Ave Atque Vale: Victor R. Fuchs, ‘Dean’ of American Health Care Economists, Dies at 99 Read the entirety of the article or, if not accessible, find a medium that is. Professor Fuchs was one of the most influential health economists of the past 50 years.
About Covid-19
Did the government get a bad deal on the Covid-19 boosters? “[HHS Secretary] Becerra said then that the price that the federal government will pay for some vaccines “will be similar to what we paid in the past for the vaccines.”
However, the Centers for Disease Control and Prevention is paying $81.61 for the Moderna booster this year, and $85.10 for the Pfizer shot — which is around triple the amount the federal government paid for each shot last year. Moderna charged the government $26.36 per booster dose last year, and Pfizer charged $30.48.
The change is partly because the federal government ran out of money to continue to buy the vaccines in bulk to distribute across the country, so the vast majority of vaccine purchases are instead flowing through normal channels and will be paid for by a variety of different insurance plans this year, including Medicare and Medicaid.”
Effectiveness of Maternal mRNA COVID-19 Vaccination During Pregnancy Against COVID-19–Associated Hospitalizations in Infants Aged <6 Months During SARS-CoV-2 Omicron Predominance — 20 States, March 9, 2022–May 31, 2023 “During the period of recent SARS-CoV-2 Omicron predominance, maternal receipt of an mRNA COVID-19 vaccine during pregnancy reduced the likelihood of COVID-19-related hospitalizations and serious complications among infants aged <6 months.”
The Top COVID-19 Hot Spots in the U.S. “After increasing for nine consecutive weeks, COVID-19 hospitalizations in the U.S. have declined week over week, based on data from the Centers for Disease Control and Prevention.
The U.S. tallied about 19,700 new hospitalizations of people with COVID-19 over the seven days ending Sept. 16, marking a 4% decline from the week ending Sept. 9 and disrupting an upward trend that started at the end of June after hospitalizations had dipped to approximately 6,300.”
Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study “After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.”
Merck & Co.'s molnupiravir tied to transmissible COVID virus mutations: study “New findings published in the journal Nature suggest Merck & Co.'s oral antiviral treatment molnupiravir can cause mutations in the COVID-19 virus that occasionally spread to other people, potentially fuelling the evolution of new variants. However, there has been no evidence that the drug, which is also known under the brand name Lagevrio, has produced more transmissible or severe strains of COVID, according to the study.”
Biden administration draws commitment from health insurers to cover COVID-19 shots “The Department of Health and Human Services (HHS) met with representatives from the health insurance industry on Wednesday, receiving commitments that the updated COVID-19 vaccines will be covered after reports arose of some people having to pay out-of-pocket for their immunizations.”
About health insurance/insurers
Deloitte Analysis: Employed Women Have as Much as $15.4 Billion More in Out-of-Pocket Medical Expenses a Year Than Men “Deloitte health actuaries found that women not only generally have more out-of-pocket medical expenditures than men but get less coverage for every health insurance premium dollar spent. Key takeaways:
· Employed women have as much as $15.4 billion more a year than men in out-of-pocket health care expenses.
· At all ages between 19 and 64, women have more in average out-of-pocket health care expenses than men, excluding maternity claims.
· For people with commercial insurance, the value of benefits for women is more than $1.3 billion less than men.
· The cost to employers to cover this actuarial value gap is less than $12 per employee or less than $1 a month.”
Federal Subsidies for Health Insurance: 2023 to 2033 From the CBO. The entire report is worth at least a skim. Overall: “Net federal subsidies for health insurance (that is, subsidies minus certain payments, such as Medicare premiums, amounts paid to providers and later recovered, and penalty payments) are projected to total $1.8 trillion in 2023 and $3.3 trillion in 2033. Measured as a share of gross domestic product (GDP), those subsidies are estimated to amount to 7.0 percent and 8.3 percent, respectively.”
Florida nurse convicted for fraudulent orders billing Medicare for $200M “A Florida nurse practitioner was convicted this week by a federal jury for her participation in a $200 million healthcare fraud scheme.
