About health insurance
Hospitals get more time to repay Medicare loans:”President Donald Trump on Sept. 30 signed a short-term spending bill that funds the government through Dec. 11 and relaxes the repayment terms for Medicare loans hospitals received earlier this year.
The funding bill, previously passed by the House of Representatives and Senate, extends the date for when CMS will begin recouping Medicare advance payments that were sent to hospitals to help offset financial strain tied to the COVID-19 pandemic. CMS will wait one year after the loan was issued to begin withholding Medicare payments to recoup the funds. The loans were originally due 120 days after they were issued.
The spending bill also delays Medicaid Disproportionate Share Hospital payment cuts.”
National Health Care Fraud and Opioid Takedown Results in Charges Against 345 Defendants Responsible for More than $6 Billion in Alleged Fraud Losses:Largest Health Care Fraud and Opioid Enforcement Action in Department of Justice History: “These defendants have been charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, including more than $4.5 billion connected to telemedicine, more than $845 million connected to substance abuse treatment facilities, or ‘sober homes,’ and more than $806 million connected to other health care fraud and illegal opioid distribution schemes across the country.”
Marketplace Coverage Enrollment by Metal Tier, 2016-2018: Trends in States Using the Healthcare.gov Enrollment Platform: From an Urban Institute study: “In 2017, on average, a benchmark (second lowest priced) silver premium was 21 percent higher than the lowest-priced bronze plan available to consumers.
In 2018, after federal reimbursement of cost-sharing subsidies ended, the silver plan premiums rose to an average of 38 percent above the lowest-premium bronze plan, sparking an 11-percentage-point drop in the share of marketplace enrollees buying silver plans. Most of that enrollment drop shifted into lower priced bronze plans, coverage that requires substantially higher out-of-pocket costs when using medical care.”
Health Plans Undercutting Obamacare Get Boost From Texas Ruling: “The U.S. judge in Texas who ruled that Obamacare’s individual mandate was unconstitutional has signed off on a kind of low-cost insurance alternative that could pull young, healthy people away from the exchanges and drive up health-care costs for those left behind.
U.S. District Judge Reed O’Connor in Fort Worth overruled the U.S. Labor Department’s objections to novel plans proposed by two would-be providers, including a small Georgia company that proposes to offer health plans to individuals who agree to have their internet activity tracked.”
There is one error in the article: ERISA plans are subject to the essential coverage items of the ACA.
About healthcare IT
HHS urges health care sector to guard against Ryuk ransomware threat: “The Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness & Response today released an update on the Ryuk ransomware threat to the health care and public health sector, and urged the sector to take certain actions to reduce the risk of an attack.”
VA EHRM, MHS GENESIS Set to Deploy in October After Delays: FINALLY…”Following delays to both the Department of Veterans Affairs’ (VA) Electronic Health Record Modernization (EHRM) program and MHS GENESIS, the Military Health System’s new EHR system, both are set to go-live in late October…
The agency plans for MHS GENESIS to improve patient experience and safety, enable the application of standardized workflows, integrate healthcare delivery, and increase provider efficiency. It will also provide a single EHR for veterans, service members, and their families….
Constructed by Cerner, MHS GENESIS uses the same software as the EHRM program. This allows secure interoperability between the two healthcare systems.”
More than 5.5M health records breached in September: Not a great month for IT. The list provides details by institution. By far the biggest breach was Inova Health System (Falls Church, Va.), with 1,045,270 individuals affected.
About the public’s health
New poll shows alarming coronavirus vaccine skepticism: “Lack of trust in a potential coronavirus vaccine is becoming a truly major problem, according to a new Stat/Harris Poll survey shared with Axios…
79% of respondents said they would worry about a vaccine's safety if it's approved quickly, and 75% said they worry about politics — rather than science — driving the process.”
HPV Vaccination and the Risk of Invasive Cervical Cancer: From a very large Swedish study: “The cumulative incidence of cervical cancer was 47 cases per 100,000 persons among women who had been vaccinated and 94 cases per 100,000 persons among those who had not been vaccinated.” By far the greatest benefit was in women vaccinated before age 17.
Moderna CEO says its vaccine won’t be ready for general public until spring: “Stéphane Bancel told the Financial Times during a pharmaceutical and biotechnology conference that the company would not be ready to apply for emergency use authorization [emphasis added] for its potential vaccine from the Food and Drug Administration until Nov. 25 at the earliest…”
Health-care spending attributable to modifiable risk factors in the USA: an economic attribution analysis:From today’s Lancet Public Health:
In 2016, US health-care spending attributable to modifiable risk factors was US$730·4 billion…corresponding to 27·0%… of total health-care spending [emphasis added]. Attributable spending was largely due to five risk factors: high body-mass index ($238·5 billion, 178·2–291·6), high systolic blood pressure ($179·9 billion, 164·5–196·0), high fasting plasma glucose ($171·9 billion, 154·8–191·9), dietary risks ($143·6 billion, 130·3–156·1), and tobacco smoke ($130·0 billion, 116·8–143·5). Spending attributable to risk factor varied by age and sex, with the fraction of attributable spending largest for those aged 65 years and older (45·5%, 44·2–46·8).”
About pharma
US congressional probe alleges Celgene, Teva schemed to drive up cost of key drugs: “The US House Committee on Oversight and Reform released two reports Wednesday outlining various tactics used by Celgene and Teva to drive up prices for their respective drugs Revlimid (lenalidomide) and Copaxone (glatiramer acetate).
… the congressional committee noted that as Medicare is prohibited from negotiating directly with pharmaceutical companies to lower drug costs, Celgene and Teva "targeted the US market for price increases, while maintaining or cutting prices for the rest of the world." For Teva in particular, the panel noted that the net price of Copaxone 40 mg/ml in 2015 was $126 per day in the US, versus $33 in Germany, $26 in Spain, $25 in the UK, and $18 in Russia.”
Remdesivir may not cure coronavirus, but it’s on track to make billions for Gilead: Nice summary odf the issues surrounding this drug. The “news” is: “The government is poised to end its control of distribution of the drug after Sept. 30, a spokeswoman for the Department of Health and Human Services said last week, pushing it into normal drug distribution channels.” AmerisourceBergen will be the sole distributer until the end of the year.
NIAID Stops COVID-19 Trial Enrollment Over Adverse Events: “The National Institute of Allergy and Infectious Diseases has stopped enrolling severely ill COVID-19 patients in a phase 3 trial of Merck’s Rebif (interferon beta-1a) with Gilead Sciences’ remdesivir because of serious adverse events.”