About Covid-19
Still no consensus on Covid’s origins, White House says “The U.S. government still has not reached a consensus on how the coronavirus pandemic started, National Security Council spokesperson John Kirby told reporters Monday — despite news reports that the Energy Department has concluded the virus most likely leaked from a lab in China.”
About health insurance/insurers
DELIVERING LOWER COSTS FOR PATIENTS AND TAXPAYERS THROUGH SITE-NEUTRAL PAYMENT REFORM An excellent review of this topic from the BCBSA that hits all the major topic points. The “bottom line” is a $471B savings over 10 years just for the federal government.
Outpatient visits billed at increasingly higher levels: implications for health costs “We examine the distribution of code levels in physician offices, urgent care centers, and emergency departments over time, for all evaluation and management claims and for specific diagnoses. This analysis only includes evaluation and management claims and does not include additional visit-associated bills such as laboratory tests or other services.
Over the 18-year period of our analysis, we find that claims across all three sites of care trended towards higher level codes, even among specific, common diagnoses like urinary tract infections and headaches. The average age of this population stayed consistent over time. However, we do not assess whether health status worsened with time, so we are not able to assess whether increases in billed complexity represent actual changes in clinical characteristics.”
CMS' most successful alternative payment models “CMS has launched more than 50 savings model programs since the agency's innovation center was created in 2010, according to the Center for Medicaid and Medicare Innovation's 2022 Report to Congress.
Though many models have been tested, only a few have clearly emerged as successful at reducing costs and improving outcomes, according to the report.
Six models led to statistically significant savings:
—Pioneer ACO Model
—ACO Investment Model
—Medicare Prior Authorization Model: Repetitive Scheduled Non-Emergent Ambulance Transport
—Home Health Value-Based Purchasing Model
—Maryland All-Payer Model
—Medicare Care Choices Model
Two models, the Pioneer ACO Model and the Medicare Care Choices Model, also showed significant improvements in care quality, according to the report.”
Association of Evaluation and Management Payment Policy Changes With Medicare Payment to Physicians by Specialty “In this retrospective observational study that included 180 624 US office-based physicians, the difference in the median total Medicare payments received by primary care physicians compared with specialists was $40 259.8 in July-December 2020 and $39 434.7 in July-December 2021 (difference, −$825.1 [2.0% decrease]).
Meaning The 2021 E/M payment policy changes were associated with changes in Medicare payments by specialty, although the payment gap between primary care physicians and specialists decreased only modestly.
See, also, the accompanying editorial: Payment, Priorities, and Primary Care: Can Cognitive Work Be Properly Valued?
Health Insurer Financial Performance in 2021 "We find that, by the end of 2021, gross margins per enrollee had returned to pre-pandemic levels in the Medicare Advantage market, while gross margins in the individual and group markets were lower than pre-pandemic levels and Medicaid margins were higher than pre-pandemic levels. Medicare Advantage plans have far higher per person gross margins—more than double those seen in other markets in 2021.”
As usual with the KFF reports, the graphics tell most of the story.
GAO: MEDICARE ADVANTAGE: Plans Generally Offered Some Supplemental Benefits, but CMS Has Limited Data on Utilization “The 3,893 MA plans reviewed had a median net projected cost for supplemental benefits of about $27 per enrollee per month in 2022— approximately $6.4 billion in total—according to our analysis of the CMS bid pricing data. The net projected costs reflect the amounts that plans expected to pay for supplemental benefits and do not include cost-sharing (such as copayments) that plans may require of enrollees.”
UPMC, head of cardiothoracic surgery will pay $8.5M to feds to settle lawsuit “UPMC, a renowned cardiothoracic surgeon there and a physicians group will pay the federal government $8.5 million to settle a lawsuit accusing them of knowingly submitting hundreds of false claims to Medicare, failing to follow medical standards for surgery and knowingly placing patients at risk.
