About hospitals and health systems
How the 3 largest nonprofit systems fared in Q1: “The largest nonprofit health systems, Ascension, CommonSpirit Health and Trinity Health, reported higher revenue in the first quarter of fiscal year 2022 than in the same period a year earlier.” The article provides more details for each system.
The 11 most expensive hospital capital projects in 2021: “Eleven capital projects of more than $1.5 billion were announced, broke ground or were completed in 2021.” Amazing that these expensive projects went ahead during the Covid pandemic.
About healthcare technology
Chan Zuckerberg Initiative to pour $3.4B over 10 years into AI, imaging and other tech to unravel biomedical challenges: “The philanthropic initiative—led by the husband-and-wife duo of Facebook founder Mark Zuckerberg and Priscilla Chan, M.D., formerly a practicing pediatrician—unveiled this week a 10-year plan to invest $3.4 billion in the development of new technologies and tools that help improve our understanding of human health and disease.
Between $800 million and $1 billion of the new funds will go to the Biohub… {the] San Francisco-based research hub launched in 2016 with an initial commitment of about $600 million. Its first projects included the construction of the Cell Atlas, a map of the various types of cells that control each major organ, and the creation of the Infectious Disease Initiative to develop new diagnostic tests and vaccines to treat HIV, Ebola, Zika and other fast-spreading diseases.”
About health insurance
Senate votes to avert Medicare cuts: “The bill halts a mandatory 2 percent federal Medicare spending sequester until April 2022 and stops a 4 percent statutory pay-as-you-go sequester. Both sequesters are meant to limit federal spending.
The bill also reduces the mandatory Medicare sequester to 1 percent from April through June of 2022 and includes a 3 percent increase in pay for providers in the Medicare physician fee schedule. The package also delays the start of the radiation oncology model until Jan. 1, 2023, to give participants the best chance to improve cancer care outcomes…
The Senate approved the bill in a 59-35 vote. The House approved the bill Dec. 7 in a 222-212 vote. It now heads to President Joe Biden.”
Doctors and Hospitals Make Late Bid to Change Surprise Billing Ban: “Three weeks before a new ban on surprise medical billing is set to start, hospital and doctor groups have filed suit to block part of it.
The suit, from the American Medical Association, the American Hospital Association and a handful of individual hospitals and providers, argues that regulators in the Biden administration have misread the law’s language — and that their faulty interpretation will harm medical providers.
The lawsuit does not seek to gut the law’s consumer protections, but could influence contract negotiations between insurers and health care providers. If successful, the lawsuit could influence which doctors and hospitals choose to go in network with insurers, and could lead to higher insurance premiums.”
Affordable Care Act exchanges seeing record interest in heavily subsidized 2022 coverage: “Plan selections in the 33 states that use the federal exchange, Healthcare.gov, are up 5% from an essentially comparable period last year, the agency said. The data is for the first five weeks of open enrollment, which began November 1 and runs through January 15, a month longer than under the Trump administration.
In the 12 states that have not expanded Medicaid to low-income adults, sign ups have increased 9%. Plan selections are up 20% in Texas and 9% in Florida, the two largest markets on the federal exchange.”
5 payers tagged by OIG for coding, reimbursement errors in 2021: Read the article for details.
Anthem-backed Hydrogen Health rolls out virtual primary care services for insurers, employers: “Hydrogen Health rolled out its services with Anthem this past summer and is now expanding to multiple Fortune 500 employers and large regional health plans, company executives said, with a plan to be live for an additional 10 million people by the end of 2022.
Hydrogen Health is a new venture from New York-based K Health, backed by an Anthem investment and funds managed by investment firm Blackstone that aims to lower healthcare costs and make care more accessible.”
Geographic Variation in Medicare Fee-for-Service Health Care Expenditures Before and After the Passage of the Affordable Care Act: “This analysis of geographic variation in per-beneficiary health care expenditures within the Medicare fee-for-service system has 3 notable findings. First, we observed a decline in geographic variation in total expenditures from 2007 to 2018. Whereas per-beneficiary monthly expenditures were $415 higher in the top vs bottom deciles in 2007, they were only $361 higher in 2018. Notably, we found reductions in geographic variation were concentrated in the highest-spending decile—the ratios of the 9th and 8th to the lowest-spending deciles were more constant during this period—showing that reductions in relative spending were not uniform across all higher-spending deciles but rather focused on outlier regions. Second, the decline in geographic variation appears to have begun in 2012, soon after Medicare began implementing value-based payment policies and increased antifraud enforcement after the ACA. Third, the types of services that accounted for the decrease in geographic variation were postacute care (which declined as a proportion of total expenditures), and most of the decline in geographic variation in postacute care was related to home health care. Notably, for both hospital and physician services, geographic variation was unchanged over the study period.”
About pharma
Utilization of Generic Cardiovascular Drugs in Medicare’s Part D Program: “Of ≈$22.9 billion spent on cardiovascular drugs in Medicare Part D prescription programs in 2017, ≈$11.0 billion was spent on medications with both brand-name and generic options. Although only 2.4% of medication fills were for the brand-name choice, they made up 21.2% of total spending. Accounting for estimated brand-name rebates, generic substitution for these medications would save $641 million, including $135 million in costs shouldered by patients. Furthermore, the minority of clinicians with the lowest generic utilization was responsible for a large proportion of the potential cost savings.”
House Democrats find in three-year investigation that drug prices are ‘unsustainable, unjustifiable and unfair’: “The findings, released Friday, show that companies studied by the committee raised prices of common brand-name drugs during the past five years by nearly four times the rate of inflation. The report seeks to debunk industry contentions that companies’ pricestrategy is needed to plow money back into researching and developing new medicines, finding that revenue is substantially greater than those investments….