Elizabeth Hernandez, 45, ‘signed thousands of orders’ for orthotic braces and genetic tests that were medically unnecessary and billed to Medicare, the Department of Justice (DOJ) said in a release announcing the conviction.”
Physician and Two Pharmacists Charged for $170M Fraud Scheme “According to court documents, Shalondria Simpson, 45, of Houston, is a pharmacist who owned and operated two pharmacies in Houston: Advance Pharmacy (Advance) and TruCare Pharmacy (TruCare). Simpson’s twin sister, physician Lashondria Simpson-Camp, 45, of Allen, Texas, allegedly referred prescriptions to Advance and TruCare in exchange for illegal kickbacks and bribes. Shayla Bryant, 38, of Houston, was a pharmacist and Advance and TruCare’s business manager.”
CMS: Most Medicare Advantage beneficiares won't see premiums rise in 2024 “The average monthly plan premium for MA plans, which is projected to increase nearly 4%, will go up from $17.86 to $18.50, but, if enrollees choose to stay in their plan, they will likely not see any price increase, according to a press release. Ahead of Medicare’s open enrollment period beginning Oct. 15, CMS expects 73% of beneficiaries will not see a premium increase, while the number of plans and supplemental benefits will both increase.”
Biden administration to ban medical debt from Americans' credit scores “The Biden administration announced a major initiative to protect Americans from medical debt on Thursday, outlining plans to develop federal rules barring unpaid medical bills from affecting patients’ credit scores.
The regulations, if enacted, would potentially help tens of millions of people who have medical debt on their credit reports, eliminating information that can depress consumers’ scores and make it harder for many to get a job, rent an apartment, or secure a car loan.”
Federal government to propose setting IDR fee under No Surprises Act at $150 “The federal government released preliminary documents Thursday, indicating that it plans to set the administrative, per-party fee for resolving out-of-network payment disputes at $150 in 2024.
Back in August, a district court sided with physicians in one of several lawsuits related to the No Surprises Act, which is aimed at protecting patients from unexpected IOUs. The Texas Medical Association and others had challenged the feds for hiking this fee by 600%, up to $350 from the original $50.”
Ensuring Continuous Eligibility for Medicaid and CHIP: Coverage and Cost Impacts for Adults “If all states adopted 12-month continuous eligibility for adults, 451,000 more adults would be enrolled in Medicaid in an average month in 2024, a 1.3 percent increase. There would be 267,000 fewer uninsured people in an average month, and the reduction in the number of people uninsured at any time would be greater. Federal and state spending in 2024 would increase by $479 million and $158 million, respectively. Both are increases of only 0.1 percent in spending on acute care for the nonelderly. Households and employers would each save about $1 billion a year in health care spending, and total health care spending would decline by $1.8 billion in 2024. Continuous eligibility for 24 months would further expand coverage and reduce costs.”
About hospitals and healthcare systems
Hospital Concentration Decreases Care for Medicaid Beneficiaries
“Concentration and Medicaid Admissions:
—A 1% increase in a hospital-specific measure of concentration was associated with a 0.59% decrease in admissions for Medicaid patients at the average hospital level.
—The impact of concentration was more pronounced for birth admissions and was associated with a 1.3% decrease in birth admissions compared to a 0.51% decrease for other Medicaid patients' admissions.
—Hospital mergers, a strong driver of hospital concentration, were linked to decreases in birth admissions for Medicaid patients at the hospital level.
—There were very small overall market-level decreases in admissions to any hospital following concentration, suggesting reduced access to inpatient care.
Impacts for Non-Profit and Public Hospitals:
Among non-profit hospitals, a 1% increase in a hospital-specific measure of concentration was associated with an average 1.42% decrease in Medicaid birth admissions, while public hospitals experienced an increase of 1.38%.
Physicians:
Concentration was associated with physicians serving high shares
of Medicaid patients attending fewer deliveries in non-profit hospitals, indicating that physician admitting privileges could be a key mechanismdriving the shift in patient flows from non-profit to public hospitals.”
CommonSpirit’s answer to losing money: get bigger “CommonSpirit Health keeps adding more hospitals — and billions in new debt — even as it bleeds money.
