HealthcareInsights.MD will be on vacation for the holidays
and will resume January 6, 2025.
I wish you health and happiness in the coming year.
About health insurance/insurers
BCBS antitrust settlement provider website goes live “The website was launched after the Blue Cross Blue Shield Association, along with the 33 independent BCBS companies, agreed to pay $2.8 billion to settle antitrust claims from healthcare providers, marking the largest settlement of its kind in the healthcare industry. The settlement was reached in October. An Alabama court granted the agreement preliminary approval on Dec. 4.”
Medical and Surgical Episodes Among Hospital Participants in the Bundled Payments for Care Improvement–Advanced Program “Findings In this cohort study that included 2 895 878 episodes, BPCI-A participation was associated with a decrease in Medicare payments of $882 per episode for medical episodes and $587 per episode for surgical or procedural episodes, a difference of $295 per episode that did not reach statistical significance when compared in absolute terms….
Conclusions and Relevance In this cohort study analyzing the outcomes of the BPCI-A program for medical and surgical episodes, BPCI-A participation was associated with modestly decreased payments for both medical and surgical episodes compared with nonparticipants. Improvements in clinical outcomes associated with BPCI-A participation were also modest for both types of episodes; this study does not support a hypothesis that either medical or surgical episodes are better-suited for episode-based payments….
[However:] Our study has limitations. The planned duration of the BPCI-A program was 8 years, and we only analyzed the first 12 months. Previous studies have shown that several years of participation may be required before changes in payments and improvements in quality attain statistical significance. We only evaluated the hospital program, and not the PGP [Physician Group Practice] component; we can draw no conclusions about the efficacy of the PGP experience under bundling.”
About hospitals and healthcare systems
10 headwinds for health systems in 2025 A really good summary.
About pharma
PhRMA dues fell almost $100 million as major drugmakers exited “Three large pharmaceutical companies left the brand-drug lobby PhRMA after the passage of Democrats’ drug pricing law in 2022. Following the exits, the organization collected $100 million less in annual membership dues, new tax filings show.”
HHS releases latest round of prescriptions in Medicare rebate program including cancer drugs “The 64 drugs with reduced co-insurance costs for Medicare patients include Kepivance, which treats mouth sores caused by chemotherapy, Talvey, used to treat patients with multiple myeloma, and Yescarta for recurrent or treatment-resistant blood cancer.”
About the public’s health
US flu season is underway, as cases surge in some areas and vaccinations lag “The Centers for Disease Control and Prevention noted sharp increases in several measures, including lab tests and emergency room visits.”
Trump’s Return May Worsen Financial Woes for Global Health Institutions “Currently, the United States provides about half of all aid for global health, exceeding that of all other donor countries combined. In 2020, Mr. Trump began the process of pulling the United States out of the World Health Organization and sought to slash American donations to the Global Fund to Fight AIDS, Tuberculosis and Malaria and to PEPFAR, a program that supplies much of the H.I.V. treatment to Africa.”
A really good article that summarizes the sources of financial aid to developing countries.
About healthcare IT
About healthcare quality
Variation in Emergency Department Physician Admitting Practices and Subsequent Mortality “In this cross-sectional study using electronic health record data from more than 2 million ED visits treated by 2098 physicians across 105 EDs, being treated by a physician with an admission propensity at the 90th percentile relative to a physician at the 10th percentile nearly doubled a patient’s probability of being admitted to the hospital but did not reduce their subsequent mortality rate.”
Aligning Quality Measures Across CMS - the Universal Foundation “To further the goals of the CMS National Quality Strategy, CMS leaders from across the Agency have come together to streamline quality measures across CMS quality programs for the adult and pediatric populations. This “Universal Foundation” of quality measures will focus provider attention, reduce burden, identify disparities in care, prioritize development of interoperable, digital quality measures, allow for cross- comparisons across programs, and help identify measurement gaps.”
About healthcare technology
FDA designates Neuralink brain implant, infectious disease tests as ‘breakthroughs’ “A brain implant to restore vision loss made by Elon Musk’s Neuralink and several tests to detect infectious diseases are among the latest medical devices to receive “breakthrough” status from the Food and Drug Administration.”