Today's News and Commentary

About Covid-19

US COVID activity remains elevated, though some markers decline “Hospitalization levels for COVID are still elevated but have been declining since early August. The CDC said the highest levels are in seniors and in children younger than 2 years old.
Deaths declined 8% compared to the previous week, and fatalities from COVID currently make up 2.3% of all deaths. The CDC received reports of 534 COVID deaths last week, based on provisional data. During the preceding week, 954 deaths were reported.” 

About health insurance/insurers

The best-rated health plans of 2024: NCQA See the list.

About hospitals and healthcare systems

AT CATHOLIC HOSPITALS, A MISSION OF CHARITY RUNS UP AGAINST HIGH CARE COSTS FOR PATIENTS  “KEY TAKEAWAYS
To maintain their tax-exempt status, all nonprofit hospitals are required to spend on community benefits, but federal law doesn't specify how much or which services qualify.
Health systems like CommonSpirit Health, Ascension, PeaceHealth, Trinity Health, and Providence St. Joseph pay their chief executives millions of dollars a year.
CommonSpirit Health's then-CEO Lloyd Dean earned roughly $28 million in 2022; Rod Hochman, CEO of Providence St. Joseph Health, earned $12.1 million and; Ascension CEO Joseph Impicciche was paid $9.1 million.”
The entire article is worth reading.

About pharma

One-Year Weight Reduction With Semaglutide or Liraglutide in Clinical Practice “In this cohort study of 3389 patients with obesity, the mean percentage of body weight change from baseline to 1 year was −5.1% for semaglutide vs −2.2% for liraglutide treatment; −3.2% for type 2 diabetes vs −5.9% for obesity indications; and −5.5% for patients with persistent medication coverage vs −2.8% with 90 to 275 coverage days and −1.8% with fewer than 90 coverage days. Factors positively associated with achieving at least 10% weight reduction at year 1 included semaglutide (vs liraglutide), obesity as a treatment indication (vs type 2 diabetes), persistent medication coverage, high dosage, and female sex.” 

About the public’s health

Flu Deaths in Children Last Season Reach 199, Matching Record “CDC reported two new flu-related deaths in children last week, bringing the total for the 2023-2024 season to 199. Any number of pediatric deaths is a deeply tragic reminder that influenza can cause severe illness, and the number of deaths reported so far this season equals the previous high of 199 reported during the 2019-2020 season.
Of the 158 children who were eligible for a flu vaccine and for whom vaccination status is known, 131 (83%) were not fully vaccinated.”

Intake of sugar sweetened beverages [SSBs] among children and adolescents in 185 countries between 1990 and 2018: population based study “This study found that intakes of SSBs among children and adolescents aged 3-19 years in 185 countries increased by 23% from 1990 to 2018, parallel to the rise in prevalence of obesity among this population globally. SSB intakes showed large heterogeneity among children and adolescents worldwide and by age, parental level of education, and urbanicity. This research should help to inform policies to reduce SSB intake among young people, particularly those with larger intakes across all education levels in urban and rural areas in Latin America and the Caribbean, and the growing problem of SSBs for public health in sub-Saharan Africa.”

Today's News and Commentary

About health insurance/insurers

US employers expect nearly 6% spike in health insurance costs in 2025, Mercer says “U.S. employers expect health insurance costs to rise an average 5.8% in 2025, largely due to increased cost of medical services as well as higher use, according to a survey released by consulting firm Mercer on Thursday.
The year 2025 is projected to be the third consecutive year in which healthcare costs for employers rise by more than 5%. Costs increased an average 3% during the decade prior, the report said.” 

About hospitals and healthcare systems

New Analysis Shows Hospitals Improving Performance on Key Patient Safety Measures Surpassing Pre-pandemic Levels  “Key Takeaways

• Despite being sicker and more complex, hospitalized patients in the first quarter of 2024 were on average over 20% more likely to survive than expected given the severity of their illnesses compared to the fourth quarter of 2019.

• Based on Vizient’s analysis, the AHA using national hospitalization data projects that while caring for sicker patients, hospitals’ efforts to improve safety led to 200,000 Americans hospitalized between April 2023 and March 2024 surviving episodes of care they wouldn’t have in 2019.

• Hospitals cared for more patients overall in the first quarter of 2024 than in the last quarter of 2019, including providing care to a sicker, more complex patient population.

• Hospitals’ central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) in the first quarter of 2024 were at rates lower than those recorded in the fourth quarter of 2019.

• Not only did multiple key preventive health screenings rapidly rebound to pre-pandemic levels, but ongoing improvement has led to a 60%-to-80% increase in breast, colon and cervical cancer screenings in the first quarter of 2024 compared to the fourth quarter 2019.” 

About pharma

Walgreens pays $107M over prescription billing fraud claim “Walgreens Boots Alliance has agreed to pay a $106.8 million fine to the U.S. Department of Justice to settle allegations that it billed government health care programs for prescriptions never dispensed.”  

About the public’s health

New CDC Data Show Adult Obesity Prevalence Remains High “New CDC population data from 2023 show that in 23 states more than one in three adults (35%) has obesity. Before 2013, no state had an adult obesity prevalence at or above 35%. Currently, at least one in five adults (20%) in each U.S. state is living with obesity.”

The 12 Cinnamon Powders You Should Never Use “12 of the 36 products measured above 1 part per million of lead—the threshold that triggers a recall in New York, the only state in the U.S. that regulates heavy metals in spices.”

Twice-a-year injection reduced risk of HIV infection by 96%, drug company says — more than daily PrEP pill “In a Phase 3 clinical trial, 99.9% of participants who took a twice-a-year injection of lenacapavir for HIV prevention did not acquire an infection, according to data from drugmaker Gilead Sciences.”

Many Americans Wary of Vaccines as Fall Flu, COVID Season Looms: Survey “More than one-third of those polled (37%) said they’d gotten vaccines in the past but don’t plan to this year, according to results from a nationwide Ohio State University Wexner Medical Center survey.
Just a slight majority -- 56% -- plan to get the flu shot this fall, researchers found.
Less than half (43%) say they’ll get the updated COVID vaccine.”

About healthcare IT

EHR Interoperability 2024 “Regardless of EHR vendor, interoperability is a major pain point for clinicians amid an already painful EHR experience. Among the 11 metrics used to calculate the Net EHR Experience Survey (NEES), clinicians are least satisfied with external integration—only 44% of respondents agree their EHR provides expected integration with outside organizations. In particular, physicians most frequently cite interoperability as a challenge and report that it is their top fix request, noting that external patient data often isn’t readily available in their EHR and, if found, is difficult to leverage (see next section). Of all clinical backgrounds measured by the Arch Collaborative, physicians have the lowest average NEES—22 points lower (on a -100 to 100 point scale) than the average NEES of other clinician types.”
The results haven’t varied significantly since 2018.

About health technology

FDA authorizes first OTC hearing aid software to be used in Apple's AirPods Pro “The U.S. Food and Drug Administration on Thursday authorized the first over-the-counter hearing aid software that is intended to be used with compatible versions of the Apple AirPods Pro headphones.” 

Today's News and Commentary

About health insurance/insurers

Behavioral Health:Information on Cost-Sharing in Medicare and Medicare Advantage [From the GAO] “Behavioral health conditions were estimated to affect at least a quarter of the 66.7 million Medicare beneficiaries in 2023. There have been longstanding concerns about behavioral health services accessibility, even for those with health coverage.
This report describes what behavioral health benefits are available under Medicare and Medicare Advantage programs, what beneficiaries pay out of pocket, and more.
For example, in traditional Medicare in 2024, beneficiaries had to pay a deductible of $1,632 for any acute or psychiatric inpatient hospital stay up to 60 days long, with coinsurance payments for additional days.”

Changes in Out-of-Pocket Spending for Common Oral Cancer Medications After the Inflation Reduction Act “This economic evaluation found that the OOP cap legislated by the IRA may save patients enrolled in Part D plans a median of $7260 in 2024 for oral cancer medications. These savings will likely continue to grow as the OOP cap decreases from about $3500 in 2024 to $2000 in 2025.”

Medicare Advantage Quality Bonus Payments Will Total at Least $11.8 Billion in 2024 
”Key Takeaways:

• After increasing by more than 400% between 2015 and 2023, federal spending on Medicare Advantage bonus payments will decline by $1 billion (8%) to $11.8 billion in 2024, following the expiration of pandemic-era policies that temporarily increased star ratings for some plans. Despite the decline, total spending on Medicare Advantage plan bonuses is higher in 2024 than in every year between 2015 and 2022.

• Most Medicare Advantage enrollees (72%) are in plans that are receiving bonus payments in 2024. Though the share declined from 2023 (85%), it is similar to the share observed in 2022 (75%).

• The average bonus payment per enrollee is highest for employer- and union-sponsored Medicare Advantage plans ($456) and lowest for special needs plans ($330), raising questions about the implications of the quality bonus program for equity.

• Bonus payments vary substantially across firms, with UnitedHealthcare receiving the largest total payments ($3.4 billion) and Kaiser Permanente receiving the highest payment per enrollee ($516).” 

About pharma

 Open-Label Placebo Injection for Chronic Back Pain With Functional Neuroimaging “The findings of this trial suggest that open-label placebo treatments can confer meaningful clinical benefits to patients with chronic back pain by engaging prefrontal-brainstem pathways linked to pain regulation and opioidergic function.” 

