About healthcare IT
Oracle to buy medical records company Cerner in its biggest acquisition ever: “Enterprise software giant Oracle will buy electronic medical records company Cerner in an all-cash deal for $95 per share, or approximately $28.3 billion in equity value.
The deal, expected to close in calendar year 2022, could help Oracle boost its presence in health care by bringing troves of health data to its cloud services.
Oracle shares closed down 5% Monday after the companies announced the deal.”
Could facility fees for telehealth appointments return: “Facility fees can add hundreds or even thousands of dollars to a patient's bill and have come under criticism from patients and consumer groups. Hospitals argue these fees are necessary for keeping their facilities operational. Fees for video appointments are rare but have taken a few patients by surprise…
In 2021, only 1.1 percent of telehealth appointments included a facility fee. As telehealth continues to be used post-pandemic, it is unclear how appointments will be billed.”
About health insurance
Former West Hollywood Doctor and Company Associated with 1-800-GET-THIN Guilty of Massive Fraud Against Health Insurers: “ A former doctor and his company were found guilty today by a federal jury of scheming to defraud private insurance companies and the Tricare health care program for military service members by fraudulently submitting an estimated $355 million in claims related to the 1-800-GET-THIN Lap-Band surgery business…
Omidi used the sleep studies to find a reason – the “co-morbidity” of obstructive sleep apnea – that GET THIN would use to convince the patient’s insurance company to pre-approve the Lap-Band procedure.
After patients underwent sleep studies – irrespective of whether any doctor had ever determined the study was medically necessary – GET THIN employees, acting at Omidi’s direction, often falsified the results. Omidi then used the falsified sleep study results in support of GET THIN’s pre-authorization requests for Lap-Band surgery.”
CMS: Insurers paid out $2B in medical loss ratio rebates for 2020 claims: “Insurers gave out approximately $2 billion in rebates for 2020 to nearly 10 million consumers under the Affordable Care Act’s (ACA's) medical loss ratio provision…
A plan must send rebates to customers by Sept. 30 via either a premium credit, lump-sum check, credit card or direct debit.
‘For the 2020 reporting year, health insurers provided approximately $1.3 billion in rebates in the individual market, $384 million in the small group market and $291 million in the large group market,’ CMS said.”
Many Medicare Beneficiaries Are Not Receiving Medication to Treat Their Opioid Use Disorder: Findings from HHS OIG:
“ About 1 million Medicare beneficiaries were diagnosed with opioid use disorder in 2020. Yet less than 16 percent of these beneficiaries received medication to treat their opioid use disorder, raising concerns that beneficiaries face challenges accessing treatment. Furthermore, less than half of the beneficiaries who received medication to treat their opioid use disorder also received behavioral therapy. These services may be provided in-person or via telehealth; however, the full extent to which beneficiaries use telehealth for behavioral therapy is unknown, as Medicare does not require opioid treatment programs to report this information.
In addition, beneficiaries in Florida, Texas, Nevada, and Kansas were less likely to receive medication to treat their opioid use disorder than beneficiaries nationwide. Furthermore, Asian/Pacific Islander, Hispanic, and Black beneficiaries were less likely to receive medication than White beneficiaries. Older beneficiaries and those who did not receive the Part D low-income subsidy were also less likely to receive medication to treat their opioid use disorder.”
Read the report for recommendations to address this problem.
About Covid-19
Pfizer to test a third dose of coronavirus vaccine in young children after two-dose regimen falls short: “The companies reported that two doses of the pediatric vaccine failed in 2-, 3- and 4-year-olds to trigger an immune response comparable to what was generated in teens and older adults. The vaccine did generate an adequate immune response in children 6 months to 2 years old.
If three doses are successful at triggering a protective immune response, the companies expect to submit the data to regulators in the first half of next year.”
Moderna booster shot should provide ‘good level of protection’ against omicron, vaccine maker says: “A booster dose of Moderna’s vaccine — half the dose used in the original shots for adults — increased antibody levels against omicron by 37 times, the company said in a statement, citing preliminary data.
Children exposed to covid can safely stay in class with in-school testing, CDC says: “Students who have been exposed to the coronavirus can safely continue in-person learning if they are regularly tested for the virus at school, avoiding disruptive at-home quarantines, the Centers for Disease Control and Prevention said Friday.
The CDC released two studies that show the effectiveness of what’s known as ‘test-to-stay.’ School districts across the country have tried this strategy, though it is not widely used.”
CDC narrows use of J&J vaccine due to concerns about rare blood clots: “The Centers for Disease Control and Prevention accepted advice from a panel of experts to recommend the use of the Moderna and Pfizer-BioNTech COVID-19 vaccines over the Johnson & Johnson jab, following growing concerns about rare blood clots.
The advisers said Thursday that vaccines from Pfizer and Moderna should be preferred by all adults, who may be at greater risk for developing severe blood clots from the J&J vaccine than those under age 18. Some committee members said the J&J vaccine should remain available for people who prefer it.
The recommendation was prompted by the occurrence of a rare and sometimes fatal blood-clotting problem called thrombosis with thrombocytopenia syndrome (TTS).”
Omicron thrives in airways, not lungs; new data on asymptomatic cases: “Compared to the earlier Delta variant, Omicron multiplies itself 70 times more quickly in tissues that line airway passages, which may facilitate person-to-person spread, they said. But in lung tissues, Omicron replicates 10 times more slowly than the original version of the coronavirus, which might contribute to less-severe illness.”
‘No evidence’ Omicron less severe than Delta, say UK researchers: “The Imperial College London research, which analysed UK infection data, casts doubt on the hopes of some experts, based on reports from medics in South Africa, that a change in the virulence of the new variant would limit pressure on health systems.”
