About anti-trust
FTC Chief Warns of Healthcare Price Fixing Risks Amid Tech Advancements “In a recent media event hosted by KFF, Lina Khan, chair of the Federal Trade Commission (FTC), issued a warning about the potential for price fixing in healthcare facilitated by technological advancements. Khan highlighted how algorithms enable companies to fix prices without explicit coordination, presenting a new challenge for regulators.
Khan emphasized the potential harm that technological advances can inflict on consumers. She pointed out that algorithms are increasingly utilized by companies to discriminate against individual consumers, ushering in what she termed ‘a somewhat novel era of pricing.”
Comment: For decades, actuaries have used similar (and evolving) models for insurance pricing.These algorithms are based on real world data and statistical analysis. How does this process morph into anti-trust?
FTC bans contracts that keep workers from jumping to rival employers “The Federal Trade Commission on Tuesday banned noncompete agreements for most U.S. workers, a move that will affect an estimated 30 million employees bound by contracts that restrict workers from switching employers within their industry.
The agency voted 3-2 to issue the rule, with commissioners in the majority saying they saw a mountain of evidence that noncompete agreements suppress wages, stifle entrepreneurship and gum up labor markets. The new rule makes it illegal for employers to include the agreements in employment contracts and requires companies with active noncompete agreements to inform workers that they are void.”
In a related article: FTC votes 3-2 on final rule to ban noncompete agreements, but legal challenges expected “The ban does not apply to nonprofits including many of the country’s healthcare provider organizations due to the limitations of the FTC’s jurisdiction, one of several points of contention that’s been raised by hospital industry groups that have opposed the ban.”
Is There Too Little Antitrust Enforcement in the U.S. Hospital Sector? “From 2002 to 2020, there were over 1,000 mergers of U.S. hospitals. During this period, the Federal Trade Commission (FTC) took enforcement actions against 13 transactions. However, using the FTC’s standard screening tools, we find that 20% of these mergers could have been predicted to meaningfully lessen competition. We then show that, from 2010 to 2015, predictably anticompetitive mergers resulted in price increases over 5%. We estimate that approximately half of predictably anticompetitive mergers had to be reported to the FTC per the Hart-Scott-Rodino Act. We conclude that there appears to be underenforcement of antitrust laws in the hospital sector.”
In a different article with the “same” message:
New evidence on the impacts of cross-market hospital mergers on commercial prices and measures of quality “Six years after acquisition, cross-market hospital mergers had increased acquirer prices by 12.9% (CI: 0.6%–26.6%) relative to control hospitals, but had no discernible impact on mortality and readmission rates for heart failure, heart attacks and pneumonia.
For serial acquirers, the price effect increased to 16.3% (CI: 4.8%–29.1%). For all acquisitions, the price effect was 21.8% (CI: 4.6%–41.7%) when the target's market share was greater than the acquirer's market share versus 9.7% (CI: −0.5% to 20.9%) when the opposite was true. The magnitude of the price effect was similar for out-of-state and in-state cross-market mergers.”
See, also: The Price Effects of Cross-Market Mergers: Theory and Evidence from the Hospital Industry
About health insurance/insurers
Humana plans to leave some Medicare Advantage markets in 2025 “The company reported its first quarter earnings April 24. Humana posted a $741 million in net income in the first quarter of 2024, beating investor expectations, but pulled its 2025 earnings guidance…
On an April 24 call with investors, Humana executives said it will look to pull back benefits and exit some markets, as CMS continues phasing in risk adjustment changes.”
Optum shutting down telehealth business “UnitedHealth Group's Optum Virtual Care is shutting down, Endpoints News reported April 24.”
CMS unveils managed care rule, refutes nursing home rule complaints “Medicaid managed care plans and the Children’s Health Insurance Program (CHIP) will be subject to new wait time standards and quality ratings requirements, the Centers for Medicare & Medicaid Services (CMS) revealed during a flurry of regulatory activity Monday.
The rule implements a maximum appointment wait time of 15 business days for primary care and 10 business days for mental health and substance use disorder services.”
About hospitals and healthcare systems
Advocate Health posts $2.2B net income in 2023 “The system posted $31.7 billion in total revenue and $31.1 billion in total expenses, according to the report. It posted a total nonoperating income of $1.6 billion.”
See the article for more details.
California Hospital Association sues Anthem Blue Cross over discharge delays “The California Hospital Association has filed suit against Anthem Blue Cross, alleging the insurer's authorization protocols for post-acute care leave patients stuck with long waits for discharge.
The lawsuit claims that Anthem failed to maintain an adequate network for these services and that it does not pay for additional hospital services incurred by patients who are waiting for discharge.”
Comment: Hospitals are held responsible for lengths of stay; however, some reasons for excess LOS are out of their control.
