was the first to be deployed and initially required storage at ultracold temperatures, represented nearly 60% of tossed doses.”
About healthcare quality
Overall Hospital Quality Star Rating: CMS explains its 2021 hospital star rating methodology. In summary:
“The new 2021 methodology uses a simple average of measure scores to calculate measure group scores and Z-score standardization to standardize measure group scores for these 5 measure groups
Mortality
Safety of Care
Readmission
Patient Experience
Timely & Effective Care”
The Leapfrog Group releases latest Hospital Safety Grades of U.S. hospitals, with straight ‘A’ hospitals sharing insights on how they were prepared for COVID-19: “Across all states, highlights of findings from the spring 2021 Leapfrog Hospital Safety Grade include:
Thirty-three percent of hospitals received an "A," 24% received a "B," 35% received a "C," 7% received a "D," and less than 1% received an "F"
Five states with the highest percentages of "A" hospitals are Massachusetts, Idaho, Maine, Virginia, and North Carolina
There were no "A" hospitals in South Dakota or North Dakota”
Fortune/IBM Watson Health 100 Top Hospitals 2021: Health Systems: FYI.
Hospice Tax Status and Ownership Matters for Patients and Families: This article is an editorial commenting on research into the headline’s issue. The tax status of ownership does make a difference: On average, for-profit compared with nonprofit hospices “provide narrower ranges of services to patients, use less skilled clinical staff, care for patients with lower-skilled needs over longer enrollment periods, have higher rates of complaint allegations and deficiencies, and provide fewer community benefits, including training, research, and charity care. For-profit hospices are more likely than nonprofit hospices to discharge patients prior to death, to discharge patients with dementia, and to have higher rates of hospital and emergency department use.”
About the public’s health
Cost-effectiveness Analysis of Nutrition Facts Added-Sugar Labeling and Obesity-Associated Cancer Rates in the US: “This economic evaluation of Nutrition Facts added-sugar labeling and obesity-related cancer rates estimated that implementing the policy was associated with a reduction of 30 000 new cancer cases, 17 100 cancer deaths, and $1600 million in medical costs among US adults over a lifetime. This policy would generate net savings of $704 million from a societal perspective and $1590 million from a health care perspective…
These findings suggest that the added-sugar labeling is associated with reduced costs and lower rates of obesity-associated cancers. Policymakers may consider and prioritize nutrition policies for cancer prevention in the US.”
Screening for Hypertension in Adults US Preventive Services Task Force Reaffirmation Recommendation Statement: “The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement. The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. (A recommendation).”
See the accompanying editorial.
USDA dietary guidelines are driven by milk marketing concerns — not nutrition — lawsuit alleges: “Three doctors filed a lawsuit Wednesday in federal court against the U.S. Department of Agriculture for its guidance in December suggesting that Americans consume three servings of dairy each day. The doctors allege in the lawsuit filed in the U.S. District Court for the Northern District of California that the dietary guidelines contradict current scientific and medical knowledge, harming the quarter of Americans who are lactose-intolerant. They also suggest that the USDA is looking out for the interests of the meat and dairy industries rather than the health of Americans.”
HHS Releases New Buprenorphine Practice Guidelines, Expanding Access to Treatment for Opioid Use Disorder: “Signed by HHS Secretary Xavier Becerra, the Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder exempt eligible physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives from federal certification requirements related to training, counseling and other ancillary services that are part of the process for obtaining a waiver to treat up to 30 patients with buprenorphine.”
FDA Moves To Ban Cigarettes And Flavored Cigars: “The U.S. Food and Drug Administration says it is moving to ban menthol cigarettes and flavored cigars, based on the evidence of the addictiveness and harm of the products. Tobacco companies have long targeted African Americans with advertising for menthol cigarettes.”
