About Covid-19
CDC recommends reformulated coronavirus booster shot for fall “The Centers for Disease Control and Prevention recommended Thursday that millions of eligible Americans, including those as young as 12, get an updated omicron-targeting booster shot to bolster defenses against serious illness and death during a potential fall or winter rise in covid-19 cases.
CDC Director Rochelle Walensky endorsed a recommendation by an advisory panel, paving the way for some clinicians, pharmacies and other providers to begin administering the shots as early as this weekend. The Advisory Committee on Immunization Practices voted 13-1 to recommend updated shots from Moderna, for those 18 and older, and from Pfizer-BioNTech, for people 12 and older.”
White House signals most people will only need annual Covid booster “‘It is becoming increasingly clear, that looking forward with the Covid-19 pandemic, in the absence of a dramatically different variant, we likely are moving towards a path with a vaccination cadence similar to that of the annual influenza vaccine, with annual updated Covid-19 shots matched to the currently circulating strains for most of the population,’ Anthony Fauci, the country’s top infectious disease official, said at the briefing.”
About health insurance/insurers
CVS Health to Acquire Signify Health From the press announcement: “ CVS Health and Signify Health ("Signify") have entered into a definitive agreement under which CVS Health will acquire Signify Health for $30.50 per share in cash, representing a total transaction value of approximately $8 billion.
Signify Health is a leader in Health Risk Assessments, value-based care and provider enablement. With a network of more than 10,000 clinicians across all 50 states and a nationwide value-based provider network, combined with its proprietary analytics and technology platforms, Signify Health is improving patient engagement, patient outcomes and care coordination for stakeholders across the health care system. Signify Health's clinicians and providers can have an even greater impact by engaging with CVS Health's unique collection of assets and connecting patients to care how and when they need it.”
Patient groups sue feds to crack down on insurer, PBM copay adjustment programs “A 2019 rule issued by the Trump administration blocks insurers from applying the drugmaker coupons to out-of-pocket limits like deductibles if there is a generic drug version on the market. However, the Trump administration decided to not enforce the rule in 2020 after complaints of confusion from stakeholders.
The 2021 Notice of Benefit and Payment Parameters rule—which outlines insurance regulations for Affordable Care Act exchange plans—enabled insurers to decide how to interpret cost-sharing. An insurer could “either include or exclude copay assistance from cost-sharing calculations,” according to a release on the lawsuit.
The groups also charged that the Department of Health and Human Services (HHS) abandoned the 2019 copay accumulator policy that enabled assistance to count toward a deductible or out-of-pocket cost responsibility except for a brand-name drug that has a generic version.
The complaint asserts that the HHS rule violates federal law and directly contradicts the government’s own definition of cost-sharing.”
Comment: These actions were necessary because pharma companies raised prices and then gave coupons for discounts. Patients paid at the same rate as generics but insurers paid significantly more. Inevitably premiums will need to be raised if these consumer demand are met.
Maximus Awarded Centers for Medicare & Medicaid Services Contract for Contact Center Operations “Maximus… announced that it has been awarded a contract for a base period for transition plus nine (one year) option periods with a total value of $6.6 billion by the Centers for Medicare & Medicaid Services (CMS) for Contact Center Operations (CCO). Under the contract, Maximus will continue supporting CMS’ contact center operations that help 75 million Americans seeking vital information about their Medicare benefits as well as navigating insurance programs available through the Federal Marketplace established by the Affordable Care Act (ACA).”
Social Risk Adjustment In The Hospital Readmissions Reduction Program: A Systematic Review And Implications For Policy “We reviewed fourteen studies of social risk adjustment in Medicare’s Hospital Readmissions Reduction Program (HRRP), a value-based payment model that initially did not adjust for social risk factors but subsequently began to do so…
These findings support the use of social risk adjustment to improve provider payment equity and highlight opportunities to enhance social risk adjustment in value-based payment programs.”
13 Novus Healthcare Fraud Defendants Sentenced to Combined 84 Years in Prison “According to plea papers and evidence presented to a jury, Novus Health Services, a Dallas-based hospice agency, defrauded Medicare by submitting materially false claims for hospice services, providing kickbacks for referrals, and violating HIPAA to recruit beneficiaries. Novus employees also dispensed Schedule II controlled substances to patients without the guidance of medical professionals and moved patients to a new hospice company in order to avoid a Medicare suspension.”
About hospitals and healthcare systems
Cybersecurity investments could go by the wayside at cash-strapped hospitals, Fitch warns “More not-for-profit hospitals will likely become susceptible to cyberattacks as slimming margins keep hard-hit organizations from making the necessary investments and preparations…
Although a handful of recent industry trends are increasing the costs of protecting hospitals from attack, the agency warned that a successful breach would only add to a hospitals’ financial woes and potentially affect their credit ratings.”