Formed through a 2019 merger and headquartered in Chicago, CommonSpirit is one of the country’s largest not-for-profit health systems, with north of 140 hospitals. Even though it has scale, the system has lost money almost every year since its inception, including $2.7 billion on operations in the past two years. CommonSpirit’s latest financial statement also shows its total debt grew $2.9 billion in the year that ended June 30.”
Ascension outlook revised to negative “While affirming its default rating and $6.6 billion of bonds at "AA+," Fitch Ratings on Sept. 26 lowered the outlook for St. Louis-based Ascension to negative from stable.
The move followed Ascension reporting a $3 billion operating loss Sept. 14, an amount described by Fitch as "noteworthy." Operating margins will be pressured for the near term even as improvements are expected in the long term, Fitch said, with a 3 percent figure expected in the next several years.”
How 23 health systems' labor costs are trending FYI
Hospital Finances Stabilize with Six Months of Positive Margins “Key trends for the month include:
Median hospital operating margins increased in August after dropping nearly one percentage point the month before, signaling that hospital finances are stabilizing with six months of positive results
Outpatient revenue had sizable increases for the month due to the ongoing shift in care to less expensive and more convenient ambulatory settings
Hospitals saw fewer high-acuity patients, as evidenced by a decline in the lengths of inpatient stays and minimal movement in the share of patients held for inpatient observation
Hospital supply and drug expenses continued to climb both on an overall and per-patient basis, driving up total non-labor costs”
How One Health System Got Rid of Bureaucratic Busywork Well-worth a quick read. The article summarizes elimination of needless work that was adding thousands of hours of work.
Costco expands healthcare footprint, teams up with Sesame to offer members $29 virtual care visits Several years ago, who would have thought that Costco would have been mentionedd in the same sentence as “healthcare?”
“Costco is joining retail competitors Walgreens, Walmart and CVS Health by expanding its healthcare footprint.
The big-box retailer teamed up with startup Sesame to offer special discount pricing to Costco members on a broad range of outpatient medical care services, including telehealth visits. Costco members nationally can book appointments directly through their Costco memberships for Sesame's "best pricing" including virtual primary care visits for $29 and online mental health therapy visits for $79.”
About pharma
Rite Aid Plans to Shut Down Hundreds of Stores in Bankruptcy “Rite Aid is negotiating with creditors over the terms of a bankruptcy plan that would include liquidating a substantial portion of its more than 2,100 drugstores, according to people familiar with the talks.
Rite Aid has proposed to close roughly 400 to 500 stores in bankruptcy, and either sell or let creditors take over its remaining operations, one of the people said.”
EXCLUSIVE: The 340B Program Reached $54 Billion in 2022—Up 22% vs. 2021 “For 2022, discounted purchases under the 340B program reached a record $53.7 billion—an astonishing $9.8 billion (+22.3%) higher than its 2021 counterpart. The difference between list prices and discounted 340B purchases also grew, to $52.3 billion (+$2.6 billion).
Hospitals accounted for 87% of 340B purchases for 2022. Every 340B covered entity type experienced double-digit growth, despite drug prices that grew more slowly than overall inflation.
Another surprise: HRSA estimated that manufacturers' contract pharmacy restrictions reduced 340B purchases by only $470 million—or less than 1% of 2022's total purchases. That's far below the figure quoted by 340B lobbyists.”
Wegovy, other weight-loss drugs scrutinized over reports of suicidal thoughts “The U.S. Food and Drug Administration has received 265 reports of suicidal thoughts or behavior in patients taking these or similar medicines since 2010, Reuters found in an examination of the agency's adverse-event database. Thirty-six of these reports describe a death by suicide or suspected suicide.”
THE BURDEN OF PATENT THICKETS “Extending patent protection nets drugmakers $158 billion on just four drugs.” Wel-worth reading the entire article.
Cough syrup deaths overseas prompt US crackdown on toxic testing “The U.S. FDA is cracking down on lax testing practices by dozens of makers of healthcare products following hundreds of deaths overseas from contaminated cough syrups, a Reuters review of regulatory alerts found.
