Below are a two studies that cover a broad range of topics on our healthcare system:
National Health Care Spending In 2022: Growth Similar To Prepandemic Rates An annual MUST-READ from Health Affairs: “Health care spending in the US grew 4.1 percent to reach $4.5 trillion in 2022, which was still a faster rate of growth than the increase of 3.2 percent in 2021 but was much slower than the rate of 10.6 percent seen in 2020. In 2022, strong Medicaid and private health insurance spending growth, including a turnaround in the net cost of insurance, was somewhat offset by continued declines in federal spending associated with the COVID-19 pandemic. The insured share of the population reached a historic high of 92.0 percent in 2022 as enrollment in private health insurance increased at a faster rate relative to 2021 and Medicaid enrollment continued to experience strong growth. The share of the economy accounted for by the health sector was 17.3 percent in 2022, which was down from a peak of 19.5 percent in 2020 but was more consistent with the average share of 17.5 percent during 2016–19.”
2023 Year in Review: Healthcare Economics Edition “From Q1 to the end of Q3, we saw an increase of 2.0% across all 500 shoppable services. This is in line with the 1.9% overall US inflation measured by the Personal Consumption Expenditures Price Index (PCE) and below the overall US inflation measured by the Consumer Price Index (CPI-U)…
While inflation across these 500 services has been moderate overall, we see a lot of variation when we investigate service by service. We see the largest price increases in areas like Chickenpox and Measles vaccines. On the deflationary side, off-hours medical services, allergy tests, and vaginal delivery of placentas have seen the largest price drops.”
About Covid-19
Covid and flu rising ahead of holidays, increasing ER visits “Respiratory viruses are rebounding in the United States on the precipice of the end-of-year holidays, with emergency room visits for covid-19, influenza and respiratory syncytial virus collectively reaching their highest levels since February.
Among the three viruses, covid continues to be the biggest driver of hospitalizations, settling into a familiar rhythm of causing periodic waves without wreaking havoc on the health-care system as it once did. Hospitals reported more than 22,000 new covid admissions the week ending Dec. 2, the highest since the peak of the summer wave in September.”
About healthcare quality/safety
Thousands of Patients May Be Undergoing Vascular Procedures Too Soon or Unnecessarily Read this expose from ProPublica. It names physicians doing these procedures and their Medicare payments.
Summary of Revisions: Standards of Care in Diabetes—2024 From the American Diabetes association
Quality First: Consumer Product Recalls Have Risen 115% Since 2018 “We recently dove deep into publicly available data about recalls in the U.S. from the U.S. Food and Drug Association (FDA) and the Consumer Product Safety Commission (CPSC). Our goal was to better understand the regulatory environment and get a clearer sense of how often companies had to recall products.
We were shocked to discover that recalls across the FDA and CPSC are up 115% since 2018.”
The article goes into more detail by product type. For example: “Allergens are the most common driver of recalls by the FDA, driving 34% of instances.”
Medicare Advantage Provides Higher Quality of Care And Better Rates of Preventive Service Use WHEN COMPARED TO ORIGINAL MEDICARE “To assess differences in quality of care and utilization of services and medication, we compared performance results for certain Healthcare Effectiveness Data and Information (HEDIS) measures focused on preventive and chronic disease care in original Medicare and Medicare Advantage in 2019. Across 11 HEDIS measures, Medicare Advantage outperformed original Medicare in all but one all but one…”
See the summary and Table 1.
About health insurance/insurers
Cigna Calls Off Humana Pursuit, Plans Big Stock Buyback “The companies couldn’t come to agreement on price and other financial terms, according to people familiar with the matter. In the near term, Cigna is turning its focus toward smaller, so-called bolt-on, acquisitions…
nstead, Bloomfield, Conn.-based Cigna said Sunday that it plans an additional $10 billion of stock buybacks, bringing its total planned repurchases to $11.3 billion. It made no comment on the Humana talks.”
Estimated Savings From the Medicare Shared Savings Program “Results The MSSP was associated with net losses to traditional Medicare of between $584 million and $1.423 billion over the study period. Savings from MSSP-related reductions to MA benchmarks totaled between $4.480 billion and $4.923 billion. Across traditional Medicare and MA, the MSSP was associated with savings of between $3.057 billion and $4.339 billion. This represents approximately 0.075% of combined spending for traditional Medicare and MA over the study period.
Conclusions and Relevance This economic evaluation found that the MSSP was associated with net losses to traditional Medicare, net savings to MA, and overall net savings to CMS. The total budget impact of the MSSP to CMS was small and continues to be uncertain due to challenges in estimating the effects of the MSSP on gross spending, particularly in recent years.”
