About hospitals
U.S. hospitals lose legal challenge to Trump price transparency rule: “A federal judge on Tuesday dismissed a challenge by hospital groups to a federal rule requiring them to disclose prices they quietly negotiate with insurers, in a victory for White House efforts to make healthcare pricing more transparent to patients.
U.S. District Judge Carl Nichols in Washington, D.C. said the rule was reasonably related to the government’s interest in lowering healthcare costs and giving consumers more pricing data to help them decide on treatment.
He rejected a claim by the American Hospital Association and other hospital groups that the rule would force them to disclose private negotiations with insurers, undermining competition and violating their First Amendment free speech rights.”
Recall several pharma companies won their price transparency suits because the court decided the rule overstepped CMS’s authority. Expect this decision to be appealed.
How the 3 largest nonprofit health systems fared in Q3: No surprise that all three suffered significant operating losses.
About the public’s health
Live updates: New coronavirus cases in the U.S. soar to highest single-day total: “…more than 36,000 new infections were reported by state health departments on Wednesday — surpassing the previous single-day record of 34,203 set on April 25. Texas, Florida and California led the way, with all three states reporting more than 5,000 new cases apiece.”
Feds About To Bail On Supporting COVID Testing Sites In Texas And Other States: “The Trump administration is ending funding and support for local COVID-19 testing sites around the country this month, as cases and hospitalizations are skyrocketing in many states.
The federal government will stop providing money and support for 13 sites across five states which were originally set up in the first months of the pandemic to speed up testing at the local level.”
Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association: “The addition of self-measured BP monitoring to office BP monitoring is cost-effective compared with office BP monitoring alone or usual care among individuals with high office BP…Therefore, self-measured BP monitoring has high potential for improving the diagnosis and management of hypertension in the United States. Randomized controlled trials examining the impact of self-measured BP monitoring on cardiovascular outcomes are needed. To adequately address barriers to the implementation of self-measured BP monitoring, financial investment is needed in the following areas: improving education and training of individuals and providers, building health information technology capacity, incorporating self-measured BP readings into clinical performance measures, supporting cointerventions, and enhancing reimbursement.”
When the Virus Hit, Japan Already Had an Army of Contact Tracers: Another model we should be emulating? “Experts contend that the existence of these [public health] centers, which implement and execute central public health policy from giving elderly diet advice to investigating child abuse, are one of the key reasons Japan was able to avoid an explosion in coronavirus cases.”
CVS to sell employers, universities COVID-19 testing program:”CVS Health is selling a program to employers and universities called Return Ready, which offers diagnostic testing to help them return to work and school safely.
CVS said the program allows employers and universities to design a customized testing strategy and to choose how, where and when to test employees or students.”
Fauci gives Congress COVID-19 warning: “Fauci said time is running out to address the spikes in cases.
’Right now, the next couple of weeks are going to be critical in our ability to address those surgings that we’re seeing in Florida, in Texas, in Arizona and in other states,’ Fauci told the House Energy and Commerce Committee Tuesday.” Read the article for more on his testimony yesterday.
More Young Americans Developing Unhealthy Predictors of Heart Disease: Another reminder that COVID-19 isn’t the only pandemic. “A new study finds that 1 in 5 people under age 40 now have metabolic syndrome, a group of risk factors that together increase the odds for many serious conditions, including diabetes, heart disease and stroke.
The rate of metabolic syndrome is rising in all age groups -- as many as half of adults over 60 have it. But among 20- to 39-year-olds, the rate rose 5 percentage points over five years, the study reported.”
U.S. and EU Officials Discuss Closer Cooperation During Pandemic
Officials discussed sharing “their common experiences and challenges in the development of COVID-19 vaccine;… extending an existing mutual recognition agreement for good manufacturing practice (GMP) inspections”…and collaborating “on COVID-19 postmarket surveillance of COVID-19 vaccines and the use of medicines in pregnant women with COVID-19.”
About health insurance
The Value of Medicaid Managed Care: States Transition to Managed Care: This study, commissioned by AHIP, is a current snapshot of the Medicaid managed care landscape. One notable statistic: 76.7% of people are enrolled in capitated arrangements. See Figure 1 for data on the rapid growth of these plans.
Insurers Not On The Hook For Diagnostic COVID Tests Mandated By Employers, Administration Rules: “Insurance companies have been anxious for guidance from the Trump administration on whether there would be patient cost-sharing responsibility for tests required by workplaces as employees return. Under the new guidance, such testing would not be covered under the Families First Coronavirus Response Act.”
CMS Unveils Major Organizational Change to Reduce Provider and Clinician Burden and Improve Patient Outcomes: CMS announced “the creation of the Office of Burden Reduction and Health Informatics to unify the agency’s efforts to reduce regulatory and administrative burden and to further the goal of putting patients first. The new office is an outgrowth of the agency’s Patients over Paperwork (PoP) Initiative, which is the cornerstone of CMS’s ongoing efforts to implement President Trump’s 2017 executive order to “Cut the Red Tape” and eliminate duplicative, unnecessary, and excessively costly requirements and regulations. This announcement permanently embeds a culture of burden reduction across all platforms of CMS agency operations…
Additionally, the Office of Burden Reduction and Health Informatics will focus on the important work of health informatics, which uses and applies health data and clinical information to provide better healthcare to patients.”
2019 AMA prior authorization (PA) physician survey: The graphic provides a summary of this study of 1000 physicians. Among the results: 24% say that the prior authorization (PA) process has led to a serious adverse event and 16% report that PA has led to the hospitalization of a patient.
Medical cost trend: Behind the numbers 2021: “Employer healthcare spending could fall in calendar year 2020 compared with 2019, and then rebound in 2021. How much it falls in 2020 and rebounds in 2021 is subject to many variables, complicated by the pandemic. For 2021, PwC’s Health Research Institute (HRI) has formulated three scenarios to help guide employers and health plans as they determine medical cost trend. “ Two factors that will increase spending are increases in mental health services and introduction of specialty pharmaceuticals. Cost mitigators are increases in telehealth and adoption of more narrow networks.
About healthcare IT
Anthem launching enhanced version of its Alexa Skill in 13 commercial markets: “Anthem is launching an enhanced version of its Amazon Alexa voice assistant skill across 13 of its commercial insurance markets.
The Anthem Skill allows members to ask Alexa for assistance with several common requests, such as scheduling a call with an Anthem customer service agent or ordering prescription refills.
Members can also seek further information about their health plans, including how close they are to meeting their deductible or the balance in their health savings account or health reimbursement account.”
About pharma
Bayer inks largest settlement in pharma history with $10B Roundup deal: “Bayer will dole out between $10.1 billion and $10.9 billion—the single largest settlement in pharma history—to put an end to thousands of lawsuits tied to its acquisition of Monsanto and glyphosate-based Roundup.”