About Covid-19
Moderna promises $0 cost for its COVID-19 vaccine post PHE “As the federal public health emergency for COVID-19 is set to end May 11, Moderna whistled a new tune Feb. 15, saying both insured and uninsured Americans will not pay a price for its vaccine.”
About health insurance/insurers
Understanding the Role of Medicaid Managed Care Plans in Unwinding Pandemic-Era Continuous Enrollment: Perspectives from Safety-Net Plans “Only about one-third of responding plans reported having verified/current contact information for between 76% to 100% of their Medicaid members. Most responding plans reported they are taking action to reach out to members directly to assist with updating contact information and many are working with third parties (e.g., providers, community-based organizations (CBOs), subcontractors/vendors etc.). Nearly all responding plans said that reaching Medicaid beneficiaries is a challenge. Plans also described challenges involved with transferring updated contact information data to the state.”
Medicare Advantage plans deny the most inpatient level-of-care claims: report “Initial clinical denial rates rose in 2022 with the highest denial rates coming from Medicare Advantage plans, according to a Feb. 15 report from Crowe Revenue Cycle Analytics…
Four things to know:
1. Through November 2022, the dollar value of initial clinical denials by payers represented 3.2 percent of billed inpatient dollars. That is 18.5 percent higher than in 2021.
2. Providers wrote off 3.6 percent of their inpatient revenue as uncollectible in 2021. That number increased to 5.9 percent in 2022, through November.
3. The initial inpatient level-of-care claim denial rate for Medicare Advantage plans was 5.8 percent in 2022, through November. That is compared to 3.7 percent for all other payer categories.
4. Clients in Crowe's benchmarking data wrote off $535.4 million on account of Medicare Advantage plan denials based on lack of medical necessity.”
Elevance Health completes BioPlus buy “Elevance Health has closed its acquisition of BioPlus, a specialty pharmacy company, the insurer announced Wednesday.
BioPlus was a subsidiary of CarepathRx, part of Nautic Partners' portfolio. BioPlus will join the insurer's Carelon arm, which is a major focus of growth within Elevance, formerly Anthem…
BioPlus will now operate as part of CarelonRx, the company's pharmacy benefit management arm.”
Evaluation of Prices for Surgical Procedures Within and Outside Hospital Networks in the US “A total of 3195 hospitals reported prices and were included in this analysis. For 15 of the 16 procedures, the median negotiated price was significantly higher at facilities within networks compared with independent hospitals... Median price for shoulder arthroscopy was 1.68 times higher at facilities within networks compared with independent hospitals ($4432 [IQR, $1611-$10 593] vs $2643 [IQR, $519-$8286]; P < .001). For each procedure, there was significant variation in negotiated prices... The median price for prostatectomy at facilities in hospital networks and independent facilities was $9567 (IQR, $3657-$18 944) and $8601 (IQR, $4038-$17 575), respectively.”
The Budget and Economic Outlook: 2023 to 2033 Annual report from the CBO. Search for Medicare mentions. For example:
”…outlays for many programs are projected to increase in 2023. The largest increases are for the following programs:
Medicare. Outlays for Medicare (net of offsetting receipts) rise by $110 billion (or 16 percent) in 2023, to $820 billion, in CBO’s projections. That increase results from a decrease in offsetting receipts and an increase in outlays. Medicare offsetting receipts are projected to decrease in 2023 because recoupments from the COVID-19 Accelerated and Advance Payment Program are expected to be lower than they were last year. Beginning in April 2020, the government provided about $100 billion in assistance to Medicare providers under that program. That sum was to be recouped later through reductions in claim payments. Because most of the outstanding amounts were recouped in 2021 and 2022, CBO expects such receipts to fall from $62 billion in 2022 to $3 billion in 2023. Additionally, Medicare outlays are projected to rise in 2023 because of increases in enrollment (which is projected to rise by 2 percent), payment rates, and spending related to beneficiaries’ use of care…”
See also: Analysis of CBO's February 2023 Budget and Economic Outlook
About hospitals and healthcare systems
CommonSpirit records $451M operating loss in 2nd half of 2022 “Chicago-based CommonSpirit Health, one of the largest healthcare systems in the country operating 138 hospitals in 21 states, has reported $451 million in operating losses for the six-month period ending Dec. 31.
Those figures compared with operating losses of $47 million for the same period in the prior year.”
Steward to sell 5 hospitals to CommonSpirit “CommonSpirit Health will acquire Steward Health Care's sites of care in Utah, which will then be managed by Centura Health, the systems announced Feb. 15.
The three health systems signed an asset purchase agreement, under which Chicago-based CommonSpirit will acquire five hospitals, more than 35 medical group clinics and a clinically integrated network of providers from Dallas-based Steward. The assets will be wholly owned by CommonSpirit but managed by Centennial, Colo.-based Centura.”
CHS' net income drops 51% in 2022 “Franklin, Tenn.-based Community Health Systems, one of the largest for-profit health systems in the country, reported $179 million net income in 2022, a 51.4 percent drop from the $368 million net income reported the prior year.
The drop was driven by a decline in net operating revenues, fewer inpatient admissions and what CHS termed ‘unfavorable changes’ in payer mix.”
About pharma
Labeling Changes for Aduhelm Detail Risks of ARIA Brain Bleeds “The FDA has updated the labeling for Biogen’s Alzheimer’s drug Aduhelm (aducanumab-avwa) to include a warning of potential amyloid-related imaging abnormalities (ARIA), which can lead to brain bleeding and swelling, and in some cases, intracerebral hemorrhage greater than one centimeter.”
About the public’s health
FDA advisers recommend approval of Narcan for over-the-counter use “The anti-opioid overdose drug Narcan should be made available for over-the-counter use, advisers to the Food and Drug Administration said Wednesday.
A joint FDA advisory panel unanimously voted 19-0 to recommend the agency approve the drug, which is currently only available by prescription. FDA approval would allow more people to acquire the treatment more easily in more places.”
Wolters Kluwer survey reveals two-thirds of patients still have questions after healthcare visits “The survey found that two-thirds (66%) of patients have questions after a provider encounter and one in five patients (19%) has new questions following the appointment. The research found that patients are eager to receive educational materials from their providers, but when left without those resources, patients turn to unvetted sources of information including website articles, peer recommendations, and social media.”
About healthcare personnel
Factors Associated With Primary Care Physician Decision-making When Making Medication Recommendations vs Surgical Referrals “Question How do the factors associated with primary care physician decision-making differ for medication recommendations compared with surgical referrals?
Findings This qualitative study found that primary care physicians use evidence-based decision support tools to make medication recommendations and used professional experiences, subjective information on quality, and convenience when making surgical referrals.
Meaning This study suggests that there is an opportunity to reduce variability and improve surgical outcomes by supporting primary care referral decision-making with valid and reliable data on surgeon and hospital quality.”
About health technology
GE HealthCare lands Class I recall for 1,200-pound scanners at risk of falling onto patients “GE HealthCare has begun a recall of several models of its nuclear medicine imaging systems that were found to be at risk of collapsing while in use, potentially crushing or trapping a patient underneath.”