About health insurance
Aetna draws criticism for automatic down-codes for office visits: “Aetna will automatically down-code claims submitted for office visits or certain modifiers when the the insurer finds an ‘apparent overcode rate of 50 percent or higher.’ The policy concerns office visits with the 99000 series of evaluation and management codes and the 92000 series of ophthalmologic examination codes, as well as modifiers 25 and 59…”
The Value of Medicaid Managed Care, Making Prescription Drugs More Affordable for States and Taxpayers: This study commissioned by AHIP claims that:
—”More than 70% of all Medicaid prescriptions nationwide were covered by Medicaid managed care plans in 2018, compared to only 28% in 2011.
—Medicaid MCOs’ net costs per prescription were approximately 27% below net costs per prescription paid in Medicaid fee-for-service1 (FFS) programs. This differential yielded $6.5 billion in net savings for states and taxpayers during FFY2 2018.
—MCOs consistently control costs more effectively than FFS programs. Over the five-year period 2013 to 2018, net costs per prescription increased 13% more in FFS programs than in MCOs.”
About the public’s health
US appeals court upholds Trump rules involving abortions: “A U.S. appeals court has upheld Trump administration rules that bar health care providers in the federal family planning program for low-income women from referring patients for abortions.”
White House asks Congress for $1.8 billion to bolster coronavirus response: The White House has now put a target “ask” to address the corona virus epidemic. The initial sum is $1.8 billion but the maximum is targeted at $2.5 billion.
Continuation of Annual Screening Mammography and Breast Cancer Mortality in Women Older Than 70 Years: Researchers reviewed “1 058 013 beneficiaries aged 70 to 84 years who had a life expectancy of at least 10 years, had no previous breast cancer diagnosis, and underwent screening mammography.” They measured the eight-year “breast cancer mortality, incidence, and treatments, plus the positive predictive value of screening mammography by age group.” The result was that continuing “annual breast cancer screening past age 75 years did not result in substantial reductions in 8-year breast cancer mortality compared with stopping screening.”
Drug overdose deaths rise in the West while they drop in the East: This article is a good update on the epidemiology of the opioid epidemic.
Alcohol-Linked Deaths Soaring in U.S., Women Hit Hardest: “The rate of alcohol-induced deaths among women increased between 3.1% and 3.6% a year from 2000 to 2016, while deaths among men increased 1.4% to 1.8% each year, according to the findings.
What's worse, the rates have accelerated in recent years -- the average annual increase for women was 7.1% between 2013 and 2016, and for men it was 4.2% between 2012 and 2016.”
While the findings are at best 3 years old, the problem needs to be addressed now.
Trump's controversial "public charge" rule takes effect, reshaping legal immigration: “After multiple legal barriers blocking the implementation of the new requirements were cleared by the conservative-leaning Supreme Court, most green card applicants in the U.S. and abroad will now be subjected to a redefined "public charge" test. Under the rules by the Departments of State and Homeland Security, immigration officials have more power to deny applications from petitioners they deem are, or could become, an economic burden on the country.”
Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials: The controversy over whether or not salt is bad for you should be put to rest by this analysis. “The magnitude of blood pressure lowering achieved with sodium reduction showed a dose-response relation and was greater for older populations, non-white populations, and those with higher blood pressure. Short term studies underestimate the effect of sodium reduction on blood pressure.” Reductions in blood pressure were observed in both hypertensive and non-hypertensive individuals.
About healthcare providers
Checkup for $30, Teeth Cleaning $25: Walmart Gets Into Health Care: Walmart opened two health centers in Georgia since last summer, and the company says volume is greater than expected. “Rather than tucked in a corner of a cavernous Supercenter, they have separate entrances visible from the parking lot. They’re run by doctors, with plenty of exam rooms to support a steady stream of patients. Paperwork is almost nonexistent because many appointments don’t involve insurance, and administrative functions such as scheduling and billing have been outsourced to a back-office specialist called Zotec. (Walmart accepts insurance, but patients are often better off paying the flat cash fee because they don’t have to pitch in copayments or satisfy plan deductibles.) In addition to medical, dental, and eye care, the centers also provide X-rays, hearing checks, and diagnostic lab tests for things like blood glucose and lipids…” Walmart sets “prices by estimating the cost of common services, including copays and deductibles, then coming in well under that, often half as much… by reducing… all that administrative baloney.”
Where have the many hospital inpatients gone?: This analysis by Deloitte found, among other things, that:
“Between 2011–18, hospital outpatient revenue grew at a higher compounded annual rate (9 percent) compared to inpatient revenue (6 percent).
The aggregate outpatient share of total hospital revenue grew from 28 percent in 1994 to 48 percent in 2018…
Much of this past shift is due to technological advances in clinical care delivery. Moreover, technologies like digital consumer apps, predictive analytics, and virtual health are accelerating it further today and are expected to continue to do so in the next few years.”
About pharma
Mallinckrodt Nets Government Support for $1.6 Billion Opioid Deal: “Drugmaker Mallinckrodt PLC said on Tuesday that it reached a settlement worth more than $1.6 billion with 47 states and U.S. territories and lawyers representing thousands of local governments to settle liabilities stemming from the opioid addiction crisis.
Under the settlement proposal, state and local governments would receive $1.6 billion of payments, phased out over eight years, and warrants for a minority stake in the company. Mallinckrodt’s generics subsidiaries would file for chapter 11 to implement the proposed deal, though the Ireland-based parent will stay out of bankruptcy.”
Sanofi to spin off drug ingredient business by 2022: About 60% of the world’s active pharmaceutical ingredients (APIs) are sourced from India and China. But those sources are often unreliable. To address that issue, “Sanofi plans to spin off its business that makes active ingredients for pharmaceuticals into a separate company by 2022… [the] drugmaker plans to float a 70 per cent stake in the new standalone company on the Paris stock exchange.”
SUPPORT-AF II: Supporting Use of Anticoagulants Through Provider Profiling of Oral Anticoagulant Therapy for Atrial Fibrillation: A Cluster-Randomized Study of Electronic Profiling and Messaging Combined With Academic Detailing for Providers Making Decisions About Anticoagulation in Patients With Atrial Fibrillation: LONG title, but here is the message. The plan was to use the methods explained in the title to enhance appropriate prescribing for anticoagulants used in patients with atrial fibrillation. Without that therapy, the irregular heartbeat can lead to strokes.
”More than 80% of intervention providers read our emails, and 98% of the time a provider reviewed our in-basket messages. Replies to messages identified patient refusal as the most common reason for patients not being on anticoagulation (11.2%). For the group of patients not on anticoagulation at baseline assigned to an intervention versus control provider, the adjusted percent increase in the use of anticoagulation over 6 months was 5.2% versus 7.4%, respectively (P=0.21).” The conclusion was: “Our electronic messaging and academic detailing intervention was feasible but did not increase anticoagulation use. Patient-directed interventions or provider interventions targeting patients declining anticoagulation may be necessary to raise the rate of anticoagulation.” Can you suggest a more effective plan to enhance compliance?