The Food and Drug Administration has reprimanded at least 28 companies this year, saying they failed to prove sufficient testing of ingredients used in over-the-counter drugs and consumer products for the toxins ethylene glycol (EG) and diethylene glycol (DEG), according to a Reuters analysis of agency import alerts and warning letters to manufacturers.”
About the public’s health
Sedentary Behavior and Incident Dementia Among Older Adults “In this retrospective study of prospectively collected data of 49 841 adults participating in the UK Biobank, more time spent in sedentary behaviors (determined through a machine learning–based analysis of wrist-worn accelerometer data) was significantly associated with higher risk of incident dementia.”
Sedentary behavior counteracts the beneficial effects of exercise.
Biden plans $100 million drive to combat drug-resistant 'superbugs' The headline is the story.
In a related article that is worth reading in its entirety: The World Needs New Antibiotics. The Problem Is, No One Can Make Them Profitably. “Six startups have won Food and Drug Administration approval for new antibiotics since 2017. All have filed for bankruptcy, been acquired or are shutting down. About 80% of the 300 scientists who worked at the companies have abandoned antibiotic development, according to Kevin Outterson, executive director of CARB-X, a government-funded group promoting research in the field…
The reason, the companies say: They couldn’t sell their lifesaving productsbecause the system that produces drugs for cancer and Alzheimer’s disease—which counts on companies selling enough of a new treatment or charging a high enough price to reward investors and make a profit—isn’t working for antibiotics.”
CDC data shows obesity prevalence more common in a growing number of states According to data from the Centers for Disease Control (CDC), the prevalence of obesity is rising all across the nation.
The CDC data found that 22 states had a prevalence, or “proportion of adults with a body mass index (BMI) equal to or greater than 30,” of obesity over 35 percent in 2022. In comparison, 17 states had a prevalence of obesity over 35 percent in 2021.”
LDL-C Reduction With Lipid-Lowering Therapy for Primary Prevention of Major Vascular Events Among Older Individuals “Our study supports a relative clinical benefit of lowering LDL cholesterol for primary prevention of major vascular events in individuals aged ≥70 years similarly as in individuals aged <70 years.”
Surrogate Adiposity Markers and Mortality “Question Among body mass index, fat mass index, and waist-to-hip (WHR) ratio, what is the optimal adiposity measure with the strongest association with mortality outcomes in adults?
Findings In this cohort study consisting of 387 672 UK adult participants from the UK Biobank, WHR was found to have the strongest and most consistent association with all-cause and cause-specific mortality.
Meaning In this study, WHR had the most robust association with mortality risk and may serve as a more appropriate target for health care intervention.”
In new effort to reset flu shot expectations, CDC to avoid messages that "could be seen as a scare tactic" “ ‘People are more likely to perceive messages as credible and trustworthy if they set realistic expectations about what vaccines can and cannot do,’ the CDC's Sara Dodge Ramey told a panel of federal vaccine advisers at a meeting Friday.
Ramey said the agency's new ‘Wild to Mild’ campaign had been created as the result of a dozen focus groups in June and July earlier this year.
That led to them rolling out a campaign this year carefully crafted to ‘avoid messages that could be seen as a scare tactic,’ she said, acknowledging some voiced ‘fatigue’ around talking about important steps to avoid dying from respiratory diseases this fall and winter.”
Biden signs bill introducing more competition to US' organ transplant network “President Joe Biden signed into law Friday a bipartisan bill that overhauls the country’s organ transplant system by increasing competition among contractors and paving the way for additional funding…
Alongside the open bidding, the new law eliminates a funding cap to make way for several network reforms floated by the Department of Health and Human Services’ Health Resources and Services Administration (HRSA) back in March.
That so-called OPTN Modernization Initiative already began with a data dashboard sharing de-identified information on donors, procurement, transplant waitlists and recipients, and with the funds would continue with other IT updates and increased independence of OPTN’s board of directors through the contracting process, per plans shared by HRSA.”
About healthcare IT
Private insurer payments for telehealth and in-person claims during the pandemic “In 2021, as was the case in 2020, private insurers continued to pay providers similarly for telehealth and in-person professional claims, on average. This is true for both evaluation and management and mental health therapy services. Among providers who offered both telehealth and in-person care, the vast majority of providers received similar payments regardless of whether the service was provided in-person or over telehealth.”
