National Health Spending Grew Slightly in 2021 “A decline in federal government spending led to more modest growth in health care expenditures last year, according to figures released today by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS). The 2021 National Health Expenditures (NHE) Report found that U.S. health care spending grew 2.7% to reach $4.3 trillion in 2021, slower than the increase of 10.3% in 2020. The slower growth in 2021 was driven by a 3.5% decline in federal government expenditures for health care that followed strong growth in 2020 due to the COVID-19 pandemic response. This decline more than offset the impact of greater use of health care goods and services and increased insurance coverage in 2021.”
About Covid-19
Get free at-home COVID-19 tests this winter The federal government is again supplying free Covid-19 tests.
Coronavirus boosters cut hospitalization risk by at least 50%, CDC data shows “Adults who received the updated coronavirus booster shots are better protected against severe disease than those who haven’t, cutting their risk of having to visit an emergency room or being hospitalized with covid-19 by 50 percent or more, according to new federal data.
Two reports released Friday by the Centers for Disease Control and Prevention give the first detailed look at how well the updated boosters from Pfizer and Moderna protect against serious illness. But uptake of the “bivalent” boosters rolled out in September has been low among vaccine-weary Americans, with only about 14 percent of those eligible — ages 5 and older — having received an updated shot.”
IDSA Guidelines on the Treatment and Management of Patients with COVID-19 A reminder of where to find the latest COVID-19 recommendations.
KFF COVID-19 Vaccine Monitor: December 2022 “The latest KFF COVID-19 Vaccine Monitor survey finds that about seven in ten adults (71%) say healthy children should be required to get vaccinated for MMR in order to attend public schools, down from 82% who said the same in an October 2019 Pew Research Center poll. Almost three in ten (28%) now say that parents should be able to decide not to vaccinate their school-age children, even if this creates health risks for others, up from 16% in 2019. Among Republicans and Republican-leaning independents, there has been a 24 percentage-point increase in the share who hold this view (from 20% to 44%).”
About health insurance/insurers
EMERGENCY: The high cost of ambulance surprise bills “In December 2020, Congress passed the No Surprises Act (NSA) to protect patients from many types of out-of-network balance bills…
It did not include protections from surprise billing by ground ambulances.
Yet, Congress acknowledged important work was left undone, by including provisions in the NSA to establish the Advisory Committee on Ground Ambulance and Patient Billing. The committee is charged with reviewing options for protecting consumers from surprise ground ambulance billing.
Studies show about half of emergency ambulance patients with insurance are at risk of receiving a surprise medical bill which is an out-of-network charge for those transportation services. Those balance bills carry a median out-of-pocket charge of $450 but in some states, the average is more than $1000.”
Lab Owner Convicted in $463 Million Genetic Testing Scheme to Defraud Medicare “According to court documents and evidence presented at trial, Minal Patel, 44, of Atlanta, owned LabSolutions LLC (LabSolutions), a lab enrolled with Medicare that performed sophisticated genetic tests. Patel conspired with patient brokers, telemedicine companies, and call centers to target Medicare beneficiaries with telemarketing calls falsely stating that Medicare covered expensive cancer genetic tests. After the Medicare beneficiaries agreed to take a test, Patel paid kickbacks and bribes to patient brokers to obtain signed doctors’ orders authorizing the tests from telemedicine companies. To conceal the kickbacks, Patel required patient brokers to sign contracts that falsely stated that they were performing legitimate advertising services for LabSolutions.
The telemedicine doctors approved the expensive testing even though they were not treating the beneficiaries and often did not even speak with them.”
Trends in Medicare Part B Spending on Discarded Drugs, 2017-2020 “During the study period, 2.2% of administered drugs were reported as discarded, with an estimated cost of $3.0 billion. Chemotherapy accounted for the greatest percentage of discarded drugs and the greatest spending ($2.1 billion)…Among the 20 drugs with the highest percentage discarded, discarded drug amounts totaled $971 million…
Data reflect Medicare Part B fee-for-service claims and do not include Medicare Advantage beneficiaries.”
In an accompanying editorial: Stemming Medicare Spending on Discarded Drugs—Waste Not, Want Not? “Beginning next year, the 2021 Infrastructure Investment and Jobs Act requires manufacturers to pay rebates for spending on discarded drugs. Although the authors of the National Academies of Sciences, Engineering, and Medicine report on drug waste raised concerns that such an approach could be associated with manufacturers increasing prices, recent changes to Medicare mitigate this concern. Specifically, the Inflation Reduction Act limits the ability of industry to raise prices on therapies that are reimbursed by Medicare beyond the rate of inflation.”
Nonprofit Health Plans With $6.8 Billion in Projected Revenue Set to Combine “Two nonprofit health plans focused on government-backed coverage are planning to combine in a deal that aims to create a sizable new player in the rapidly growing business of managed Medicare and Medicaid.