Federal appeals court revives Biden's vaccine mandate for health workers in 26 states: “A federal appeals court has reinstated in 26 states a Biden administration vaccination mandate for health workers at hospitals that receive federal funding.
A three-judge panel of the 5th U.S. Circuit Court of Appeals in New Orleans ruled (PDF) that a lower court had the authority to block the mandate in only the 14 states that had sued and was wrong to impose a nationwide injunction.”
Covid Data Tracker Weekly Report: From the CDC: “The United States recently surpassed 50 million COVID-19 cases and 800,000 deaths since the start of the pandemic. This week also marks the first anniversary of the first COVID-19 vaccination in the United States. In recent weeks, COVID-19 cases and hospitalizations have increased, with many parts of the country experiencing substantial or high levels of community transmission. These increases and the recent emergence of the Omicron variant highlight the importance of prevention strategies to help people stay safe and reduce the spread of the virus that causes COVID-19.”
7 signs those new N95s at your physician practice might be fake: A reminder from the AMA, as we face a resurgence of Covid-19 cases.
According to the National Institute for Occupational Safety and Health (NIOSH), “here are seven signs of counterfeit respirators that physicians and staffers at medical groups and health systems should look for:
· No markings at all on the filtering facepiece respirator.
· No approval number on filtering facepiece respirator or headband.
· No NIOSH markings.
· NIOSH spelled incorrectly.
· Presence of decorative fabric or other decorative add-ons.
· Claims of approval for children—NIOSH does not approve any type of respiratory protection for children.
· Filtering facepiece respirator has ear loops instead of headbands”
OSHA vaccine mandate penalties to start Jan. 10: “The Occupational Health and Safety Administration said Saturday that it would not issue citations tied to its coronavirus vaccination mandate before Jan. 10, so that companies have time to adjust to and implement the requirements.
The federal agency separately said there would be no citations of companies regarding its testing requirements before Feb. 9.”
Novavax’s COVID-19 Vaccine Gets WHO Emergency Use Listing: “The listing was supported by two phase 3 studies — a 30,000-person trial in the U.S. and Mexico and a 14,000-person trial in the UK — in which the vaccine, NVX-CoV2373, showed strong efficacy and a positive safety and tolerability profile.
The company is currently evaluating its vaccine against the Omicron variant and is also developing a separate shot targeted specifically at the mutant strain.”
About the public’s health
Biden administration details push to finally rid the nation of millions of lead pipes: “Half a dozen years after the water-contamination fiasco in Flint, Mich., shined a national spotlight on the persistent problem, the Environmental Protection Agency is set to write stricter standards for drinking water that would compel water utilities to dig up and replace lead lines from coast to coast.
Up to 10 million lead pipes still carry water to homes and businesses around the nation, the EPA estimates, carrying with them the risk of leaching the dangerous neurotoxin into drinking water. President Biden campaigned on removing all of the nation’s lead service lines as part of his plan to upgrade the nation’s aging infrastructure and alleviate the burden of pollution borne most heavily by poor and minority communities.”
FDA eliminates key restriction on abortion pill as Supreme Court weighs case that challenges Roe v. Wade: “The elimination of the rule by the Food and Drug Administration means abortion pills can be prescribed through telehealth consultations with providers and mailed to patients in states where permitted by law. Previously, the pills could not be mailed, though that regulation had been temporarily suspended by the FDA.”
About pharma
US judge strikes down Purdue's $4.5-billion opioid settlement: “A US federal judge late Thursday upended Purdue Pharma's opioid settlement, reversing a bankruptcy judge's earlier ruling, because of a provision that would shield the company's owners from facing litigation of their own. Judge Colleen McMahon for the Southern District of New York said that the $4.5-billion deal to resolve thousands of US opioid lawsuits should not go forward, arguing that the bankruptcy court lacked the authority to release members of the Sackler family from civil liability.”
Biogen slashes Aduhelm's price in half: Although the company defended the price as cost-effective, “Biogen reduced the price of Aduhelm, its controversial Alzheimer's drug, from an average annual cost of $56,000 to $28,200, the drugmaker said Dec. 20.
The change will take effect Jan. 1.” Now that the company has lost market credibility, how much lower can the price really go?
About healthcare professionals
CMS Funding 1,000 New Residency Slots for Hospitals Serving Rural & Underserved Communities: “The Fiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS) final rule with comment period establishes policies to distribute 1,000 new Medicare-funded physician residency slots to qualifying hospitals, phasing in 200 slots per year over five years. CMS estimates that funding for the additional residency slots, once fully phased in, will total approximately $1.8 billion over the next 10 years. In implementing a section of the Consolidated Appropriations Act (CAA), 2021, this is the largest increase in Medicare-funded residency slots in over 25 years. Other sections of the CAA being implemented further promote increasing training in rural areas and increasing graduate medical education payments to hospitals meeting certain criteria…
In allocating these new residency slots, CMS will prioritize hospitals with training programs in areas demonstrating the greatest need for providers, as determined by Health Professional Shortage Areas. The first round of 200 residency slots will be announced by January 31, 2023, and will become effective July 1, 2023.”
Doximety 2021 Physician Compensation Report: “Our findings show that average pay for doctors increased by 3.8% this year, which is up from an increase of 1.5% last year. Like last year, the increase did not outpace the rate of inflation. In 2021, the 12-month headline inflation rate was 6.2% [2] as measured by the Consumer Price Index (CPI). Thus, physicians on average experienced a decline in real income over the calendar year when compared with inflation.
In addition, our data showed that the gender pay gap among physicians was 28% this year. Male doctors currently earn over $122,000 more than their female counterparts.”
The report divides results by geography, subspecialty and sex; it is worth looking over.