The U.S. Attorney’s Office filed a lawsuit against UPMC, Dr. James Luketich and University of Pittsburgh Physicians in September 2021 alleging Luketich was regularly scheduling multiple complex surgeries at the same time, forcing him to move between operating rooms and sometimes hospitals, while requiring patients to stay under additional hours of anesthesia.
In one case, a patient lost parts of a hand and another lost a lower leg as a result, the government said.”
BCBS Louisiana acquisition cost Elevance Health $2.5B “Elevance Health agreed to pay $2.5 billion for Blue Cross and Blue Shield of Louisiana, its first state Blue Cross Blue Shield acquisition in over 15 years… According to documents acquired by the outlet, additional conditions could raise the value of the transaction by $1 million.
BCBS Louisiana, a nonprofit, will use the funds from the acquisition to establish a foundation to address health equity and provide payouts to many of its members. The insurer will become a for-profit subsidiary of Elevance.”
About hospitals and healthcare systems
National Hospital Flash Report February 2023 “Key Takeaways
1. Hospitals get off to smoother start to the year compared to 2022.
The start of 2022 coincided with the Omicron COVID surge, putting hospitals in a difficult financial position to start the year.
With no spike in COVID cases in January 2023, hospitals entered the year on more stable footing, but continued to experience the same challenges that made 2022 the worst financial year since the start of the pandemic. According to Kaufman Hall experts, while the start to 2023 was better than 2022, beginning-of-the-year performance still lagged behind 2021 and 2020.
2. Margins are down slightly from the end of 2022.
Hospital operating margins in January 2023 were down slightly compared to December 2022. One factor that contributed to the dip in performance, according to Kaufman Hall experts, is the normal trend of hospitals making purchases for the year in January.
3. Hospitals continue to experience lower volumes and higher expenses.
Volumes, emergency department visits, discharges and total revenues were down in January 2023 compared to December 2022. Expenses—particularly related to labor—increased over the same time period; though, not as fast as in previous months.
4. 2023 could represent a new normal for hospitals.
Hospitals must continue to explore how to treat lower-acuity patients in novel settings as patient volumes continue to shift to outpatient locations. Furthermore, with future COVID surges likely and difficult financial months ahead, managing cash effectively will be critical to weathering the storm.”
AdventHealth reports almost $838M loss as investment returns tank The article highlights the importance to hospitals of investment income that offsets operating losses.
Rural Hospitals Are Shuttering Their Maternity Units “From 2015 to 2019, there were at least 89 obstetric unit closures in rural hospitals across the country. By 2020, about half of rural community hospitals did not provide obstetrics care, according to the American Hospital Association.
In the past year, the closures appear to have accelerated, as hospitals from Maine to California have jettisoned maternity units, mostly in rural areas where the population has dwindled and the number of births has declined.
A study of hospital administrators carried out before the pandemic found that 20 percent of them said they did not expect to be providing labor and delivery services in five years’ time.”
About pharma
Lilly to cut some insulin prices by 70%, bolster cost cap “Eli Lilly on Wednesday announced price reductions of 70% for its most commonly prescribed insulins, and said it is also making improvements to a programme that caps out-of-pocket insulin costs for patients at $35 a month…
The change, which Eli Lilly said takes effect immediately, puts the drugmaker in line with a provision in the US Inflation Reduction Act, which last month imposed a $35 monthly cap on the out-of-pocket cost of insulin for seniors enrolled in Medicare.
As part of the measures announced Wednesday, Eli Lilly said the list prices for Humalog (insulin lispro) and Humulin (insulin human) will be slashed by 70% starting in the fourth quarter of 2023. Humalog currently carries a list price of $530 for a five-pack of injection pens and $274 for a vial, although Eli Lilly said most people with commercial insurance and Medicare pay no more than $95 a month.”
Distributors Win Milestone Trial Over Individual Opioid Abuse “Pharmaceutical wholesalers aren't responsible for harms to individuals whose family members abused narcotics, a Georgia jury decided Wednesday, capping off a first-of-its-kind trial that threatened to open a massive new front in opioid litigation despite multibillion-dollar settlements covering harms suffered by communities.”
