About health insurance
Obamacare's chances of surviving Supreme Court diminished with RBG's death: The article is an excellent summary of the possible ACA scenarios that could come from the Supreme Court’s consideration of the ACA’s constitutionality.
Radiation Oncology (RO) Model Fact Sheet: CMS is introducing bundled payments for radiation oncology services. This page provides details.
CMS Announces Transformative New Model of Care for Medicare Beneficiaries with Chronic Kidney Disease: The End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model “will test shifting Medicare payments from traditional fee-for-service payments to payments where providers are incentivized for encouraging receipt of home dialysis and kidney transplants. This value-based payment model will encourage participating care providers to invest in and build their home dialysis programs, allowing patients to receive care in the comfort and safety of their home. Home dialysis gives patients the freedom to choose the therapy that works best with their lifestyles, without being tied to the dialysis facility’s schedule.
The ETC Model also incentivizes transplantation by financially rewarding ESRD facilities and clinicians based on their transplant rate calculated as the sum of the transplant waitlist rate and the living donor transplant rate.” Also see: Industry Voices—David vs. Goliath: New entrants changing the face of dialysis
New Rule Expands the Scope of Reimbursable Expenses for Living Organ Donation: “In support of President Trump’s Executive Order on Advancing American Kidney Health, the Department of Health and Human Services (HHS) through the Health Resources and Services Administration (HRSA) has finalized a new rule to expand the scope of qualified reimbursable expenses incurred by living organ donors to include lost wages, child-care and elder-care expenses. The new rule amends regulations of the National Organ Transplant Act of 1984, as amended.”
About the public’s health
Cancer statistics for adolescents and young adults, 2020:Read the abstract for the specifics, which vary by age category and disease. Reasons for many of the increases are not known.
U.S. sets record with over one million coronavirus tests in a day: “The United States set a one-day record with over 1 million coronavirus diagnostic tests being performed, but the country needs 6 million to 10 million a day to bring outbreaks under control, according to various experts.”
Covid-19 Can Spread On Long Airline Flights, Per Two New Studies: The headline speaks for itself.
About pharma
Prescriptions Slowly Recovering From Pandemic Hit: “As retail prescriptions fell by 4%, mail order prescriptions increased by 5.2%…
COVID-19 has also been a contributing factor in the increase in 90-day prescription refills…The beginning of the pandemic saw a dramatic drop in 30-day retail prescriptions (down 12.5%) at the same time that 90-day retail prescriptions jumped by 7.5%. In the mail order category, both 30- and 90-day prescriptions increased, but 90-day grew by much more (16.4% compared with 4.8%).”
3 former pharmacy execs indicted in alleged $50M healthcare fraud scheme: “The three men and their conspirators prompted more than $50 million in fraudulent insurance claims for compounded medications that weren't medically necessary, the indictment states. They also took patients' names, dates of birth and other identifying information without their consent from their prescriptions and used them to make false claims to the pharmacy benefits administrator, according to the indictment.“
Illumina to pay $8B to reacquire cancer blood test maker Grail, with all eyes on 2021: “Illumina will put down a total of $8 billion to reacquire its former spinout Grail, which, after nearly five years on its own, is nearing completion of a simple blood test capable of detecting 50 different cancers in their earliest stages.
Both companies expect it all to come together in 2021: The transaction is slated to close in the second half of next year—consisting of $3.5 billion in cash and $4.5 billion in Illumina stock upfront—while Grail has on its calendar two commercial launches of tumor-screening tests. Illumina has predicted the finished deal will immediately start adding to its bottom line.”
About healthcare quality
NAACOs urges Congress to address qualifying thresholds in value-based care models:”The National Association of Accountable Care Organizations (NAACOs) surveyed 116 ACOs across a number of programs, and found that 90% were concerned they would be unable to reach qualifying thresholds in 2021, which must be met to receive bonuses under the program.
The survey shows that 96% of the responding ACOs would not meet the 2021 targets based on their 2020 performance.”
About Healthcare IT
NIH to fund 7 digital health projects aimed at COVID-19:”The National Institutes of Health has picked seven companies and academic centers to help develop digital health solutions aimed at the COVID-19 pandemic—including smartphone apps, wearables and big data programs to mitigate the personal and public health impacts of the novel coronavirus.
Each one-year contract includes two phases: an initial award for feasibility testing, followed by an option for additional development funding. If all seven progress to the second phase, the total value of awards would reach $22.8 million.”
The article has project examples.