About health insurance
Latest Findings Indicate Payment Incentive for Providing Primary Care in the Home Has Not Had Desired Impacts: “The Independence at Home (IAH) Demonstration tests whether implementing a payment incentive and delivering home based primary care leads to reductions in overall spending and improvements in quality of care for chronically ill and disabled Medicare beneficiaries. Mathematica’s evaluation of the first six years of IAH provided no compelling evidence that the IAH payment incentive reduced Medicare spending or hospital use for high-need patients of practices participating in the demonstration. When examining dually eligible beneficiaries who received home-based primary care from any provider, Mathematica’s analysis found lower expenditures on institutional care and higher expenditures on home-based services—but no reduction in total Medicare or Medicaid spending.”
Provider groups urge feds to change dispute process, good faith estimates in surprise billing rule: “The No Surprises Act calls for the creation of an independent arbitration process in case payers and providers cannot come to terms on an out-of-network charge. Under the law, a third-party arbiter chooses between amounts offered by the payer and provider.
But providers claim that the Biden administration gravely misconstrues congressional intent in how the arbiter should choose which offer. They point to language in the rule that calls for the arbiter to primarily consider which amount is closest to the ‘qualifying payment amount’ that is the insurer’s median in-network rate for a specific region.”
Centene to pay Kansas $27.6M to settle drug overbilling allegations: “Centene reached a $27.6 million agreement with Kansas to settle allegations it overcharged the state for drugs, Kansas Attorney General Derek Schmidt said Dec. 6 in a news release.
Kansas began its investigation into Centene in 2019, after a similar effort in Ohio revealed pharmacy benefit managers were overbilling states. Kansas' investigation concluded that Centene artificially inflated dispensing fee amounts reported to state regulators and failed to report discounts it received from CVS-Caremark on certain retail pharmacy claims.”
CVS Health Contributes $9.2M to Address SDOH, Homelessness in DC: “The payer’s contributions will go toward building a 41-unit housing development in DC that aims to reduce homelessness and increase access to affordable housing.”
Underinsurance Among Children in the United States: “From 2016 to 2019, the proportion of US children experiencing underinsurance rose from 30.6% to 34.0% (+3.4%; 95% CI, +1.9% to +4.9%), an additional 2.4 million children. This trend was driven by rising insurance inadequacy (24.8% to 27.9% [+3.1%; 95% CI, +1.7% to +4.5%]), which was mainly experienced as unreasonable out-of-pocket medical expenses. Although the estimate of children lacking continuous insurance coverage rose from 8.1% to 8.7% (+0.6%), it was not significant at the 95% CI (−0.5% to +1.7%). We observed significant growth in underinsurance among White and multiracial children, children living in households with income ≥200% of the federal poverty limit, and those with private health insurance. Increased child health complexity and private insurance were significantly associated with experiencing underinsurance (adjusted odds ratio, 1.9 and 3.5, respectively).”
About Covid-19
Real-time alerting system for COVID-19 and other stress events using wearable data: “…analysis of smartwatch signals by an online detection algorithm provides advance warning of SARS-CoV-2 infection in a high percentage of cases. This study shows that a real-time alerting system can be used for early detection of infection and other stressors and employed on an open-source platform that is scalable to millions of users.”
Rise in Blood Pressure Observed Among US Adults During the COVID-19 Pandemic: “… annual BP increase was significantly higher in April to December 2020 than 2019 (P<0.0001 for systolic and diastolic BP). During the pandemic period, mean changes each month, compared with the previous year, ranged from 1.10 to 2.50 mmHg for systolic BP and 0.14 to 0.53 mmHg for diastolic BP; systolic and diastolic BP increases held true for men and women and across age groups; larger increases were seen in women for both systolic and diastolic BP, in older participants for systolic BP, and in younger participants for diastolic BP (all P<0.0001)…
Weight gain was not the apparent reason for the observed rise in BP during the pandemic…”
Gen Z most stressed by coronavirus, citing pandemic toll on careers, education and relationships, poll says: “Higher proportions of Americans between ages 13 and 24 say the pandemic has made their education, career goals and social lives more difficult, compared with millennials and Gen X.”
About pharma
Biden points to drug prices in call for Senate social spending vote: “Lowering drug prices is one of the most popular parts of Biden's sweeping climate and social spending measure, and Democrats are looking to tout the changes and hammer Republicans for opposing them. A Kaiser Family Foundation poll found that 83 percent of the public supports allowing the government to lower drug prices.”
The unraveling of Walgreens Boots Alliance: “Walgreens Boots Alliance is reportedly exploring the sale of its Boots pharmacy so that the Deerfield-based company can focus on plans to transform its U.S. stores into health care destinations…
Sky News, which first reported the potential deal, said the company could also spin off the chain into a separately listed company.
