About Covid-19
Pfizer Shot Is Far Less Effective in 5- to 11-Year-Olds Than in Older Kids, New Data Show: “The vaccine’s effectiveness against hospitalization declined to 73 percent from 85 percent in the older children. In the younger children, effectiveness dropped to 48 percent from 100 percent. But because few children were hospitalized, these estimates have wide margins of error.
The numbers for protection from infection are more reliable. Vaccine effectiveness against infection in the older children decreased to 51 percent from 66 percent. But in the younger children, it dropped sharply to just 12 percent from 68 percent.”
Nearly half of Biden’s 500M free COVID tests still unclaimed: “Nearly half of the 500 million free COVID-19 tests the Biden administration recently made available to the public still have not been claimed as virus cases plummet and people feel less urgency to test.
Wild demand swings have been a subplot in the pandemic, from vaccines to hand sanitizer, along with tests. On the first day of the White House test giveaway in January, COVIDtests.gov received over 45 million orders. Now officials say fewer than 100,000 orders a day are coming in for the packages of four free rapid tests per household, delivered by the U.S. Postal Service.”
Japanese study examines efficacy and side effects of mixed vaccines: “The average antibody level for people with triple Pfizer increased 54.1-fold and for those who received Moderna as their third dose, the average antibody level increased 67.9-fold.”
It remains to be seen whether this difference is clinically significant.
Children with, without asthma maintain oxygen levels while masked during exercise: “Oxygen saturation did not significantly decrease among children who participated in low- or moderate-intensity exercise while masked, according to data presented at American Academy of Allergy, Asthma & Immunology Annual Meeting.
Also, researchers found no significant differences in peripheral oxygen saturation (SpO2) or dyspnea among those with and without asthma.”
So much for those who complain that masking children is bad for their physical health.
Health Canada Approves Plant-Based COVID-19 Vaccine: “Health Canada has approved Medicago’s Covifenz COVID-19 two-dose vaccine, the first authorized vaccine that uses plant-based proteins.
The vaccine, which is authorized for people aged 18 to 64 years old, was found to be 71 percent effective against symptomatic infection and 100 percent effective against severe disease in clinical trials. Each 3.75-mg dose is meant to be administered 21 days apart.”
Evusheld May Have Less Efficacy Against Omicron Subvariants: “AstraZeneca’s COVID-19 antibody Evusheld (tixagevimab/cilgavimab) may have limited efficacy against the Omicron subvariants, BA.1 and BA.1.1, the FDA said.
The agency also amended the therapy’s Emergency Use Authorization (EUA) to double the initial dosage to 300 mg of tixagevimab and 300 mg of cilgavimab, given the concerns over diminished efficacy.”
Moderna faces new lawsuit over lucrative coronavirus vaccine: “Arbutus and Genevant said in their lawsuit that Moderna infringed on their patent for so-called lipid nanoparticle technology, which they say was key in the development of Moderna’s mRNA vaccine and took scientists from Arbutus and Genevant ‘years of painstaking work to develop and refine.’ The suit had been expected after Moderna lost a U.S. Court of Appeals ruling last year in the protracted patent battle.”
“Practice Point 1: Consider Remdesivir for 5 Days to Treat Hospitalized Patients With COVID-19 Who Do Not Require Invasive Ventilation or ECMO
Practice Point 2: Consider Extending the Use of Remdesivir to 10 Days to Treat Hospitalized Patients With COVID-19 Who Develop the Need for Invasive Ventilation or ECMO Within a 5-Day Course
Practice Point 3: Avoid Initiating Remdesivir to Treat Hospitalized Patients With COVID-19 Who Are Already on Invasive Ventilation or ECMO”
About health insurance
UnitedHealthcare axes paper prior authorization, decision letters: UnitedHealth Group is beginning to act on its November promise to shore up its sustainability efforts by halting its mailing paper of prior authorization and clinical decisions to providers, according to a Feb. 25 post on the California Medical Association website.
The first move — a nationwide shift to digital clinical decision letters — is effective March 4 for most UnitedHealthcare Medicare Advantage and commercial plan members. Instead of receiving a mail appeal decision, providers can view the decisions digitally immediately after they are made.
According to the announcement, more UnitedHealthcare communications will make the shift to digital during 2022. The payer will issue warnings for each document moving to virtual distribution 90 days in advance.”
Lawyers say the California malpractice ruling will have minimal impact on insurance rates.: “Legal experts say the new ruling, which upholds California’s medical malpractice limit, will not materially impact providers’ insurance rates.
On Thursday, the California Supreme Court upheld a lower court decision to cut $4.25 million in malpractice compensation for pain and suffering to the state’s $250,000 non-economic damages limit.”
Read the article for the particulars of the case. Many states have set or tried to set limits for non-economic damages for malpractice.
About hospitals and healthcare systems
February 2022 National Hospital Flash Report: From KaufmanHall.
”Margins
The sudden volume shifts and persistent expense increases pushed margins down in January. Not including federal CARES aid, the median change in Operating Margin dropped 71.3% from December to January. Year-over-year (YOY), the median change in Operating Margin was down 23.7% versus January 2021 and 73.3% compared to before the pandemic in January 2020, not including CARES.
The median change in Operating EBITDA Margin declined 52% month-over- month, 14.9% versus January 2021, and 52.7% versus January 2020. With CARES, the median change in Operating Margin declined 80.7% month-over-month and 23.8% YOY. The median change in Operating EBITDA Margin (with CARES) decreased 59.4% month-over-month and 19.6% YOY.
