February 2022 Health Sector Economic Indicators Briefs: “National health spending for all of 2021 grew by 3.4%, reflecting significant federal government support in response to the COVID-induced recession in 2020 and a lower level of such support in 2021. Taking these support dollars out of both 2020 and 2021 estimates, spending growth from 2020 to 2021 would have been 8.4%, as the economy continued to recover…
Including the federal support, health spending in December 2021 represented 18.8% of GDP; it was 17.8% of GDP if the additional government expenditures are excluded. For all of 2021, health spending represented 18.5% of GDP with the support and would have been 18.1% without it.”
See the article for February trends.
About Covid-19
Covid infections plummet 90% from U.S. pandemic high, states lift mask mandates: “The U.S. is reporting about 84,000 new cases per day on average, according to data compiled by Johns Hopkins University, down from a pandemic high of more than 800,000 daily cases on Jan. 15. And the decline is widespread across the nation, with average daily cases down by at least 40% in all U.S. regions over the past two weeks, according to a CNBC analysis of Hopkins data.
Hospitalizations have also fallen sharply. There are about 66,000 patients in U.S. hospitals with Covid as of Monday, according to a seven-day average of data from the Department of Health and Human Services, down from the Jan. 20 peak of 159,000 patients.”
Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States: The CDC added “considerations for an 8-week interval between the first and second doses of a primary mRNA vaccine schedule.”
Effectiveness of mRNA-1273 against SARS-CoV-2 Omicron and Delta variants: “The 3-dose VE [ vaccine effectiveness] against hospitalization with Delta or Omicron was >99% across the entire study population. Our findings demonstrate high, durable 3-dose VE against Delta infection but lower effectiveness against Omicron infection, particularly among immunocompromised people. However, 3-dose VE of mRNA-1273 was high against hospitalization with Delta and Omicron variants.”
Sanofi, GSK to seek approval of COVID-19 vaccine: “Sanofi and GlaxoSmithKline said Wednesday that they plan to seek approval of their candidate COVID-19 vaccine following positive data from studies as both a primary series and booster. The companies noted that they are in discussions with the FDA and European Medicines Agency regarding submissions for the adjuvanted protein-based vaccine.
In the Phase III VAT08 trial, two doses of the vaccine in seronegative populations demonstrated 100% efficacy against severe COVID-19 disease and hospitalisations, as well as 75% efficacy against moderate or severe illness. Meanwhile, the vaccine offered 57.9% protection against any symptomatic COVID-19 disease.”
Rural hospitals stave off mass exodus of workers to vaccine mandate: “Rural hospital officials who expected Covid vaccine mandates to cause a staffing crisis are facing a pleasant surprise: Religious exemptions and education efforts for the hesitant are keeping almost all health care workers on the job.
Nearly two dozen rural hospital officials and state hospital association leaders told POLITICO they have lost just a fraction of their staff to the federal immunization requirement, which mandated that health care workers in every state except Texas received at least one shot of the vaccine by last week.”
Johnson & Johnson, Moderna set to face shareholder votes on vaccine pricing strategy, manufacturing tech sharing: “At J&J's upcoming annual meeting, shareholders will have a chance to vote on an Oxfam proposal to force the company to release its COVID-19 vaccine pricing strategy. Oxfam previously asked J&J to share the information considering the drugmaker received substantial funding assistance from the U.S. government while it was developing the shot. During the company's shareholder meeting last year, 32% of J&J's shareholders voted for a similar resolution…
Meanwhile, at Moderna, shareholders will vote on whether the company should study the feasibility of sharing vaccine technology to help increase global production.”
About health insurance
Oregon agrees to sunset limit on benefits for kids on Medicaid: “In an email earlier this month, two top state officials said that in response to public feedback, Oregon will not seek to renew a waiver in its Medicaid plan that has allowed it to deviate from a federal standard, known as Early and Periodic Screening, Diagnostic, and Treatment, or EPSDT.
The EPSDT standard requires states to cover all medically necessary treatment for children on Medicaid, regardless of what services states provide to adults.
Oregon has been the only state with federal approval to take a different approach. It limits children’s coverage to a prioritized list of services determined by the legislature and a commission of medical experts appointed by the governor.
The agency is now saying that after a phase-out period, some medical treatments that the state has historically categorized as not prioritized for coverage will be funded on a case-by-case basis.”
This program highlights the great variations in care that are possible with a Medicaid waiver.
CMS ends ACO track in rural payment model: “CMS said Feb. 22 it is ending the ACO Transformation Track in the Community Health Access and Rural Transformation Model.
The ACO track was part of an alternative payment model for rural health system transformation, which was created by the Trump administration's HHS in 2020. The goal of the ACO track was to increase ACO adoption in rural areas.”