Evernorth making Stelara biosimilar available for $0 out-of-pocket “Evernorth Health Services, a subsidiary of Cigna, plans to have a Stelara biosimilar available for $0 out-of-pocket cost for eligible patients of its specialty pharmacy, Accredo, beginning in early 2025.
The interchangeable biosimilar will be produced for Evernorth's affiliate private label distributor, Quallent Pharmaceuticals, and will be available at $0 out-of-pocket for most patients through Quallent's copay assistance program.
The program is expected to save individual patients around $4,000 on average per year, according to Evernorth.”

About healthcare quality and safety

Data analysis reveals common errors that prevent patients from getting timely, accurate diagnoses “ECRI's data analysis found that most errors (nearly 70 percent) occurred during the testing process – including when healthcare staff are ordering, collecting, processing, obtaining results, or communicating results. Twelve percent of errors occurred in the monitoring and follow-up phase; with nearly nine percent during the referral and consultation phase.
Of errors that occurred during testing, more than 23 percent were a result of a technical or processing error, like the misuse of testing equipment, a poorly processed specimen, or a clinician lacking the proper skill to conduct the test. Another 20 percent of testing errors were a result of mixed-up samples, mislabeled specimens, and tests performed on the wrong patient.”

About healthcare personnel

US faces maternity care crisis, with 1 in 3 counties lacking obstetric doctors to provide care, report warns  The United States is facing an ongoing maternity health crisis in which 1 in every 3 counties does not have a single obstetric clinician, affecting women’s access to care, according to a new report.
The report, released Tuesday by the infant and maternal health nonprofit March of Dimes, says that in many parts of the country, obstetrician/gynecologists and family physicians who deliver babies are leaving the workforce, which worsens access to care.
Ob/gyns nationwide delivered more than 85% of babies born in 2022, according to the report, but the American College of Obstetricians and Gynecologists (ACOG) now projects that the nation will face a shortage of 12,000 to 15,000 ob/gyns by 2050.”

Today's News and Commentary

About health insurance/insurers

Share of Americans with insurance falls despite record Obamacare enrollment “The share of Americans who had health insurance for all or part of the year in 2023 was 92 percent, a slight drop from the 92.1 percent seen in 2022, according to a report from the U.S. Census Bureau released Tuesday.  
About 26.4 million Americans — 8 percent of the country — did not have insurance at any time last year, according to the report, which officials said was not statistically different than the year before.  
But a breakdown of uninsured rates in the report shows a drop in coverage among Americans under 45, while more older Americans enrolled in health insurance that year.”

On the other hand: Almost 50 Million Americans Have Had an Obamacare Plan Since 2014 “Nearly 50 million Americans have been covered by health insurance plans through the Affordable Care Act’s marketplaces since they opened a decade ago, according to tax data analyzed by the Treasury Department and published on Tuesday.
Federal officials said that the findings represent roughly one in seven U.S. residents, a broad swath of the population that underscores the vast, and seemingly irreversible, reach of the 2010 law.”

About pharma

Optum Rx to pull Humira from some of its preferred formularies: report “UnitedHealth Group's Optum Rx will join its peers in the big three pharmacy benefit managers by pulling Humira from some of its preferred formularies, according to a report from Reuters.
Instead, it will recommend a cheaper biosimilar as the preferred option beginning Jan. 1, 2025, according to the article. Amgen's Amjevita biosimilar will be among the options.
CVS Health's Caremark announced similar steps in April, and Cigna's Express Scripts unit followed suit in August. Prescriptions for Sandoz's Hyrimoz biosimilar spiked after CVS removed Humira from its major commercial formularies, according to a report in Stat.”

About the public’s health

Decades of national suicide prevention policies haven't slowed the deaths “Despite… evolving strategies, from 2001 through 2021 suicide rates increased most years, according to the Centers for Disease Control and Prevention. Provisional data for 2022, the most recent numbers available, shows deaths by suicide grew an additional 3% over the previous year. CDC officials project the final number of suicides in 2022 will be higher.
In the past two decades, suicide rates in rural states such as Alaska, Montana, North Dakota and Wyoming have been about double those in urban areas, according to the CDC.
Despite those persistently disappointing numbers, mental health experts contend the national strategies aren't the problem. Instead, they argue, the policies — for many reasons —simply aren't being funded, adopted and used. That slow uptake was compounded by the pandemic, which had a broad, negative impact on mental health.”

Today's News and Commentary

About health insurance/insurers

White House to require insurers pay for mental health the same as physical health “Health insurers will be required to cover mental health care and addiction services the same as any other condition under a highly anticipated final rule being released Monday by the Biden administration. 
The move is part of the administration’s ongoing battle with health insurers, who officials say are skirting a 2008 law requiring plans that cover mental health and substance use care benefits do so at the same level as physical health care benefits.” 

About pharma

Rite Aid emerges from bankruptcy with $2.5B in exit financing and a new CEO at the helm “Retail pharmacy chain Rite Aid has emerged out of bankruptcy after slashing about $2 billion from its debt, the company announced last week.
The company also added about $2.5 billion in exit financing to support the business going forward, Rite Aid said.”

Pharmacy Benefit Manager Market Concentration for Prescriptions Filled at US Retail Pharmacies “In 2023, all 3 payer markets for PBM services were highly concentrated, but concentration varied and was highest in Medicare Part D. While CVS Caremark held the dominant share in all 3 payer markets, each of the PBMs appeared focused on a different payer: Express Script’s largest share was in the commercial market, while Optum Rx’s and CVS Caremark’s were in Medicare Part D and Medicaid managed care, respectively. These findings underscore the importance of considering payer-specific concentration when evaluating PBMs’ anticompetitive practices, as the 3 top PBMs may be pursuing different market strategies. The dominance of a few large PBMs across all payers and a smaller PBM (SS&C Health) in Medicare Part D alone has important antitrust implications.”

New AMA analysis of consolidation in PBM markets “The American Medical Association (AMA) today published its new annual analysis (PDF) of pharmacy benefit manager (PBM) markets confirming low competition among these middlemen in the pharmaceutical supply chain and high vertical integration of PBMs with health insurance companies…
The analysis lists national-level shares of the 10 largest PBMs. It finds that:
—The four largest PBMs collectively have a 70% share of the national PBM market.
—CVS Health is the largest PBM (21.3% market share), followed by OptumRx (20.8%), Express Scripts (17.1%), and Prime Therapeutics (10.3%).
—At the local level, the average PBM market is highly concentrated according to federal antitrust guidelines.
—Eight-two percent of PDP region-level PBM markets are highly concentrated.
—This indicates that only a few PBMs supplied insurers with PBM services and suggests low competition among PBMs…
The analysis found significant vertical integration between insurers and PBMs.
—Nationally, insurers that are vertically integrated with a PBM covered 72% of people with a commercial or Medicare Part D PDP.
—The share of people covered by an insurer that is vertically integrated with a PBM is higher in the Medicare Part D market (77%) than the commercial PDP market (69%).
—At the PDP region level, an average of 70% of people are covered by an insurer that is vertically integrated with a PBM.
—There is wide variation across PDP regions, with some having little vertical integration between insurers and PBMs, while others are almost entirely vertically integrated.”

About the public’s health

Deloitte Analysis: 50% of US Women Skip or Delay Medical Care due to Cost, Access, or Negative Experiences  “Key takeaways

• Fifty percent of women surveyed report skipping or delaying medical care; women are 35% more likely to skip care than men.

• Women surveyed are 50% more likely than men to skip care due to long wait times, and 31% more likely than men to skip care due to cost.

• The top three types of care women skip due to cost are acute illness (e.g., cold or flu), preventive care, and care for women's health issues.

• Women surveyed are twice as likely as men to miss medical appointments due to transportation issues.”

Today's News and Commentary

About health insurance/insurers

Healthcare billing fraud: 10 recent cases Note these cases were from defrauding federal programs.

About pharma

Tern’s oral GLP-1 shows 5% weight loss at 1 month at highest dose “The small-scale, 28-day study saw 36 healthy adults with obesity or overweight receive one of three oral doses of the GLP-1 agonist, dubbed TERN-601, or placebo. The nine individuals who received the highest, 740 mg, dose of TERN-601 saw a placebo-adjusted mean weight loss of 4.9%, while those who received the 500 mg and 240 mg doses saw weight loss of 3.8% and 1.9%, respectively.”
Comment: If this drug pans out, it could disrupt its entire class of medications with respect to payment sources.

Drugmaker might be 1st healthcare company to top $1 trillion valuation “Pharmaceutical company Eli Lilly may become the first healthcare company to hit a market value of $1 trillion…”

About the public’s health

Cuffs on At-Home Blood Pressure Monitors Don't Fit Some Patients “Key Takeaways”
—Many Americans don’t fit standard blood-pressure cuffs
—About 18 million adults, around 7%, have arms too large or too small for standard cuff sizes
—The improper fit is likely to return unreliable results for these folks”

Almost 1 in 4 U.S. Adults Under 40 Have High Blood Pressure “Nearly a quarter of people ages 18 to 39 have high blood pressure, with readings above the healthy level of 130/80…
Nearly 14% of children ages 8 to 19 have elevated or high blood pressure…”

Time to Say Goodbye to the B.M.I.? “The body mass index has long been criticized as a flawed indicator of health. A replacement has been gaining support: the body roundness index…” Here is a calculator to figure out your BRI.