Amazon moves into healthcare generative AI with $4B investment “Amazon is making a big bet on generative artificial intelligence — and its use in healthcare — with a $4 billion investment in AI company Anthropic.
The tech giant will take a minority ownership in the startup and incorporate Anthropic's AI assistant, Claude, into Amazon Bedrock, Amazon Web Services' new generative AI service.”
Telehealth: The Innovation That’s Not Yet a Habit “The Top Takeaways: A few services lead telehealthuse, but the picture is mixed. Providers use telehealth for follow-up more than any other reason, with behavioral health second. All other services rank well below these two.
—Highest Use: Follow-up visits comprise 37% of practice telehealth services and 27% of hospital services.
—Lowest Use: Providers use telehealth the least for initial visits (11%) and triage (5%).
— Increases: For practices, the biggest year-over-year usage gain was for behavioral health (13% to 20%); for hospitals, it was for chronic care management (8% to 19%).
—Decreases: Telehealth year-over-year use declined the most for hospital initial visits (21% to 11%).
—2025 Projections: Practices expect telehealth use to increase the most for behavioral health and primary care (4% each). Hospitals project that behavioral health services will grow from 20% to 31%.”
About healthcare personnel
75,000 Kaiser workers plan to strike: 6 things to know FYI
The less than 1%: 49 hospitals with 5+ Magnet certifications “Of the 6,000-some hospitals in the United States, less than 1 percent have achieved five Magnet certifications.
Forty-nine hospitals have at least five Magnet certifications, and 14 — or 0.23 percent — have more than five, according to the American Nurses Credentialing Center's website.”
CMS' staffing proposal will cost nursing homes $6.8B for 102K nurse hires, industry-backed report finds “Meeting the Biden administration’s minimum staffing proposals for nursing homes would require facilities nationwide to hire more than 102,000 additional nurses at a cost of $6.8 billion, well above the government’s $4 billion estimate, according to a report released Tuesday by an industry group.”
About health technology
Sources of Low-Value Care Received by Medicare Beneficiaries and Associated Spending Within US Health Systems “In this national analysis, specialists accounted for a higher share of spending relative to volume across 40 low-value services, building on evidence that specialists have greater aggregate low-value spending to suggest they may both offer higher-cost services (eg, procedures) and use higher cost options within given low-value service definitions. PCPs ordered most examined drugs and laboratory tests, which have lower direct costs but potential for direct harms and care cascades. To encourage employed and affiliated clinicians to reduce these services, health systems could use evidence-based interventions including clinical decision support (eg, point-of-care alerts) and clinician feedback (eg, peer comparisons).”
About healthcare finance
Virgin Pulse, HealthComp to merge in $3B deal aimed at improving employer health “Virgin Pulse and benefits administrator HealthComp are set to merge in a $3 billion deal that aims to drive lower costs and improve outcomes for employers.
The deal was first reported in The Wall Street Journal. Virgin Pulse is backed by Marlin Equity Partners and HealthComp is backed by New Mountain Capital, according to the report. New Mountain will hold a majority ownership of the new, combined company.”
Intercept, once a biotech trailblazer, sells itself for less than $1 billion “Intercept Pharmaceuticals, a firm whose treatment for a prevalent liver disease once made it the hottest stock in biotech, said Tuesday it would sell the company for less than $1 billion.
Alfasigma, an Italian pharmaceutical firm, will pay $19 a share for Intercept, in a roughly $800 million cash deal that represents an 80% premium to the company’s recent trading price. Intercept expects the deal to close by the end of the year.”
Pfizer hooks up with Ginkgo for $331M biobucks deal on unspecified targets “Ginkgo Bioworks has snared one of its biggest partners to date. The biology biotech will work with none other than Pfizer in a drug discovery deal for RNA medicines worth $331 million in biobucks for three programs.
The companies did not break down the deal details, but the $331 million encompasses an upfront payment, research fees and development and commercial milestone payments plus royalties later on.”