FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule — CMS-1785-F and CMS-1788-F Fact Sheet
Too much content to summarize in this important document. Topics range from prospective payment adjustments to interoperability rules. It is a bit long but not difficult. Well-worth at least skimming.
About Covid-19
Comparative Risks of Potential Adverse Events Following COVID-19 mRNA Vaccination Among Older US Adults “In this cohort study of 6 388 196 older US adults, a 4% lower risk of pulmonary embolism, a 2% lower risk of thromboembolic events, and a 14% lower risk of diagnosed COVID-19 were observed among those who received the mRNA-1273 [Moderna]vaccine compared with the BNT162b2 [Pfizer] vaccine. Although both vaccines were safe across frailty subgroups, differences were generally greater in individuals without frailty.”
COVID hospital admissions jump in what could be a new norm of summer surges “Total COVID-19 hospital admissions jumped by 12.1 percent in the past week, according to the most recent data from the Centers for Disease Control and Prevention (CDC), marking the highest jump in admissions since last winter.
This week’s hospital admission rate follows last week’s rise of more than 10 percent. While this data suggests more infections, a metric the CDC does not track anymore, it remains unclear how concerned people should be.
While hospital admissions have risen by more than 10 percent in each of the past two weeks, the number of patients currently hospitalized has risen by a comparatively smaller degree. Compared with last week, the number of patients hospitalized for COVID this week rose by 7 percent to 6,121. Deaths due to COVID-19 have also not changed in recent weeks as hospital admissions have risen.”
Coronavirus Variant EG.5 Takes Top Spot from ‘Arcturus’ EG.5 was responsible for more than 17% of new coronavirus cases over the past two weeks, according to data from the Centers for Disease Control and Prevention. That’s the highest prevalence of any strain circulating, rising above the so-called “arcturus” variant, which caused nearly 16% of infections…
XBB.1.5, which will be the target of the updated COVID-19 vaccines coming in the fall, is decreasing in the U.S. Still, health experts say that the shot should work on other omicron subvariants as well.”
Dynamic role of personality in explaining COVID-19 vaccine hesitancy and refusal “Vaccine hesitancy and refusal are threats to sufficient response to the COVID-19 pandemic and public health efforts more broadly. We focus on personal characteristics, specifically personality, to explain what types of people are resistant to COVID-19 vaccination and how the influence of these traits changed as circumstances surrounding the COVID-19 pandemic evolved. We use a large survey of over 40,000 Canadians between November 2020 and July 2021 to examine the relationship between personality and vaccine hesitancy and refusal. We find that all five facets of the Big-5 (openness to experience, conscientiousness, extraversion, agreeableness, and negative emotionality) are associated with COVID-19 vaccine refusal. Three facets (agreeableness, conscientiousness, and openness) tended to decline in importance as the vaccination rate and COVID-19 cases grew. Two facets (extraversion and negative emotionality) maintained or increased in their importance as pandemic circumstances changed. This study highlights the influence of personal characteristics on vaccine hesitancy and refusal and the need for additional study on foundational explanations of these behaviors. It calls for additional research on the dynamics of personal characteristics in explaining vaccine hesitancy and refusal. The influence of personality may not be immutable.”
About health insurance/insurers
Big payers ranked by Q2 profits FYI
Employer-based health coverage steady despite concerns about moving workers to ACA “Among the highlights of the study:
Between 2013 and 2021, the percentage of workers with employment-based health insurance was steadily between 71% and 73%.
At the same time, the percentage of children with employment-based coverage held steady at between 54% and 56%.
The percentage of non-working adults with employment-based coverage was 36% between 2013 and 2018, increased to 39% in 2019 and subsequently fell to 35% by 2021. Before 2013, the percentage of workers and their families with such insurance had been declining.”
How Do Dual-Eligible Individuals Get Their Medicare Coverage? See Figure 1. first. “Key takeaways:
Just over half (51%) of dual-eligible individuals received their Medicare benefits through traditional Medicare in 2020, while the remaining 49% were enrolled in Medicare Advantage plans (Figure 1).