Guidelines Recommending That Clinicians Advise Patients on Lifestyle Changes: A Popular but Questionable Approach to Improve Public Health “The National Institute for Health and Care Excellence (NICE) in the United Kingdom recommends 379 lifestyle interventions, of which almost 100 apply to more than 25% of the general population . Of these, only 3% were supported by high- or moderate-certainty evidence that the recommended clinician intervention helps people change behavior, and another 13% by low- to very-low-certainty evidence .
We argue that even high-quality guidelines recommending lifestyle interventions often overestimate benefit, miss key limitations of the evidence, neglect possible harms, and do not adequately consider feasibility and opportunity costs. We suggest a set of questions for guideline panels to consider when making recommendations about lifestyle interventions (Table).

Table. Questions for Guideline Panels to Facilitate Evaluation of Lifestyle Interventions

1. Do the supporting studies provide direct or only linked (indirect) evidence that the recommended intervention (e.g., giving advice) will have beneficial effects? Is there direct evidence of an effect from the intervention itself on patient-important outcomes? If not, is there linked indirect evidence suggesting a beneficial effect of the intervention on patient-important outcomes:  The intervention results in the desired behavior change (ideally from high-quality randomized trials), and;  people who change behavior benefit from the changes (usually from observational studies)?
 2. How confident are we that the benefits in supporting studies will translate into clinical practice? Is the recommended intervention similar to the intervention in the supporting studies, and is it feasible to implement in clinical practice? Is the population eligible for the intervention in clinical practice as likely to change behavior as the participants in the supporting studies? Is the behavior change reported in the supporting studies measured accurately, and is it large enough and sustained over a sufficient period after the end of the intervention to plausibly improve patient-important outcomes? 
3. Does the intervention cause harm, and what are the opportunity costs? May there be psychosocial harms from receiving unrequested lifestyle advice? What proportion of clinician time would be needed to implement the recommendation?”

About healthcare personnel

States are making it easier for physician assistants to work across state lines “By 2028, the nation as a whole will be short some 100,000 critical health care workers — doctors, nurses and home health aides — according to a new report from Mercer, a management consulting firm.
The looming shortage is one reason why 13 states have joined the PA Licensure Compact, a multistate agreement that allows PAs to practice in any participating state, without having to get an additional license.”

Today's news and Commentary

About health insurance/insurers

How much and why ACA Marketplace premiums are going up in 2025 “For 2025, across 324 insurers participating in the 50 states and DC, this analysis shows a median proposed premium increase of 7%, which is similar to last year. Based on a more detailed analysis of publicly available documents from insurers in 10 states and DC, growth in health care prices stood out as a key factor driving costs in 2024. In addition to inflation, some insurers also mention increased utilization of weight loss and other specialty drugs as influencing premiums. Pandemic-related costs and the unwinding of Medicaid continuous coverage are having little, if any, impact on individual market premiums for 2025.” 

About the public’s health

Food Insecurity, Hunger Increased in the United States in 2023 “The trend of food insecurity persists in the United States, with food insecurity, food expenditures, and need of assistance all reported in the country throughout 2023, according to a a new report from the US Department of Agriculture (USDA)…
The new report found that 13.5% of households in the US were food insecure, totaling approximately 18 million households. Food insecurity in this context was defined as households who had difficulty providing enough food for their residents at some point during the year. The percentage increased from 2022 when it was 12.8%, from 2021 when it was 10.2%, and 2020 when it was 10.5%.1 Low food security was reported in 5.1% of households in the country, which wasn’t different from the 2022 number but an increase from 3.8% reported in 2021. This food insecurity led to disrupted eating patterns through the year.”

About health technology

Abbott follows rival Dexcom with OTC glucose monitor launch in US “Abbott has launched its over-the-counter continuous glucose monitoring system in the U.S., the company said on Thursday, making it the second such device on the market to help people track their blood sugar levels.
The device, called Lingo, will compete with a rival from DexCom, launched last week, and will be available for adults who are not on insulin.”
Comment: The insurance industry will need to keep up on coverage of these devices, since companies paid for much more expensive items.

Today's News and Commentary

About health insurance/insurers

Medicare Statistics And Facts In 2024 A good summary from Forbes.

 Humana exiting Medicare Advantage in 13 markets “Humana reaffirmed its full-year guidance but is leaving 13 Medicare Advantage (MA) markets next year, Chief Financial Officer Susan Diamond said during the Wells Fargo Healthcare Conference on Wednesday.
Other members will have fewer plans to choose from in certain geographies.
Diamond explained around 560,000 members, or 10% of its individual MA membership base, would be impacted by the cutbacks, but Humana anticipates it will absorb about half of those members into other plans.”

About hospitals and health systems

National Hospital Flash Report Key Takeaways

1. Hospital finances continue to stabilize with strong operating margins. Key indicators including outpatient revenue and average lengths of stay show continued improvement.
2. Decreases in average lengths of stay have also led to declines in expenses.
3. Overall hospital performance has been strong in 2024. In comparison, the performance of health systems has been trending lower than hospital performance. 

About pharma

Prescription Medication Use, Coverage, and Nonadherence Among Adults Age 65 and Older: United States, 2021–2022 “In 2021–2022, 88.6% of older adults took prescription medication, 82.7% had prescription drug coverage, 3.6% did not get needed prescription medication due to cost, and 3.4% did not take medication as prescribed due to cost. Older adults with no prescription drug coverage were more likely to not get prescription medication and to not take needed medication as prescribed than older adults with private or public prescription drug coverage. For both measures, cost-related nonadherence was six times higher among older adults who were food insecure compared with those who were food secure, and more than twice as likely among older adults reporting fair or poor health or with disabilities compared with those in excellent, very good, or good health, or without disabilities.”

Today's News and Commentary

About health insurance/insurers

Value-Based Contracting in Clinical Care “We found saturation of the quality measure environment as a possible explanation: average physicians were incentivized to meet 57.08 different quality measures annually.”
Comment: Accrediting organizations require many of these measures, so contracting health plans have no choice but to require them.

About pharma

US will still pay at least twice as much after negotiating drug prices “A Reuters review of publicly available maximum prices set by other wealthy nations - Australia, Japan, Canada and Sweden - show that they have negotiated far lower prices for the same drugs.” The graphic is especially illustrative of the wide differences.

Antibiotic Prescribing for Respiratory Tract Infections in Urgent Care: A Comparison of In-Person and Virtual Settings “Antibiotic prescriptions were more common in virtual versus in-person urgent care, including among physicians who provided care in both platforms. This appears to be related to the high rate of sinusitis diagnosis in virtual urgent care.”

Comment: Would there be a role for enhanced virtual simulation education?

About the public’s health

The effect of exposure to radiofrequency fields on cancer risk in the general and working population: A systematic review of human observational studies “Highlights
—Exposure to RF from mobile phone use likely does not increase the risk of brain cancer.
—RF from broadcasting antennas or base stations likely does not increase the risk of childhood cancer.
—Occupational exposure to RF may not increase the risk of brain cancer.”

Coronavirus vaccines, once free, are now pricey for uninsured peopleCoronavirus vaccines, once free, are now pricey for uninsured people “The federal Bridge Access Program covering the cost of coronavirus vaccines for uninsured and underinsured people ran out of funding. Now, Americans with low incomes are weighing whether they can afford to shore up immunity against an unpredictable virus that is no longer a public health emergency but continues to cause long-term complications and hospitalizations and kill tens of thousands of people a year.”
Comment: Vaccinations are not just an individual problem but a public health issue. The same logic applies to providing care for those in this country illegally.

Supreme Court allows HHS to divert funds over abortion referrals “The Supreme Court on Tuesday cleared the way for the Biden administration to strip millions of health-care dollars from Oklahoma over its refusal to direct patients to information about abortions — a federal requirement that the state says would be at odds with its strict ban on terminating pregnancies.”

About healthcare IT

FDA's drug center to consolidate AI efforts under single council “The FDA’s Center for Drug Evaluation and Research (CDER) is consolidating its artificial-intelligence-related activities under a single AI Council, in part in response to efforts from the Biden administration to ensure the safety and security of machine learning software.” 

About health technology

Association Between False-Positive Results and Return to Screening Mammography in the Breast Cancer Surveillance Consortium Cohort “Women were less likely to return to screening after false-positive mammography results, especially with recommendations for short-interval follow-up or biopsy, raising concerns about continued participation in routine screening among these women at increased breast cancer risk.”
Comment: In addition to  the cost and anxiety of false positives, add another factor- reduced followup.

Welcome back!

After a summer hiatus, I am back to providing periodic, significant news stories.
you will need to check stories, since I will no longer send daily notices.

National Health Expenditure Projections, 2023–32: Payer Trends Diverge As Pandemic-Related Policies Fade Annual report in Health Affairs is always worth reading. “Health care spending growth is expected to outpace that of the gross domestic product (GDP) during the coming decade, resulting in a health share of GDP that reaches 19.7 percent by 2032 (up from 17.3 percent in 2022). National health expenditures are projected to have grown 7.5 percent in 2023, when the COVID-19 public health emergency ended. This reflects broad increases in the use of health care, which is associated with an estimated 93.1 percent of the population being insured that year. In 2024, Medicaid enrollment is projected to decline significantly as states continue their eligibility redeterminations. Simultaneously, private health insurance enrollment is projected to increase because of the extension of enhanced subsidies for direct-purchase health insurance under the Inflation Reduction Act (IRA) of 2022, as well as a temporary special enrollment period for qualified people losing Medicaid coverage (after eligibility redeterminations).” 

