About health insurance/insurers
CMS releases final payment rules for 2023: 15 takeaways A good summary of the rules for 2023.
Hospitals, Surgery Centers Get Payment Bump Under Medicare Plan “Providers caring for Medicare beneficiaries in hospital outpatient departments will receive a 3.8% payment increase in 2023, or roughly $6.5 billion more than in 2022, the Biden administration reported Tuesday.
Medicare payments to ambulatory surgical centers will also increase 3.8% next year, up $230 million compared with 2022, according to the new final payment rule (RIN 0938-AU82).
The pay hikes will push total Medicare payments to an estimated $86.5 billion for hospital outpatient care next year, while payments to ambulatory surgical centers will reach an estimated $5.3 billion.”
Humana's $1.2B Q3 “Humana reported $1.2 billion in profits during the third quarter and is expecting major increases in Medicare Advantage membership, according to the company's Nov. 2 earnings report.
The company reported $22.8 billion in third quarter revenues, increasing 10.2 percent from $20.7 billion year over year. Total revenues in 2022 are $70.4 billion “
About hospitals and healthcare systems
Medicare Fines for High Hospital Readmissions Drop, but Nearly 2,300 Facilities Are Still Penalized “The average payment reduction was 0.43%, also the lowest since 2014. The reductions will be applied to each Medicare payment to the affected hospitals from Oct. 1 through next September and cost them $320 million over that 12-month period.”
About pharma
CVS, Walgreens announce opioid settlements totaling $10B “The two largest U.S. pharmacy chains, CVS Health and Walgreen Co., announced agreements in principle Wednesday to pay about $5 billion each to settle lawsuits nationwide over the toll of opioids, and a lawyer said Walmart, a third pharmacy behemoth, is in discussions for a deal…
The deals, if completed, would end thousands of lawsuits in which governments claimed pharmacies filled prescriptions they should have flagged as inappropriate. With settlements already proposed or finalized between some of the biggest drugmakers and distribution companies, the recent developments could be the among the last multibillion-dollar settlements to be announced.
They also would bring the total value of all settlements to more than $50 billion, with most of it required to be used by state and local governments to combat opioids, which have been linked to more than 500,000 deaths in the U.S. over the last two decades.”
Estimating Savings Opportunities From Therapeutic Substitutions of High-Cost Generic Medications “This cross-sectional study of the top 1000 CO-APCD generics identified 45 high-cost products that had lower-cost therapeutic alternatives of same clinical value. Overall, high-cost generics were 15.6 times more expensive than their therapeutic alternatives (median values). If the lower-cost alternatives had been used, total spending would have been reduced from $7.5 million to $873 711, resulting in 88.3% savings. Most substitutions (28 of 45 [62.2]%) involved different dosage forms or different strengths of the same drug and provided mean (SD) discounts of 94.9% (3.8%) and 77.1% (19.9%), respectively.”
About the public’s health
Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons “The USPSTF recommends against the use of combined estrogen and progestin for the primary prevention of chronic conditions in postmenopausal persons. (D recommendation) The USPSTF recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal persons who have had a hysterectomy. (D recommendation).”
Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019 “The estimates in this cross-sectional study of 694 660 mean deaths per year between 2015 and 2019 suggest that excessive alcohol consumption accounted for 12.9% of total deaths among adults aged 20 to 64 years and 20.3% of deaths among adults aged 20 to 49 years. Among adults aged 20 to 64 years, the proportion of alcohol-attributable deaths to total deaths varied by state.”
About healthcare personnel
Addressing the healthcare staffing shortage “As of Q4 2021, a total of 230,609 healthcare providers have left the profession.” The report details the numbers by specialty and type of practitioner.
About health technology
Johnson & Johnson doles out $16.6B to snatch up miniaturized heart pump maker Abiomed “The deal includes an upfront cash payment of $380 per share, representing a 50% premium over Abiomed’s closing stock price the day before the announcement. Shareholders will also be able to receive another $35 per share if Abiomed’s pipeline and portfolio pass certain clinical and commercial milestones.”
BioIntelliSense launches skin tone-sensitive pulse oximetry sensor as FDA meets on racial bias “According to BioIntelliSense, the system continuously adjusts the amount of light emitted based on its absorption by the skin to ensure the blood cells are being illuminated at equal levels; darker skin tones have been found to absorb more light before it can reach the tissue.
The company reported that several studies of its pulse oximetry chipset have confirmed that it can detect hypoxia—in which blood oxygen drops to potentially life-threateningly low quantities—with similar accuracy across all skin tones, even when tested on a variety of oxygen saturation levels.”
Abbott blood test that spots concussions in 15 minutes makes ER debut “After more than a decade of research, the Abbott Laboratories test is being used for the first time in a real-world setting to evaluate patients at Tampa General Hospital in Florida. Doctors using the test say it’s better at evaluating concussions than the brain scans that have been widely used for the last 30 years.”