About health insurance/insurers
Aligning fee-for-service payment rates across ambulatory settings MedPAC is recommending aligning ambulatory payment systems for hospital-owned and non hospital-owned providers by eliminating the facility fees for the former when the latter cannot charge for that item.
Biden says he’s expanding some migrants’ health care access “President Joe Biden announced Thursday that hundreds of thousands of immigrants brought to the U.S. illegally as childrenwill be able to apply for Medicaid and the Affordable Care Act’s health insurance exchanges.
The action will allow participants in the Obama-era Deferred Action for Childhood Arrivals program, or DACA, to access government-funded health insurance programs.”
Supreme Court looks at whether Medicare and Medicaid were overbilled under fraud law “The case essentially began in 2006, when Walmart upended the retail pharmacy world by offering large numbers of frequently used drugs at very cheap prices — $4 for a 30-day supply — with automatic refills. That left the rest of the retail pharmacy industry desperately trying to figure out how to compete.
The pharmacies came up with various offers that matched Walmart's prices for cash customers, but they billed Medicaid and Medicare using far higher prices, not what are alleged to be their usual and customary prices.
Walmart did report its discounted cash prices as usual and customary, but other chains did not.”
Health Coverage: State-to-State 2023 “AHIP’s Health Coverage: State-to-State details the important role health plans play in all 50 states and Washington, D.C. This report catalogues what health plans contribute in terms of: Access to health care coverage; Number of jobs the industry generates, both directly and indirectly; and Tax revenues paid to support the local economy.”
UnitedHealth Group reports $5.6B in Q1 profit, revenues up 15% year over year “UnitedHealth Group's revenue grew 15% year over year in the first quarter, reaching $91.9 billion, according to the company's earnings report released Friday.
By comparison, the insurer reported $80.1 billion in revenue for the first quarter of 2022. The healthcare giant also reported $5.6 billion in profit for the quarter, up from $5 billion in the prior-year quarter.”
Optum dives into provider loans “Optum now provides financing for healthcare organization customers who need advanced funds.
Optum Pay Advance provides a loan from Optum Bank to healthcare providers who have been Optum Pay customers for at least two years. The loan is provided with one fixed fee and the company adds repayment automatically as a percentage of the organization's future Optum Pay payments, according to the company's website.”
Humana Announces Additional $40 Million Investment in Affordable Housing “Latest round of funding raises Humana’s total financial commitment for affordable housing to $90 million, increases scope of national program to include additional communities.
Humana’s affordable housing program is intended to help vulnerable Americans remain stably housed by expanding the supply of low-cost rental units in communities nationwide, including in the states of Arizona, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Michigan, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Virginia, Washington and Wisconsin.
Humana’s national housing strategy continues to seek to address members’ housing needs through a three-part approach, including interventions and investments that reduce health care costs and improve outcomes for vulnerable members and communities.”
About hospitals and healthcare systems
M&A Quarterly Activity Report: Q1 2023 “What is increasingly clear is that a new type of post-pandemic activity is taking shape, as mid-sized regional health systems seek partners while they remain in a position of financial strength, with some looking to balance their desire to influence local healthcare delivery with utilizing the capabilities and resources of larger health systems. This trend is reflected in the rapidly increasing size of the smaller party in M&A transactions over the past few years and the number of transactions where the smaller party has between $250 million and $750 million in annual revenues.”
About pharma
Examining Opportunities to Increase Savings From Medicare Price Negotiations “Findings In this cross-sectional study analyzing 2020 Medicare prescription drug claims, including drugs with generic competitors/biosimilars and ranking drugs by net rather than gross spending was associated with increased estimated savings for 2026 for 10 Part D drugs from $3.2 billion to $9.5 billion and for 2029, when negotiation expands to 60 drugs, from $16.0 billion to $28.3 billion.
Meaning The study results suggest that as Congress considers future expansions of Medicare price negotiation, relaxing certain eligibility criteria and using net spending for drug selection may substantially increase estimated savings.”
FDA mandates new safety warnings for opioid pain medicines “The U.S. Food and Drug Administration said on Thursday it will require new safety warnings to be added in the prescribing information on labels for opioid pain relievers, including a warning about increased sensitivity to pain.
FDA said data suggests patients who use opioids for pain relief after surgery often have leftover tablets, which puts them at risk for addiction and overdose.