Weight Gain After Smoking Cessation and Risk of Major Chronic Diseases and Mortality: Many smokers who want to quit are worried that the resultant weight gain was just as bad for their health. as tobacco use. This study puts that concern to rest: “In this nationally representative cohort study of 16 663 Australian adults studied between 2006 and 2014, people who quit smoking had significantly lower risk of death than those who continued smoking regardless of change to weight and body mass index after quitting. Neither weight change nor body mass index change following smoking cessation was significantly associated with the risk of cardiovascular disease, type 2 diabetes, cancer, or chronic obstructive pulmonary disease.”
About healthcare professionals
NP practice authority by state: “Twenty-three states and the District of Columbia grant nurse practitioners full practice authority as soon as they earn their licenses, according to the American Association of Nurse Practitioners. “
Physician Flash Report: April 2021: From Kaufman Hall:
Key findings from the quarterly report include:
· Median Investment/Subsidy per Physician FTE rose 6.8% from 2019 to $239,656 in 2020
· Physician Compensation per FTE declined 1.6% from 2019 to $303,181 in 2020
· Physician wRVUs per FTE fell 8.4% from 2019 to 2020
· Net Revenue per Physician wRVU rose just 1.4% from 2019 to 2020
· Total Direct Expense per Physician FTE fell 4.9% from 2019 to $782,518 in 2020
Cross-state licensing process now live in 30 states: “Prior to the COVID-19 pandemic, a major force in supporting telehealth expansion was the Interstate Medical Licensure Compact (IMLC), which was designed to preserve state regulation of medical practice while making it easier for physicians to provide care remotely and in person to patients in other states…
Louisiana became the compact’s 32nd member in October, joining 29 other states, Guam and the District of Columbia. Legislation to join the compact has been introduced this year in Missouri, New Jersey, New York, North Carolina, Ohio, Oregon, Rhode Island, and Texas.”
About hospitals and health systems
How CHS, Tenet, HCA and UHS fared in Q1: Mixed results for these systems. Still need to factor out government Covid support to look at underlying fundamentals.
Hospital payments increase 2.8% under CMS proposed rule: Before taking into account Medicare disproportionate share hospital payments and Medicare uncompensated care payments, the proposed increase in operating payment rates, increases in capital payments, increases in payments for new medical technologies, increases in payments due to implementation of the imputed floor and other proposed changes will increase hospital payments in FY 2022 by $3.4 billion, or 2.8%...
The proposed rule would require hospitals to report vaccination rates among healthcare staff. CMS is proposing the adoption of the COVID-19 Vaccination Coverage among Healthcare Personnel Measure to require hospitals to report COVID-19 vaccinations of workers in their facilities.
One of the biggest proposals is the repeal of the mandate that hospitals disclose their privately negotiated [ Medicare Advantage] rates with payers.”
Quality Declines When Hospitals Have Trouble Borrowing: “In the first paper to directly study the effects of a credit crunch on hospital quality, researchers found that hospitals tend to deliver lower-quality care and worse patient outcomes when they respond to tightening credit by making up the difference through increased patient revenue.”
About health insurance
Some health insurers ending waivers for Covid treatment fees: “Starting at the end of last year — and continuing into the spring — a growing number of insurers are quietly ending those fee waivers for Covid-19 treatment on some or all policies…”
However, federal law requires insurers to waive costs for Covid-19 testing and vaccination.
Obamacare Cost-Sharing Change Cuts Out-Of-Pocket Costs By $400: “CMS on Friday significantly changed how Affordable Care Act exchanges will run next year, intending to lower out-of-pocket costs for Obamacare customers, streamline enrollees’ user experience and update how insurers are paid for the risks they take on their members.
In its second update to the annual benefit and payment parameters rule, the agency announced consumers’ maximum out-of-pocket costs will be limited to $8,700 for individuals and $17,400 for plans that cover multiple people. The update is $400 lower than previous caps, CMS said.”