Three in 10 (30%) dual-eligible individuals were enrolled in a dual-eligible plan, most of whom (24%) were in coordination-only dual eligible special needs plans (D-SNPs). Coordination-only D-SNPs are designed for dual-eligible individuals and are required to coordinate with state Medicaid programs, with some variation in the specific requirements across states.
Enrollment of dual-eligible individuals in traditional Medicare ranged from less than 30% in Hawaii and Puerto Rico to 70% or over in 11 states (Alaska, Delaware, Maryland, Montana, North Dakota, New Hampshire, Oklahoma, South Dakota, Vermont, West Virginia, and Wyoming).
Among dual-eligible individuals, Medicare Advantage enrollment rates were higher among beneficiaries who were age 65 and older than those under age 65 (53% vs 41%) and among beneficiaries who were Black (54%), Hispanic (65%), and Asian/Pacific Islander (48%) than non-Hispanic White beneficiaries (41%).”
About hospitals and healthcare systems
Analysis of Selected Medicare Quality Measure Reporting Data by Hospital Ownership This study compares physician-owned hospitals with non-physician-owned hospitals. Caveat: It was commissioned bt the AHA and Federation of American Hospitals.
“As compared to non-POHs in the same market as a POH, POHs appear to report fewer measures in most of the CMS Hospital Compare Star Ratings Domains and are less likely to have adequate volume to qualify for the full breadth of HRRP measures. This suggests POHs are accountable for a narrower scope of quality measure performance than non-POHs. POHs have sometimes asserted that offering more focused services facilitates stronger quality performance. Yet, this analysis shows POHs appear to have slightly higher average readmission penalties. POHs also are disproportionately more likely than similarly situated non-POH hospitals to experience the maximum HRRP penalty. These findings build on our prior work that shows POHs care for a less medically complex Medicare population than non-POHs.”
Which Drugs Are Driving Next Year’s 3.42% Increase in Hospital Pharmacy Spend? “Hospitals’ pharmacy spending is projected to rise by 3.42% next year, according to a new report. Specialty drugs, including Ozempic and Humira, as well as neurology medications are the primary drivers of this increase in pharmacy expenses.”
About pharma
Below are 3 articles about the new weight-loss drugs
1.KFF Health Tracking Poll July 2023: The Public’s Views Of New Prescription Weight Loss Drugs And Prescription Drug Costs Some Key Findings:;
“As a relatively new class of prescription drugs, initially approved to treat type 2 diabetes, have been gaining attention for their use as effective weight loss drugs, the latest KFF Health Tracking Poll finds that nearly half of adults (45%) say they would generally be interested in taking a safe and effective prescription weight loss drug, including nearly six in ten (59%) of those who are currently trying to lose weight and half (51%) of those who are trying to lose less than 10 pounds. About seven in ten adults say they have heard at least “a little” about this new class of weight loss drugs, which include Ozempic, Wegovy and Mounjaro.
While there is overall interest in taking a prescription weight loss drug, interest decreases substantially once people are asked if they would take a drug administered as routine injection (23% of all adults would still be interested), if it was not covered by their insurance (16%), if it was not approved by the FDA for weight loss specifically (16%), or if they heard they may gain weight back after stopping use (14%).”
2. Employers Cut Off Access to Weight-Loss Drugs for Workers “So many people have turned to drugs used for weight loss that some employers are cutting off insurance coverage to head off climbing bills.
Spending on the popular drugs, which belong to the class including Ozempic and can cost as much as $1,350 a month for a patient, has quickly leapt into the tens of millions of dollars for insurance plans. The outlays are straining the finances of some plans, including those funded by employers…
Last month Morgan Stanley analysts raised their estimate for the anti-obesity market to $77 billion worldwide in 2030, up $23 billion from a previous forecast.”
3.Makers of Ozempic and Mounjaro sued over 'stomach paralysis' claims “The drugmakers Novo Nordisk and Eli Lilly failed to adequately warn patients about the possible risk of severe stomach problems associated with their blockbuster drugs Ozempic and Mounjaro, according to a lawsuit filed Wednesday.
