Americans less satisfied with almost every part of the health system “Americans are happiest with the care they received from nurses, with 82% rating the care as excellent or good — down 6 percentage points from 2010.
69% said the same about physicians this year, down from 84% percent in 2010.
Americans were least satisfied with nursing home care. Just 25% rated nursing homes as excellent or good, while 37% rated them as poor.”
FTC merger enforcement hits highest level in 20 years “The Federal Trade Commission and the Justice Department filed 50 merger enforcement actions in fiscal year 2022 — the highest level of enforcement activity in more than 20 years.
The commission brought 24 merger enforcement challenges in FY 2022, including:
Eleven in which it issued final consent orders after a public comment period
Seven in which the transaction was abandoned or restructured due to antitrust concerns
Six in which the FTC initiated administrative or federal court litigation”
About Covid-19
Paxlovid halved deaths, hospitalizations with optimal timing: Study “Pfizer's COVID-19 antiviral Paxlovid cut the prevalence of hospitalizations and deaths in half when it was used within the first day of diagnosis, according to a study published Dec. 16 in Nature…
The risk grew as more days passed since symptoms appeared, the researchers found. The incidence of 28-day all-cause deaths and hospitalizations was 5.1% for early initiators and 6.6% for delayed users.”
COVID-19 vaccinations shift to regular immunization as COVAX draws to a close “COVAX, the multilateral mechanism for equitable global access to COVID-19 vaccines launched in 2020, will draw to a close on 31 December. Jointly led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance (Gavi), UNICEF and the World Health Organization (WHO), COVAX has so far supplied nearly 2 billion COVID-19 vaccine doses and safe injection devices to 146 economies. Its efforts are estimated to have helped avert the deaths of at least 2.7 million people in the COVAX Advance Market Commitment (AMC) low- and lower middle-income participating economies (lower-income economies) that received free doses through the mechanism, alongside nearly US$ 2 billion in critical support to turn vaccines into vaccinations.”
About health insurance/insurers
White House touts record-breaking ObamaCare enrollment “More than 15 million people to date have signed up for health insurance, a 33 percent increase over the same point last year. The administration said it estimates more than 19 million people will have selected plans by the Jan. 16 deadline, an increase of 7 million compared to when President Biden took office.
On Dec. 15, the deadline for coverage starting Jan. 1, more than 745,000 people selected a plan through HealthCare.gov — the most in a day in history, according to the Department of Health and Human Services.”
Feds Finalizes $115 Participation, Other Fees for IDR Process “The Departments said in a final rule…r that each party will have to pay $115 for disputes initiated on or after Jan. 20th, or 30 days after the publication of the final rule in the Federal Register. The Federal Register has scheduled publication for Dec. 21st.
The final rule also solidified future certified IDR entity fees, finalizing a fee between $200 and $840 for single determinations and a fee between $268 and $1,173 for batched determinations. However, the Departments will charge between $75 and $250 if batched determinations exceed 25 dispute line items. The fees will apply to each increment of 25 dispute line items included in the batch dispute.”
Medicaid Enrollment and Unwinding Tracker “At least 13,379,000 Medicaid enrollees have been disenrolled as of December 20, 2023, based on the most current data from all 50 states and the District of Columbia. Overall, 34% of people with a completed renewal were disenrolled in reporting states while 66%, or 23.9 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.”
The $2.5B Elevance Health, BCBSLA merger is back from the dead “Two months ago, Elevance Health and Blue Cross and Blue Shield of Louisiana hit the pause button on a potential $2.5 billion merger in the midst of regulatory scrutiny.
The insurers brought the deal back to life… with BCBSLA filing an updated application on Thursday seeking to reorganize as a for-profit, which would allow it to be purchased by Elevance Health.”
About hospitals and healthcare systems
Jefferson Health, Lehigh Valley Health Network targeting $14B, 30-hospital merger “Philadelphia-based Jefferson Health and Allentown, Pennsylvania-based Lehigh Valley Health Network (LVHN) have taken the initial steps toward a $14 billion merger, the systems announced Tuesday.