About health insurance/insurers

Expanding Medicare Coverage Of Anti-Obesity Medicines Could Increase Annual Spending By $3.1 Billion To $6.1 Billion “Assuming that anti-obesity drugs were covered in 2025 and that 5 percent or 10 percent of newly eligible patients were prescribed one, annual Part D costs were estimated to increase by $3.1 billion or $6.1 billion, respectively. The marginal costs of this policy could fall by as much as 62.5 percent from baseline estimates if products were approved for additional indications in coming years because these additional conditions are common among people with obesity. This would increase Medicare spending but would occur regardless of a policy change.”

Use Of High- And Low-Value Health Care Among US Adults, By Income, 2010–19 “Among nonelderly adults, significant differences between those with high and low incomes were found for five of nine low-value services, and among elderly adults, significant differences by income level were found for three of twelve low-value services.” 

Potential US Health Care Savings Based on Clinician Views of Feasible Site-of-Care Shifts “In this survey study of 1069 clinicians surveyed in 2021 and historical claims data from 2019, 10.3 percentage points of commercial and 10.9 percentage points of Medicare volume could be shifted from the hospital to alternative sites using today’s technology without compromising clinical outcomes. Based on observed reimbursement rates, this would be associated with savings of $113.8 billion (3.2%) to $147.7 billion (4.1%) in 2019 dollars annually for the overall US health care system.”
See, also:Site-of-Care Shifts and Payments—A Viable Strategy to Control Health Care Costs?

Medicare Physician Fee Schedule Reform An excellent review of the background, current status and proposals for reform for physician payment schemes.

About hospitals and healthcare systems

Financial and Clinical Characteristics of Hospitals Targeted by Private Equity [PE] Firms “PE hospitals were, on average, not worse off financially or clinically than comparable non-PE hospitals before acquisition. On the contrary, PE hospitals carried less debt and owned more of their inherent value before acquisition, likely representing more financial stability. Financially healthier hospitals may be better able to absorb new debt and cost-cutting such as reductions in staffing. Earnings, operating margin, hospital-acquired adverse events, and in-hospital mortality were all similar before acquisition relative to controls. Changes in financial or clinical performance after acquisition may thus reflect management—of debt, personnel, and capital—more so than differences in these preacquisition characteristics… These findings do not support the notion that PE investments generally target struggling hospitals and instead support broader evidence that PE firms target successful entities for acquisition.”

About pharma

Pfizer finalizes DTC virtual health platform for streamlined access to vaccines, tests and treatments This strategy is a major departure for a pharma company and could have a major disruptive influence on such channel participants as PBMs. “Just a few months after confirming that it was in the process of developing an online service to cut out middlemen and work directly with patients to help them access vaccines, diagnostic tests and medications, Pfizer has made good on its word.
The newly launched PfizerForAll platform is designed to connect patients in the U.S. with a range of healthcare services, serving as a one-stop shop where they can make doctor’s appointments, find vaccines and order tests and treatments.
To start, according to Pfizer’s launch announcement…, the platform’s services will focus on providing access to treatments for common conditions like migraine, COVID-19 and the flu as well as vaccines for COVID, flu, respiratory syncytial virus and pneumococcal pneumonia. Those services are powered by partnerships with other direct-to-consumer providers in healthcare and beyond…”

Time From Approval to Reimbursement of New Drugs: A Comparative Analysis Between the United States, England, Germany, France, and Switzerland (2011–2022) “Findings: A total of 290 drugs approved by all regulatory bodies (FDA, EMA, MHRA, and Swissmedic) were included in the analysis.
Median time from approval until reimbursement was fastest in Switzerland at 5.8 months (95% CI, 4.5 to 7.0), followed by Germany (7.4 months [CI, 7.2 to 7.6]), the United States (9.2 months [CI, 8.3 to 10.1]), France (12.9 months [CI, 10.6 to 15.4]), and England (17.7 months [CI, 13.8 to 24.9]).
One month after approval, France had the highest reimbursement rate at 25.9% (CI, 20.6% to 30.7%), followed by Switzerland (9.7% [CI, 6.2% to 13.0%]) and England (0.7% [CI, 0% to 1.6%]). The United States and Germany had 0 drugs reimbursed at 1 month.
One year after approval, Germany, the United States, and Switzerland had the highest reimbursement rates at 74.3% (CI, 68.7% to 78.9%), 70.7% (CI, 65.0% to 75.5%), and 62.8% (CI, 56.8% to 67.9%) of drugs, respectively. Reimbursement rates in England and France were 37.1% (CI, 31.3% to 42.5%) and 49.0% (CI, 42.9% to 54.4%), respectively.
All countries were faster in reimbursing cancer drugs versus noncancer drugs, with the exception of Switzerland with a median time of 7.1 months (CI, 0.9 to 12.8) for cancer drugs versus 4.5 months (CI, 3.1 to 6.3) for noncancer drugs.
At the end of the follow-up period (31 December 2023), 276 drugs were reimbursed in Germany, 266 in the United States, 242 in Switzerland, 231 in England, and 230 in France.”

About healthcare IT
Talkdesk survey reveals the right prescription of artificial intelligence and human support is vital to superior patient experience “Half of all United States patients surveyed are optimistic that artificial intelligence (AI) will improve their overall experience with medical providers and the healthcare system in the next year and anticipate seeing more administrative efficiencies. 
4 in 5 individuals want medical advice from a human healthcare representative. Still, half of Americans like that AI chatbots don’t judge, while approximately one-third appreciate that chatbots don’t rush them or make them feel stupid.
Two-thirds of patients with sensitive health issues would be more comfortable making appointments with an online chatbot than with human staff.”

Today's News and Commentary

About health insurance/insurers

 Healthcare billing fraud: 8 recent cases FYI

Physician Group Practices Accrued Large Bonuses Under Medicare’s Bundled Payment Model, 2018–20 “The Bundled Payments for Care Improvement Advanced Model (BPCI-A), a voluntary Alternative Payment Model for Medicare, incentivizes hospitals and physician group practices to reduce spending for patient care episodes below preset target prices…We found that physician groups earned $421 million in incentive payments during BPCI-A’s first four performance periods (2018–20). Target prices were positively associated with bonuses, with a mean reconciliation payment of $139 per episode in the lowest decile of target prices and $2,775 in the highest decile. In the first year of the COVID-19 pandemic, mean bonuses increased from $815 per episode to $2,736 per episode. These findings suggest that further policy changes, such as improving target price accuracy and refining participation rules, will be important as the Centers for Medicare and Medicaid Services continues to expand BPCI-A and develop other bundled payment models.”

About hospitals and healthcare systems

 CommonSpirit posts $365M quarterly loss, -3.9% margin “Chicago-based CommonSpirit reported operating losses of $365 million and $411 million during the three- and nine-month periods ending March 31, 2024, compared to losses of $619 million and $1 billion during the same periods the year prior.”

Cleveland Clinic's operating margin inches up as inflation pressures hold volume gains in check “The nonprofit system reported this week a $50.2 million operating gain (1.3% operating margin) as opposed to the prior year’s $32.3 million (0.9% operating margin). Operating revenues rose 10.2% year over year to nearly $3.9 billion while operating expenses followed close behind with a 9.8% increase.”

Surging Hospital Prices Are Helping Keep Inflation High “Hospital prices specifically jumped 7.7% last month from a year ago, the highest increase in any month since October 2010, the Labor Department said Wednesday.
Among the procedures with hefty recent price increases are angioplasties placing stents in arteries to improve blood flow, which grew $670, or 4.5%, to $15,640 in the first three months of the year from the same period a year ago, according to Turquoise Health.”
Comment: Hospitals are always raising prices; but what they are paid depends on contracts (with private insurers) or regulations (with Medicare and Medicaid). So, while the Consumer Price Index includes what is actually paid (price and payment are identical or close) hospital payments diverge greatly from prices.

Performance Trends Report Market Analysis and Hospital & Patient Volume Benchmarks “Key findings include:
—U.S. hospitals experienced up to a 17.9% shortfall in payment volumes in the first quarter.
—Expansion of the Two-Midnight Rule governing how long patients can be kept in outpatient observation status could affect more than 20% of Medicare Advantage encounters in 2024.
—Median hospital operating margins continue to stabilize, with the metric holding above 4.5% throughout the first quarter as hospitals saw an 11th straight month of gross revenue growth.
—Year-over-year growth in inpatient revenue exceeded outpatient revenue increases for the first time since late 2021.
—The share of knee replacement surgeries performed on an outpatient basis exceeded 80% in Q1 2024, up from about 20% five years ago.”
Comment: The entire report is worth reading.

Calculation of Overall Hospital Quality Star Ratings With and Without Inclusion of the Peer Grouping Step “Question  What are the implications of applying a peer grouping step on hospitals’ Overall Star Ratings?
Finding  In this cross-sectional study of 3076 hospitals that received a star rating in 2023, presence of the peer grouping step resulted in 585 hospitals (19.0%) being assigned a different star rating than if the peer grouping step was absent, including considerably more hospitals having a higher star rating (517 hospitals) than a lower star rating (68 hospitals).”

