About healthcare systems
Higher Medicare Spending On Imaging And Lab Services After Primary Care Physician Group Vertical Integration: Yet another study showing how integration raises costs:
”After vertical integration, the monthly number of diagnostic imaging tests per 1,000 attributed beneficiaries performed in a hospital setting increased by 26.3 per 1,000, and the number performed in a nonhospital setting decreased by 24.8 per 1,000. Hospital-based laboratory tests increased by 44.5 per 1,000 attributed beneficiaries, and non-hospital-based laboratory tests decreased by 36.0 per 1,000. Average Medicare reimbursement rose by $6.38 for imaging tests and $0.57 for laboratory tests, which translates to $40.2 million and $32.9 million increases in Medicare spending, respectively, for the entire study period.”
Local providers, community organizations band together against Mass General Brigham's proposed expansion: “Expansions planned by Mass General Brigham (formerly Partners HealthCare) are facing organized opposition from a collection of local providers, community organizations and business groups that say the development will increase healthcare costs and threaten the availability of existing services.”
2021 WINNING HOSPITALS: AVOIDING OVERUSE: “The Lown Institute Hospitals Index is the first ranking to apply overuse criteria to over 3,100 U.S. hospitals to assess their success at avoiding tests and procedures that offer little to no clinical benefit to patients.” Check the lists of best and worst ranked hospitals and comparison with US News Best Hospitals list.
About Covid-19
New U.S. COVID cases fall for third week, deaths lowest since July: “New cases of COVID-19 in the United States fell for a third week in a row, dropping 15% last week to 347,000, the lowest weekly total since October, according to a Reuters analysis of state and county data.
Nearly a third of the country's population has been fully vaccinated as of Sunday, and 44% has received at least one dose of a COVID-19 vaccine, according to the U.S. Centers for Disease Control and Prevention.”
White House will make unordered vaccine supply available to other states: “The White House on Tuesday told states that coronavirus vaccine doses they choose not to order will become available to other states — the most significant shift in domestic vaccine distribution since President Biden took office, and part of an effort to account for flagging demand in parts of the country.”
$100 as an Incentive to Get a Shot? Experiment Suggests It Can Pay Off: “A cash reward works best with Democrats, and relaxing safety guidelines seems to motivate Republicans, a survey study shows.”
F.D.A. to Authorize Pfizer Vaccine for Adolescents by Early Next Week: The headline is the message.
HHS launches new vaccine reimbursement program for providers: “The Department of Health and Human Services, through the Health Resources and Services Administration, has announced a new program for providers to cover the cost of administering COVID-19 vaccines to patients enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing.
The COVID-19 Coverage Assistance Fund addresses a provider need to be reimbursed for uncompensated costs. Providers cannot bill patients for COVID-19 vaccination fees.”
Biden administration rolls out COVID-19 vaccine text-line: “The service will launch alongside a vaccine finder website and a to-be-released 1-800 number to help connect individuals with appointments in their area.”
Moderna to supply up to 500 million COVID-19 vaccine doses to COVAX: “Moderna announced Monday that it has signed an agreement with Gavi, the Vaccine Alliance to supply up to 500 million doses of its COVID-19 vaccine mRNA-1273. An initial 34 million doses will be delivered to the COVAX vaccine-sharing facility in the fourth quarter, while Gavi retains the option to procure an additional 466 million doses in 2022.”
DuPage County judge orders Elmhurst Hospital to allow COVID-19 patient to receive controversial medication: This order sets a very dangerous precedent. “A DuPage County judge on Monday ordered Elmhurst Hospital to allow a comatose woman suffering from COVID-19 to receive a medication the Food and Drug Administration says could be unsafe, but the legal fight appears bound to escalate…
Elmhurst Hospital’s attorney, Joseph Monahan, said at the hearing none of its doctors would agree to administer ivermectin for COVID-19, and that an internal ethics panel concluded its use couldn’t be justified. He argued that judges shouldn’t overrule medical decisions.”
About healthcare IT
Telehealth use falls 16% in 1 month: “Telehealth usage among individuals with private insurers fell month-over-month for the first time since September, dropping by 16 percent in February, according to healthcare data cost organization Fair Health…
The top five reasons for telehealth visits in February were mental health conditions (54.6 percent), joint and soft tissue diseases and issues (3.2 percent), developmental disorders (3 percent), acute respiratory diseases and infections (2.2 percent), and hypertension (1.8 percent).”
CMS names winner of AI health outcomes competition: “CMS chose Austin, Texas-based health data analytics company ClosedLoop.ai and Danville, Pa.-based Geisinger as the winner and runner-up, respectively, of the agency's Artificial Intelligence Health Outcomes challenge.
