HAPPY NEW YEAR!
About Covid-19
Guidance Extends FDA COVID-19 Monoclonal Antibody EUA Policy Beyond Pandemic “The 14-page guidance, “Development of Monoclonal Antibody Products Targeting SARS-CoV-2 for Emergency Use Authorization,” focuses on the data and information that may be used to support a request for emergency use authorization of a drug product to prevent or treat the virus. The guidance, set to be effective immediately, is intended to remain in effect only for the duration of circumstances that exist to justify the authorization of emergency use of COVID-19 drugs.”
About health insurance/insurers
Healthcare billing fraud: 11 recent cases Once again, most are related to federal program.
Georgia offered Medicaid with a work requirement. Few have signed up. “A GOP experiment forcing low-income people to work to qualify for public health insurance benefits is stumbling in Georgia.
The state’s Republican governor, Brian Kemp, expected 31,000 Georgians to sign up in the first year of the program, which started in July. Through four months, only 1,800 people enrolled — and critics blame the paltry expansion on an overly complex program with too many hurdles for people to clear.”
About hospitals and healthcare systems
Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition “…private equity acquisition was associated with a 25.4% increase in hospital-acquired conditions, which was driven by falls and central line–associated bloodstream infections. Medicare beneficiaries at private equity hospitals were modestly younger, less likely to have dual eligibility for Medicare and Medicaid, and transferred more to other acute care hospitals relative to control, likely reflecting a lower-risk population of admitted beneficiaries. This potentially explained a small relative reduction for in-hospital mortality that dissipated by 30 days after hospital discharge.”
Financial updates from 29 health systems: HCA, Mayo & more FYI
About pharma
McKinsey and Co. agrees to $78 million settlement over claims it helped fuel opioid crisis “Consulting firm McKinsey and Co. has agreed to pay $78 million to settle claims from insurers and health care funds that its work with drug companies helped fuel an opioid addiction crisis.
The agreement was revealed late Friday in documents filed in federal court in San Francisco. The settlement must still be approved by a judge.”
Exclusive: Drugmakers set to raise US prices on at least 500 drugs in January “Excluding different doses and formulations, more than 140 brands of drugs will have their prices raised next month, the data showed.
The expected price hikes come as the pharmaceutical industry gears up for the Biden Administration to publish significantly discounted prices for 10 high-cost drugs in September, and continues to contend with higher inflation and manufacturing costs.”
Biosimilar Uptake in Medicare Advantage vs Traditional Medicare “After accounting for some differences due to indication, biosimilar market share was consistently greater in MA than TM, aligned with other studies supporting more lower cost prescribing substitution in MA.
A study of lower cost uptake in Medicaid of an insulin biosimilar and complex generic found uptake was more than 10 times higher in managed care vs fee-for-service Medicaid. One suggested explanation was differential statutory state inflation rebates in managed care vs fee-for-service payers. Implementing the Medicare inflationary rebate may also affect MA and TM biosimilar uptake.”
About healthcare personnel
Medical group expenses per physician top $1M “Medical group revenue per physician jumped 16.7% in 2023 but expenses are also on the rise, according to the AMGA Medical Group Operations and Finance Survey.
The median revenue per physician hit $719,901, which is up even 9.1% from pre-pandemic levels, while the median expense per physician soared 14.7%, hitting $1.03 million for the year.
System-affiliated medical groups reported an annual loss of $249,000 on average, according to the survey of more than 15,000 providers. Labor costs and changes to the CMS fee schedule in addition to other policy updates have driven financial trends for the last 12 months.”
Comment: The actual “loss” for system-affiliated groups is debatable, since allocated costs may be higher than with free-standing groups.