SCAN Group, based in Long Beach, Calif., and CareOregon, of Portland, Ore., plan to join up under the new name HealthRight Group, they said.
The planned combination, which the nonprofits are expected to announce Wednesday, would create an organization that they anticipate would have annual revenue next year of around $6.8 billion and membership of about 800,000 people.”
About healthcare quality
Diagnostic Errors in the Emergency Department: A Systematic Review “Overall diagnostic accuracy in the emergency department (ED) is high, but some patients receive an incorrect diagnosis (~5.7%). Some of these patients suffer an adverse event because of the incorrect diagnosis (~2.0%), and some of these adverse events are serious (~0.3%). This translates to about 1 in 18 ED patients receiving an incorrect diagnosis, 1 in 50 suffering an adverse event, and 1 in 350 suffering permanent disability or death. These rates are comparable to those seen in primary care and hospital inpatient care.
We estimate that among 130 million emergency department (ED) visits per year in the United States that 7.4 million (5.7%) patients are misdiagnosed, 2.6 million (2.0%) suffer an adverse event as a result, and about 370,000 (0.3%) suffer serious harms from diagnostic error.”
For a more nuanced report on these findings, see this The NY Times article.
About hospitals and healthcare systems
Joint Commission surveys to include safety briefings in 2023 “The Joint Commission will hold a safety briefing with healthcare organizations at the start of every accreditation survey starting in 2023…
Site surveyors and staff members preselected by the healthcare organization will conduct an informal, five-minute briefing to discuss any potential safety concerns — such as fires, an active shooter scenario or other emergencies — and how surveyors should react if safety plans are implemented while they are on site.”
Hospital systems are creating their own staffing agencies as a cheaper alternative to temp and travel nurses “An increasing number of hospital systems like Allegheny Health Network have created in-house staffing teams to cope with the pandemic-fueled nursing shortage—and try to beat private temp staffing agencies at their own game. Depending on the system, the nurses could work a weeklong stint or a multiple-week assignment at a hospital and then do a similar schedule at another facility. Some even work self-scheduled shifts in various locations, unlike regular staff nurses, who typically work in a single medical unit within one hospital. These workers differ from “float” nurses, who shift from unit to unit on an as-needed basis within a single hospital.
The goal of the in-house teams is to offer enough pay and flexibility to attract nurses to the jobs—and thus reduce the systems’ heavy dependence on more expensive RNs from outside agencies.”
Mass General Brigham Reports Fiscal Year 2022 Financial Results “Mass General Brigham, a not-for-profit, integrated health care system, reported a loss from operations of $432 million (-2.6% operating margin) for the fiscal year ending September 30, 2022. The health care system’s financial performance continues to be impacted by external pressures that have intensified over the past year, including historic cost inflation, significant workforce shortages, and a worsening capacity crisis.”
About pharma
1st patient to receive base editing gene therapy in remission “The world's first patient to be infused with base-edited T-cells is in remission for leukemia 28 days after receiving the gene therapy, according to the U.K.-based Great Ormond Street Hospital.
Six months after being treated with base editing — a technique that modifies the genetic code to reduce side-effect risk — and a second bone marrow transplant, the 13-year-old patient, Alyssa, is still in remission and is doing well, according to a GOSH news release.”
DEA Serves Order to Show Cause on Truepill Pharmacy for its Involvement in the Unlawful Dispensing of Prescription Stimulants The “DEA served an Order to Show Cause on Truepill, a retail pharmacy that is alleged to have wrongfully filled thousands of prescriptions for stimulants used in the treatment of Attention Deficit/Hyperactivity Disorder (ADHD). Truepill was the pharmacy for telehealth companies, including Cerebral, that marketed ADHD treatments, including Adderall ® and its generic forms, directly to consumers using Internet advertisements and social media. Cerebral arranged for patients to receive prescriptions for ADHD treatments through a telehealth visit, and for Truepill to fill those prescriptions.”
Eli Lilly says 4 new launches will help drive its 2023 revenue past $30B “Next year, Lilly plans to submit regulatory applications for five products plus initiate six phase 3 trials and present data from six other phase 3 trials, executives said in an investor presentation Tuesday. In all, several new approvals—plus market advances for diabetes launch Mounjaro—will help the company deliver more than $30 billion in sales next year, Lilly execs said.”
Biogen 19th drugmaker to shirk access in 340B program, nonprofit says “Biogen said two of its drugs that treat multiple sclerosis, Avonex and Plegridy, will not be discounted through 340B entities' partner pharmacies. 340B Health President and CEO Maureen Testoni said the decision, which Biogen said will take place Feb. 1, is ‘depriving safety-net hospitals of needed resources from mandated 340B discounts and keeping those dollars.’”
AbbVie leaves 2 pharmaceutical lobbies “North Chicago, Ill.-based AbbVie is cutting ties with the Pharmaceutical Research and Manufacturers of America and the Biotechnology Innovation Organization, two leading pharmaceutical lobby groups.