The Comprehensive Primary Care Plus [CPC+] Model and Health Care Spending, Service Use, and Quality “CPC+ was not associated with a reduction in total expenditures over 5 years. Positive interaction between CPC+ and the Shared Savings Program suggests transformation models might be more successful when provider cost-reduction incentives are aligned across specialties.”
Comment: The second “conclusion” is so longstanding that to say “might” is unnecessary.
A New Government Forum for Surprise Medical Bills Is Getting More Disputes Than It Can Handle So Far From the GAO: “As of June 2023, over 490,000 disputes have been submitted, a much larger number than anticipated by the agencies.
And 61% of the disputes are unresolved as of June 2023…
To address concerns from insurers and providers, CMS and Labor look into complaints; however, stakeholder groups expressed concern with what they describe as a lack of response to submitted complaints. The departments reported limited ability to increase enforcement efforts due to budget constraints.:
Payers' increasing claims denials, delays 'wreaking havoc' on provider revenue cycles “Kodiak RCA (formerly Crowe healthcare consulting), pulls average revenue cycle performance benchmarks from platform incorporating more than 1,800 hospitals’ and 200,000 physicians’ data.
The analysis found, among other trends, an increase in overall initial denial rates from 10.15% in 2020 to 11.2% in 2022, and then up again to 11.99% in the first three quarters of 2023…
The other report, released late last month by Syntellis and the American Hospital Association (AHA), reviewed the financial data of more than 1,300 hospitals and health systems.
Its highlights included 55.7% and 20.2% increases in denials from Medicare Advantage and commercial payers, respectively, from the top of 2022 to the midway point of 2023.”
The cities with the most competitive commercial insurance markets | 2023 FYI
For the full analysis, see: COMPETITION in HEALTH INSURANCE A comprehensive study of U.S. market See Table A-1 (starting on page 160 in the appendix for information on all SMSAs.
About hospitals and healthcare systems
100 largest hospitals and health systems in the US | 2023 FYI
7 hospitals, health systems recently hit with rating downgrades FYI
In a related article: CHS suffers credit rating downgrade
68 health systems with strong finances FYI
The 340B repayments 100 hospitals are set to receive “CMS bookmarked $9 billion for the 2,600 340B hospitals to repay unlawful payment cuts, and nearly half, $4.3 billion, is planned for 100 of those hospitals, according to data from the Community Oncology Alliance.”
A list of hospitals is in the article.
About pharma
Biden administration to impose inflation penalties on dozens of drugmakers “Prices of 48 drugs that fall under Medicare Part B, which covers drugs administered at a health facility, surged faster than inflation in the last quarter of 2023, according to the White House.
These drugs may be subject to inflation rebates in the first quarter of 2024 as a result of the IRA, which Biden, a Democrat, signed last year.
The Centers for Medicare and Medicaid Services and the White House did not immediately respond to requests for more details on the 48 drugs.”
An analysis of the $6 billion in grants distributed by PhRMA and its member companies A must-read to see how large and pervasive these payments are.
Pfizer finds room for ADC snack after swallowing Seagen, inking deal for mesothelin candidate “Pfizer just swallowed a $43 billion antibody-drug conjugate (ADC) company and still isn’t full. Hours after Pfizer closed the Seagen buyout, Nona Biosciences put out news that the Big Pharma has committed $53 million in upfront and near-term payments for rights to its mesothelin-targeted ADC.”
Justices will review lower-court ruling on access to abortion pill The Supreme Court on Wednesday morning agreed to review a ruling by a federal appeals court that would significantly restrict (but not eliminate altogether) access to a drug [mifepristone] used in medication abortions, which account for over half of all abortions performed in the United States. Wednesday’s announcement means that the justices will weigh in on the issue of abortion for the first time since overruling the constitutional right to an abortion last year in Dobbs v. Jackson Women’s Health Organization. Their decisions in the new cases, Food and Drug Administration v. Alliance for Hippocratic Medicine and Danco Laboratories v. Alliance for Hippocratic Medicine, are likely to come sometime next summer, in the middle of the 2024 presidential campaign.”
Spending on Dual Over-the-Counter and Prescription Drugs in the Medicare Part D Program “Medicare Part D frequently paid more for dual OTC and prescription drugs than the OTC cash prices. Patients’ cost-sharing was sometimes higher than what they would pay for the same drug without insurance or a prescription.”
Comment: These findings are not new, but it is a good reminder of the issue.
Unsupported Price Increases Occurring in 2022 [Institute for Clinical and Economic Review, 2023] “The price of many existing drugs, both brand and generic, can increase substantially over time, and questions are frequently raised regarding whether these price increases are justified. State policymakers have been particularly active in seeking measures to address this issue. Despite these initiatives, there had been no systematic approach at a state or national level to determine whether certain price increases are justified by new clinical evidence or other factors.”
