About Covid-19
US, global COVID-19 markers show declines “Of the two main severity indicators, hospitalizations last week declined by 0.2%, with some counties in the moderate range—especially in Montana—and a few counties listed as high, mainly in the central part of the country, the Centers for Disease Control and Prevention (CDC) said in its weekly data updates.
Deaths rose 12.5% compared to the week before, with the percentage of deaths from COVID highest in North Carolina, at 4%, compared to 2.7% for the nation as a whole.”
About health insurance/insurers
CMS drops 4 final payment rules for 2024: 19 takeaways A really good summary of these rules.
New Research Examining ACA Impact on Employers Offering Health Insurance Finds a 5 Percent Increase in Worker Eligibility for Employment-Based Health Coverage Since 2014 A couple key points from the research:
• In 2017, the overall percentage of private-sector employers offering health benefits increased for the first time in nearly a decade. In 2008, 56.4 % of private-sector employers offered health benefits. By 2016, it was down to 45.3%. By 2020, it was up to 51.1%, but it fell to 48.3% in 2022.
• In 2022, nearly 81% of workers employed by private-sector employers were eligible for health benefits.”
CMS: Insurers to lose $1.1B in risk adjustment payments from Bright Health, Friday exits Bright Health and Friday Health Plans are unable to meet their risk-adjustment payment obligations, leaving other insurers $1.1 billion short, CMS disclosed Oct. 27.
Bright Health exited the ACA exchange market at the end of 2022, and Friday Health Plans went out of business in June 2023.
In the ACA market, insurers must pay in risk-adjustment payments to CMS, designed to even out financial risk between payers with higher- and lower-risk enrollees in each market.”
Comment: Since these insurers cannot make their payments, other companies will not receive their risk adjustments.
Feds float No Surprises Act changes “Federal officials issued proposed changes to the No Surprises Act's independent dispute resolution process…”
This article is a good summary of the lengthy CMS press release.
Medicare expands options for mental health care “For decades, Medicare has covered only mental health services provided by psychiatrists, psychologists, licensed clinical social workers and psychiatric nurses. But with rising demand and many people willing to pay privately for care, 45 percent of psychiatrists and 54 percent of psychologists don’t participate in Medicare, the federal insurance system for some 65 million older or disabled Americans.
Citing low payments and bureaucratic hassles, more than 124,000 behavioral health practitioners have opted out of Medicare — the most of any medical specialty…
Beginning in January, Medicare for the first time will allow marriage and family therapists and mental health counselors to provide services. This cadre of more than 400,000 professionals makes up more than 40 percent of the licensed mental health workforce and is especially critical in rural areas.”
Errors in Patient Access Such as Eligibility or Missing Prior Authorization Cited as Top Reason for Initial Payer Denials by Financial Leaders “Rounding out the top five reasons for initial payer denials, healthcare leaders cited lack of documentation to support medical necessity, missing or incorrect patient information, physician documentation issues, and utilization management. These were closely followed by coding, duplicate claims, and untimely filing.”
CVS Health posts $2.3B profit in Q3 “CVS Health posted $2.3 billion in net income in the third quarter and revenue growth across its core lines of business in insurance, care delivery, pharmacy and retail, according to the company's earnings report published Nov. 1.”
Read the article for a breakdown by service line.
Harvard-Inovalon Medicare Study: Quality Outcomes Under Medicare Advantage vs. Medicare Fee-for-Service “We find that MA delivers superior quality and health outcomes relative to FFS, especially after rigorously adjusting for enrollment differences across the two programs and for the pre-existing disadvantages faced by MA members in terms of baseline demographic, clinical, and social risk factors. These differences were outlined in detail in the first white paper in this series ‘Who Enrolls in Medicare Advantage vs. Traditional Medicare Fee-for-Service.’
Specifically, MA enrollees have over 70% fewer hospital readmissions and 25% fewer preventable inpatient admissions. At the same time, we find that MA exhibits lower rates of inappropriate medication use, and comparable rates of medication adherence.”
Medicaid Enrollment and Unwinding Tracker Some highlights from this KFF study:
At least 10,046,000 Medicaid enrollees have been disenrolled as of November 1, 2023, based on the most current data from 50 states and the District of Columbia. Overall, 35% of people with a completed renewal were disenrolled in reporting states while 65%, or 18.2 million enrollees, had their coverage renewed (one reporting state does not include data on renewed enrollees). Due to varying lags for when states report data, the data reported here undercount the actual number of disenrollments to date.
There is wide variation in disenrollment rates across reporting states, ranging from 65% in Texas to 10% in Illinois…
Across all states with available data, 71% of all people disenrolled had their coverage terminated for procedural reasons.”