Volumes
The Omicron surge drove a drop in outpatient care as many providers and patients delayed nonurgent procedures in efforts to mitigate spread of the virus and ease traffic to hospitals experiencing an influx of COVID-19 cases. Operating Room Minutes were down 15.7% from December to January and 20.4% compared to before the pandemic in January 2020.
Hospitals saw an increase in more severe patients requiring longer hospital stays. Patient Days rose 1.7% month-over-month and 2.1% YOY. The Average Length of Stay (LOS) jumped 8.6% from December to January, and was up 4.9% compared to January 2021 and 17.2% versus January 2020.”
Mayo Clinic operating income jumps to $1.2B: Still, there are some “winners.”
“Rochester, Minn.-based Mayo Clinic's revenue totaled $15.7 billion last year, up from $13.8 billion in 2020. Net medical service revenue was up 7.7 percent year over year…
Mayo Clinic's operating expenses climbed 11.1 percent year over year to $14.5 billion in 2021. The health system saw expenses increase across several categories, including salaries and benefits.
Mayo Clinic ended 2021 with an operating income of $1.2 billion, up from $728 million a year earlier.”
About pharma
FDA Patient-Focused Drug Development Guidance Series for Enhancing the Incorporation of the Patient’s Voice in Medical Product Development and Regulatory Decision Making: “ FDA is developing a series of four methodological patient-focused drug development (PFDD) guidance documents to address, in a stepwise manner, how stakeholders can collect and submit patient experience data and other relevant information from patients and caregivers for medical product development and regulatory decision making…
These guidances are part of FDA’s PFDD efforts in accordance with the 21st Century Cures Act and The Food and Drug Administration Reauthorization Act of 2017 Title I.”
About the public’s health
New Report Recommends Changes to U.S. Organ Transplant System to Improve Fairness and Equity, Reduce Nonuse of Donated Organs, and Improve the System’s Overall Performance: “Realizing the Promise of Equity in the Organ Transplantation System [ Note: Free pdf download] makes near- and long-term recommendations to create a fairer and more equitable, transparent, cost-effective, and efficient system for deceased donor organs. In addition to organ donors and patients, the key components of the transplantation system include donor hospitals, where the deceased donor is admitted; organ procurement organizations (OPOs), which procure organs after declaration of death; transplant centers, where the recipient is taken to surgery and gets the organ transplant; and the U.S. Department of Health and Human Services (HHS), which oversees the system’s performance. The report recommends actions that HHS should take to improve coordination across the different parts of the system, and ensure they have common goals and unified policies and processes.”
Children Living in Households That Experienced Food Insecurity: United States, 2019–2020: “In 2020, 10.8% of children aged 0–17 years lived in households that experienced food insecurity during the past 30 days.
The percentage of children who lived in food-insecure households was higher for non-Hispanic Black (18.8%) than Hispanic (15.7%) children, and higher for both non-Hispanic Black and Hispanic children than for non-Hispanic White children (6.5%).”
About healthcare IT
STAT and MIT rooted out the weaknesses in health care algorithms. Here’s how we did it: “In July 2021, STAT and the Massachusetts Institute of Technology set out to answer a simple question with big implications for the use of AI in medicine: How do popular algorithms used to warn of bad outcomes for patients hold up over time?
The months-long experiment, born of a novel partnership in journalism and science, yielded an illuminating result: the algorithms deteriorated over several years, delivering faulty advice about which patients were at the highest risk of deadly complications and prolonged hospital stays.”
Digital Reshaping the Health-Care Ecosystem: From Bloomberg Intelligence: “Health-care delivery via telehealth will continue to accelerate after the industry's sea change in value with the pandemic. We believe the channel could reach $20 billion in revenue and represent 15% of outpatient visits by 2027 as barriers to adoption fall and new offerings such as virtual primary care take root. Incumbents like Teladoc and large managed-care companies will drive the next leg of growth….
At a minimum, we foresee the market expanding by 25% annually which essentially triples revenues to almost $17 billion in 2027.”
Teladoc set to launch on Amazon's Alexa: “Teladoc Health customers in the U.S. will be able to connect with a Teladoc care provider 24/7 from Echo devices for general medical needs. To get connected, patients can say “Alexa, I want to talk to a doctor” to their device. Echo will then connect with a Teladoc doctor for a virtual visit related to nonemergency needs, such as experiencing symptoms of a cold, flu or allergies, according to a Feb. 28 press release.
The cost per visit will vary, ranging from $0 per visit with insurance or $75 without insurance.”
About healthcare personnel
Association of Physician Management Companies and Private Equity Investment With Commercial Health Care Prices Paid to Anesthesia Practitioners: “What is the association between outpatient facilities that contract with physician management companies (PMCs) and prices paid to anesthesia practitioners?
Findings This cohort study of 2 255 933 privately insured patients who received anesthesia services in hospital outpatient departments and ambulatory surgery centers from 2012 to 2017 found that allowed amounts and unit prices increased by 16.5% and 18.7%, respectively, when facilities contracted with a PMC relative to non-PMC facilities. Larger increases were found if the PMC received private equity investment.”
PMCs consolidate practices, so they have better negotiating leverage. But the profit motive is still an important component of the higher negotiated fees.
The accompanying editorial is a good overview of PMCs: Physician Management Companies—Should We Care?