Today's News and Commentary

About health insurance

CMS releases rule to require ACA insurers to send separate bill for abortion coverage: “Affordable Care Act exchange insurers must send separate bills to consumers for the portion of their premiums attributable to certain types of abortion services, according to a final rule.
The rule released Friday by the Centers for Medicare & Medicaid Services imposes the new requirements on insurers to ensure they meet a federal prohibition on public funding for abortion coverage, officials said. It also has new requirements for states to help identify people who are enrolled on both exchanges in addition to other government health programs.”

Open enrollment on ACA exchanges remains stable: “…preliminary figures indicate more than 8.3 million people enrolled for coverage on the ACA exchanges through Dec. 17 for the 2020 open enrollment period. That's down about 2.4% from the approximately 8.5 million individuals who enrolled for 2019 coverage during last year's open enrollment period.” A late surge and short extension accounted for these numbers.

How 2 former debt collectors helped erase $1B in medical bills: A great holiday story! “Craig Antico and Jerry Ashton had decades of experience as medical debt collectors when they founded RIP Medical Debt in 2014. Since then, the nonprofit organization has helped eliminate medical debt for more than 500,000 people across the U.S.
RIP raises funds from individual donors, philanthropists and organizations to purchase medical debt in bulk for pennies on the dollar. Once RIP buys debt, it is forgiven. Over the past five years, the organization has erased $1 billion in medical debt, including $65 million in debt owed by veterans.”

Patient loyalty to healthcare providers is at risk over transparency, finds AccessOne survey: Loyalty has a price: “Two in five consumers say they would switch providers to access affordable payment arrangements to cover their costs of care -- including half of households with children, an AccessOne survey has found.
That's an increase over 2018 survey figures, when 33% of individuals and 43% of households with children said they would be willing to switch providers for more affordable payment options.”
Unfortunately, the study does not detail the amounts over which patients would switch.

Trump signs bills to avoid shutdown, scrap Obamacare taxes and raise tobacco buying age: The tax agreement is now law. See previous posts for healthcare implications.

About healthcare quality

Doctors Online Reviews are Polarized:Compared to hotel and restaurant Yelp reviews, “people’s experiences with doctors are polarized: either awful or spectacular… The most prevalent issues in negative doctors’ online reviews include frustration and difficulty making appointments, long waiting room times, and rude front desk, billing and nursing staff.
There is good news for physicians, however. Patients are almost twice as likely to give doctors good reviews as poor ones.”

Today's News and Commentary

About health insurance

Congress unveils $1.3T spending deal: 5 healthcare takeaways: The Senate passed the House version of the budget, which the President is expected to sign. To summarize its previously-reported healthcare provisions:

1. Provides federal funding for gun violence research for the first time in more than two decades.

2. Repeals the ACA's Cadillac tax, health insurer tax and medical device tax at a cost of nearly $400 million.

3. Delays Medicaid Disproportionate Share Hospital payment cuts for about five months.

4. Raises the national age for tobacco sales to 21.

5. Omits legislation to address surprise medical bills and cutting pharma costs.

Democrats Debate Whether ‘Medicare For All’ Is ‘Realistic’: Nothing new on healthcare from last night’s Democratic debate. This article is a nice summary of who said what (by now, predictable).

What Happens When a Health Plan Has No Limits? An Acupuncturist Earns $677 a Session: The gist of this article is in the headline. Well worth a read!

About pharma

Duke launches privately funded innovation company for drug discovery: “Duke University's Office of Licensing & Ventures partnered with healthcare investment firm Deerfield Management Company to launch Four Points Innovation, a private company aiming to accelerate drug discovery and development.” These types of deals represent an evolution of university-originated tech commercialization. Instead of doing only basic science research and transferring the tech to commercial companies, this step involves the actual product development.

New USMCA Deal Drops Exclusivity for Biologics:  As part of the deal, the US dropped provisions requiring at least 10  years of exclusivity for biologics.