AbbVie, the fourth-largest drugmaker by revenue, will also leave the Business Roundtable, a lobby organization that's comprised of CEOs from healthcare companies…”
The company did not furnish a reason for this decision.
About the public’s health
Can politics kill you? Research says the answer increasingly is yes. “In one study, researchers concluded that people living in more-conservative parts of the United States disproportionately bore the burden of illness and death linked to covid-19. The other, which looked at health outcomes more broadly, found that the more conservative a state’s policies, the shorter the lives of working-age people.The reasons are many, but, increasingly, it is state — and not just federal — policies that have begun to shape the economic, family, environmental and behavioral circumstances that affect people’s well-being. Some states have expanded their social safety nets, raising minimum wages and offering earned income tax credits while using excise taxes to discourage behaviors — such as smoking — that have deleterious health consequences. Other states have moved in the opposite direction.”
The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions “Compared to states where abortion is accessible, states that have banned, are planning to ban, or have otherwise restricted abortion have fewer maternity care providers; more maternity care “deserts”; higher rates of maternal mortality and infant death, especially among women of color; higher overall death rates for women of reproductive age; and greater racial inequities across their health care systems.”
Trajectories of ENDS and cigarette use among dual users: analysis of waves 1 to 5 of the PATH Study “Concurrent electronic nicotine delivery system (ENDS) and cigarette (dual) use is harmful. Identifying longitudinal trajectories of ENDS and cigarette use among dual users can help to determine the public health impact of ENDS and inform tobacco control policies and interventions…
Most dual users maintained long-term cigarette smoking or dual use, highlighting the need to address cessation of both products. Continued monitoring of trajectories and their predictors is needed, given ongoing changes to the ENDS marketplace.”
Only 14% of Cancers Are Detected Through a Preventive Screening Test From the NORC, the headline is the story. The charts breaks down rates by type of cancer by state.
USPSTF recommends clinicians prescribe PrEP to those at high risk for HIV “The U.S. Preventive Services Task Force has released a draft recommendation advocating for clinicians to prescribe preexposure prophylaxis to patients at increased risk for HIV.
The recommendation, an A grade, is consistent with the USPSTF’s 2019 ruling on preexposure prophylaxis (PrEP) use for reducing HIV infection in those who are at higher risk.”
About healthcare IT
CMS Responding to Data Breach at Subcontractor “The Centers for Medicare & Medicaid Services (CMS) is responding to a data breach at Healthcare Management Solutions, LLC (HMS), a subcontractor of ASRC Federal Data Solutions, LLC (ASRC Federal), that may involve Medicare beneficiaries’ personally identifiable information (PII) and/or protected health information (PHI). No CMS systems were breached and no Medicare claims data were involved. Initial information indicates that HMS acted in violation of its obligations to CMS and that the incident involving HMS has the potential to impact up to 254,000 Medicare beneficiaries’ personally identifiable information out of the over 64 million beneficiaries that CMS serves. This week, CMS is mailing beneficiaries that have been potentially impacted a letter from CMS notifying them directly of the breach. A copy of that letter can be found below.”
Google aims to translate hand-scribbled doctors' notes and prescriptions using AI “According to a report from TechCrunch, the future feature will be built into Google Lens—the search giant’s image recognition app. An early version of the tech was spotlighted at the company’s annual conference in India.
Built with the help of pharmacists, the artificial intelligence program will start with a cellphone snapshot of a handwritten doctor’s note. The app will then highlight any medicines listed by attempting to decipher the physician’s quickly written shorthand.
About healthcare personnel
THE PRODUCTIVITY OF PROFESSIONS: EVIDENCE FROM THE EMERGENCY DEPARTMENT From a NBER Working Paper: “Using data from the Veterans Health Administration and quasi- experimental variation in the patient probability of being treated by physicians versus NPs in the emergency department, we find that, compared to physicians, NPs significantly increase resource utilization but achieve worse patient outcomes.”
U.S. medical schools grew more diverse in 2022, AAMC data shows “The number of Black, Hispanic, and women applicants and enrollees continued to increase at U.S. medical schools in the 2022-23 academic year, according to datareleased today by the Association of American Medical Colleges.”
About healthcare finance
Nine in 10 health care companies with financial stress are owned by private equity “Almost 90% of the health care companies deemed to be under financial stress by a leading credit rating agency are owned by private equity, a stark indicator of the toll financial investors have taken on a vital sector.
The striking finding is part of a new Moody’s Investors Service report released this week that shows broad turbulence throughout an industry weakened by private equity’s practice of loading companies with debt, making them less resilient to challenges like Covid-19, rising interest rates, litigation, or changes from a new federal law against surprise billing. Among the 193 North American health care companies Moody’s rates, the agency had placed almost 18% at or below its rating that indicates credit stress, B3 negative, as of Nov. 30. That’s compared with just 4% at the end of 2015.”