The organizations said they have signed a non-binding letter of intent…
Pending further negotiations, regulatory approvals and closing conditions, the combined 62,000-employee system would span 30 hospitals and over 700 care sites in Pennsylvania and New Jersey. The systems are targeting a 2024 close.”
Froedtert, ThedaCare to launch combined system Jan. 1 “Milwaukee-based Froedtert and Neenah, Wis.-based ThedaCare have finalized their merger agreement and will launch as a combined 18-hospital system Jan. 1.”
386 hospitals now owned by private equity firms: 6 things to know FYI
Community Health Network pays $345M to settle illegal referral scheme allegations “Indianapolis-based Community Health Network has agreed to a $345 million settlement with the Department of Justice to settle allegations of illegal physician referrals and related False Claims Act violations.
Announced Tuesday, the deal stems from a whistleblower complaint filed in 2014 by the nonprofit’s former chief financial officer and chief operating officer, Thomas Fischer, which was investigated by the Department of Health and Human Services’ Office of Inspector General (HHS OIG) and Federal Bureau of Investigations (FBI).
The government alleged that Community Health Network had knowingly submitted false claims to Medicare from 2008 to 2017 as part of senior management’s “illegal scheme to recruit physicians for employment for the purpose of capturing their lucrative ‘downstream referrals,’” the Justice Department said.”
Nearly 20% of hospitals have been warned over price transparency violations “Government regulators evaluated 1,750 hospitals as of early December, and about 1,300 have received warnings of rule violations, according to the report. Most corrected errors after receiving warnings. To date, only 446 hospitals that CMS has reviewed were free of violations.”
About pharma
Mark Cuban Cost Plus Drugs teams up with 4th PBM company “Mark Cuban Cost Plus Drug Co. has announced a partnership with pharmacy benefit management company PCA Rx to bring members even more clarity about drug pricing, according to a Dec. 18 news release. The company is now the fourth PBM to team up with Cost Plus.”
48% of biotechs leaning on Big Pharma as current funding method: ICON survey “Against a backdrop of a tough funding environment, nearly half (48%) of biotechs are using partnerships with Big Pharmas as a financing method, according to a survey commissioned by CRO Icon.
Venture capital firms are the second most sought-after financiers, at 32%, followed by government grants/public funding at 28%, according to a Citeline report commissioned by Icon. The survey was completed this summer by 133 senior-level decision-makers in biotech, about half (46%) of whom are based in North America, with a similar proportion based in Europe and 8% in the Asia-Pacific region.”
Reduced Coinsurance for Certain Part B Rebatable Drugs under the Medicare Prescription Drug Inflation Rebate Program A list of the drugs and rebate amounts.
FirstWord’s most-read stories of 2023 and what they say about biopharma state of play FYI
German court quashes CureVac patent after challenge by BioNTech “A German court on Tuesday invalidated a patent that was the basis of a patent violation lawsuit brought by CureVac against its domestic rival BioNTech, in a blow to CureVac's claims for a share in billions of euros in COVID-19 vaccine revenues.”
BMS inks $14-billion buyout for Karuna “Bristol Myers Squibb is raising its bet on selling psychiatric and neurological drugs with a cash deal to buy Karuna Therapeutics for about $14 billion. The FDA is expected to make a decision by September 26 next year on whether to approve Karuna's lead asset, KarXT – an experimental treatment Bristol Myers Squibb sees as eventually making ‘a significant revenue contribution.’”
About the public’s health
Flu Activity 'Elevated,' CDC Warns of Low Vaccination Rates “CDC estimates there have been at least 3.7 million illnesses, 38,000 hospitalizations and 2,300 deaths so far this season, and reported that 1 in 10 clinical lab tests for influenza were positive during the week ending Dec. 9, up from about 7% a week earlier.”
Fewer young adults smoke today than in 2011. That’s not true of seniors. “Just 5 percent of young adults in the United States smoked in 2022, down from 19 percent in 2011, according to research published in JAMA Health Forum.