For a quick look atbthe results of this year’s analysis, see Table ES1.
Pharmacies sharing medical data without police warrant: Congressional investigation “A congressional investigation has discovered that law enforcement agencies have been accessing patient prescription records through pharmacies without warrants, with most people unaware that their private data is being handed over to authorities.”
Moody's cuts Walgreens to junk on health care strategy push “Walgreens Boots Alliance Inc. had its senior unsecured credit rating cut to junk by Moody’s Investors Service, with the credit grader citing the drugstore chain’s high debt relative to earnings and risks associated with its push to offer more healthcare services.
The downgrade to Ba2 — two steps into high-yield — reflects ‘Walgreens’ stubbornly high financial leverage, weak interest coverage and pressured free cash flow that Moody’s believes will be sustained over the next 12-18 months,’ senior credit officer Chedly Louis wrote in a note Monday.”
AstraZeneca buys US vaccine company in $1.1bn deal “AstraZeneca is buying its first vaccine company in a $1.1bn deal that will expand the vaccine and immune therapy business it set up during the Covid pandemic.
Britain’s biggest drugmaker has agreed to take over the Seattle-based company Icosavax, which is developing a potential vaccine for two common respiratory diseases.
The US firm’s lead product targets two diseases – respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) – that cause severe illness and hospitalisation in adults over 60 and people with chronic conditions such as cardiovascular, kidney and respiratory disease. RSV and hMPV can also be serious in young children.”
Sigma Healthcare Agrees to $5.79 Billion Merger With Pharmacy Chain “Australian drug supplier Sigma Healthcare agreed to merge with privately owned pharmacy operator CW Group, creating a listed company worth more than 8.8 billion Australian dollars (US$5.79 billion)…
The merger will create a combined healthcare wholesaler, distributor and retail pharmacy franchiser, Sigma said.”
Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity “Findings After 36 weeks of open-label maximum tolerated dose of tirzepatide (10 or 15 mg), adults (n = 670) with obesity or overweight (without diabetes) experienced a mean weight reduction of 20.9%. From randomization (at week 36), those switched to placebo experienced a 14% weight regain and those continuing tirzepatide experienced an additional 5.5% weight reduction during the 52-week double-blind period.
Meaning In participants with obesity/overweight, withdrawing tirzepatide led to substantial regain of lost weight, whereas continued treatment maintained and augmented initial weight reduction.”
Comment: The non-clinical implication is that medications in this class of drugs will need to be prescribed for a chronic illness, with attendant costs.
2023's Most Influential Drug and Vaccine Approvals — As Selected by GoodRx Pharmacists FYI. At the top of the list is Paxlovid.
Half of Diabetes Patients Taking Class of Meds That Includes Ozempic, Mounjaro Stop Using Them “Many Americans battling diabetes are turning to a new class of injected drugs that includes blockbusters like Ozempic (semaglutide) and Mounjaro (tirzepatide).
But a new study finds half of patients who use these "second line" therapies -- a class called GLP-1 RAs -- quit them within a year.
One potential reason why: Gastrointestinal issues like nausea, vomiting and diarrhea, according to the researchers.”
Pfizer set to close $43-billion Seagen purchase after gaining US nod “Pfizer announced on Tuesday that it agreed to address concerns from the US Federal Trade Commission (FTC) related to its $43-billion acquisition of Seagen. The company noted that it now expects to close the deal for the antibody-drug conjugate (ADC) developer on December 14 having secured clearance from the European Commission in October.”
First postpartum depression pill now available in the US, drugmakers say “The US Food and Drug Administration approved the therapy, called Zurzuvae, in August. The product, which is now at specialty pharmacies, can be shipped directly to patients, Biogen and Sage Therapeutics Inc. said in an announcement Thursday.
However, the medication will cost $15,900 per course before insurance, raising some concerns about how many people will be able to access it.”
About the public’s health
US CDC says there's urgent need to increase respiratory vaccine coverage “The U.S. Centers for Disease Control and Prevention (CDC) on Thursday issued an alert urging healthcare providers to increase immunization coverage for influenza, COVID-19 and respiratory syncytial virus (RSV).
The health regulator said that low vaccination rates, coupled with ongoing increases in respiratory disease activity, could lead to more severe disease and increased healthcare capacity strain in the coming weeks.”
Texas top court rules against woman who sought abortion for medical emergency “The Texas Supreme Court on Monday overturned a lower court's ruling that would have allowed a pregnant woman to get an emergency abortion under the medical exception for the state's near-total abortion ban, granting a petition by Republican Attorney General Ken Paxton.”
Read the entire article. the Court’s double-talk is astounding!