The 26-page lawsuit, filed on behalf of a Louisiana woman who says she was ‘severely injured’ after taking the two diabetes drugs, is the first to allege that they can cause gastrointestinal injuries.”
Prevalence of Use of Potentially Inappropriate Medications Among Older Adults Worldwide “A total of 94 articles with 132 prevalence estimates were analyzed, including nearly 371.2 million older participants from 17 countries. Overall, the pooled prevalence of PIM use was 36.7% (95% CI, 33.4%-40.0%). Africa had the highest prevalence of PIM use (47.0%; 95% CI, 34.7%-59.4%), followed by South America (46.9%; 95% CI, 35.1%-58.9%), Asia (37.2%; 95% CI, 32.4%-42.2%), Europe (35.0%; 95% CI, 28.5%-41.8%), North America (29.0%; 95% CI, 22.1%-36.3%), and Oceania (23.6%; 95% CI, 18.8%-28.8%). In addition, the prevalence of PIM use is highest in low-income areas. Use of PIMs among older patients has become increasingly prevalent in the past 2 decades.”
FDA approves first oral drug for postpartum depression “The Food and Drug Administration on Friday approved the first pill to treat postpartum depression, a potential milestone for treating a condition that can afflict about 1 in 7 women following childbirth.
The agency announced zuranolone, under the brand name Zurzuvae, had been approved as a once-daily pill to be taken for 14 days.”
Trends in 340B Drug Pricing Program Contract Growth Among Retail Pharmacies From 2009 to 2022 “The number of retail pharmacies participating in 340B increased from 789 in 2009 to 25 775 in 2022 or from 1.3% to 40.9% of all retail pharmacies, respectively. Depth [number of contracts per pharmacy] increased over time. In 2009, 81% of contract pharmacies had only 1 contract, and by 2022, 40% had 1, 23% had 2, 27% had 3 to 5, 7% had 6 to 9, and 3% had 10 or more (P < .001).
Spread increased over time. In 2009, the farthest CE [covered entity]was within the same zip code for 48% of pharmacies, less than 5 miles for 19%, 5 to 15 miles for 17%, and 16 miles or more for 16%. By 2022, only 9% of the farthest CEs were in the same zip code, and for 51% of pharmacies it was 16 miles away or more (P < .001). Among pharmacies in this category, the median (IQR) distance was 35 (23-67) miles, with a 90th percentile of 176 miles.”
Comment: No surprises here as the program has proved profitable for the pharmacies. However, the problem is:
“Safety-net composition decreased over time. In 2009, 95% of pharmacies contracted exclusively with safety-net hospitals and clinics. By 2022, only 54% of pharmacies contracted exclusively with safety-net facilities, and 16% contracted with no safety-net facilities (P < .001).”
Changes in the Number of Continuation Patents on Drugs Approved by the FDA Background: “Brand-name pharmaceutical manufacturers often sustain high prices in the US by obtaining patents that delay generic competition. Patents may be obtained on active ingredients and “secondary” features of drugs such as new formulations and methods of use. One legal strategy to obtain large numbers of secondary patents is via a special type of application to the US Patent and Trademark Office (USPTO), called a continuation, in which a patent holder adds new applications to a prior submission by offering minor clarifications or additions without substantial change to the underlying invention. Continuation patents can deter competition by increasing uncertainty for generic manufacturers, since they must avoid infringing (or must challenge) evolving patent claims on drugs.”
Findings: “Brand-name drug manufacturers listed with the FDA an increasing number of continuation patents on drugs approved from 2000 to 2015. More continuation patents mean that generic firms seeking to challenge existing protections on brand-name drugs must contest and potentially litigate more patents. Continuation patents are typically invalidated at a higher rate than patents on active ingredients. However, lawsuits brought by brand-name firms on patents listed with the FDA can earn 30-month stays on generic drug approval even if these lawsuits eventually fail. Study limitations include that the frequency of successful challenges on litigated continuation patents was not examined.