About pharma
25 most popular drugs in healthcare FYI. Top 5:
1. Semaglutide — $38.6 billion (100.1% change from 2022)
2. Adalimumab — $35.3 billion (9.1% change)
3. Apixaban — $22.1 billion (17.1% change)
4. Dulaglutide — $16.3 billion (5.1% change)
5. Empagliflozin — $15.9 billion (34% change)
25 most expensive hospital drugs FYI. TOP 5:
Pembrolizumab — $1.4 billion (4.4% change from 2022)
Immune globulin — $1 billion (-5.1% change)
Remdesivir — $727,409,000 (-45% change)
Bictegravir/emtricitabine/tenofovir/alafenamide — $643,390,000 (18.9% change)
Sugammadex — $636,441,000 (23.9% change)
U.S. $772.5B PHARMACY SPEND IN 2023 DRIVEN BY WEIGHT-LOSS DRUGS “KEY TAKEAWAYS
—Hospitals' drug spending fell by 1.1%, continuing a steady period of falling expenditures that was interrupted during the COVID pandemic.
—Drug cost inflation was marginal (2.9%) and for the fourth straight year lagged the 3.4% inflation in the overall economy as measured by the Consumer Price Index.
—Spending for semaglutide doubled in 2023, making it the top-selling drug in the nation, replacing autoimmune disease drug adalimumab, which also saw sales growth despite the availability of cheaper biosimilars.
—Retail pharmacies accounted for $307.8 billion (42.6%) of total expenditures, mail-order pharmacies $206.6 billion (28.6%), clinics $135.7 billion (18.8%), and nonfederal hospitals $37.1 billion (5.1%).”
In a related article: Diabetes drugs helping to drive rise in US medication expenditures “Key takeaways: —Total expenditures for diabetes medications rose from $27.15 billion in 2011 to $89.17 billion in 2020.
—Expenditures increased for insulin, incretin mimetics, DPP-IV inhibitors and combination drugs.”
Pharma groups warn of supply crunch over China spying law “Western pharmaceutical groups are warning of worsening disruption to supply chains because of problems certifying manufacturing sites in China, with some factory inspectors refusing to visit the country over fears of arrest for spying and others denied entry to facilities. China is one of the world’s largest makers of active pharmaceutical ingredients and antibiotics and a major supplier of drugs to the EU and US. However, a tightening of anti-espionage laws by Beijing has led to concerns that foreign citizens gathering data on Chinese sites could be deemed spies.”
Walgreens Launches Gene and Cell Services as Part of Newly Integrated Walgreens Specialty Pharmacy Business “Under the new business, Walgreens Specialty Pharmacy has an unmatched offering and is the only specialty pharmacy in the market with the following services and assets at scale:
Gene and Cell Services Pharmacy and Innovation Center – a dedicated 18,000-square-foot center in Pittsburgh, PA, with services and capabilities for these emerging therapies, including innovative solutions for managing the complexity of the supply chain, logistics and financing as well as clinical and social needs management to ensure success for patients and partners.
Four central specialty pharmacies – each holding several national pharmacy accreditations – where pharmacists and care teams across the country work together to dispense highly complex medications and help patients manage chronic or rare diseases and conditions. These pharmacies hold distinctions in oncology and rare/orphan conditions and offer patients and caregivers clinical services that drive engagement, adherence and outcomes.
Nearly 300 community-based specialty pharmacies across the nation – more than any other pharmacy. These specialty pharmacies are strategically located near medical office buildings and health systems, closely aligning care provision with local physicians, offering patients access to specialty medications faster than the industry average, as well as services like injection training, medication side-effect management and financial assistance coordination for medications.
More than 1,500 specialty-trained pharmacists, 5,000 patient advocacy support team members and dedicated Specialty360 teams that support all specialty condition and therapies.
A growing roster of 240 limited distribution drugs, including 40 narrow networks and 12 exclusive limited distribution drugs.”
F.D.A. Approves Antibiotic for Increasingly Hard-to-Treat Urinary Tract Infections “The Food and Drug Administration on Wednesday approved the sale of an antibiotic for the treatment of urinary tract infections in women, giving U.S. health providers a powerful new tool to combat a common infection that is increasingly unresponsive to the existing suite of antimicrobial drugs.
The drug, pivmecillinam, has been used in Europe for more than 40 years, where it is often a first-line therapy for women with uncomplicated U.T.I.’s, meaning the infection is confined to the bladder and has not reached the kidneys. The drug will be marketed in the U.S. as Pivya and will be made available by prescription to women 18 and older.” [Emphasis added]
Health care lobbying giants spent big as little got done in Congress “Congress did nothing this spring to rein in how pharmacy benefit managers operate, which is precisely the outcome the industry’s lobbyists wanted.
And the PBM industry spent big to get that result, new disclosures show. The Pharmaceutical Care Management Association, the industry’s biggest trade group, spent a whopping 71% more on lobbying in the first three months of this year compared with 2023, increasing its spending from $2.8 million to $4.8 million.”