The updated safety warnings for these drugs will provide clarity about which patients opioid pain drugs should be prescribed to and the appropriate dosage and administration, the health regulator said.”
FTC puts health companies on watch for misleading ads “Nearly 700 companies are receiving a warning from the Federal Trade Commission about the civil penalties they face for advertisements containing claims about products that cannot be backed up with reliable evidence.
Pharmaceutical, retail, and health and wellness companies that market over-the-counter drugs, dietary supplements, homeopathic products and health foods make up a large portion of the 670 companies receiving a notice of penalties from the FTC. With the notice issued, the agency can seek civil penalties — up to $50,120 per violation — against companies that knowingly engage in marketing conduct that has been found unlawful in previous FTC administrative orders.”
About the public’s health
U.S. Malnutrition Deaths Have More Than Doubled “Deaths attributed to malnutrition more than doubled, from about 650 in 2018 to roughly 1,400 in 2022, according to preliminary death certificate data from the California Department of Public Health. The same trend occurred nationwide, with malnutrition deaths more than doubling, from about 9,300 deaths in 2018 to roughly 20,500 in 2022, according to the U.S. Centers for Disease Control and Prevention.”
High court temporarily blocks restrictions on abortion pill “In an order signed by Justice Samuel Alito, the court put a five-day pause on the fast-moving case so the justices can decide whether lower court rulings restricting the Food and Drug Administration’s approval of the drug, mifepristone, should be allowed to take effect in the short term.”
Chronic Pain Affects 21% of Americans, CDC Reports “During 2021, an estimated 51.6 million adults (20.9%) had chronic pain lasting 3 months or longer, and 17.1 million (6.9%) had high-impact chronic pain -- pain severe enough to restrict daily activities -- reported S. Michaela Rikard, PhD, of the CDC's National Center for Injury Prevention and Control, and co-authors.
Pain prevalence was higher in adults who were American Indian or Alaska Native, who identified as bisexual, or who were divorced or separated, the researchers said in Morbidity and Mortality Weekly Report.”
About healthcare IT
VA Pauses Rollout of $16 Billion Health Record System “The Department of Veterans Affairs is holding up further rollout of a problem-plagued, multibillion-dollar electronic health record system as the contract is renegotiated.
Officials from the VA and Oracle Corp., which last year acquired the company that developed the system, are in discussions about changes in the contract designed to provide the VA with a record system.
The system was adopted, in large part, because it is used by the Department of Defense and the Coast Guard and is designed to provide seamless medical records for troops from the time they enlist until the day they die.”
HIMSS 2023 Global Conference Preview and Top 5 Topics HIMSS annual conference starts today. This article provides a good summary of the major topics that will be presented.
About healthcare personnel
'Crisis' looms as 800,000 more nurses plan to exit workforce by 2027: study “The critical nursing shortage in the United States is going to get worse — much worse — according to results of a comprehensive National Council of State Boards of Nursing and National Forum of State Nursing Workforce Centers study…
Key findings of the study: Here's a breakdown of the study's main finding that one-fifth of 4.5 million nurses employed in the profession today say they intend to leave the workforce in the next four years. (Again, this statistic includes the 100,000 nurses who left the profession in the past two years.)
A total of 610,388 RNs reported an "intent to leave" the nursing workforce by 2027, citing stress and burnout as the main drivers.This number also includes retirement-related attrition.
These same challenges were most cited by another 188,962 RNs younger than 40 who also said they intended to leave the profession by 2027. In fact, there already has been a 3.3 percent decline in this age group of nurses in the past two years.
More than 33,800 licensed practical/vocational nurses have already left the profession due to pandemic burn out.”
Medscape Physician Compensation Report 2023 As usual, the top earners are plastic surgeons and at the bottom are primary care and public health physicians. One piece of good news, the gender gap has narrowed for the first time in five years.
About healthcare finance
Merck & Co. agrees to buy Prometheus for $10.8 billion “Merck & Co. announced Sunday that it agreed to acquire Prometheus Biosciences for $200 per share in cash, or a total equity value of about $10.8 billion. The company said the move will bolster its pipeline with the addition of PRA023, a late-stage asset Prometheus is working on for the treatment of ulcerative colitis (UC), Crohn's disease and other autoimmune conditions.”