These findings suggest that continuation patents are becoming increasingly common in drug patent thickets, likely delaying or deterring generic competition and thus potentially contributing to delays in patient access to generic medications and increases in health care spending.”
About the public’s health
Age of onset and cumulative risk of mental disorders: a cross-national analysis of population surveys from 29 countries “The lifetime prevalence of any mental disorder was 28·6% (95% CI 27·9–29·2) for male respondents and 29·8% (29·2–30·3) for female respondents. Morbid risk of any mental disorder by age 75 years was 46·4% (44·9–47·8) for male respondents and 53·1% (51·9–54·3) for female respondents. Conditional probabilities of first onset peaked at approximately age 15 years, with a median age of onset of 19 years (IQR 14–32) for male respondents and 20 years (12–36) for female respondents. The two most prevalent disorders were alcohol use disorder and major depressive disorder for male respondents and major depressive disorder and specific phobia for female respondents.”
A Collaborative Effort to Establish Common Metrics for Use in Mental Health The article provides an excellent explanation of the nomenclature problem and the common metrics upon which the National Institute of Mental Health and the Wellcome Trust agreed.
US CDC panel recommends Sanofi-AstraZeneca's preventive RSV therapy for babies “The U.S. Centers for Disease Control and Prevention (CDC) said its advisory panel on Thursday recommended use of Sanofi and partner AstraZeneca's antibody therapy to prevent respiratory syncytial virus (RSV) in infants and toddlers.
The Advisory Committee on Immunization Practices unanimously recommended nirsevimab for preventing lower respiratory tract disease in newborns and infants below eight months of age born during or entering their first RSV season.”
Insight: Promising new Alzheimer's drugs may benefit whites more than Blacks “Groundbreaking treatments for Alzheimer's disease that work by removing a toxic protein called beta amyloid from the brain may benefit whites more than Black Americans, whose disease may be driven by other factors, leading Alzheimer's experts told Reuters…
Prospective Black volunteers with early disease symptoms did not have enough amyloid in their brain to qualify for the trials, the 10 researchers explained.
Hispanics, who experience dementia at one and a half times the rate of whites, were also excluded at a somewhat higher rate due to low amyloid, though the issue was not as pronounced as for Black people, five of the researchers said.”
About healthcare IT
Hospitals' risk of data breach doubles just before, after a merger deal, research shows “Between 2010 and 2022, U.S. hospitals on either side of a merger deal were twice as likely to report a data breach in the year before and after close, according to a recent analysis of government and proprietary data.
The peer-reviewed research, conducted by a University of Texas at Dallas doctoral student and presented at a July information security conference, found that the probability of a data breach was about 6% for buyers and sellers within the two-year deal window. Outside of that period, data breach probability was 3% among the same hospitals.”
About health technology
Time From Authorization by the US Food and Drug Administration to Medicare Coverage for Novel Technologies “In this cross-sectional study, 64 devices and diagnostics authorized by the US Food and Drug Administration through premarket approval and de novo pathways between 2016 and 2019 required establishment of new Medicare coverage; at least nominal explicit or implicit Medicare coverage supportive of patient access was achieved by 28 (44%) within a median of 5.7 years.”
About healthcare finance
After FTC scrutiny, CooperSurgical calls off $875M deal for Cook Medical's reproductive health portfolio “CooperSurgical has ended plans to acquire Cook Medical’s reproductive health portfolio—a $875 million deal that would have included medical hardware for obstetrics, gynecology and in vitro fertilization.
In a brief announcement from the Federal Trade Commission, the agency said it “has learned” of the termination and described the move as “a win for patients,” adding that it came after cooperation with international antitrust regulators in Australia and the U.K.”
Walgreens cuts stake in AmerisourceBergen to raise $1.85B: 5 notes “Proceeds from the transaction will primarily be used to pay down debt and then general corporate purposes, according to Walgreens Boots Alliance…
In June, Walgreens Boots Alliance reported profits dropped 59 percent in the third quarter of 2023, and the company revised its full-year earnings outlook.”