In a counterpunch, the Oversight committee’s Republicans issued their own drug-industry report, based on a less exhaustive look at companies known as pharmacy benefit managers, which act as go-betweens to manage drug benefits on behalf of private insurers, Medicare drug plans and other payers. The pharmaceutical industry and other critics have contended for years that PBMs, as they are known, are a major reason for the growth of drug spending because they receive undisclosed payments — called rebates — based on a medicine’s list price, so the higher the price the greater the payment.”
Federal Jury Convicts Pharmacy Owner for Role in $174 Million Telemedicine Pharmacy Fraud Scheme: This case is a rare example of a multiyear scam that did not target federal programs. “According to court documents and evidence presented at trial, Bolos and his co-conspirators, Andrew Assad, Michael Palso, Maikel Bolos, Larry Smith, Scott Roix, HealthRight LLC, Mihir Taneja, Arun Kapoor, and Sterling Knight Pharmaceuticals, as well as various other companies owned by them, deceived pharmacy benefit managers (PBMs), such as Express Scripts and CVS Caremark, regarding tens of thousands of prescriptions. The PBMs processed and approved claims for prescription drugs on behalf of insurance companies. Bolos and his co-conspirators defrauded the PBMs into authorizing claims worth more than $174 million that private insurers such as Blue Cross Blue Shield of Tennessee, and public insurers such as Medicaid and TRICARE, paid to pharmacies controlled by the co-conspirators.”
About the public’s health
Becerra names incoming acting NIH director: “Lawrence Tabak, who currently serves as the principal deputy director at NIH, will take on the acting position starting on Dec. 20, while the administration searches for Collins’s permanent replacement, the HHS secretary said in an announcement.”
Association of Air Pollution and Physical Activity With Brain Volumes: “Physical activity is associated with beneficial brain outcomes, while AP is associated with detrimental brain outcomes. Vigorous physical activity may exacerbate associations of AP with white matter hyperintensity lesions, and AP may attenuate the beneficial associations of physical activity with these lesions.” Beneficial individual efforts are balanced out by public errors.
Supreme Court lets Texas abortion law continue but says providers can sue: “In this latest decision, court said in an 8-1 vote that abortion providers should be allowed to sue in federal court, with only Justice Clarence Thomas saying in a dissent that he would have thrown out the providers' case.
By a 5-4 vote, the Supreme Court's conservative majority said that the providers could not sue state court clerks, as clinics had sought to do in their efforts to short-circuit the private state court litigation that could be brought against them for violating the six-week ban. Chief Justice John Roberts said that the Court should have allowed lawsuits to proceed against those and other officials.”
In a related article: Judge says Texas abortion law’s enforcement mechanism unconstitutional: "The enforcement mechanism for Texas’s abortion ban, which is the most restrictive in the nation and effectively outlaws the procedure, violates the Texas constitution, a state judge ruled Thursday.
While a win for abortion rights advocates, the narrow decision by District Judge David Peeples of Austin does not include an injunction that would halt litigation against doctors or others who “aid or abet” an abortion.”
NHS waiting list in England hits record high in October: A cautionary note fro those advocating a national health scheme like the one in England: “The number waiting for non-emergency NHS hospital treatment has risen to 6m, the highest since records began almost 15 years ago, underlining the health service’s fragility as it braces for the consequences of the new Omicron coronavirus variant. Official data from NHS England published on Thursday showed a large jump in the backlog in October, with about 35 per cent of patients waiting more than 18 weeks to start treatment, against a target of just 8 per cent.”
IDF Diabetes Atlas 10th edition 2021: From the International Diabetes Federation: “Findings of the current 10th edition confirm that diabetes is one of the fastest growing global health emergencies of the 21st century (see Map 1). In 2021, it is estimated that 537 million people have diabetes, and this number is projected to reach 643 million by 2030, and 783 million by 2045. In addition, 541 million people are estimated to have impaired glucose tolerance in 2021. It is also estimated that over 6.7 million people aged 20–79 will die from diabetes-related causes in 2021. The number of children and adolescents (i.e. up to 19 years old) living with diabetes increases annually. In 2021, over 1.2 million children and adolescents have type 1 diabetes. Direct health expenditures due to diabetes are already close to one trillion USD and will exceed this figure by 2030.”
About Covid-19
US government has granted vaccine mandate exceptions to 165,000 workers: “8% of federal employees remain unvaccinated against Covid-19 despite November mandate.”
Austrians who refuse Covid jabs face fines of up to €3,600: “Government plans to make vaccination compulsory for everyone aged above 14 from February.”
Covax promised 2 billion vaccine doses to help the world’s neediest in 2021. It won’t even deliver even half that.: “The U.N.-led initiative is now racing to deliver 800 million doses by the end of the year, according to interviews with senior officials involved in Covax, which includes the World Health Organization and other groups. Even if that benchmark is met, it will be a far cry from the 2.3 billion doses hoped for in January by a program designed to counter a glut of vaccines in wealthy nations.
Covax lowered its estimate of doses delivered in 2021 to between 800 million and 1 billion doses late this year after a range of complications with supply and delivery.“
AstraZeneca’s COVID-19 Long-Acting Antibody Combo Snags EUA: “The FDA has granted AstraZeneca’s long-acting antibody combination Evusheld an Emergency Use Authorization (EUA) for preventing COVID-19 in adults and children 12 years of age and older with weak immune systems.
The combination tixagevimab/cilgavimab treatment is indicated for people with moderate-to-severe immunocompromise caused by a medical condition or immunosuppressive drugs who may be unable to mount a proper immune response to a COVID-19 vaccine, as well as those who shouldn’t receive a coronavirus vaccine at all.”