About quality and safety
Top 10 Patient Safety Concerns 2024 “The [ECRI] List for 2024
1. Challenges Transitioning Newly Trained Clinicians from Education into Practice
2. Workarounds with Barcode Medication Administration Systems
3. Barriers to Access Maternal and Perinatal Care
4. Unintended Consequences of Technology Adoption
5. Decline in Physical and Emotional Well-Being of Healthcare Workers
6. Complexity of Preventing Diagnostic Error
7. Providing Equitable Care for People with Physical and Intellectual Disabilities
8. Delay in Care Resulting from Drug, Supply, and Equipment Shortages
9. Misuse of Parenteral Syringes to Administer Oral Liquid Medications
10. Ongoing Challenges with Preventing Patient Falls”
About health insurance/insurers
Medicare announces emergency funds for doctors affected by Change Healthcare hack “Federal health officials on Saturday said they would offer emergency funding to physicians, physical therapists and other professionals that provide outpatient health care, following a cyberattack that crippled the nation’s largest processor of medical claims and left many organizations in financial distress.
The Centers for Medicare and Medicaid Services also announced that it would make advance payments available to suppliers that bill through Medicare Part B, which serves a wide array of health-care organizations.”
United’s surreptitious surgery center buying spree “UnitedHealth Group is so big that it doesn’t have to publicly announce a vast majority of its acquisitions. But a STAT analysis of company financial documents shows the health care conglomerate quietly acquired dozens of outpatient facilities in 2023, with a particular focus on surgery centers.
And it’s not adding random surgery centers, either. There seems to be an explicit strategy: Many of UnitedHealth’s new centers sit in geographic areas where the company is the biggest Medicare Advantage player, based on the latest insurance market share data. That overlap reinforces how UnitedHealth is looking to funnel more of its insurance members toward providers that it owns, with the overarching goal of capturing more profit.
One of the biggest undisclosed transactions came this past December, when UnitedHealth bought National Cardiovascular Partners from Fresenius Medical Care. The only mention of NCP is buried within UnitedHealth’s annual report for investors, where the company listed “NCP Investment Holdings, Inc.” as a new subsidiary. Fresenius confirmed to its investors in January that it sold NCP, which operates 21 cardiac cath and vascular labs. But Fresenius never disclosed the buyer and erased NCP information from its website. And wouldn’t ya know it: NCP’s facilities are located in places like Phoenix and large metro areas in Texas where UnitedHealth has the biggest MA market share.”
CBO’s Approach to Estimating the Budgetary Effects of the No Surprises Act of 2021 “In CBO’s estimation, prohibiting surprise billing:
Reduces insurers’ spending for previously covered out-of-network care;
Increases spending on previously uncovered out-of-network services—both directly (by increasing what is covered) and indirectly (because patients consume more care); and
Reduces negotiated prices for all in-network care. Setting the benchmark amount for payment disputes at the median in-network rate reduces in-network prices.”
Tunneling and Hidden Profits in Health Care “This study examines “tunneling” practices through which health care providers covertly extract profitby making inflated payments for goods and services to commonly-owned related parties. While incentivesto tunnel exist across sectors, health care providers may find it uniquely advantageous to do so. Maskingprofits as costs, thereby obscuring true profitability, may dissuade regulators from imposing stricterquality standards and encourage public payers to increase reimbursement rates. Likewise, tunnelingeffectively “shields” assets from malpractice liability risk, by moving them off the firm’s balance sheet.Using uniquely detailed financial data on the nursing home industry, we apply a difference-in-differencesapproach to study how firms’ stated costs change when they start transacting with a related party,allowing us to infer by how much these payments are inflated. We find evidence of widespread tunnelingthrough inflated rents and management fees paid to related parties. Extrapolating these markups to allfirms’ related party transactions, our estimates suggest that in 2019, 63% of nursing home profits werehidden and tunneled to related parties through inflated transfer prices.”
Comment: This research raises n important issue in evaluating insurance company medical loss ratios. If a company creates a related subsidiary and pays excess fees, the higher MLR will protect it from penalties.
This issue was discussed in a paper last year from USC- Brookings:Medicare Advantage spending, medical loss ratios, and related businesses: An initial investigation. The authors found: “Transfer prices among related parties for multi-entity health care enterprises are typically not publicly available…. the increased health cost spending reduces profits from MA business, but transactions with related parties can still represent profits to the parent company, especially if higher transfer prices allow the plans to evade the MLR regulations.” The authors estimates this effect over several years.
About hospitals and healthcare systems
From -6.8% to 12.2%: 34 health systems ranked by operating margins FYI
Hackensack Meridian hospitals first to attain Joint Commission's new sustainability certification “Four Hackensack Meridian Health (HMH) hospitals are the first in the country to achieve the Joint Commission’s sustainable healthcare certification.
The voluntary program for hospitals went into effect at the start of this year and provides a framework to help organizations tackle decarbonization efforts. Attaining the certification means the hospitals have met rigorous standards and elements of performance to accelerate the sector’s sustainability efforts, according to a joint press release.”
About pharma
The top 10 drugs losing US exclusivity in 2024 FYI
Colorado isn’t giving up on its drug importation dream “The FDA has rebuffed Colorado’s appeals for help with its drug importation plan.”
About the public’s health
Except for flu, US respiratory virus levels continue to ebb “Last week, 20 jurisdictions reported high or very high respiratory illness activity, down from 26 the previous week, the CDC said in its latest respiratory virus snapshot. Emergency department visits for flu, COVID, and respiratory syncytial virus (RSV) all declined last week.”
Measles outbreak threatens US status of ‘eliminating’ virus “The rash of measles outbreaks around the country has sparked concerns that the U.S. risks losing its status as a country where the disease has been eliminated, a distinction held since 2000.
As of last week, 41 measles cases have been confirmed across 15 states and New York City, according to the Centers for Disease Control and Prevention (CDC). That puts the nation already on track to surpassing the 58 total cases that were detected in 2023.”