About health insurance/insurers
Payers ranked by Medicare Advantage membership | Q1 2023 FYI.
About hospitals and healthcare systems
15 health systems reporting Q1 financial results FYI.
Humana partners with 2 durable medical equipment companies for home care “The Medicare Advantage insurer reached agreements with AdaptHealth Corp. and Rotech Healthcare to provide value-based DME services to members in its HMO plans starting July 1. Each company will service a different region of the country, Humana said in the announcement.”
About pharma
Senate panel advances bill that would ban spread pricing “Despite pushback from Republicans, a key Senate committee has advanced a bill that aims to reform pharmacy benefit managers, including a ban on spread pricing.
The PBM bill was among four passed by the Senate Health, Education, Labor and Pensions (HELP) committee on Thursday, one day after the senators heard input from major PBM and pharmaceutical manufacturer executives. The HELP committee approved the bill by a vote of 18 to 3.
The most contentious part of the PBM bill was a provision that would prevent these firms from deploying spread pricing models for their clients. In this model, a PBM would charge the insurer or plan sponsor more for a drug than it costs at the pharmacy and then pocket the difference.”
Comment: I do not usually report committee actions, but this one may have “legs.”
About the public’s health
WHO says mpox is no longer a global health emergency “After a heated meeting this week, WHO’s emergency committee for mpox recommended an end to the emergency, and WHO Director-General Tedros Adhanom Ghebreyesus agreed with its assessment.” However: Monkeypox is back, coinciding with a rise of STD rates in Chicago. And the CDC is reporting a rise in all STIs.
US FDA eases restrictions on blood donation “The U.S. Food and Drug Administration on Thursday set guidelines for blood donation organizations, recommending they screen donors based on one set of criteria, ending a restrictive policy that applied only to men who have sex with men and their female partners…
Individuals, other than those who report having a new sexual partner or multiple partners and had anal sex in the past three months, will be eligible to donate blood, provided all other eligibility criteria are met.”
About healthcare IT
Physician Electronic Health Record Use After Changes in US Centers for Medicare & Medicaid Services Documentation Requirements “On January 1, 2021, the US Centers for Medicare & Medicaid Services (CMS) modified outpatient evaluation and management (E/M) coding requirements, including the elimination of history and physical examination documentation. Centers for Medicare & Medicaid Services sought to reduce physician documentation burden by reducing electronic health record (EHR) documentation time. This study assesses changes in outpatient physician documentation time after these changes…
Across the 2 largest EHR vendors in the US, this study, along with that of Apathy et al, 3 found small reductions in documentation time following the changes in CMS E/M coding requirements, but not at clinically meaningful levels. Apathy et al observed a small decrease immediately postimplementation, while reductions took longer to manifest in the Cerner EHR sample. The magnitude of reduction was modest in both studies and less than the 19-second CMS-estimated reduction in documentation time per visit.”
About healthcare personnel
Medical Liability Claim Frequency Among U.S. Physicians “ In 2022, 31.2 percent of physicians had been sued during their careers to date.
The risk of getting sued varies widely by certain factors, especially over the longer term. In both the short and longer term, the widest variation in liability risk comes from specialty. Among the strongest and most consistent results is that OB/GYNs, general surgeons, orthopedic surgeons and other surgeons have a much higher incidence of claims.
Of OB/GYNs, 62.4 percent have been sued in their careers, followed by 59.3 percent of general surgeons. Controlling for other factors, OB/GYNs and general surgeons are 33.6 and 28.6 percentage points more likely than general internists to have ever been sued…
Twenty four percent of women physicians have been sued in their careers compared to 36.8 percent of their male counterparts…
Finally, there is a strong positive correlation between longer-term claim frequency and age. Physicians under the age of 40 are 15.6 percentage points less likely and those over 54 are 21.9 percentage points more likely to have ever been sued than their age 40-54 counterparts.”
About health technology
Fake Publications in Biomedical Science: Red-flagging Method Indicates Mass Production[Preprint and not yet peer reviewed] “From 2010 to 2020 the RFP [red-flagged fake publications] rate increased from 16% to 28%. Given the 1.3 million biomedical Scimago-listed publications in 2020, we estimate the scope of >300,000 RFPs annually. Countries with the highest RFP proportion are Russia, Turkey, China, Egypt, and India (39%-48%), with China, in absolute terms, as the largest contributor of all RFPs (55%).”