About pharma

 In Big Pharma's growth rankings, Lilly took top spot from Novo Nordisk in Q1 “The momentum the biopharma industry showed in the fourth quarter of 2023 has continued into this year. With 18 of the industry’s top 25 companies achieving year-over-year revenue gains, the first quarter of 2024 nearly matched the final quarter of last year, when 21 of the industry's top 25 companies posted sales increases.”

About the public’s health

Justice Department formally moves to reclassify marijuana as a less dangerous drug in historic shift “A proposed rule sent to the federal register recognizes the medical uses of cannabis and acknowledges it has less potential for abuse than some of the nation’s most dangerous drugs. The plan approved by Attorney General Merrick Garland would not legalize marijuana outright for recreational use.
The Drug Enforcement Administration will next take public comment on the proposal in a potentially lengthy process.”

About healthcare IT

 Scammers send fake MyChart messages “Scammers have been trying to trick patients into giving up personal information by sending fake MyChart messages.
Tacoma, Wash.-based MultiCare Health System is the latest system to warn of the scam.” 

About health technology

Going beyond A, B and O: Thermo Fisher unveils DNA test for the rarest blood types “Thermo Fisher Scientific has put forward a DNA-based test it says can offer much more precise identification of blood and its potential compatibility—going much further than the traditional positive and negative blood types of A, B, AB and O.
Currently available for research use only, the company said its genetic approach could help support the development of cost-effective diagnostics for screening blood donations and matching them to the proper patients in need, including those with extremely rare blood types.

Today's News and Commentary

About healthcare quality

 2023 Sentinel Event Data Annual Report “The most prevalent event types identified in 2023 include the following:

• Falls (48%)

• Wrong surgery (8%)

• Unintended retention of foreign object (8%)

• Assault/rape/sexual assault/homicide (8%)

• Delay in treatment (6%)

• Suicide (5%)

These event types comprised 83% of all reported sentinel events in 2023. The majority of these events – 96% (1,358) – were voluntarily self-reported to The Joint Commission by an accredited or certified entity.” 

About health insurance/insurers

UnitedHealth's investments in affordable housing top $1B “UnitedHealth Group's investments in affordable housing have topped $1 billion, with the program a keystone in its overarching strategy to address health equity and disparities.
The company has made investments in housing since 2011 and, in that time, has supported the development of affordable and mixed income units across 31 states and the District of Columbia, creating more than 25,000 homes for people and families who face housing insecurity.”

About hospitals and healthcare systems

 42 health systems ranked by net income FYI

About pharma

Wegovy could bankrupt US health system, Sanders says in new report “Blockbuster weight-loss drug Wegovy could bankrupt the U.S. health care system unless the price drops, according to a staff report released Wednesday from the office of Senate Health Committee Chair Bernie Sanders (I-Vt.). 
Unless prices dramatically decline, Wegovy and weight loss drugs could push Americans to spend $1 trillion per year on prescription drugs, the report concluded.”

Lilly’s weekly insulin works as well as daily products, new studies show “Eli Lilly reported Thursday that its experimental weekly insulin worked as well as daily basal insulin products in two late-stage studies, paving the way for the drug to compete with a similar weekly insulin developed by Novo Nordisk.
In a 52-week trial of type 2 diabetes patients using insulin for the first time, those on the weekly insulin, called efsitora alfa, had a 1.34% reduction in blood sugar levels, while people on the comparator daily insulin degludec, sold as Tresiba by Novo, had a 1.26% lowering. That resulted in patients having blood sugar levels, known as A1C readings, of 6.87% and 6.95%, respectively.”

About the public’s health

 AI predicts vape flavours can break down into potentially harmful compounds when heated “An artificial intelligence-based approach has predicted hundreds of harmful compounds that could form when e-cigarette flavour chemicals are heated in vaping devices. The research adds to mounting evidence concerning the safety of vaping, finding that many of the predicted pyrolysis products from flavours are classed as either acutely toxic, health hazards or irritants. What’s more, their impact on health might take years to emerge, say the researchers.” 

About healthcare IT

 Artificial Intelligence and Machine Learning (AI/ML)-Enabled Medical Devices FYI: “he FDA is providing this list of AI/ML-enabled medical devices marketed in the United States as a resource to the public about these devices and the FDA’s work in this area.”

About healthcare personnel

Association between anaesthesia–surgery team sex diversity and major morbidity “Care in hospitals with greater anaesthesia–surgery team sex diversity was associated with better postoperative outcomes. Care in a hospital reaching a critical mass with over 35% female anaesthetists and surgeons, representing higher team sex-diversity, was associated with a 3% lower odds of 90-day major morbidity.” 

Today's News and Commentary

About health insurance/insurers

 CVS warns it could lose up to 10% of its Medicare members next year “The company was $900 million short of its health care benefits estimates on its medical cost line. Within that $900 million, about $400 million was attributed to high utilization among outpatient services, outpatient pharmacy and behavioral mental health.”

About hospitals and healthcare systems

The cost of unnecessary hospital days in 8 numbers FYI- Well worth reading.

 How a ransomware attack is affecting Ascension's facilities across the US FYI

Jefferson, Lehigh Valley Health Network ink definitive agreement to merge “Philadelphia-based Jefferson and Allentown, Pa.-based Lehigh Valley Health Network have signed a definitive agreement to merge into a 30-hospital system with more than 700 care sites. 
Under the agreement, Jefferson and LVHN will integrate identity, clinical care and operations. The integrated system will comprise more than 65,000 employees and offer new educational opportunities to existing physicians and allow for recruitment opportunities, according to a joint May 15 news release.”

About pharma

 Most Approved Cancer Drugs Don’t Improve Overall Survival [OS], Data Suggest “Of the 305 drugs that were approved based on a surrogate endpoint, 153 (50%) were later evaluated for OS, and 29 (8%) demonstrated an OS benefit.
Overall, 125 of the 392 drugs evaluated (32%) have demonstrated improvements in OS, and the remaining 267 drugs (68%) have not.”
 

About the public’s health

FDA approves self-collection screening tests for HPV, allowing women to avoid pelvic exams for cervical cancer “The FDA has approved two diagnostic devices that allow women to collect vaginal samples themselves for cervical cancer screening—a major step toward catching more early and potentially preventable cases without requiring an invasive gynecological exam.
The separate self-collection offerings from BD and Roche still need to be used in a healthcare setting—they have not received agency green lights for solo, at-home use—but the two companies said the move could improve access to screening by enabling HPV testing at locations such as retail pharmacies or mobile clinics.”

Study highlights inappropriate antibiotic prescribing in US emergency departments “A review of US emergency department (ED) visits involving antibiotic prescribing found that more than a quarter had inappropriate antibiotic prescriptions, and nearly half of those didn't even have a plausible indication for antibiotics, US researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.”

CDC makes public influenza A wastewater data to assist bird flu probe “The U.S. Centers for Disease Control and Prevention (CDC) on Tuesday released data on influenza A found in wastewater in a public dashboard that could assist in tracking the outbreak of H5N1 bird flu that has infected cattle herds.
Last week, an agency official told Reuters about U.S plans to make public data collected by its surveillance system.”

Drug overdose deaths fell for first time in five years, though still exceeded 100,000 “U.S. drug deaths decreased slightly in 2023, according to new data, the first decrease in five years.
Last year saw 107,543 U.S. drug overdose deaths, according to preliminary statistics released Wednesday by the Centers for Disease Control and Prevention, roughly a 3% drop from 2022.” 

Today's News and Commentary

About Covid-19

Data: Heart-failure patients have 82% better odds of living longer if vaccinated against COVID “The first study of COVID-19 vaccine effectiveness in a large population of adult heart-failure patients suggests that vaccinated participants are 82% more likely to live longer than their unvaccinated peers, according to
an analysis presented over the weekend at the Heart Failure 2024 scientific congress of the European Society of Cardiology (ESC) in Lisbon, Portugal.” 

Do Not Use Cue Health’s COVID-19 Tests Due to Risk of False Results: FDA Safety Communication “The U.S. Food and Drug Administration (FDA) is warning home test users, caregivers, and health care providers not to use Cue Health’s COVID-19 Tests for Home and Over-the-Counter (OTC) Use and its COVID-19 Test intended for patient care settings due to increased risk of false results.” 

About health insurance/insurers

 20 things to know about site-neutral payment policies  FYI

About hospitals and healthcare systems

 Kaiser Permanente posts 3.4% operating margin, billions in net income for Q1 2024  '‘Kaiser Permanente kicked off 2024 with $935 million of operating income (3.4% operating margin) and more than $2.7 billion of net income when excluding a one-time, $4.6 billion net asset gain from its Geisinger Health acquisition, according to top-line first-quarter numbers shared late Friday.
The performance handily outpaces the $233 million operating income (0.9% operating margin) and $1.2 billion bottom line of last year’s opening quarter.”