About pharma
In blow to public health, judge tosses FDA lawsuit targeting a clinic offering unproven stem cell treatments “A federal judge in Riverside declared a California stem cell treatment firm to be exempt from Food and Drug Administration regulations, opening the door to the further proliferation of clinics offering therapies the FDA says are scientifically unproven and potentially dangerous…
[Judge] Bernal accepted the center’s position that its treatments qualified for an exception from FDA regulations, in part because they were tantamount to surgical procedures.”
Read the entire article. This decision is not only scientifically and legally wrong [see the FDA definition of a drug] but will be harmful to the public. I hope it will be appealed soon.
Walgreens Boots Alliance Completes Majority Share Acquisition of CareCentrix “Walgreens Boots Alliance, Inc… announced it has completed its previously announced majority share acquisition of CareCentrix, Inc.—the leading independent home-centered platform that coordinates care to the home for health plans, patients and providers. The majority investment in CareCentrix accelerates Walgreens Health’s capabilities in delivering quality healthcare across a spectrum of settings including primary care, specialty pharmacy care, post-acute care and home care.”
About the public’s health
Juul to pay $439 million in settlement over marketing to teens “E-cigarette company Juul, which at the height of its success dominated the market with its sweet flavors, has agreed to pay $438.5 million in a settlement with 33 states and one territory over marketing its product to teens.
Connecticut Attorney General William Tong (D), who led the plaintiff effort, said in a statement that the settlement will send millions of dollars to programs aimed at reducing tobacco use.”
About healthcare IT
Assessment of Clinician Diagnostic Concordance With Video Telemedicine in the Integrated Multispecialty Practice at Mayo Clinic During the Beginning of COVID-19 Pandemic From March to June 2020 “Findings In this diagnostic study of 2393 patients who underwent a video telemedicine consultation followed by an in-person outpatient visit for the same clinical problem in the same specialty within a 90-day window, the provisional diagnosis established over video telemedicine visit matched the in-person reference standard diagnosis in 86.9% of cases.
Meaning These findings suggest that video telemedicine visits yield a high degree of diagnostic concordance to in-person visits for most new clinical concerns.”
Amazon Care is dead, but the tech giant’s health-care ambitions live on An excellent summary of Amazon’s recent healthcare activities.
Medical Record Closure Practices of Physicians Before and After the Use of Medical Scribes “This [study] suggests that the use of scribes may not be a solution to clinical documentation burdens.”
Medicare Boosts Incentives for Hospitals to Provide Data to Public Health Agencies “A final rule announced Aug. 1 by the Centers for Medicare & Medicaid Services (CMS) makes changes for hospitals participating in the Medicare Promoting Interoperability Program that should result in better data to help improve responses to public health threats. The rule, which takes effect Oct. 1, gives hospitals greater financial incentives to report information electronically about patient illnesses, injuries, and treatments to state and local health departments.”
About healthcare personnel
Association of Private Equity Acquisition of Physician Practices With Changes in Health Care Spending and Utilization “Question What are the implications of private equity acquisition of physician practices for health care spending and utilization?
Findings This difference-in-differences event study of 578 private equity−acquired dermatology, gastroenterology, and ophthalmology physician practices and 2874 similar independent practices found that spending, new and unique patient volume, and total encounters increased differentially compared with controls. The share of outpatient visits longer than 30 minutes increased, and there were modest differences along key outcomes within specialties.
Meaning The findings of this economic evaluation suggest that among a large commercially insured population, private equity acquisitions of physician practices were associated with increased health care spending and several measures of utilization.”
Private Equity Acquisitions Of Ambulatory Surgical Centers Were Not Associated With Quality, Cost, Or Volume Changes “There was no statistically significant observed change in the probability of an unplanned hospital visit, total costs, or total encounters after acquisition by private equity relative to acquisition by non–private equity entities. When we compared private equity–acquired ASCs with matched ASCs that were never acquired, we also found no statistically significant relative change in the probability of an unplanned hospital visit, total costs, or total encounters. Regulators should ensure that data on private equity acquisitions are transparent and that data are available to track the long-term quality and financial implications of these acquisitions.”
About health technology
Illumina wins case against FTC in bid to hold onto early cancer detection company Grail “Sequencing behemoth Illumina on Thursday won its case against the Federal Trade Commission in its bid to hold onto Grail, a Bay Area early cancer detection company that the genomics giant acquired for $8 billion last year.
An administrative law judge rejected the FTC’s argument that the San Diego company’s acquisition of Grail would quash competition in the nascent market for multi-cancer early detection…”