About health insurance/insurers
Why is the NHS in its worst ever crisis? This Financial Times article is an excellent summary of the multiple factors contributing to the ailing British healthcare system.
The 10 parties initiating 75 percent of out-of-network disputes “Ten parties have initiated 75 percent of all disputes involving out-of-network emergency and nonemergency items in services under the No Surprises Act's independent dispute resolution process, according to a recent CMS report.
Many of the top top parties were large management companies, medical practices or revenue cycle management companies representing hundreds of individual practices, providers or facilities, according to the report.”
Medicare lost millions in savings due to spotty oversight: federal watchdog “A federal watchdog has found that Medicare lost out on millions of potential savings due to spotty oversight of the average sales price of medications, impacting how much Medicare Part B beneficiaries pay for coverage…
The Office of Inspector General (OIG) for the Department of Health and Human Services found in two reports released Tuesday that while the CMS has an established procedure to oversee data on the average sales price of medications, the agency lacks a process to review the manual analysis. Invalid or missing ASP data resulted in the CMS being unable to determine payment amounts for 8 percent of products between 2016 and 2020.”
About hospitals and healthcare systems
RURAL HOSPITALS AT RISK OF CLOSING “More than 600 rural hospitals – nearly 30% of all rural hospitals in the country – are at risk of closing in the near future.”
The article also discusses how commonly offered solutions will not save them. The authors suggest fair insurance company payments: “It would only cost about $3 billion per year to prevent closures of the at-risk hospitals and preserve access to rural healthcare services.”
National Hospital Flash Report: December 2022 “Key Takeaways
Hospital margins remained negative for 2022.
Hospitals saw margins improve in November. However, median hospital margins remained negative for 2022 to date.Hospital expenses declined in November, driving improved margins.
The average patient length of stay declined slightly—along with several other key volume metrics— leading to relatively flat revenue. However, hospital expenses declined, resulting in improved margins.Labor expenses decreased in November.
Like in other industries, significant increases in the cost of labor made it harder for hospitals to see positive margins in 2022. In November, however, hospitals saw labor expenses decrease, potentially due to hospitals relying less on contract labor, which is often more expensive.Hospital outpatient revenue is up this year.
Hospital outpatient clinics and services have been a bright spot in hospitals’ revenue column in 2022. While inpatient service continue to hamper margins, hospitals could lean on their outpatient services to buoy margins.”
About pharma
PBMs Announce 2023 Coverage Plans for Adalimumab Biosimilars “AbbVie’s Humira, which treats multiple inflammatory diseases, had sales that nearly reached $21 billion in 2021. The only more profitable medication that year was Pfizer’s COVID-19 vaccine. But with the first adalimumab biosimilar, Amgen’s Amjevita, launching in January 2023 followed by at least 7 more—including Boehringer Ingelheim’s Cyltezo, which is the only approved adalimumab biosimilar to have interchangeability—Humira’s reign is likely about to come to an end.
In addition to the 8 approved biosimilars, there are another 2 under review with the FDA. One of these biosimilars, AVT02, has an application for interchangeability under review. AVT02 would be the first interchangeable, high-concentration adalimumab biosimilar when it is approved.”
FDA says it will greenlight pharmacies to fill prescriptions for abortion pill “The abortion pill mifepristone is safe enough that retail pharmacies can begin dispensing it so long as a certified health care provider prescribes the drug and if that pharmacy meets certain requirements, according to new rules published Tuesday by the U.S. Food and Drug Administration.”
Allscripts Announces Corporate Name Change to Veradigm Inc. “Allscripts Healthcare Solutions, Inc. announced today that, effective January 1, 2023, it has changed its name to Veradigm Inc. Allscripts had been transitioning its solutions to the Veradigm brand during 2022, and Allscripts will now formally be known as Veradigm.”
Comparison of Opioids Prescribed by Advanced Practice Clinicians vs Surgeons After Surgical Procedures in the US “In this cross-sectional analysis, one-fifth of perioperative opioid prescriptions and one-quarter of refill prescriptions were written by APCs. While surgeons wrote most perioperative opioid prescriptions that were intended for perioperative analgesia, higher total dosages from APCs suggest that opioid stewardship initiatives that support the role of APCs may be warranted.”
About healthcare IT
Association of Habitual Checking Behaviors on Social Media With Longitudinal Functional Brain Development “These results suggest that habitual checking of social media in early adolescence may be longitudinally associated with changes in neural sensitivity to anticipation of social rewards and punishments, which could have implications for psychological adjustment.”
I am reminded of the John Price song Spanish Pipedream, which included in the refrain:
“Blow up your TV
Throw away your paper
Go to the country
Build you a home…”
In the same issue of JAMA Pediatrics is: Physical Activity Interventions to Alleviate Depressive Symptoms in Children and AdolescentsA Systematic Review and Meta-analysis “The available evidence supports physical activity interventions as an alternative or adjunctive approach to alleviate depressive symptoms in children and adolescents, substantiating the beneficial influence of physical activity on the mental health of pediatric populations.”
In other words, get off your computer/smart phone and exercise! Good advice for adults as well.
Samsung's New Telemedicine App, Camera Aims to Give Your TV Telehealth Powers “After users choose from a list of symptoms and input how long they've been ill, the app "will show relevant available doctors." Samsung will then create a link between the doctor and the at-home patient. The company says its service will ‘generally’ connect a doctor ‘within 60 seconds.’
After being connected, the doctor will be able to ‘conduct an exam through video conferencing via the app’ using a camera attached to the TV. The app can also integrate with other devices beyond the TV including Samsung's own Galaxy Watch. After the exam is over, Samsung says that users will not only be able to rate their experiences but also schedule a follow-up appointment, have a prescription filled remotely including having it ‘delivered directly to their doorstep all via the on-screen app.’