How Corporate Executives View Rising Health Care Cost and the Role of Government: A really good analysis of this issue from the Kaiser Family Foundation. For a quick view, look at the graphics. In summary: “The responding employers largely believe that the cost of health benefits is excessive. While in general respondents felt that employers individually or collectively can have an impact on health care costs, more than four in five believe that the cost of providing health benefits will become unsustainable at some point in the next five to ten years, and that there will need to be a greater role for government in providing coverage and controlling costs. Respondents generally expressed some agreement with a variety of policies that would expand the government’s role in health benefits, including limiting provider prices in non-competitive situations and expanding options for employees and others to enroll in public programs.”
CMS extends hip and knee replacement model for 3 years: “The Biden administration has extended through 2024 a bundled payment model that aims to lower costs and improve quality for hip and knee replacements…
The rule also makes some adjustments to price calculations.
The Comprehensive Care for Joint Replacement model aims to pay providers based on total episodes of care for hip and knee replacements to curb costs and improve quality.”
CVS Health launches $100 million venture fund: “The fund will initially launch with $100 million allocated for investments and will focus on companies with the potential for technology-enabled innovation and disruption in digital health care that are anchored in CVS Health's core strategy. CVS Health Ventures will build relationships with early-stage companies via investment as well as by offering expertise and insights from CVS Health's unique perspective.
CVS Health has already made more than 20 direct investments through the CVS and Aetna businesses.”
BCBS Association beats lawsuit over cancer coverage: “Roslyn Gonzalez sued BCBSA for denying coverage of proton beam radiation therapy to treat a malignant tumor in her lower left abdomen. BCBSA had deemed the treatment experimental.
In fall 2020, BCBSA filed a motion to dismiss the case, arguing Ms. Gonzalez's state-law claims against the health insurance company were preempted by The Federal Employees Health Benefits Act. The court agreed with BCBSA.”
Humana Announces Agreement to Acquire remaining 60 Percent Interest in Kindred at Home, Accelerating Integration of the Nation’s Largest Home Health Provider into Humana’s Payer-Agnostic Healthcare Services Platform: “Humana Inc…announced it has signed a definitive agreement to acquire the remaining 60 percent interest in Kindred at Home (KAH), the nation’s largest home health and hospice provider, from TPG Capital (TPG)… for an enterprise value of $8.1 billion, which includes Humana’s existing equity value of $2.4 billion associated with its current 40 percent minority ownership interest. KAH employs approximately 43,000 caregivers providing home health, hospice and community care services to over 550,000 patients annually. KAH has locations in 40 states, providing extensive geographic coverage with approximately 65 percent overlap with Humana’s individual Medicare Advantage membership.”
How Lowering the Medicare Eligibility Age Might Affect Employer-Sponsored Insurance Costs: “We find that, if people age 60-64 were no longer enrolled in employer-sponsored insurance, costs for employer health plans could drop by up to 15%. Similarly, if all people age 55 and over were no longer enrolled in employer-sponsored insurance, costs for employer plans could drop by as much as 30%. And if all people age 50 and over were no longer enrolled in employer-sponsored insurance, costs for employer plans could drop up to 43%. However, there are reasons to suspect the actual impact on employer-sponsored costs and premiums would be much smaller.”
The Utilization and Costs of Grade D USPSTF Services in Medicare, 2007–2016: “During the study period, we identified 95,121 unweighted Medicare patient visits, representing approximately 2.4 billion visits. Each year, these seven Grade D services were utilized 31.1 million times for Medicare beneficiaries and cost $477,891,886. Three services—screening for asymptomatic bacteriuria, vitamin D supplements for fracture prevention, and colorectal cancer screening for adults over 85 years—comprised $322,382,772, or two-thirds of the annual costs of the Grade D services measured in this study.”
