About Covid-19
U.S. court upholds block on Biden's vaccine order for federal workers “A federal appeals court in New Orleans on Thursday upheld a judge's ruling blocking enforcement of President Joe Biden's 2021 executive order requiring all federal employees take a COVID-19 vaccine.”
About health insurance/insurers
Reducing Medicare Advantage Benchmarks Will Decrease Plan Generosity, But Those Effects Will Likely Be Modest “We assessed the relationships between MA benchmarks and plan generosity and benefits. We estimated that a $1,000 per year decrease in benchmarks would lead to small increases in annual premiums of about $60 and increases in annual deductibles of about $27. Copays would also increase modestly, and the propensity to offer benefits would generally decline by less than 5 percentage points, with the greatest impact being on the availability of dental, hearing, and vision benefits. These results suggest that although cuts to MA benchmarks would adversely affect plan generosity, those effects would be modest.”
UPMC for You partners to offer Medicaid redetermination coverage in laundromats “Ahead of Medicaid redeterminations on April 1, UPMC's Medicaid managed care plan has announced a partnership with Fabric Health to provide on-site health support and social services access in certain laundromats.
The initiative with UPMC's Medicaid plan UPMC for You, will provide WiFi access as Fabric Health staff in laundromats help individuals navigate access to preventative and other healthcare coverage, apply for assistance programs, including Medicaid, SNAP and LIHEAP, and connect with other support services, UPMC said.
With over 32 million Americans using a laundromat each week, these businesses provide opportunities to connect with individuals who may need support, according to Fabric Health, that provides engagement in laundromats.”
Comment: The outreaches to such organizations as churches and barber shops are well-know. However, this program is very creative and, to my knowledge, unique. Are there other commonly used site that could be useful?
CVS set to close $8B deal for health services company Signify Health FYI
How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them An exposé by ProPublica well-worth reading. This essence of the article is: Cigna “has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials. Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show.”
9 in 10 employers plan to change health and wellbeing vendors in next two years, WTW survey finds
“…the survey of 232 U.S. employers found nearly nine in 10 respondents (88%) are planning to make changes to their vendor partnerships either this year or next. Such changes include adding, enhancing or ending various solutions and services, or working with a different vendor in the foreseeable future.”
Comment: More details about types of vendors are in the article. While these these turnover numbers are extraordinarily high, the reasons for these changes are not clear. The article hints a link to ROI, which means companies are not finding these programs cost-effective, or even effective.
TWO OUT OF THREE PATIENTS HAVE NEVER DISPUTED A MEDICAL BILL “Almost two-thirds of respondents (64%) said they have never disputed the accuracy or validity of a bill, which was the case for 78% of uninsured individuals.
While 78% of respondents reported getting charges reduced or removed when they did contest a bill, it sometimes took more than six months for it to be resolved.”
Comment: One reasons patients do not challenge bills is that they do not understand them. Also, with the increased use of EMRs, copy and paste notes often do not accurately reflect the visit—leading to incorrect billing.
About healthcare quality
Consultation With Reduction in Adverse Postoperative Outcomes and Use of Processes of Care Among Residents of Ontario, Canada “In this cohort study, preoperative medical consultation was not associated with a reduction but rather with an increase in adverse postoperative outcomes, suggesting a need for further refinement of target populations, processes, and interventions related to preoperative medical consultation. These findings highlight the need for further research and suggest that referral for preoperative medical consultation and subsequent testing should be carefully guided by individual-level consideration of risks and benefits.”
Comment: As an accompanying editorial states: “Given the potential risks of preoperative evaluation, follow-up testing, procedures, and treatment, as well as its role in delaying needed surgeries, randomized clinical trials are urgently needed to document the risks and benefits of this common process.”
About hospitals and healthcare systems
MARCH 2023 National Hospital Flash Report “Key Takeaways:
A new normal continues to emerge.
Hospital margins in February were down slightly from the previous month. This represents the eighth straight month in which the variation in month-to-month margins has decreased relative to the last three years. Due to external economic factors, relatively flat margins are likely to continue in the near term.Volumes stay relatively steady.
Due to the shorter month, discharges, patient days, and ED visits were all down slightly in February compared to January. On a per-day basis, however, hospitals experienced moderate growth in volumes in February. Average length of stay in the hospital was down, and patients continued to shift to ambulatory settings, with ambulatory surgery centers and outpatient operating rooms minutes seeing volume increases last month.Outpatient settings drive revenue.