Based on data on 353,555 adults, the study found that the prevalence of smoking in those years declined in nearly all age groups, and did so at a faster pace among younger adults — averaging an 11 percent annual decrease for young adults (ages 18 to 24) compared with a 3 percent annual decline for those 40 to 64.
By comparison, smoking prevalence among the oldest adults (those 65 and older) increased slightly, although less than 1 percent, to about 9 percent.
The increase, however, was greatest among those with lower incomes. The researchers found that in all age groups, smoking prevalence was highest among those with the lowest incomes.”
Few Providers Use Z-Codes to Document Social Determinants of Health “The first study, completed by researchers from the NYU School of Global Public Health, showed that despite the utility of Z-codes, they aren’t being used for very diverse social determinants of health. More than half of the hospitals tested used the Z-code for housing insecurity, but other than that, the use of Z-codes was scant, the researchers found.
In the second study from experts at the Colorado School of Public Health and Johns Hopkins, researchers found that Z-code use was 50 percent more common in the Medicaid population than for commercially insured patients, and it was most commonly used in mental health or psychiatric settings.”
Healthcare quality
30 moves from The Joint Commission in 2023 FYI
About healthcare IT
Google unveils MedLM generative AI models for healthcare with HCA, Augmedix and BenchSci as early testers “This week, the tech giant unveiled MedLM, a family of foundation models designed for healthcare industry use cases and available through Google Cloud.”
Health data breaches hit an all-time high in 2023 “As many as 116 million individuals have been impacted by large health data breaches reported to the Department of Health and Human Services this year, according to records from its Office for Civil Rights as of December 21. That number has more than doubled over recent counts, driven primarily by a surge in hacking and ransomware attacks on health care organizations regulated by the privacy rule HIPAA.”
Comment: These numbers are why Americans don’t trust IT and prevents the much-needed single patient identifier.
About healthcare personnel
Kroger eyes opportunities in senior-focused primary care, rolls out service in Atlanta clinics “The grocery chain has teamed up with Better Health Group, a provider network, to shift some of its in-store clinics, called The Little Clinic, into primary care centers for seniors, in addition to offering regular services.
Better Health Group is rolling out the value-based model at eight of Kroger's Altanta-area stores.”
Well-Being Parameters and Intention to Leave Current Institution Among Academic Physicians “In this cross-sectional study of 18 719 academic physicians, approximately one-third reported moderate or greater intention to leave. Burnout, lack of professional fulfillment, and other personal and organizational factors were associated with intention to leave.”
Medical schools in 2023: Fewer applicants, mixed results in diversity “This year, there were 52,577 applicants, a 4.7% decline compared to 2022-23, and it’s the second consecutive year medical schools saw a drop in applicants. It’s worth noting that medical schools saw a record number of applicants in the 2021-22 year, possibly driven by people inspired to pursue careers in medicine due to the COVID-19 pandemic.
Even with the drop in applicants, the number of matriculants, or first-year enrollees, rose 1.2% compared to 2023, according to AAMC data.”
Medical Groups Faced High Expenses, Staffing Challenges in 2023 “From 2020 to 2023, medical groups’ revenue grew by 9.1 percent, while expenses increased by 26.5 percent…
System-affiliated groups faced financial challenges, with the median loss per physician at more than $249,000. While median total revenue per physician increased from $608,639 to $719,901, median total expenses per physician grew from $905,283 to $1,036,238.”
About health technology
Illumina sets a date to divest Grail following antitrust appeal ruling “The DNA sequencing giant announced it will aim to finalize the details of the divestiture within the first six months of the new year—whether it be through a sale to an interested suitor or by having Grail take itself public…
While the Fifth Circuit did indeed vacate the FTC’s order—with its opinion saying the agency had applied an erroneous legal standard during its analysis—the panel of judges determined the commission still ‘had substantial evidence to support its conclusion’ that its antitrust concerns were valid…”