About pharma
Several companies reported first quarter earnings- a mixed bag:
BMS backs annual guidance despite 3% drop in Opdivo sales in Q1
Merck & Co.'s Q1 sales stagnate as hit to vaccines wipes out Keytruda growth
Gilead's Q1 sales up 16% driven by Veklury
AbbVie lifts annual earnings outlook as Q1 sales surge 51%
AstraZeneca's Q1 sales top forecasts, boosted by cancer drugs
Landmark trial over the opioid crisis is set to start next week at ground zero: “The landmark trial in West Virginia against drug distributors known as the “Big Three” — AmerisourceBergen, Cardinal Health and McKesson — comes after an 11th-hour settlement averted an Ohio trial in October 2019 and coronavirus-related delays stalled opioid cases across the country.
It’s described as the country’s most complex civil case, and thousands of local governments and jurisdictions are arguing that the companies had a responsibility to ensure that the billions of pain pills pumped into their communities were not diverted for illegal use. The distributors say they complied with the law, delivering drugs approved by the government to pharmacies.”
U.S. lawmakers introduce eight antitrust bills aimed at drug prices: “Two of the bills, one in the House and another in the Senate, is aimed at stopping product-hopping, or making a minor change to a medication to win a new patent.
Others would seek to ban pay-for-delay patent settlements, where brand name drug companies pay generics to delay entering the market. Another enables the Federal Trade Commission to ban sham citizen petitions, where drug companies petition the Food and Drug Administration about a generic company seeking approval for a rival drug with the goal of delaying its approval.”
Pharmaceutical Innovation and Invention Index: “The PII aims at ranking companies in their ability to bring products from Phase I/II to market and commercialize them successfully, and utilizes a range of clinical, regulatory and commercial metrics to do this, ranging from the corporate level down to individual products.” See how companies rank.
New PhRMA report shows nearly 90 medicines in development to fight drug-resistant infections, but future pipeline remains challenging: “To address the challenges of early and late-stage clinical development and to overcome the market's failure to drive innovation for new antimicrobial medicines, innovative partnerships and initiatives within and between the public and private sectors have evolved. The biopharmaceutical industry in particular is taking action through the AMR Action Fund. This fund aims to bring two to four new antimicrobials to market by 2030, focusing on innovative medicines that address the highest priority public health needs. This industry-driven effort will also work to drive comprehensive policy reforms that are needed to advance new reimbursement methodologies and create incentives that enable appropriate patient access, creating a sustainable ecosystem for antimicrobial R&D and commercialization.”
The top 15 biopharma licensing deals of 2020: “Cancer-related assets accounted for more than half (eight) of the top 15, with four in the cancer immunotherapy area, demonstrating that biopharma's appetite for this area is far from sated. Collectively, the cancer deals had a value (biobucks included) of almost $24 billion out of a total of just over $40 billion overall.”
About diagnostics
LabCorp, still riding the COVID-19 testing wave, exceeds its own expectations with $4.2B Q1 revenue: “In total, LabCorp saw its revenues jump to $4.16 billion for the first three months of the year, a nearly 50% increase compared to 2020's initial quarter. The company’s net earnings, meanwhile, registered a billion-dollar annual increase that brought it firmly out of the red, from last year’s $317 million loss to approximately $770 million in earnings.
As a result, LabCorp upped its outlook for the remainder of 2021. The company is now expecting total annual revenues to increase by 2% to 6.5%, compared to its previous predictions that revenues would fall somewhere between a 1% loss and a 4.5% increase.
The vast majority of the quarter’s revenues were driven by organic growth, one-third of which came from COVID testing alone.”
About healthcare IT
CMS proposes modifications to the Promoting Interoperability Program: The proposed rule would make it mandatory for hospitals to report on four measures, rather than allowing a pick-and-choose approach, as had been the case before:
Syndromic Surveillance Reporting.
Immunization Registry Reporting.
Electronic Case Reporting.
Electronic Reportable Laboratory Result Reporting.
Teladoc Q1 revenue more than doubles to $454M as telehealth visits continue to climb: “Despite a historically weak flu season, the telehealth giant delivered 3.2 million virtual visits in the first quarter of 2021, up 56% compared to the first quarter in 2020.”