The albuterol shortage is about to get worse “Children’s hospitals across the country lost a supplier of a commonrespiratory medicine with the sudden shutdown of an Illinois manufacturing plant last week, which specialists warned will prolong shortages of an important treatment for kids with RSV and asthma who show up in emergency rooms.
Akorn, a company that has struggled under bankruptcy for two years and had been the subject of Food and Drug Administration enforcement actions, shut down its U.S. operations on Thursday, including manufacturing facilities in Illinois, New Jersey and New York.”
Jazz Pharmaceuticals Loses Narcolepsy Drug Patent Appeal “A federal appeals court has rejected Jazz Pharmaceuticals’ attempt to overturn a lower court ruling invalidating a patent claim covering the company’s Risk Evaluation and Mitigation Strategies (REMS) distribution system for its blockbuster narcolepsy therapy Xyrem (oxybate).”
For more background on the case, see: A Drug Company Exploited a Safety Requirement to Make Money
About the public’s health
FDA panel narrowly backs Pfizer RSV vaccine for older adults “The Food and Drug Administration panel voted 7-4 on two separate questions of whether Pfizer’s data showed the vaccine was safe and effective against the respiratory virus for people 60 and older. One panelist abstained from voting. The recommendation is non-binding and the FDA will make its own decision on the vaccine in the coming months.
The positive vote came despite concerns about rare potential reactions and questions about how the vaccine fared in people who face the greatest risks from RSV. Pfizer’s shot was more than 85% effective at preventing severe disease in a company study, but panelists noted there were few people with underlying health problems.”
Governor Reeves Signs Bill Banning Gender Reassignment Procedures for Children “ Governor Tate Reeves today signed House Bill 1125 – the Regulate Experimental Adolescent Procedures Act – which bans gender reassignment procedures for Mississippians under the age of 18.”
One type of artificial sweetener may increase heart attack risk, preliminary study says “The sweetener erythritol, which is becoming increasingly popular in snack bars and low-sugar ice cream substitutes, may increase the risk of heart attacks and strokes, according to a paper published Monday in the journal Nature Medicine.
Outside experts who reviewed the findings emphasized that more evidence is needed, with some raising concerns that the results of the study could be due to other factors that make it appear the sweetener causes risks when it does not.”
About healthcare IT
Healthcare Most Hit by Ransomware Last Year, FBI Finds “The FBI's Internet Complaint Center last year received 870 complaints that ‘indicated organizations belonging to a critical infrastructure sector were victims of a ransomware attack,’ said David Scott, deputy assistant director of the FBI's Cyber Division…
Critical manufacturing and the government, including schools, followed healthcare as the most-attacked sectors…”
Epic, Press Ganey to integrate patient experience data into MyChart “Epic Systems has partnered with consumer experience company Press Ganey to integrate patient experience data into MyChart.
Under the agreement, Press Ganey's data and insights will be integrated into Epic's MyChart patient portal and Cheers CRM, according to a March 1 news release from Press Ganey. The initial integrations will be available later this year.”
HHS Announces New Divisions Within the Office for Civil Rights to Better Address Growing Need of Enforcement in Recent Years Because the caseload has increased 69% between 2017 and 2022, the “U.S. Department of Health and Human Services, through the Office for Civil Rights (OCR), announced the formation of a new Enforcement Division, Policy Division, and Strategic Planning Division.” The announcement explains how each will work.
DEA’s Proposed Rules on Telemedicine Controlled Substances Prescribing after the PHE Ends An excellent legal guide.
Predicting the Survival of Patients With Cancer From Their Initial Oncology Consultation Document Using Natural Language Processing “These findings suggest that models performed comparably with or better than previous models predicting cancer survival and that they may be able to predict survival using readily available data without focusing on 1 cancer type.”
About healthcare personnel
Two articles bout physician management companies:
Privia Health nets $17.8M in profit in Q4 as it eyes national expansion of provider network “Physician enablement company Privia Health turned a profit in the fourth quarter of 2022 and is forecasting strong growth this year as it eyes geographic expansion.
