About Covid-19
Eligible Individuals Can Receive Second COVID-19 Booster Shot at No Cost CMS “announced it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna COVID-19 vaccines without cost sharing… People with Medicare pay nothing to receive a COVID-19 vaccine and there is no applicable copayment, coinsurance or deductible. People with Medicaid coverage can also get COVID-19 vaccines, including boosters, at no cost.”
FcγR-mediated SARS-CoV-2 infection of monocytes activates inflammation This Nature article explains the cause of the virus’ severe inflammatory action.
”These findings taken together suggest that antibody-mediated SARS-CoV-2 uptake by monocytes/macrophages triggers inflammatory cell death that aborts production of infectious virus but causes systemic inflammation that contributes to COVID-19 pathogenesis.”
Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study The clotting/bleeding problems of hospitalized patients with the virus are well-known. This research investigated the longer-term complication rates.
”Compared with the control period, incidence rate ratios were significantly increased 70 days after covid-19 for deep vein thrombosis, 110 days for pulmonary embolism, and 60 days for bleeding…
These results could impact recommendations on diagnostic and prophylactic strategies against venous thromboembolism after covid-19.”
About health insurance
Florida’s BayCare Health System and Hospital Affiliates Agree to Pay $20 Million to Settle False Claims Act Allegations Relating to Impermissible Medicaid Donations This case is a good example of a prohibited Medicaid funding activity.
”BayCare Health System Inc. and entities that operate four affiliated Florida hospitals (collectively BayCare) have agreed to pay the United States $20 million to resolve allegations that BayCare violated the False Claims Act by making donations to the Juvenile Welfare Board of Pinellas County (JWB) to improperly fund the state’s share of Medicaid payments to BayCare. The four hospitals are Morton Plant Hospital, Mease Countryside Hospital, Mease Dunedin Hospital and St. Anthony’s Hospital.
The Florida Medicaid program provides medical assistance to low-income individuals and individuals with disabilities, and is jointly funded by the federal and state governments. Under federal law, Florida’s share of Medicaid payments must consist of state or local government funds, and not “non-bona fide donations” from private health care providers, such as hospitals. A non-bona fide donation is a payment — in cash or in kind — from a private provider to a governmental entity that is then returned to the private provider as the state share of Medicaid. The private provider’s donation triggers a corresponding federal expenditure for the federal share of Medicaid, which is also paid to the private provider. This unlawful conduct causes federal expenditures to increase without any corresponding increase in state expenditures, since the state share of the Medicaid payments to the provider comes from and is returned to the provider. The prohibition of this practice ensures that states are in fact paying a share of Medicaid payments and thus have an incentive to curb Medicaid costs and prevent unnecessary services.”
Optum, Change Healthcare set $650M merger reversal fee, extend agreement through 2022 “Optum and Change Healthcare are extending their merger agreement through the end of 2022 and setting a $650 million reversal fee if the deal isn't successful…
In a joint statement, the companies said, "The extended agreement reflects our firm belief in the potential of our combination to improve health care, and in our commitment to contesting the meritless legal challenge to this merger."
Optum, a subsidiary of UnitedHealth Group, first announced its intention to acquire Nashville, Tenn.-based Change Healthcare for $13 billion in January 2021.”
CMS proposes indefinite delay for Radiation Oncology model already postponed by Congress “The radiation oncology mandatory payment model is intended to reimburse oncology practices and hospital outpatient sites for total episodes of care and will make site-neutral payments for certain radiation therapies.
But the model has generated major pushback from the oncology industry. The advocacy group Community Oncology Alliance said last August the mandatory model’s cuts will hurt oncology practices already under strain from the pandemic.
The alliance had asked the model to be pushed back to 2023 and the cuts to be stopped. Congress agreed and passed legislation back in December to delay the start date from Jan. 1, 2022, to 2023.”
About hospitals and healthcare systems
The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff This book is now the standard on this topic. In brief:
”The Committee on the Quality of Care in Nursing Homes was charged with examining the ways in which the United States currently delivers, finances, measures, and regulates the quality of nursing home care. After a thorough review of the evidence, the committee arrived at seven overarching conclusions.”
The first conclusion drives the recommended actions:
“First, the way in which the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable.”
About pharma
Judge rules AIG, Chubb not obligated to defend McKesson in opioid cases “A federal court judge in California has ruled that insurers AIG and Chubb are not obligated to pay defense costs for healthcare company McKesson, on the basis that policies issued by the carriers do not provide coverage for the massive settlements it has reached to settle its liability for costs ...”
National trends in prescription drug expenditures and projections for 2022 “In 2021, overall pharmaceutical expenditures in the US grew 7.7% compared to 2020, for a total of $576.9 billion. Utilization (a 4.8% increase), price (a 1.9% increase) and new drugs (a 1.1% increase) drove this increase. Adalimumab was the top drug in terms of overall expenditures in 2021, followed by apixaban, and dulaglutide. Drug expenditures were $39.6 billion (a 8.4% increase) and $105.0 billion (a 7.7% increase) in nonfederal hospitals and in clinics, respectively. In clinics and hospitals, new products and increased utilization growth drove growth, with decreasing prices for both sectors acting as an expense restraint. Several new drugs that are likely to influence spending are expected to be approved in 2022. Specialty and cancer drugs will continue to drive expenditures along with the evolution of the COVID-19 pandemic.
Conclusion For 2022, we expect overall prescription drug spending to rise by 4.0% to 6.0%, whereas in clinics and hospitals we anticipate increases of 7.0% to 9.0% and 3.0% to 5.0%, respectively, compared to 2021.”
About the public’s health
Use Duodenoscopes with Innovative Designs to Enhance Safety: FDA Safety Communication From the FDA: “The U.S. Food and Drug Administration (FDA) is updating the April 2020 Safety Communication to provide new information supporting the transition to fully disposable duodenoscopes and those with disposable components as well as new information on completed postmarket surveillance studies…
Given the cleaning concerns and contamination data with fixed endcap duodenoscopes and the increasing availability of duodenoscope models that facilitate or eliminate the need for reprocessing, hospitals and endoscopy facilities should complete transition to innovative duodenoscope designs that include disposable components such as disposable endcaps, or to fully disposable duodenoscopes.”
2022 Building H Index “The 2022 Building H Index ranks 37 companies in four industries – entertainment, food, housing and transportation – on how their products and services impact the health of their customers and consumers. The ranking reflects how companies score across five health-related behaviors: healthy eating, physical activity, sleep, social engagement, and time spent outdoors.” The bottom 5 are all streaming services.
About health technology
Law groups, professors lash out against Thermo Fisher in suit over the 'immortal cells' of Henrietta Lacks “It’s been decades since medical researchers at Johns Hopkins unethically took tissue samples from Henrietta Lacks and used them to create the world’s first known “immortal” cell line.
Now, Thermo Fisher is looking to evade a lawsuit claiming it continues to profit from the cells without permission from Lacks’ estate…
Three amici curiae, or ‘friend of the court,’ briefs were filed on Tuesday against Thermo Fisher’s motion to dismiss all claims against itself…
Lacks’ estate filed a complaint back in 2021 seeking, among other stipulations, profits from the commercialization of the cell line, and an order barring the company from using the cells without permission.”