10 healthcare industry lawsuits, settlements FYI

About pharma

 Users of Novo Nordisk’s Wegovy sustain weight loss for 4 years, new analysis shows “Patients taking Novo Nordisk’s anti-obesity jab sustained weight loss for up to four years and had a reduced risk of heart disease regardless of their weight, according to new research that adds evidence to the drug’s broader health benefits. Two new studies published on Tuesday in Nature Medicine built on Novo Nordisk trial data first published in November, which found that patients using Wegovy had a 20 per cent reduction of risk of heart attacks and other cardiovascular events. One of the new studies based on the Select trial found that users of the drug over a period of three years and four months sustained their weight loss over four years, in a 17,604-person trial.”

AbbVie inks $2B-plus next-gen neuro deal with Gilgamesh “AbbVie has inked a new deal with Gilgamesh Pharmaceuticals aimed at developing next-gen therapies for psychiatric disorders.
The two companies have agreed to research and develop a portfolio of therapeutics using Gilgamesh’s research platform designed to discover novel neuroplastogens—compounds that improve neuroplasticity. Under the deal, AbbVie will have the option to lead development and commercialization activities.”

About the public’s health

 Four in 10 cancer cases linked to obesity, study finds “Around 40 per cent of cancer cases are linked to obesity, with excess weight being a factor in 32 types of the disease, research has found.
A study released ahead of the European Congress on Obesity in Venice tracked four million adults for decades and showed the impact of excess body fat.”
And in a related article: Breast cancer incidence and mortality by metabolic syndrome and obesity: The Women’s Health Initiative

USDA, FDA turf battles hamper responses to outbreaks like H5N1 bird flu The headline is the story.

Broad Public Support for Legal Abortion Persists 2 Years After Dobbs “About six-in-ten (63%) say abortion should be legal in all or most cases.This share has grown 4 percentage points since 2021 – the year prior to the 2022 decision in Dobbs v. Jackson Women’s Health Organization that overturned Roe.”

About health devices/technology

FACT SHEET: President Biden Takes Action to Protect American Workers and Businesses from China’s Unfair Trade Practices The last item is medical products. For example: “The tariff rates on syringes and needles will increase from 0% to 50% in 2024. For certain personal protective equipment (PPE), including certain respirators and face masks, the tariff rates will increase from 0–7.5% to 25% in 2024. Tariffs on rubber medical and surgical gloves will increase from 7.5% to 25% in 2026.”

 Salt Meter Could Improve Compliance With Low-Sodium Diet “Using a salt meter or sensor in food itself, in conjunction with other measures, can help reduce sodium intake by improving control of arterial hypertension at the community level, according to a Thai study. The results were described at the World Congress of Nephrology…
The salt meter tested in the study is immersed in liquid solutions and displays the degree of salt concentration in seconds through a smiling, surprised, or frowning face. It could be particularly appropriate for diets in Asian countries, where more than 60% of excess sodium comes from soups, sauces, and broths prepared at home.”

Today's News and Commentary

About health insurance/insurers

CMS extends Medicaid waivers to 2025 “CMS will extend flexibilities designed to help states keep more eligible individuals enrolled in Medicaid through June 2025. 
The waivers, previously set to expire at the end of 2024, will be extended for six more months, Daniel Tsai, deputy CMS administrator and director of the Center for Medicaid and CHIP services, wrote in a May 9 memo to states.”

Optum forgoes physician noncompetes at Oregon medical group “Optum's Eugene-based Oregon Medical Group will not enforce noncompete agreements for any departing physicians or advanced practice providers, ABC-affiliate KEZI reported May 10.
In March, the medical group dropped some patients due to a lack of available physicians, 32 of whom have departed from the organization over the last two years. Oregon Medical Group was purchased by Optum in 2020.”

State Agencies Could Be Obtaining Hundreds of Millions in Additional Medicaid Rebates Associated With Physician-Administered Drugs “State agencies could have invoiced and obtained rebates from the manufacturers for $225.7 million (Federal share) for physician-administered drugs reimbursed on a fee-for-service basis, and should have collected additional rebates associated with $236.2 million (Federal share) for physician-administered drugs administered to Medicaid managed-care organization enrollees…”

About hospitals and healthcare systems

 Here's what the CEOs and CFOs of public for-profit health systems made in 2023 FYI

 Prices Paid to Hospitals by Private Health Plans “Key Findings

• Only Arkansas had an overall relative price below 170 percent of Medicare prices, while other states (California, Florida, Georgia, New York, South Carolina, West Virginia, and Wisconsin) had relative prices that were above 300 percent of Medicare prices.

• In 2022, across all hospital inpatient and outpatient services (including both facility and related professional claims), employers and private insurers paid, on average, 254 percent of what Medicare would have paid for the same services at the same facilities.

• State-level median prices have remained stable across the past three study rounds: 254 percent of Medicare prices in 2018 (Round 3), 246 percent in 2020 (Round 4), and 253 percent in 2022 (Round 5—the current study).

• Prices for common outpatient services performed in ambulatory surgery centers (ASCs) averaged 171 percent of Medicare prices but would have averaged approximately 107 percent of Medicare prices if paid using Medicare payment rates for hospital outpatient departments (HOPDs).

• Although relative prices are lower for ASC claims priced according to HOPD rules, HOPD prices are higher than ASC prices.

• Commercial insurance prices for administered drugs received in a hospital setting averaged 278 percent of average sales price (ASP) compared with 106 percent of ASP paid by Medicare for administered drugs.

• Very little variation in prices is explained by each hospital's share of patients covered by Medicare or Medicaid; a larger portion of price variation is explained by hospital market power.”

About pharma

 Walgreens contacts potential buyers for $8.8 billion Boots chain “Walgreens Boots Alliance is reaching out to potential buyers of the $8.8 billion Boots drugstore chain in the UK, according to people familiar with the matter.”

Sanofi, Pfizer, AstraZeneca invest a combined €1.87B to bolster operations in France “Taking the bronze medal is AstraZeneca, which will spend 365 million euros ($394 million) to enhance its facilities at its manufacturing site in Dunkirk, France. Earning the silver is Pfizer with a pledge to invest 500 million euros ($540 million) over the next five years to bolster its R&D capabilities in France.But not to be outdone in its home country is gold-medal winner Sanofi. The Paris drugmaker has earmarked more than 1 billion euros ($1.1 billion) to increase its manufacturing capacity at three sites in France.”

Johnson & Johnson looks to offload remaining Kenvue stake in $3.75B deal “In a Monday securities filing, Kenvue revealed J&J's plan to offer 182.33 million shares of Kenvue in exchange for debt to be held by Goldman Sachs and J.P. Morgan Securities. The "debt-for-equity" exchange looks to be worth about $3.75 billion, based on Kenvue's Friday closing share price of $20.54.”

Patent Portfolios Protecting 10 Top-Selling Prescription Drugs “In this cross-sectional study of 1429 patents and patent applications protecting the 10 highest-revenue brand-name drugs in the US in 2021, almost three-quarters were filed after US Food and Drug (FDA) approval. Patents filed after FDA approval and those protecting parts of the drug other than the active ingredient contributed to dense patent thickets.”

About the public’s health

Survey: Trust in vaccines declines among teenagers, parents “Key takeaways:

• Most parents and teenagers reported concerns about the safety of vaccines in general.

• Only 46% of parents and 33% of teenagers felt it important to receive the latest COVID-19 vaccine.”

Federal dollars to increase bird flu testing for dairy cows, farm workers “The federal government Friday unveiled a major package of financial incentives to dairy farm owners — up to $28,000 per farm over the next four months — to encourage broader testing of cattle and expanded security measures to control a growing outbreak of the bird flu virus in cows.”

About healthcare IT

50-State Survey of Telehealth Insurance Laws FYI

 About health technology

First person to receive a genetically modified pig kidney transplant dies nearly 2 months later “The first recipient of a genetically modified pig kidney transplant has died nearly two months after he underwent the procedure, his family and the hospital that performed the surgery said Saturday.
Richard “Rick” Slayman had the transplant at Massachusetts General Hospital in March at the age of 62. Surgeons said they believed the pig kidney would last for at least two years.”

Today's News and Commentary

About antitrust

Assistant Attorney General Jonathan Kanter Announces Task Force on Health Care Monopolies and Collusion “The Justice Department today announced the formation of the Antitrust Division’s Task Force on Health Care Monopolies and Collusion (HCMC). The HCMC will guide the division’s enforcement strategy and policy approach in health care, including by facilitating policy advocacy, investigations and, where warranted, civil and criminal enforcement in health care markets…
The HCMC will consider widespread competition concerns shared by patients, health care professionals, businesses and entrepreneurs, including issues regarding payer-provider consolidation, serial acquisitions, labor and quality of care, medical billing, health care IT services, access to and misuse of health care data and more. The HCMC will bring together civil and criminal prosecutors, economists, health care industry experts, technologists, data scientists, investigators and policy advisors from across the division’s Civil, Criminal, Litigation and Policy Programs, and the Expert Analysis Group, to identify and address pressing antitrust problems in health care markets.”

About health insurance/insurers

Community Health Systems adds another antitrust lawsuit to MultiPlan's collection “Community Health Systems is the latest health system to allege that MultiPlan’s data-driven claims repricing business meets the bar for antitrust violation.
The public for-profit system filed a lawsuit in a New York federal court Wednesday, following in the wake of similar litigation launched last year by AdventHealth and just a few weeks ago by Allegiance Health Management.
Though the new lawsuit does not name major health insurers as co-defendants, CVS Health’s Aetna, Elevance Health, Centene Corporation, Cigna, Health Care Service Corporation, UnitedHealth Group and Humana are highlighted as “co-conspirators” in the “MultiPlan Cartel,” which CHS wrote “includes virtually all of the major healthcare insurance payors in the United States.”