The CMS website lists only 4 participants in this program.
Association of Dual Medicare and Medicaid Eligibility [DE] With Outcomes and Spending for Cancer Surgery in High-Quality Hospitals: “The findings of this study indicate that, even among the highest-quality hospitals, DE patients had poorer outcomes and higher spending. Dually eligible patients were more likely to be discharged to a facility and therefore incurred higher postacute care costs. Although treatment at high-quality hospitals is associated with reduced differences in outcomes, DE patients remain at high risk for adverse postoperative outcomes and increased readmissions and postacute care use.”
About hospitals and healthcare systems
Expenses push major health systems to operating margins under 1%: “Although hospital revenue and volume saw an upswing in the last quarter of 2021 — largely driven by COVID-19 hospitalization surges and higher-acuity patients — growing expenses are still offsetting gains in these areas for many hospitals…
While [some] major hospital operators saw narrow operating margins, many ended the period with profits, mainly driven by nonoperating gains.
Many hospitals across the U.S. have been sounding the alarm over rising expenses. This has led the American Hospital Association to urge Congress to add $25 billion in additional relief to help providers across the nation address financial challenges attributed to surges tied to the omicron and delta variants.”
About pharma
California officials win an empty victory as they try to salvage a pay-to-delay law: “In a closely watched battle, California officials convinced a federal judge to modify a temporary hold on a law that bans so-called pay-to-delay deals between pharmaceutical companies, a contentious issue that has factored into the larger debate over the cost of prescription medicines. But as a practical matter, the ruling likely amounts to an empty victory for the state, because little may change. At issue is a law that went into effect in the fall of 2019 that made California the first state in the nation to outlaw pay-to-delay deals, a step California officials said was necessary to prevent drug companies from thwarting competition and maintaining higher prices. The move was also significant because California is generally seen as a bellwether state.”
Eli Lilly Launches Genetic Medicine and RNA-Focused Facility: “Eli Lilly has invested $700 million to launch a Boston, Mass., facility focusing on RNA-based therapeutics and genetic medicines.
Called the Lilly Institute for Genetic Medicine, the new site will focus on medicines acting at the nucleic acid level to advance a new class of drugs that target the root cause of diseases…
Genetic medicines already account for 20 percent of Lilly’s diabetes, immunology and central nervous system portfolio, but the goal is to push that further.”
GSK announces independent Consumer Healthcare company is to be called Haleon: “Haleon (pronounced ‘Hay-Lee-On’) is inspired by the merging of the words 'Hale', which is an old English word that means 'in good health' and Leon, which is associated with the word 'strength'. The new brand identity was developed with input from employees, healthcare practitioners and consumers and will be deployed in more than 100 markets around the world where the business operates.”
About the public’s health
Task Force Issues Draft Recommendation Statement on Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: From the USPTF: “People ages 40 to 75 who are at high risk for CVD should take a statin to prevent a first heart attack or stroke. This is a B grade. People ages 40 to 75 who are at
increased risk, but not at high risk, for CVD may benefit from statin use and should decide with their clinician if taking a statin is right for them. This is a C grade. More research is needed on whether people 76 or older should start taking a statin. This is an I statement. These recommendations only apply to people without a history of CVD and who are not already taking statins.
Grades in this recommendation:
B: Recommended.
C: The recommendation depends on the patient’s situation.
I: The balance of benefits and harms cannot be determined.”
Maternal Mortality Rates in the United States, 2020: “In 2020, 861 women were identified as having died of maternal causes in the United States, compared with 754 in 2019. The maternal mortality rate for 2020 was 23.8 deaths per 100,000 live births compared with a rate of 20.1 in 2019.
In 2020, the maternal mortality rate for non-Hispanic Black women was 55.3 deaths per 100,000 live births, 2.9 times the rate for non-Hispanic White women (19.1). Rates for non-Hispanic Black women were significantly higher than rates for non-Hispanic White and Hispanic women. The increases from 2019 to 2020 for non-Hispanic Black and Hispanic women were significant. The observed increase from 2019 to 2020 for non-Hispanic White women was not significant.”
Rural vs Urban Residents More Likely to Have Cancer Fatalism, Information Overload: “Rural residents were more inclined to believe that everything causes cancer (OR, 1.29; 95% CI, 1.17-1.43), prevention is not possible (OR, 1.34; 95% CI, 1.19-1.51), there are too many recommendations to prevent cancer (OR = 1.26; 95% CI, 1.13-1.41), and cancer is always fatal (OR = 1.21; 95% CI, 1.11-1.33) when compared with their urban counterparts. These concepts were referred to as the study’s ‘4 core beliefs…’
When comparing between rural and urban residents, investigators noted significant differences. Those in rural areas were older, White, and were more likely to be female, have lower income, abd be less educated. Additionally, the population was more likely to be retired, be receiving Medicare, married, a smoker, and classified as obese according to their body mass index.”