All hail drug reps: Most cancer docs rely on pharma salespeople for info, survey finds: Where do physicians get their information about new drugs? “Seventy-one percent of U.S. oncologists surveyed by Cardinal Health Specialty Solutions agreed sales reps play an important role in their new-product education.” But the reps ability to see these physicians is not as open as it once was: “48% allow full access to sales reps, while 45% allow access with limits.”

FDA Launches App to Identify New Uses for FDA-Approved Drugs: “The FDA launched CURE ID, an app-based web repository that would allow healthcare professionals to report their off-label uses of FDA-approved drugs.”

Low-cost breast cancer drug 'could save lives in low-income countries': “A cheap version of the groundbreaking breast cancer drug Herceptin has been approved by the World Health Organization, raising the possibility of lifesaving treatment for the first time for women in low-income countries…The WHO listed it as an essential medicine for all countries to buy, but it has been unaffordable in much of the world, with a price tag of about $20,000 (£15,000) per patient…With the drug now out of patent, the WHO has approved a biosimilar version – a cheap copy – of the monoclonal antibody made by a company in the Netherlands…The price will be 65% lower than Herceptin itself, which at about $9,000 is still a burden for lower income countries.”

CMS updates drug dashboards to increase pricing transparency: “The dashboards focus on average spending per dosage for prescription drugs paid for by Medicare Parts B and D as well as Medicaid. They also track the change in average spending per dosage over time, display the name of each drug's manufacturer and show information on drug uses and clinical indications…
The data showed that in 2018, total gross spending on prescription drugs was $168.1 billion in Medicare Part D, $33.3 billion in Medicare Part B, and $66.4 billion in Medicaid. 
The proportion of prescription drugs with a unit price increase went down from 2017 to 2018 in both the Medicare Part B program and in Medicaid. In the Medicare Part D program, the proportion of prescription drugs with a unit price increase remained steady from 2017 to 2018.”
To check the data go to this CMS website.  

How Patients Feel About Cancer Drug Development: This survey of more than a thousand people found, among other opinions, that:
88% would share their healthcare data if it helped develop therapies faster for treating cancer.
82% believe patients should be compensated for sharing health data, suggesting potential for profit-sharing in drug development.
69% would want a share of the profit if their or a family member’s data was used to help develop a new cancer drug.
Read the study for more insights.

Cigna’s Express Scripts And Big Blue Cross PBM In Major Deal To Tame Drug Costs: “Cigna’s Express Scripts pharmacy benefit management unit and a PBM owned by 18 Blue Cross and Blue Shield plans [Prime Therapeutics] have joined forces to tame drug costs for a massive client list that covers 100 million people…The collaboration will allow Prime’s member Blue Cross health plans to gain leverage through Express Scripts’ buying clout and large pharmacy network.”

About the public’s health

Plasma metabolite biomarkers of boiled and filtered coffee intake and their association with type 2 diabetes risk: Good news for some coffee drinkers. 2 cups of filtered coffee per day reduces risk for Type 2 diabetes. The reduction does not occur for less consumption of filtered coffee or for boiled coffee (like percolated).

Biocompatible near-infrared quantum dots delivered to the skin by microneedle patches record vaccination: The researchers developed a vaccine delivery system with dissolvable microneedles that imbed patterns of near-infrared light-emitting microparticles to the skin. The microparticles encode the vaccination information, including administration date, and can be read with a modified smartphone.

About healthcare IT

Identifying Potential Patient Safety Issues From the Federal Electronic Health Record Surveillance Program: [Full access to this JAMA article by subscription]“…findings begin to estimate the extent of vendor lack of adherence to certification standards and the potential for patient harm, with 3.7% of total product IDs having a nonconformity issue that could be a contributing factor to a patient harm event.” For example, one error gave a medication dose 10 times what was recommended. Clearly manual oversight is needed.

Artificial Intelligence in Healthcare: Excellent monograph from the National Academy of Medicine covering this important and emerging topic..