UnitedHealth offers to divest 100 locations in Amedisys deal: Report “UnitedHealth Group and Amedisys plan to divest more than 100 clinic locations to make its proposed acquisition more palatable to regulators, Capitol Forum reported. 

About hospitals and healthcare systems

US Hospital Service Availability and New 340B Program Participation “This longitudinal observational study including 2152 general acute care hospitals found that public hospitals were significantly more likely to sustain unprofitable services after 340B participation, but there was not a meaningful association between 340B participation and service offerings at nonprofit hospitals, except for oncologic services.” 

About pharma

KFF Health Tracking Poll May 2024: The Public’s Use and Views of GLP-1 Drugs “The latest KFF Health Tracking Poll finds that about one in eight adults (12%) say they have ever taken a GLP-1 agonist – an increasingly popular class of prescription drugs used for weight loss and to treat diabetes or prevent heart attacks or strokes for adults with heart disease – including 6% who say they are currently taking such a drug. The share who report ever taking these drugs rises to four in ten (43%) among adults who have been told by a doctor that they have diabetes, a quarter who have been told they have heart disease, and one in five (22%) who have been told by a doctor that they are overweight or obese in the past five years. Public awareness of GLP-1 drugs has increased in the past year, with about one-third (32%) of adults now saying they have heard ‘a lot’ about these drugs, up from 19% in July 2023.”

Pfizer agrees to settle more than 10,000 Zantac cancer suits “Pfizer Inc. has agreed to settle more than 10,000 cases accusing it of hiding the cancer risks of its Zantac heartburn drug, according to people familiar with the deal, the biggest of the litigation. 
The agreements cover cases in state courts across the US but don’t completely resolve the company’s exposure to Zantac claims, according to the people, who spoke on the condition of anonymity because they weren’t authorized to discuss the settlement publicly. Financial details of the accords weren’t immediately available.
The deal is likely to reassure investors, who have seen other Zantac makers, including GSK Plc and Sanofi, sign settlements. Concerns about the drugmakers’ exposure to Zantac suits helped wipe out about $45 billion in combined market value in the summer of 2022. The shares have since recovered and have risen on news of the earlier deals.”

About the public’s health

Prevalence of Cardiovascular-Kidney-Metabolic [CKM] Syndrome Stages in US Adults, 2011-2020 “Almost 90% of US adults met criteria for CKM syndrome (stage 1 or higher) and 15% met criteria for advanced stages, neither of which improved between 2011 and 2020. The lack of progress, in part, may reflect concomitant improvement and worsening of different risk factors over time.2,5 Substantial between-subgroup differences in advanced stages were observed, with older age, men, and Black adults at increased risk.” 

About healthcare IT

White House to push cybersecurity standards on hospitals “In parallel to pushing out rules for hospital cybersecurity, the Biden administration intends to offer free training to 1,400 small, rural hospitals across the country, according to Neuberger. She said the training will become available ‘in the next few weeks.’”

About healthcare personnel

Medical residents are increasingly avoiding states with abortion restrictions “Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. The new analysis by the AAMC—a preliminary copy of which was exclusively reviewed by KFF Health News before its public release—found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2%, compared with a 0.6% drop in states where abortion remains legal.
Notably, the AAMC’s findings illuminate the broader problems abortion bans can create for a state’s medical community, particularly in an era of provider shortages: The organization tracked a larger decrease in interest in residencies in states with abortion restrictions not only among those in specialties most likely to treat pregnant patients, like OB-GYNs and emergency room doctors, but also among aspiring doctors in other specialties.”

Fewer nurses intend to leave healthcare, surveys suggest “AMN Healthcare's Nurses in 2024 report, a survey of 1,155 nurses, found that only 35% of nurses plan to change jobs and about 20% said they are optimistic that their work will improve this year. A February report by AMN also found 31% of nursing leaders are considering leaving their jobs.” 

Today's News and Commentary

About Covid-19

 There's a New Set of COVID Variants Called FLiRT: What You Need to Know “Key Takeaways

• New COVID-19 variants dubbed FLiRT have fast become the dominant strains in the United States, the CDC says

• Symptoms appear to be similar those of the prior dominant variant, JN.1

• There's concern that FLiRT may not be as susceptible to the last updated COVID-19 vaccine” 

About health insurance/insurers

Cigna, Oscar Health to shutter small group business “Oscar Health and Cigna will discontinue their co-branded Cigna + Oscar business at the end of 2024. 
On a May 7 call with investors, Oscar CEO Mark Bertolini said it chose not to renew the offering in 2025 as part of its strategy to focus on the individual market.” 

CMS proposes new mandatory organ transplant model for end-stage renal disease “The Centers for Medicare & Medicaid Services (CMS) has unveiled a new mandatory model proposal it says will improve access for individuals needing kidney transplants, reduce disparities and help selected hospitals better perform transplants.
The proposed Increasing Organ Transplant Access (IOTA) Model, announced Wednesday afternoon, is a six-year model to be carried out by the CMS Innovation Center beginning Jan. 1, 2025.
The proposed model will also help reduce Medicare spending and pinpoint living donors, according to a CMS fact sheet.”

About hospitals and healthcare systems

 Nonprofit hospitals aren't immune to FTC's noncompete ban, lawyers, Fitch analysts warn “The FTC’s jurisdiction extends to corporations that are organized to carry out business for their own profit or for those of its members—a limitation that puts it at odds with an industry in which more than half of all acute care hospitals are classified as nonprofits. These organizations would ostensibly be the source of a substantial portion of the noncompete clauses that, per the American Medical Association, bind an estimated 35% to 45% of physicians.
During last week’s open hearing and vote on the final rule, Commissioner Rebecca Slaughter acknowledged that there are numerous healthcare workers with noncompetes ‘that our rule will struggle to reach.’”

Ascension reports systems, clinical operations disrupted amid apparent 'cybersecurity event' “St. Louis-based Ascension’s statement did not describe the scale of the interruptions nor whether any of its data have been compromised, writing that it is still assessing an ongoing situation. The system said it has also notified the ‘appropriate authorities’ and will provide further updates as they are made available.”

About pharma

Drug supplies for millions would be jeopardized by U.S. crackdown on China biopharma industry, trade group says “U.S. legislation that would sever ties with Chinese drugmakers would jeopardize the drug supply for millions of American patients if it’s passed, the biotechnology industry’s main trade group has told Congress.
Congress is considering legislation, called the BIOSECURE Act, that would make it difficult for Chinese contract development and manufacturing organizations to do business with biotechnology companies that work with the U.S. federal government. Biotechs hire Chinese CDMOs, as they’re often called, for services that include product manufacturing, development, formulation, packaging, and distribution.”

About the public’s health

 A meta-analysis on global change drivers and the risk of infectious disease “Specifically, reducing greenhouse gas emissions, managing ecosystem health, and preventing biological invasions and biodiversity loss could help to reduce the burden of plant, animal and human diseases, especially when coupled with improvements to social and economic determinants of health.”

About healthcare finance

'We have not seen anything similar': Novo Nordisk pens $600M obesity pact with Flagship's Metaphore “In its ongoing mission to find the next Wegovy, Novo Nordisk has penned another partnership to seek out next-gen obesity treatments. This time, it's a $600 million biobucks pact with Flagship-founded Metaphore Biotechnologies to develop up to two candidates.
The latest agreement is part of a broader partnership between Flagship Pioneering and Novo that takes aim at cardiometabolic and rare diseases.”

Today's News and Commentary

About Covid-19

HHS's COVID vaccine campaign saved $732 billion in averted infections, costs “The US Department of Health and Human Services' (HHS's) COVID-19 vaccination campaign saved $732 billion by averting illness and related costs during the Delta and Omicron variant waves, with a return of nearly $90 for every dollar spent, estimates a study by HHS and the research firm Fors Marsh.” 

About health insurance/insurers

Centene to Face Proposed Class Fraud Claims Over Health Plans 
About 2 million people in 26 states have these groups’ plans.
Health insurance consumers can proceed with a proposed class action alleging that Centene Corp. and its subsidiaries deceived them into buying plans their doctors wouldn’t accept.
The plaintiffs adequately alleged a civil violation of the federal Racketeer Influenced and Corrupt Organizations Act and violations of consumer protection laws in 11 states, the US District Court for the Northern District of Illinois said Thursday.
Centene is the largest provider of Medicaid managed care plans and Affordable Care Act exchange plans in the country…”

About hospitals and healthcare systems

Steward plans sale of all hospitals, reports $9B in debt “Dallas-based Steward Health Care has placed its 31 U.S. hospitals up for purchase to help offload its $9 billion debt after the health system filed for Chapter 11 bankruptcy…
During a court hearing May 7 in Houston, Steward attorney Ray Schrock told U.S. Bankruptcy Judge Chris Lopez that the for-profit health system is aiming to keep all of its hospitals open and to finalize the sale of the facilities by the end of this summer, the news agency reported.”
For a summary of events leading up to this action, see: The Private-Equity Deal That Flattened a Hospital Chain and Its Landlord

About the public’s health

 Flame Retardant [FR] Exposure in Vehicles Is Influenced by Use in Seat Foam and Temperature “These results suggest that FRs used in vehicle interiors, such as in seat foam, are a source of OPE exposure, which is increased in warmer temperatures.”