The company, which went public in May 2021, brought in $17.8 million in net income in the fourth quarter, or 14 cents per diluted share, compared to a net loss of $12 million, or a loss of 11 cents per share, in the same quarter a year ago.”
Aledade notches another acquisition, adds 450 practices to growing network as the primary care market heats up “As investment in value-based primary care heats up, Aledade picked up value-based care analytics company Curia to build out its tech capabilities.
Aledade did not disclose financial details of the transaction.
It marks the company's second M&A deal after its tuck-in acquisition of Iris Healthcare a year ago.”
Women’s Experiences with Provider Communication and Interactions in Health Care Settings: Findings from the 2022 KFF Women’s Health Survey “Summary of Findings
· Among women ages 18-64 who have seen a health care provider in the past two years:
o Twenty-nine percent report that their doctor had dismissed their concerns in that time period, 15% reported that a provider did not believe they were telling the truth, 19% say their doctor assumed something about them without asking, and 13% say that a provider suggested they were personally to blame for a health problem. A higher share of women (38%) than men (32%) report having had at least one of these negative experiences with a health care provider.
o One in ten (9%) women ages 18-64 say that they have experienced discrimination because of their age, gender, race, sexual orientation, religion, or some other personal characteristic during a health care visit in the past two years.
o Few women report being asked about social and economic factors that may influence health. While 58% report that in the past two years their provider asked them about what kind of work they do, far fewer report having been asked about their housing situation (30%), their ability to afford food (20%), or access to reliable transportation (20%). Women with Medicaid and those with low incomes are more likely to say they have been asked about these last three indicators than women with private insurance and those with higher incomes.
· Communication is an important component of health care quality; however, 21% of women (including 38% of uninsured women), say it is difficult to find a doctor who explains things in a way that is easy to understand.
· Just over one-third (35%) of women ages 40-64 say their health care provider ever talked to them about what to expect in menopause.”
About health technology
Organoid intelligence (OI): the new frontier in biocomputing and intelligence-in-a-dish
Fascinating potential, though it reminds me of the PK Dick novella The Minority Report.
“Key points
Biological computing (or biocomputing) could be faster, more efficient, and more powerful than silicon-based computing and AI, and only require a fraction of the energy.
‘Organoid intelligence’ (OI) describes an emerging multidisciplinary field working to develop biological computing using 3D cultures of human brain cells (brain organoids) and brain-machine interface technologies.
OI requires scaling up current brain organoids into complex, durable 3D structures enriched with cells and genes associated with learning, and connecting these to next-generation input and output devices and AI/machine learning systems.
OI requires new models, algorithms, and interface technologies to communicate with brain organoids, understand how they learn and compute, and process and store the massive amounts of data they will generate.
OI research could also improve our understanding of brain development, learning, and memory, potentially helping to find treatments for neurological disorders such as dementia.
Ensuring OI develops in an ethically and socially responsive manner requires an ‘embedded ethics’ approach where interdisciplinary and representative teams of ethicists, researchers, and members of the public identify, discuss, and analyze ethical issues and feed these back to inform future research and work.”
About healthcare finance
Humana seeks up to $1.25B with bond issues “Humana will issue up to $1.25 billion in bonds to pay off debt and finance operations, the company announced Tuesday. The insurer plans to use the proceeds to pay off a $500 million loan from 2021 to offset the cost of its deal to acquire home care company Kindred at Home, and for general corporate purposes.”
CD&R, Humana-Backed Gentiva Inks $710 Million Hospice Deal “Gentiva, a hospice company backed by Clayton Dubilier & Rice and Humana Inc., has agreed to acquire a business from not-for-profit health-care system ProMedica, Gentiva’s chief executive officer said.
Gentiva’s deal for hospice and home-care assets from ProMedica’s Heartland is valued at $710 million, including debt, according to people familiar with the matter, who asked not to be identified because the information is private.”