The onset of the COVID-19 pandemic kickstarted a shift in patient behavior that continues today. Patients continue to seek more of their care away from inpatient settings. This is illustrated in outpatient revenues continuing to grow in early 2023.Costs of goods and services are increasing faster than labor.
Hospitals continue to face labor shortages. Labor expenses, however, appear to be holding steady indicating less dependence on contract labor. Meanwhile, inflation and pricing pressures are leading to significant cost increases in goods and services. This represents a change in what is driving hospital expenses from labor to the costs of goods and services.”
What’s Behind Losses At Large Nonprofit Health Systems? “We collected the most recent quarterly financial statements from 10 nonprofit hospital systems: Advent, Ascension, Advocate Aurora, CommonSpirit, Mass General Brigham, Sutter, Trinity, UPMC, Northwell, and Providence. Financial statements were downloaded from each hospital system’s website. These systems were selected due to their size and the public availability of their financial reports. While this did not constitute a statistically representative sample, it did provide insight into the financial profiles of some of the nation’s largest systems and the most important factors behind those profiles.
All 10 hospital systems reported negative overall profit margins (net income divided by revenue). Average overall profit margin fell from 9 percent in 2021 to -6 percent in 2022.
Large nonprofit health systems are reporting financial strain, even as the worst of the pandemic has passed. This financial strain is driven primarily by investment losses. [Emphasis added] Stock markets struggled in 2022, with the S&P 500 declining in value by approximately 20 percent. Hospital systems that invest heavily in stock markets, like many large nonprofit organizations, may be particularly exposed to these financial headwinds. Hospital systems that also invest in private equity funds, such as Ascension, are also subject to the financial risks of their specific funds.”
About pharma
Genomadix Genetic Test for Potential Drug Effectiveness Cleared “Genomadix has received FDA clearance for its Cube CYP2C19 test for assessing the potential effectiveness of drugs metabolized by the CYP450 2C19 genetic pathway.
The polymerase chain reaction test, which determines the presence of several gene mutations from swab taken from inside the mouth, delivers results in about an hour.”
Comment: This metabolism pathway for many drugs can guide dosing of some medications. The question is: Is it necessary and cost-effective. Past research on Coumadin (warfarin) showed that testing for CYP450 did not add to efficacy or reduce side effects.
Top 10 pharma R&D budgets in 2022 FYI
About the public’s health
Minnesota suit against e-cigarette maker Juul goes to trial “Minnesota Attorney General Keith Ellison is slated to lead off opening statements expected for Tuesday in his state’s lawsuit against Juul Labs – marking the first time any of the thousands of cases against the e-cigarette maker over its alleged marketing to young people is going to play out in a courtroom.”
US FDA seeks to allow salt substitutes in everyday foods “The U.S. Food and Drug Administration (FDA) on Friday said it was proposing a rule to allow the use of salt substitutes in everyday foods including cheese, frozen peas and canned tuna, in a bid to cut Americans' salt consumption.”
About healthcare IT
FDA outlines plan for digital health technologies for clinical trials “The US Food and Drug Administration (FDA) plans to hold at least one public meeting and release several guidances on digital health technologies (DHT) to be used in drug clinical trials by the end of the year. While it has issued guidances on digital health products generally, there is still concern about whether such products are accurate and reliable enough to gather data for the drug development process.
As part of FDA’s commitment under the Prescription Drug User Fee Act (PDUFA VII), the agency published a framework on 23 March on how it plans to address long-standing questions on the use of DHTs in drug clinical trials.”
Digital Access Coordinator Program Pilot Site Launches at Mass General “Mass General Brigham has launched a Digital Access Coordinator (DAC) Program pilot site at Mass General – a United Against Racism initiative to address gaps in digital literacy and increase patient access to tools, including Patient Gateway and virtual visits.”
Comment: While this announcement was published last June, I just found it and thought it was a very creative solution.
FBI Internet Crime Report 2022 Well worth scanning, particularly because among infrastructure sectors victimized by ransomware, healthcare is far and away the most frequently affected (see page 14).
Also, see page 18—losses are directly correlated to age.
About healthcare personnel
Healthcare employment rebounds to pre-pandemic levels “Contrary to widespread reports of staffing shortages, healthcare employment reached pre-pandemic levels with the addition of 44,200 jobs in February, according to a recent report from Altarum.”
About health technology
Combining Acoustic Bioprinting with AI-Assisted Raman Spectroscopy for High-Throughput Identification of Bacteria in Blood Don’t let the title dissuade you from scanning this article. This technology allows rapid identification of pathogens- which can guide early treatment.