Today's News and Commentary

About pharma

Novartis plans giveaway of world's most expensive drug: “Novartis plans to give away up to 100 doses annually of Zolgensma, its $2.1 million spinal muscular atrophy treatment, under a new managed-access program.” Patients must meet certain clinical criteria, but the constraining factor is that the drug must not be approved in the country where the patient resides.

FDA Issues Draft Guidance for Developing Hemorrhoids Treatments: The story is not specifically about hemorrhoids, but it emphasizes the FDA’s desire to include more patient reported outcomes in evaluating treatments.

About the public’s health

Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity: This research suggests “with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity… and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030… and the prevalence will be higher than 25% in 25 states.”

About health insurance

Medicaid, CHIP enrollment decline for 2nd straight year: “Enrollment in Medicaid and the Children's Health Insurance Program (CHIP) declined nationally for the second year in a row, with a 2.6% decrease over the past two years, according to a new report. 
The Medicaid and CHIP Payment and Access Commission (MACPAC) released its annual look at enrollment, spending, benefits and service use for Medicaid and CHIP. The group found that Medicaid and CHIP enrollment dropped in 34 states and the District of Columbia. 
This trend was felt in both states that expanded Medicaid and those that did not.”

Democrats want a 2020 Supreme Court hearing on the lawsuit that could upend Obamacare: A really good summary (and expert comments) of yesterday’s story about the Appellate Court’s decision that the individual mandate is unconstitutional.

About healthcare IT

Blue Button 2.0 API Update: According to CMS, Blue Button 2.0 is a “developer-friendly, standards-based API that enables Medicare beneficiaries to connect their claims data to the applications, services and research programs they trust.”
“On December 4th, a third-party application partner reported a data anomaly with the Blue Button 2.0 API (BB2.0). CMS verified the anomaly and immediately suspended access to the production environment. We discovered a bug in the BB2.0 codebase which may be causing certain beneficiary protected health information to be inadvertently shared with another beneficiary or the wrong BB2.0 application.”
See the website for the impacted applications.

Hospital execs say they are getting flooded with requests for your health data: This article is a nice review of the opportunities for hospitals to profit by supplying clinical data to companies.

Today's News and Commentary

IMPORTANT BREAKING STORY

Appeals court strikes down individual mandate in ACA case, but punts on severability: “In a blow to the ACA, federal appeals judges have ruled 2-1 that the landmark healthcare law's individual mandate is unconstitutional but punted on the question of whether that mandate can be excised from the remainder of the law…’The individual mandate is unconstitutional because it can no longer be read as a tax, and there is no other constitutional provision that justifies this exercise of congressional power,’ they wrote in their opinion (PDF).” I predict that the lower court will find the whole law is now invalid. The ruling will be appealed to the Supreme Court, where Chief Justice Roberts (who wrote the original opinion on the law) is still in charge. But the composition of the court is now Republican-leaning. The outcome is uncertain.

About pharma

US Unveils Proposed Rules to Allow Some Canadian Drug Imports: ‘The FDA and HHS will unveil a plan Wednesday to allow certain prescription drug imports from Canada—but one that leaves out, for now, many specialty medications and other therapies for chronic disease that cost patients the most. [Exclusions are controlled substances, biologics and intravenously injected drugs.] Through a Notice of Proposed Rulemaking and a draft guidance for industry, the FDA will seek request for comment on 2 pathways. One would allow states to submit proposals to the FDA to allow the importation of small molecule brand-name medicines sold at retail pharmacies— typically ones that have rebates attached to them…
the other… is draft guidance for industry, which would let manufacturers import the same versions of FDA-approved drugs they now sell in foreign countries. Under this pathway, drugmakers would use a new National Drug Code (NDC) and sell these drugs in the United States at cheaper prices.”

Lawmakers try to find next opportunity to tackle drug prices, surprise billing after setback: Both those initiatives will be pushed back to at least this coming May.

Lawmakers expand definition of biologics in year-end spending bill: Another proposed inclusion in the budget compromise: A “provision would change the definition of biologic drugs to include ‘chemically synthesized polypeptides,’ which includes such drugs as Novo Dordisk's diabetes medication Victoza and Eli Lilly's osteoporosis drug, Forteo. 