U.S. Tightens Rules on Risky Virus Research “The White House has unveiled tighter rules for research on potentially dangerous microbes and toxins, in an effort to stave off laboratory accidents that could unleash a pandemic.
The new policy, published Monday evening, arrives after years of deliberations by an expert panel and a charged public debate over whether Covid arose from an animal market or a laboratory in China.” 

Today's News and Commentary

About healthcare quality

The Safety of Outpatient Health Care: Review of Electronic Health Records “Overall, 7.0% (95% CI, 4.6% to 9.3%) of patients had at least 1 AE [adverse event] (8.6 events per 100 patients annually). Adverse drug events were the most common AE (63.8%), followed by health care–associated infections (14.8%) and surgical or procedural events (14.2%). Severity was serious in 17.4% of AEs, life-threatening in 2.1%, and never fatal. Overall, 23.2% of AEs were preventable. Having at least 1 AE was less often associated with ages 18 to 44 years than with ages 65 to 84 years (standardized risk difference, −0.05 [CI, −0.09 to −0.02]) and more often associated with Black race than with Asian race (standardized risk difference, 0.09 [CI, 0.01 to 0.17]). Across study sites, 1.8% to 23.6% of patients had at least 1 AE and clinical category of AEs varied substantially.”

About health insurance/insurers

US Social Security, Medicare get slight boost from strong economy “The Medicare Hospital Insurance Trust Fund's reserves are now expected to be depleted in 2036, five years later than was forecast in last year's report, Treasury said. After that date, the program that provides healthcare to seniors and some people who are disabled would be able to pay only 89% of total scheduled benefits, based on annual tax collections.”
See also:Fact Sheet: 2024 Social Security and Medicare Trustees Reports and
Strong Economy, Low Unemployment, and Higher Job and Wage Growth Extend Social Security Trust Funds to 2035

Medicare Advantage Health Risk Assessments [HRAs]Contribute Up To $12 Billion Per Year To Risk-Adjusted Payments “In this study, we evaluated the impact of HRAs on Hierarchical Condition Categories (HCC) risk scores, variation in this impact across contracts, and the aggregate payment impact of HRAs, using 2019 MA encounter data. We found that 44.4 percent of MA beneficiaries had at least one HRA. Among those with at least one HRA, HCC scores increased by 12.8 percent, on average, as a result of HRAs. More than one in five enrollees had at least one additional HRA-captured diagnosis, which raised their HCC score. Potential scenarios restricting the risk-score impact of HRAs correspond with $4.5–$12.3 billion in reduced Medicare spending in 2020. Addressing increased coding intensity due to HRAs will improve the value of Medicare spending and ensure appropriate payment in the MA program.”

 Oscar Health Announces Results for First Quarter 2024 First profitable quarter due to 43% increase in membership and lower than expected costs. However, insurance companies are almost always profitable after rapid growth. The revenue is high but the Incurred But Not Reported (IBNR) claims are not yet realized. Before breaking out the champagne, let’s see what happens over the next year.

About hospitals and healthcare systems

 Hospital operator Steward Health Care files for bankruptcy protection “Hospital operator Steward Health Care filed for bankruptcy protection early Monday morning, but pledged to maintain the eight hospitals it operates in Massachusetts…
 Steward said it is finalizing the terms of ‘debtor-in-possession financing’ from its landlord Medical Properties Trust for initial funding of $75 million and ‘up to an additional $225 million upon the satisfaction of certain conditions.’”
The company’s debt is more than $9B.

About pharma

 As drug shortages reach record highs, regulators weigh next steps “Drug shortages hit a new high in the first quarter of 2024, forcing patients and doctors to scramble to secure ADHD medications, cancer treatments and other needed drugs. While shortages have been rising for some time, the persisting struggle to get them under control has spurred new calls for action…
 Manufacturing quality issues often contribute to shortages, as do production delays and problems with the flow of needed raw materials or components. Companies can also spark shortages when they decide to abandon low-priced generic drugs that are no longer worth their time to manufacture and distribute.”

 About healthcare personnel

Physician Flash Report “Key Takeaways

1. Investment/subsidy per provider is up 2% since Q1 2023. Overall labor expenses continue to rise, and Q1 2024 data show that labor represented 84% of total expenses.
2. Revenue and expenses remain on an upward trajectory. Net Patient Revenue per Provider FTE is up 4% from Q1 2023, while Total Direct Expense per Provider FTE is up 3% in the same time frame.
3. Provider productivity as measured by unit of work (wRVUs) per FTE rose 4% from Q1 2023. However, the ratio of support staff per 10,000 provider wRVUs is not keeping pace, and has decreased by 6% since Q1 2023.”

About health technology

 First Patient Begins Newly Approved Sickle Cell Gene Therapy  “…Kendric Cromer, a 12-year-old boy from a suburb of Washington, became the first person in the world with sickle cell disease to begin a commercially approved gene therapy that may cure the condition….
[Manufacturer] bluebird bio [the firm does not use caps in its name] says the cost is $3.1million.”
Although 20,000 patients are thought to be eligible for the treatment, bluebird can only handle treatments for 85 to 105 patients each year.
In a related article: Young boy dies in trial for Pfizer Duchenne gene therapy “Pfizer said the boy died of cardiac arrest, but that researchers had not yet determined precisely what happened or whether the death was linked to the treatment.”

FDA approves ColoSense stool RNA test to detect colorectal cancer in average-risk adults “The FDA has approved Geneoscopy Inc.’s ColoSense multitarget stool RNA test for adults aged 45 years or older at average-risk for developing colorectal cancer, according to a company press release.
Previously granted FDA breakthrough device designation in January 2020, ColoSense is the ‘first noninvasive colorectal cancer screening test to provide a dynamic view of disease activity by using RNA biomarkers,’ Geneoscopy noted…”

About healthcare finance

Healthcare Dealmakers—Kaiser wraps Geisinger buy; Advocate Health sells off MobileHelp and more FYI

Today's News and Commentary

Why Market Power Matters for Patients, Insurers, and Hospitals “Overall, our data show that the largest health systems have, on average, a combined 43.1% of the market share (as measured by total inpatient hospital discharges) in each state, while the top three large-group insurers hold an average of 82.2% of the market share in each state…
When the market share of an insurer far exceeds the market share of an individual health system — as is the case in most states, according to our analysis — that can negatively impact the amount that insurers are willing to pay hospitals and health systems for patient care.”

About healthcare quality

A National Quality Improvement Collaborative to Improve Antibiotic Use in Pediatric Infections “This multisite collaborative increased appropriate antibiotic use for community-acquired pneumonia, skin and soft tissue infections, and urinary tract infection among diverse hospitals.”
Comment: Read the methods and look at the Figures. This effort shows it is possible to improve quality on a national scale with projects across multiple unrelated pediatric institutions.

About health insurance/insurers

Payers ranked by medical loss ratios in Q1 FYI
and in a related story: Here's how major payers fared in a Q1 dragged by a cyberattack, MA challenges

Medicare Advantage extras on the chopping block in 2025 “Medicare Advantage insurers are planning to pare down their plan offerings in 2025. 
Facing lower reimbursement rates from CMS and higher medical costs, many plan executives said they will prioritize margins over growing their membership numbers.”

NORC Report Highlights Strong Satisfaction with Access to Care Through Employer-Provided Coverage [EPC] “Key takeaways from the report include:

• 89% of survey respondents said their EPC has a provider network that includes options that are convenient for them.

• 88% of respondents agreed their plan offered tools that helped them find in-network providers.

• 82% of respondents said they had access to high-quality providers through their EPC.

• The majority of respondents across all geographic areas reported high levels of satisfaction with their access to high-quality providers – even rural respondents, who can often face more barriers to care.”
  

About hospitals and healthcare systems

 How HCA, Tenet, CHS and UHS performed in Q1 FYI

 15 health system projects worth $500M or more FYI

About the public’s health

Three health foundations tackle biggest disease threats in $300mn deal “The three largest charitable foundations focused on public health are to join forces for the first time to tackle climate change’s impact, infectious diseases and measures to improve nutrition and wellbeing. Denmark’s Novo Nordisk Foundation, the Bill & Melinda Gates Foundation and UK-based Wellcome will commit an initial total of $300mn over three years and aim to expand their collaboration to other public, private and philanthropic partners.” 

Nitrogen dioxide exposure, health outcomes, and associated demographic disparities due to gas and propane combustion by U.S. stoves “Gas and propane stoves increase long-term NO2 exposure 4.0 parts per billion volume on average across the United States, 75% of the World Health Organization’s exposure guideline. This increased exposure likely causes ~50,000 cases of current pediatric asthma from long-term NO2 exposure alone. Short-term NO2exposure from typical gas stove use frequently exceeds both World Health Organization and U.S. Environmental Protection Agency benchmarks. People living in residences <800 ft2 in size incur four times more long-term NO2 exposure than people in residences >3000 ft2 in size; American Indian/Alaska Native and Black and Hispanic/Latino households incur 60 and 20% more NO2 exposure, respectively, than the national average.”