[Emphases in the original]
Medical Debt Was Erased from Credit Records for Most Consumers, Potentially Improving Many Americans' Lives “Since the changes went into effect, consumers who had medical debt collections in August 2022—about 27 million adults—experienced a significant improvement in their Vantage scores. From August 2022 to August 2023, their average score increased from 585 to 615 points, moving these consumers from a subprime level (below 600) to near prime level (between 601 and 660). In contrast, consumers without medical debt in the records in August 2022 experienced almost no change in their credit scores by August 2023 (from 712 to 711).”
About hospitals and healthcare systems
Avoiding Overuse: Coronary Stents “KEY TAKEAWAYS
U.S. hospitals performed over 229,000 unnecessary coronary stents from 2019-2021. That’s a rate of one every seven minutes.
Of the approximately 1 million stents placed by hospitals, 22 percent met criteria for overuse.
Medicare wasted as much as $2.44 billion on unnecessary stents from 2019-2021.
Rates of overuse varied widely: at some hospitals, more than 50 percent of all stents met criteria for overuse, while at others, fewer than 5 percent were unnecessary.”
How CHS, Tenet, HCA and UHS fared in Q3 FYI
Hospital Operating Margins Increase for Second Month but Remain Narrow, According to New Syntellis Performance Solutions Data “Hospitals nationwide had a median operating margin — measured as actual year-to-date operating margin — of 1.6% for the month, up slightly from 1.4% in August. The increase marked a seventh consecutive month of positive operating margins, and a second consecutive month of increases after margins slid downward from 2% in June to 1.1% in July.”
And in a related study:
National Hospital Flash Report “Key Takeaways
1. Hospital performance in September declined slightly when compared to the previous month. Volume decreased across all categories; however, the data show that September 2023 levels are still an improvement over 2022. YTD margins increased slightly, paradoxically, due to the historical variation in performance of hospitals across 2023.
2. Bad debt and charity care remained elevated on a year-over-year basis. This is partly attributed to the ongoing Medicaid redetermination process, which has resulted in at least 9.5 million people disenrolled.
3. Labor expenses increased, though overall expenses softened as volume decreased. Labor expenses and workforce issues continue to challenge hospitals and health systems.”
CMS has finalized its remedy for 340B payments, and hospitals are not happy “As part of its final rule, CMS is maintaining budget neutrality. The agency estimates that hospitals were paid $7.8 billion more for non-drug items and services during that time period than they otherwise would have been without the 340B payment policy. To carry out the nearly $8 billion budget neutrality adjustment, CMS will reduce future non-drug item and service payments by adjusting the conversion factor for payments for outpatient services.”
Hospitals file lawsuit to bar HHS' ban on 3rd-party web trackers “In a new federal lawsuit—filed Thursday in the Northern District of Texas by the American Hospital Association (AHA), the Texas Hospital Association and two health systems, Texas Health Resources and United Regional Health Care System—the hospital lobby called on the judicial branch to bar enforcement of a December 2022 bulletin released by HHS’ Office for Civil Rights (OCR).
That bulletin addressed tools like the Meta Pixel and Google Analytics that media and researcher investigations have found across nearly all hospital websites and that have since become a focus of class-action lawsuits.”
CMS finalizes $140M increase to home health payments “Centers for Medicare & Medicaid Services (CMS) released a rule Wednesday that increases the 2024 home health payments by 0.8%, or $140 million.”
About pharma
Drugmakers Are Set to Pay 23andMe Millions to Access Consumer DNA “GSK Plc will pay 23andMe Holding Co. $20 million for access to the genetic-testing company’s vast trove of consumer DNA data, extending a five-year collaboration that’s allowed the drugmaker to mine genetic data as it researches new medications.
An estimated 4,500 participating in CVS, Walgreens walkouts: 5 updates A quick read updating this story.
Cost-Effectiveness of Pharmacist Prescribing for Managing Hypertension in the United States “In this simulated cost-effectiveness analysis of a 5-state Markov model, 50% uptake of a pharmacist-prescribing intervention to improve blood pressure control was associated with a $1.137 trillion in cost savings and could save an estimated 30.2 million life years over 30 years.”
About the public’s health
Effect of Time-Restricted Eating on Weight Loss in Adults With Type 2 Diabetes “Question Is time-restricted eating (TRE) without calorie counting more effective for weight loss and lowering of hemoglobin A1c (HbA1c) levels compared with daily calorie restriction (CR) in adults with type 2 diabetes (T2D)?Findings In a 6-month randomized clinical trial involving 75 adults with T2D, TRE was more effective for weight loss (−3.6%) than CR (−1.8%) compared with controls. However, changes in HbA1c levels did not differ between the TRE (−0.91%) and CR (−0.94%) groups compared with controls.”