Racial Disparities in Dementia Diagnoses: “In studies across 39 Alzheimer’s Disease Research Centers (ADRCs) funded by the National Institute on Aging (NIA), the prevalence of dementia diagnoses at baseline visits was far greater among White individuals recruited for ADRC studies than Black recruits—despite population-based research showing that among people who are 65 years or older, Black individuals are more likely than those of other races and ethnicities to have Alzheimer disease and related dementias (ADRD).The findings, which demonstrate that participants enrolled in ADRC studies may not be representative of the general population of individuals with ADRD, were published in Alzheimer's & Dementia.”
About healthcare quality and safety
Sentinel Event Data—General Information & 2021 Update: From the Joint Commission. A must-read for those working in this area. By far, the single most frequent event category is falls, which largely accounts for the marked increase in sentinel events this past year.
About healthcare IT
State of Telemedicine Report: From a Doximity survey. Some highlights: “The percentage of patients who participated in a telemedicine visit in the past year jumped from 42% in 2020 to 67% in 2021. We found that patients with chronic illness adopted telemedicine earlier in the pandemic…
58% of patients reported an intention to use telemedicine ‘more’ frequently or at ‘the same’ frequency after the end of the pandemic.
In 2021, over 73% of patients surveyed reported they planned to receive ‘some’ or ‘all’ of their care through telemedicine after the pandemic. It’s clear that telemedicine is now an expected part of their health-care experience, even as they think about life beyond the pandemic. Notably, this was consistent across race/ethnicity.”
Teladoc stock faces turbulence with shrinking Q4 losses but modest 2022 guidance: “The company reported a net loss of $10.9 million in the fourth quarter of 2021, or a loss of seven cents per share, dwarfing Wall Street’s projections of a loss of 59 cents per share.
That leaves Teladoc with a full-year loss of $428.8 million or $2.73 per share, compared with a loss of $485.1 million or $5.86 per share in 2020…
Teladoc also predicts losses to widen in the first quarter to between 50 and 60 cents per share.”
Oracle's waiting period to acquire Cerner has expired: “Under the Hart-Scott-Rodino Act, the waiting period for Oracle to acquire Cerner expired at 11:59 p.m. EST on Feb. 22.
Oracle's tender offer for Cerner shares remains under review.”
In a related article: CERNER REPORTS FOURTH QUARTER AND FULL YEAR 2021 RESULTS:
2021 Full Year Highlights
“Revenue of $5.765 billion, up 5% compared to $5.506 billion for 2020.
GAAP Operating Margin of 12.3%, down from 16.6% for 2020.
Adjusted Operating Margin (non-GAAP) of 21.7% up 180 basis points from 19.9% for 2020.
GAAP diluted EPS of $1.84, down 27% compared with $2.52 for 2020.
Adjusted Diluted EPS (non-GAAP) of $3.35 up 18% compared to $2.84 for 2020.
GAAP cash flow from operating activities of $1.772 billion, up 23% compared to $1.437 billion for 2020.
Free Cash Flow (non-GAAP) of $1.174 billion, up 37% compared to $857 million for 2020.
Share Repurchases of $1.500 billion at an average purchase price of $74.96.
Quarterly dividend increased by 23%.”
About healthcare personnel
Surveyed nurses consider leaving direct patient care at elevated rates: “Thirty-two percent of registered nurses (RNs) surveyed in the United States in November said they may leave their current direct-patient-care role, according to McKinsey’s latest research. That is an increase of ten percentage points in under ten months.”
About health technology
Permanente doctor helps create open-source O2 concentrator: A great story of a truly disruptive technology: “Family physician Ted O’Connell, MD, wants COVID-19 patients around the world to have access to unlimited oxygen if they need it. Anticipating that oxygen-equipment shortages would get to crisis levels during the pandemic, he provided clinical expertise for a small team of experts to help conceive an oxygen-concentrator kit—dubbed OxiKit—that people could use anywhere, with locally sourced materials.”
Medtronic's earnings flatten out as COVID pandemic, healthcare worker shortage rage on: “…as the year has gone on, the medtech giant has been set back by ever more variants of the virus, global supply chain and manufacturing issues and, most recently, a growing shortage of healthcare workers.
Those factors sent its second-quarter gains down to just about 3% and, now, have more than flattened revenues during the company's third fiscal quarter ended Jan. 28.
For the latest three-month period, Medtronic raked in $7.76 billion, about 1% lower than the previous quarter’s haul and 0.2% below its earnings for the same period in 2021.”