Provider markups on specialty drugs increased commercial premiums “Provider markups on specialty drugs increased 2024 commercial health insurance premiums by $13.1 billion, according to research from Oliver Wyman commissioned by AHIP…
Among the top ten specialty drugs by total claim dollars, the average cost of the drugs that were buy-and-bill was 50 percent to 103 percent higher when supplied by a hospital facility and 2 percent to 33 percent higher when supplied by a professional office compared to the cost when supplied by a specialty pharmacy.
The average markup was 42 percent, with the total amount of all markups representing 0.7 percent of total medical and pharmacy claim dollars. This rate resulted in an average premium increase of $48 per contract per year for individual and small group plan members, $61 for large group single plan members, and $175 for large group family plan members.”
Comment: Medicare has limited the markup to 6% over average sales price for 20 years. Why has the commercial sector taken so long to adopt a similar policy?
About the public’s health
Early tests of H5N1 prevalence in milk suggest U.S. bird flu outbreak in cows is widespread “The researchers expect additional lab studies currently underway to show that those samples don’t contain live virus with the capability to cause human infections, meaning that the risk of pasteurized milk to consumer health is still very low. But the prevalence of viral genetic material in the products they sampled suggest that the H5N1 outbreak is likely far more widespread in dairy cows than official counts indicate. So far, the U.S. Department of Agriculture has reported 33 herds in eight states have tested positive for H5N1.”
In a related article: Is There a Vaccine for H5N1 Influenza? “On the heels of a multi-state outbreak of highly pathogenic avian influenza A (H5N1) in dairy cows, experts told MedPage Today that a trio of H5N1 vaccines for humans has already been developed and approved in the U.S.”
State of the Air From the American Lung Association. Enter your zip code and get a report of the air quality in your county.
New rules will slash air, water and climate pollution from U.S. power plants “The Environmental Protection Agency on Thursday finalized an ambitious set of rules aimed at slashing air pollution, water pollution and planet-warming emissions spewing from the nation’s power plants.
Sign up for the Climate Coach newsletter and get advice for life on our changing planet, in your inbox every Tuesday. “If fully implemented, the rules will have enormous consequences for U.S. climate goals, the air Americans breathe and the ways they get their electricity. The power sector ranks as the nation’s second-largest contributor to climate change, and it is a major source of toxic air pollutants tied to various health problems.
Before the restrictions take effect, however, they will have to survive near-certain legal challenges from Republican attorneys general, who have been emboldened by the Supreme Court’s skepticism of expansive environmental regulations.”
CDC Launches Online 'Heat Forecaster' Tool as Another Summer Looms “The HeatRisk Forecast Tool is a joint effort between the CDC and the National Oceanic and Atmospheric Administration's National Weather Service to give Americans a week-long heads-up that broiling temperatures are headed their way.
It's all close at hand at the HeatRisk Dashboard online -- just plug in your zip code for the latest forecast and updates.”
About healthcare IT
The Impact Of Telemedicine On Medicare Utilization, Spending, And Quality, 2019–22 “Patients receiving care from health systems in the highest quartile of telemedicine use had modest increases in office visits, care continuity, and medication adherence, as well as decreases in ED visits, relative to patients of health systems in the lowest quartile. We did not observe differences in testing or preventive service use. The relative increase in visits was larger among patients without chronic illness and among lower-income, non-White patients. However, these changes were accompanied by a 1.6 percent increase in health care spending, largely driven by inpatient and drug spending.
Our results are qualitatively consistent with those of other recent studies. An analysis by the Medicare Payment Advisory Commission found that geographic areas with higher telemedicine uptake through 2021 had a 3 percent relative increase in total clinical encounters and a relative spending increase of $165 per person.”
The Joint Commission Launches Telehealth Accreditation “The Joint Commission today announced it is launching a new Telehealth Accreditation Program for eligible hospitals, ambulatory and behavioral healthcare organizations, effective July 1, 2024. This accreditation program provides updated, streamlined standards to provide organizations offering telehealth services with the structures and processes necessary to help deliver safe, high-quality care using a telehealth platform.
The Telehealth Accreditation Program was developed for healthcare organizations that exclusively provide care, treatment and services via telehealth. Hospitals and other healthcare organizations that have written agreements in place to provide care, treatment and services via telehealth to another organization’s patients have the option to apply for the new accreditation.”
About healthcare personnel
You Might Fare Better If Your Doctor Is Female, Study Finds “About 10.15% of men and 8.2% of women died while under the care of a female doctor, versus 10.23% and 8.4% when treated by a male doctor, according to results published April 22 in the Annals of Internal Medicine…
Not only were patients less likely to die with a female doctor, but they also were less likely to land back in the hospital within a month of discharge, researchers found…
More research is needed into how and why male physicians practice medicine differently, as well as the impact this difference has on patient care…”