America’s Health Rankings 2023 Annual Report: Chronic Conditions on the Rise “Eight chronic conditions reached their highest levels since America’s Health Rankings began tracking them. Notably:
Diabetes prevalence increased to 11.5% of the adult population, impacting nearly 31.9 million adults.
Depression prevalence increased to 21.7% of the adult population, affecting nearly 54.2 million adults.
Stark disparities across nearly all demographic groups include:
Chronic Obstructive Pulmonary Disease was 7.1 times higher among American Indian/Alaska Native adults than Asian adults.
Cancer was 3.9 times higher among white adults than Asian adults.
Depression was 2.4 times higher among adults who identified as LGBQ+ than straight adults.
When compared to white adults with diabetes, Hispanic and Black adults were 2.1 times and 1.8 times more likely to have uncontrolled blood sugar levels, as indicated by the A1c test.”
About healthcare IT
Survey Reveals Only 36% of Healthcare Organizations are Prepared to Meet the Requirements of the 21st Century Cures Act “…while more than half of surveyed organizations (61%) have invested effort and resources into meeting the requirements of the Cures Act, only 36% report having the necessary comprehensive data quality programs in place to do so.
The 21st Century Cures Act set standards for the secure and frictionless exchange of data among payers, providers and consumers, including the establishment of an information-blocking rule that was finalized earlier this year.”
Patterns of Telemedicine Use and Glycemic Outcomes of Endocrinology Care for Patients With Type 2 Diabetes Not everything is better with telemedicine:
Findings In this cohort study including 3778 adults, there was no significant change in estimated hemoglobin A1c (HbA1c) over 12 months (−0.06%) among patients using telemedicine alone, while patients who used in-person (−0.37%) and mixed care (−0.22%) had significant HbA1c improvements.
Meaning These findings suggest that patients with type 2 diabetes who rely on telemedicine alone to access endocrinology care may require additional support to achieve glycemic goals.”
HHS finalizes rule to move the needle on interoperability, algorithm transparency “The rule, called Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency and Information Sharing, or the HTI-1, implements key provisions of the 21st Century Cures Act, with a specific emphasis on health IT certification and information blocking.”
Artificial Intelligence:Agencies Have Begun Implementation but Need to Complete Key Requirements “GAO's analysis of agencies' inventories of use cases identified instances of incomplete and inaccurate data. Specifically, five agencies provided comprehensive information for each of their reported use cases while the other 15 had instances of incomplete and inaccurate data. For example, some inventories did not include required data elements, such as the AI life cycle stage or an indication of whether an AI use case was releasable or not. In addition, two inventories included AI uses that were later determined by the agencies to not be AI. Without accurate inventories, the government's management of its use of AI will be hindered by incomplete and inaccurate data.”
Healthcare providers to join US plan to manage AI risks - White House “Twenty-eight healthcare companies, including CVS Health, are signing U.S. President Joe Biden's voluntary commitments aimed at ensuring the safe development of artificial intelligence (AI), a White House official said on Thursday.
The commitments by healthcare providers and payers follow those of 15 leading AI companies, including Google, OpenAI and OpenAI partner Microsoft to develop AI models responsibly.”
About healthcare personnel
Top 25 physician groups by size and Medicare charges FYI
Most healthcare provider leaders are eying the door—and many have already heard offers, survey finds “The poll of 666 executives, directors and managers from provider organizations from staffing firm AMN Healthcare found that 66% of respondents intend to seek out a new position. Twelve percent plan to do so immediately, 62% within the next year and 38% within the next three to five years, according to the survey.
The responses also suggest there’s no shortage of open doors for job seekers. Nearly four in five survey participants said they had been approached about a new job opportunity within the past half month, with 17% of the full sample indicating that they had pursued the offer.”
About health technology
Bluebird’s sickle cell gene therapy comes with safety warning and higher price. Can Lyfgenia overcome CRISPR’s halo? “Alongside a historic approval for the first therapy utilizing the Nobel Prize-winning CRISPR/Cas9 gene-editing technology, the FDA has cleared bluebird bio’s rival gene replacement therapy, Lyfgenia, also for sickle cell disease (SCD).
But a higher price tag, a black box warning and the absence of a much-needed cash infusion could usher in a tough time for bluebird, several analysts figured.”
Floreo nabs FDA breakthrough label for its VR software “Floreo, maker of virtual reality (VR) behavioral therapy content, has received the Food and Drug Administration’s breakthrough device designation…
Launched in 2016, Floreo develops clinically designed VR lessons that help teach life skills aimed at children with autism and other neurodevelopmental disorders. It works with healthcare providers and the education sector, with its products already on the market for use alongside educators and clinicians. It also has Medicaid waivers in several states.”