Food insecurity increased as pandemic-era meal waivers ended “Food insecurity in U.S. households with children increased to 17.3% in 2022, up from 12.5% the year before and 14.8% in 2020, according to federal research released Wednesday on household food security by the U.S. Department of Agriculture’s Economic Research Service.
Food insecurity among children, specifically, rose from 6.2% in 2021 to 8.8% in 2022. An increased percentage of children also experienced more severe food insecurity, up to 1% in 2022 from 0.7% in 2021.”
Infant mortality rose in 2022 for the first time in two decades “The U.S. infant mortality rate rose last year for the first time in two decades. The rate refers to the number of infants who died before their first birthdays out of every 1,000 live births.
The U.S. recorded 5.6 infant deaths per 1,000 live births in 2022, a 3% increase over the previous year, according to a report Wednesday from the Centers for Disease Control and Prevention.”
Survey: 10% of US students report current tobacco use “Survey responses analyzed by the CDC and FDA showed that 10% of middle and high school students in the United States reported currently using a tobacco product, although use fell among high schoolers over the past year.
The data were from this year’s edition of the National Youth Tobacco Survey, in which U.S. middle school students in grades 6 to 8 and high school students in grades 9 to 12 answered questions about tobacco products.”
About healthcare IT
Biden plans to step up government oversight of AI with new 'pressure tests' “Tech companies currently do their own ‘red-teaming’ of products – subjecting them to tests to find potential problems, like disinformation or racism. The White House has already worked with the major developers on a series of voluntary commitments to red-team their systems by third parties before releasing them.
But Biden's executive order requires the government to set new standards, tools and tests for red-teaming – and requires companies to notify the government and share the red-teaming results for the products that could pose major risks before releasing systems. The power to require companies to do so comes from the Defense Production Act, a Korean-War era law that expands presidential authorities, especially when it comes to national security issues.”
Use of Telemedicine and Quality of Care Among Medicare Enrollees With Serious Mental Illness “In this cohort study of 120 050 Medicare beneficiaries with schizophrenia or bipolar I disorder, patients receiving mental health care at practices that almost exclusively switched to telemental health service had 13.0% more mental health visits than those receiving care at practices that largely used in-person visits. There were no changes in medication adherence, hospital and emergency department use, or mortality based on the extent of telemental health use.”
About healthcare personnel
Clinician of the Future 2023 Education Edition Some highlights:
—“25% of medical students in the USA and 21% in the UK are considering quitting their studies
—58% see their current studies as a stepping-stone towards a broader career in healthcare
While a minority of students plan to quit their studies, the majority report that they plan to move into roles in which they do not intend to treat patients directly.
—60% are worried about their current mental health”
Smaller Employers Weigh a Big-Company Fix for Scarce Primary Care: Their Own Clinics “KFF’s annual survey of workplace benefits this year found that about 20% of employers who offer health insurance and have 200 to 999 workers provide on-site or near-site clinics. That compares with 30% or better for employers with 1,000 or more workers.
Those figures have been relatively steady in recent years, surveys show.”
Nearly 60% of doctors work in a practice that’s part of an ACO “More than one-third (34.4%) of physicians were in a practice that was an accredited or recognized medical home in 2022, compared with 32.3% in 2020 and 23.7% in 2014.
Participation in ACOs has seen similar growth, with 57.8% of physicians surveyed saying that their practice belonged to at least one type of ACO in 2022, compared with 44% in 2016.
Among the three types of ACOs, participation in commercial ACOs was the most prevalent, 45.1% in 2022, up from 42.7% in 2020; followed by Medicare ACOs, 38.1% in 2022, 36.7% in 2020; and Medicaid ACOs, 30% in 2022, 29.5% in 2020.”
Changes in Employment in the US Health Care Workforce, 2016-2022 “Health care employment growth declined after the onset of the COVID-19 pandemic and recovery patterns varied by health care subsectors… Staffing in SNFs had already declined before the pandemic and further declines after the pandemic are concerning. The differential employment trends across health care subsectors may be driven by worker concerns of infectious disease threats, modest wage levels, and high turnover rates among many long-term care occupations.”
Please see the article for specific sector data.
About healthcare finance
Healthpeak Properties, Physicians Realty Trust to Merge in $21B Deal “The merger is expected to generate run-rate synergies of at least $40 million by the end of year one and up to $60 million by the end of year two.”