CMS launched the challenge in March 2019 to encourage companies to create AI tools that predict unplanned healthcare facility admissions and adverse events within 30 days.”
HCSC leads $280M funding round for digital health benefits startup : “HCSC inked a partnership with Collective Health in March to bring the startup's claims management and digital health benefits services to HCSC members. The insurer will start offering Collective Health's digital programs to self-funded Blue Cross and Blue Shield customers in Illinois and Texas in 2022, with plans to expand into all HCSC markets.”
Changes in Clinician Attitudes Toward Sharing Visit Notes: Surveys Pre-and Post-Implementation: “Following implementation, more primary and specialty care clinicians agreed that sharing notes with patients online was beneficial overall. Fewer had concerns about more time needed for office visits or documentation. Most thought patients would worry more and reported being less candid in documentation.”
2020 National Progress Report: This annual report from Surescripts is an excellent overview of e-prescribing. To put the company’s importance into perspective, “The Surescripts Network Alliance connects virtually all electronic health record (EHR) vendors, pharmacy benefit managers (PBMs), pharmacies and clinicians, plus an increasing number of health plans, long-term and post-acute care organizations, specialty hubs and specialty pharmacy organizations…[there are] 324 million patients in our master patient index, representing 98% of the U.S. population.”
EHR Vendor Fined $3.8M for Illegal EHR Kickback Scheme: “CareCloud offered and provided its “Champions Program” clients money bonuses, cash equivalent credits, and percentage success payments to suggest its EHR solution to potential clients, DOJ explained. Potential customers were unaware of the illegal kickback practice or participant agreements that prohibited negative information or conversation about the EHR vendor.
According to the published statement, these marketing ploys allegedly resulted in sales for the EHR vendor and caused providers to submit false claims to the federal government. These claims are associated with incentive payments for the Medicare and Medicaid EHR Incentive Programs, or meaningful use program, and the Merit-Based Incentive Payment System, or MIPS.”
About payers
Blue Health Insurers Drop Revenue Rule That Limited Competition: “The Blue Cross Blue Shield Association said it dropped a rule that limited competition among its member insurers, moving to implement a key aspect of an antitrust settlement the companies reached last year with customers.
The settlement hasn’t won final approval from the federal judge presiding over the litigation, so it isn’t being fully implemented…
Previously, the rule was that two-thirds of a Blue licensee’s national net revenue from health plans and related services must stem from Blue-branded business.”
CVS Health boosts guidance after posting $2.2B in profit for Q1: “CVS is boosting its earnings outlook to between $7.56 and $7.68 per share and expects full-year cash flow from operations of between $12 billion and $12.5 billion.
CVS' Aetna subsidiary boasted 23.6 million members in the first quarter, an increase of 214,000 compared to the end of 2020. The company said this reflects growth in its government plans but is partially offset by some declines in commercial membership.”
The Caremark and retail divisions also showed growth.
Health Insurer Financial Performance in 2020: From the Kaiser Family Foundation:
”We find that, by the end of 2020, gross margins per member per month across these four markets remained relatively high and medical loss ratios were relatively low or flat compared to recent years. These findings suggest that many insurers remained profitable through 2020. According to a recent KFF analysis, commercial insurers are going to owe substantial rebates to consumers this year under the Affordable Care Act’s (ACA) Medical Loss Ratio provision. For Medicaid, application of risk sharing arrangements that many states have in place may ultimately reduce overall margins calculated using the annual NAIC data.” As usual for this site, there are many helpful graphics.
About healthcare finance
Value of healthcare IPOs more than double to $13.8B in Q1: “The total valuation of global healthcare initial public offerings in the first quarter of 2021 more than doubled, to $13.8 billion, according to a new report from S&P Global Market Intelligence. In the first quarter of 2020, the value of these offerings was $5.4 billion.
In the first quarter, 84 healthcare companies went public, the highest number of first-quarter IPOs in the last five years, according to the report.”
About pharma
Pharmacy-related buprenorphine access barriers: An audit of pharmacies in counties with a high opioid overdose burden: Highlights of the research:
—Nearly 30 % of pharmacies reported limitations to filling buprenorphine prescriptions.
—One in five pharmacies would not fill buprenorphine prescriptions entirely.
—Limitations were more common among independent pharmacies and those in south.
Fewer Pharmacies In Black And Hispanic/Latino Neighborhoods Compared With White Or Diverse Neighborhoods, 2007–15: About a third of the neighborhoods in the 30 largest cities lack convenient access to a pharmacy.