Analysts agree that offloading Boots makes sense for Walgreens. The company already sold the majority of distributor Alliance Healthcare to AmerisourceBergen earlier this year for $6.5 billion, including cash and stock.”
About hospitals and health systems
Nearly All States Have At Least 70% Of Hospital And ICU Beds Occupied: “Nearly all U.S. states have at least 70% of their hospital and intensive care unit beds occupied and could face hospital constraints if coronavirus cases continue to surge amid the spread of the delta variant and new omicron variant.
There are 611,917 (78.7%) hospital beds and 65,226 (79.3.%) intensive care units occupied in the U.S., with Covid-19 patients occupying 59,579 (7.75%) of hospital beds and 13,736 (17.53%) of ICU beds, according to the Department of Health and Human Services.”
Top Hospitals: From the Leapfrog Group. Note the absence of some of the top rated hospitals, e.g., Cleveland and Mayo Clinics, Children’s Hospital of Pennsylvania, etc.
Supreme Court won't hear antitrust suit against Atrium Health: “The justices won't review a March decision from the U.S. Court of Appeals for the 4th Circuit, which rejected a proposed class-action lawsuit that argued Atrium exploited its market dominance to prohibit insurers from directing patients toward lower-cost care options.”
About healthcare IT
Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristics and Location: From CMS:
”KEY POINTS
The number of Medicare fee-for-service (FFS) beneficiary telehealth visits increased 63-fold in 2020, from approximately 840,000 in 2019 to nearly 52.7 million in 2020.
Despite the increase in telehealth visits during the pandemic, total utilization of all Medicare FFS Part B clinician visits declined about 11% in 2020 compared to levels in 2019.
Most beneficiaries (92%) received telehealth visits from their homes, which was not permissible in Medicare prior to the pandemic.
Prior to the pandemic, telehealth made up less than 1% of visits across all visit specialties but increased substantially in 2020. Telehealth increased to 8% of primary care visits, while specialty care had smallest shift towards telehealth (3% of specialist visits).
Visits to behavioral health specialists showed the largest increase in telehealth in 2020. Telehealth comprised a third of total visits to behavioral health specialists. While data limitations preclude clear identification of audio-only telehealth services, up to 70% of these telehealth visits during 2020 were potentially reimbursable for audio-only services.
Black and rural beneficiaries had lower use of telehealth compared with White and urban beneficiaries, respectively. Telehealth use varied by state, with higher use in the Northeast and West, and lower in the Midwest and South.”
Ascension, Johns Hopkins & 14 others launch campaign to protect telehealth access: “Sixteen leading healthcare organizations have partnered to launch Telehealth Access for America, a public education campaign to defend telehealth access.
The campaign, launched Dec. 2, is urging Congress to protect access to telehealth, arguing such services lead to better health outcomes, greater equity, more patient choice and lower costs.
The 16 members are: Adventist Health Policy Association, Alliance for Connected Care, AARP, American Heart Association, American Hospital Association, American Telemedicine Association, Ascension, Athenahealth, Consumer Technology Association, Executives for Health Innovation, Health Innovation Alliance, Healthcare Leadership Council, Included Health, Johns Hopkins Medicine, Partnership to Advance Virtual Care, and Teladoc Health.”
In a related article: Top 25 telehealth hospitals ranked by visit claims: “University of Michigan Hospitals and Health Centers in Ann Arbor topped the list of hospitals providing the most telehealth visits billed to Medicare during the first quarter of 2021, according to a Dec. 6 analysis from Hospital Pricing Specialists.”
About health care professionals
Female Physicians Earn An Estimated $2 Million Less Than Male Physicians Over A Simulated 40-Year Career: “Differences in income between male and female academic physicians are well known, but differences for community physicians and career differences in income have not been quantified. We used earnings data from 80,342 full-time US physicians to estimate career differences in income between men and women. The differences in annual income between male and female physicians that we observed in our simulations increased most rapidly during the initial years of practice. Over the course of a simulated forty-year career, male physicians earned an average adjusted gross income of $8,307,327 compared with an average of $6,263,446 for female physicians—an absolute adjusted difference of $2,043,881 and relative difference of 24.6 percent. Gender differences in career earnings were largest for surgical specialists ($2.5 million difference), followed by nonsurgical specialists ($1.6 million difference) and primary care physicians ($0.9 million difference). These findings imply that over the course of a career, female US physicians were estimated to earn, on average, more than $2 million less than male US physicians after adjustment for factors that may otherwise explain observed differences in income, such as hours worked, clinical revenue, practice type, and specialty.”