About health insurance/insurers
Audits — Hidden Until Now — Reveal Millions in Medicare Advantage Overcharges “Newly released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans for seniors, with some plans overbilling the government more than $1,000 per patient a year on average.
Summaries of the 90 audits, which examined billings from 2011 through 2013 and are the most recent reviews completed, were obtained exclusively by KHN through a three-year Freedom of Information Act lawsuit…”
Boost in people seeking HealthCare.gov coverage, HHS says “Nearly 3.4 million people have signed up for coverage — an increase of 17% compared to the same time last year. The boost in enrollment comes as the number of uninsured Americans this year reached a historic low of 8%.”
Medicare Advantage Premiums Rise, Zero-Dollar Premium Plan Uptake Declines “Medicare Advantage premiums rose to $7 per month on average for 2023 open enrollment season, an eHealth survey uncovered.
For the past four years, Medicare Advantage plan premium costs have been stable or falling. In 2019, the cost was $10 and by 2022 it had dropped to $4 per month. But now that trend is reversing and seniors will face, on average, a $3 premium hike…
During the 2022 open enrollment season, zero-dollar premium plans were responsible for keeping premium costs low. Zero-dollar premium health plans continue to be a significant share of Medicare Advantage plans. In fact, the number of Medicare Advantage plans with zero-dollar premiums has swelled from 59 percent in 2022 to 66 percent in 2023…Even though the number of plans with zero-dollar premiums grew in the past year, the percentage of beneficiaries who selected zero-dollar premium plans fell after four consecutive years of growth.”
Accounting for the Growth of Observation Stays in the Assessment of Medicare’s Hospital Readmissions Reduction Program [HRRP] “Findings In this cohort study including 8 944 295 hospitalizations, fully accounting for observation stays as both index hospital discharges and readmissions more than halved the apparent decrease in 30-day readmissions (−1.48 vs −0.66 percentage points). In addition, an association of the program with lower readmission rates identified when only inpatient hospitalizations were considered was not found.
Meaning The findings of this study suggest that much of the estimated reduction in readmissions associated with the implementation of the HRRP can be attributed to reclassification of inpatient admissions to observation stays.”
Georgia moves ahead with Medicaid work requirement plan “he state plans to implement a new Medicaid expansion plan – Georgia Pathways — that includes work requirements next July after several years of legal wrangling over the controversial proposal.
‘I can confirm that we are moving forward with implementing the Pathways plan,’ said Andrew Isenhour, a spokesman for Republican Gov. Brian Kemp.
The limited Medicaid expansion plan will require enrollees to work, study or volunteer for at least 80 hours per month.”
About hospitals and healthcare systems
Nonprofit health systems' Q3 earnings: Baylor Scott & White, Sutter Health's operations stand tall among the pack “Motley earnings numbers from more than a dozen major nonprofit health systems show third-quarter operating incomes landing on both sides of zero, though issues such as labor shortages, limited volume recovery and worsening payer mix look to be a constant across much of the sector.”
About pharma
FDA approves most expensive drug on market “The FDA approved a hemophilia B drug with a list price of $3.5 million — which could save the healthcare system millions per patient according to drug maker CSL Behring.
Hemgenix is the first and only onetime gene therapy treatment for adults with hemophilia B who ‘currently use factor IX prophylaxis therapy, or have current or historical life-threatening hemorrhage, or have repeated, serious spontaneous bleeding episodes,’ according to a Nov. 22 CSL release.”
Teva, AbbVie's Allergan lock in $6.6B deal to settle thousands of US opioid lawsuits “Under an agreement floated in July, Teva is on the hook to pay $4.25 billion—a sum that will be paid out over 13 years and includes up to $1.2 billion worth of Teva’s generic version of the overdose reversal drug Narcan. Allergan, for its part, will provide up to $2.37 billion to help state and local efforts to fight opioid addiction and substance use disorder in the U.S.”
‘Skinny labels’ on biosimilar medicines saved Medicare $1.5 billion over a recent five-year period “Ahotly contested provision of a federal law designed to speed copycat drugs to market and foster competition saved Medicare $1.5 billion from 2015 to 2020 — or nearly 5% of the $30.2 billion spent by the health care program — on just five medicines during that period, according to a new analysis.”
About the public’s health
The International Code of Medical Ethics of the World Medical Association “The World Medical Association (WMA) has developed the International Code of Medical Ethics as a canon of ethical principles for the members of the medical profession worldwide. In concordance with the WMA Declaration of Geneva: The Physician’s Pledge and the WMA’s entire body of policies, it defines and elucidates the professional duties of physicians towards their patients, other physicians and health professionals, themselves, and society as a whole.”
Changes in Home Births by Race and Hispanic Origin and State of Residence of Mother: United States, 2019–2020 and 2020–2021 “Following average annual increases of 2% from 1990 (0.67%) to 2019 (1.03%), the percentage of home births rose 22% from 2019 to 2020 (1.26%), and another 12% from 2020 to 2021 (1.41%). The 2021 level was the highest since at least 1990, demonstrating a higher rate of increase in home births during the first 2 years of the COVID-19 pandemic. From 2020 to 2021, levels increased by 10% to 21% for each of the race and Hispanic-origin groups.”
About healthcare IT
Google rolls out search features that aim to make it easier to sign up for Medicaid, Medicare “When many people are looking to enroll in health benefits, they turn to Google as a source of key information on eligibility, the application process and in-network providers.
In this spirit, the Google Search team has quietly rolled out multiple features for its search engine that aim to make it easier for users to access key information about obtaining Medicaid and Medicare benefits, as well as which doctors locally accept those types of coverage.”
About health technology
FDA classifies Baxter's hospital bed system recall as most serious “The U.S. health regulator on Wednesday classified the recall of hospital bed systems by Baxter International Inc as the most serious type, on concerns it could lead to life-threatening injuries or death…
The device was found to interfere with other nearby critical devices such as infusion pumps, insulin pumps, blood glucose sensors and bladder scanners, among others.The Food and Drug Administration said the interference from WatchCare may lead to erroneous reading or malfunctions on other devices, causing inappropriate medical treatment for patients.”
About healthcare finance
Baxter's blunder with Hillrom raises questions about its future “Baxter International flubbed its biggest acquisition ever, tanking its stock price while raising doubts about CEO José Almeida’s growth strategy and potentially making Baxter itself a takeover target.
The Deerfield-based medical products manufacturer last month disclosed a $3.1 billion impairment charge related to the $10.5 billion purchase last year of Hillrom, confirming Almeida overpaid significantly for the Chicago-based maker of hospital equipment.”