Biologic drugs, which are made from living cells, get 12 years of market exclusivity, while ‘small molecule’ drugs get five years. The policy change would give more drugs longer periods of market exclusivity, which would give larger profits to drugmakers and force consumers to wait longer to get cheaper generic versions…” The provision would only apply to new drugs approved after the law passes.
Clearly the pharma industry remains very powerful.

About the public’s health

Trump Administration Proposes New Rules to Increase Accountability and Availability of the Organ Supply: This enhancement would be accomplished by reducing financial barriers by expanding “the scope of reimbursable expenses for living donors to include lost wages, and childcare and eldercare expenses for those donors who lack other forms of financial support,” and updating the criteria for Organ Procurement Organization (OPO) Conditions for Coverage. The question is: are the factors these solutions are aimed at fixing the ones that are responsible for delayed transplantations?

Weekly U.S. Influenza Surveillance Report: The CDC reports we are now into the flu season. The overall hospitalization rate is about the same as previous seasons while the mortality rate thus far is lower.

US permits sale of cigarettes with 95% less nicotine: “The Food and Drug Administration will allow 22nd Century Group to begin selling the first low-nicotine cigarettes reviewed by federal health regulators. The products contain roughly 95% less nicotine than standard cigarettes, according to the FDA…Regulators stressed that their ruling does not mean the new products are safer than regular cigarettes. The agency noted there are no safe tobacco products. Cigarettes cause cancer, lung disease, stroke and a number of other deadly diseases.” The question here is whether smokers will smoke more cigarettes to get the same amount of nicotine and thus be worse off than if they smoked traditional cigarettes.

About health insurance

In medical billing, fraudulent charges weirdly pass as legal: This story is by the Kaiser Health News Editor-in Chief and details from personal experience charges that she believes are mostly legal but unethical. Great discussion piece.

Hospitals avoid $4B payment cut — for now: Yet another measure in the budget bill: a temporary delay in cuts to Medicaid Disproportionate Share Hospitals payments.  

Today's News and Commentary

About the public’s health

Congress reaches deal to fund gun violence research for first time in decades: As part of the budget compromise, Democrats were able to get funding for gun violence research: $12.5 million each for the Centers for Disease Control and Prevention (CDC) and National Institutes of Health. Previously the Republicans had held up such funding.

From Border Security To Tobacco Age, Both Parties Tout Key Wins In Spending Deal: Another benefit from the budget compromise is raising the national smoking age to 21.

Flexible Hierarchical Wraps Repel Drug-Resistant Gram-Negative and Positive Bacteria: Diverse solutions have been offered to stem the spread of pathogenic bacteria, This latest one is unique: “a flexible plastic wrap that combines a hierarchical wrinkled structure with chemical functionalization to reduce bacterial adhesion, biofilm formation, and the transfer of bacteria through an intermediate surface. These hierarchical wraps were effective for reducing biofilm formation of World Health Organization-designated priority pathogens Gram positive methicillin-resistant Staphylococcus aureus(MRSA) and Gram negative Pseudomonas aeruginosa by 87 and 84%, respectively.”

Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis: Recently, the acute (often fatal) consequences of e-cigarette use has been in the news. This study looks at long term effects of such use. The authors found: “Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking. Dual use, the most common use pattern, is riskier than using either product alone.”

Chili Pepper Consumption and Mortality in Italian Adults: “In a large adult Mediterranean population, regular consumption of chili pepper is associated with a lower risk of total and CVD death independent of CVD risk factors or adherence to a Mediterranean diet. Known biomarkers of CVD risk only marginally mediate the association of chili pepper intake with mortality.”

About health insurance

Congress poised to repeal HIT, medical device and 'Cadillac' ACA taxes as part of spending deal: “Congress is expected to repeal the Affordable Care Act’s (ACA's) health insurance, medical device and ‘Cadillac’ taxes as part of a must-pass spending agreement set to be passed this week.” With the continued repeal of sources of income to operate the ACA, how will it be able to function?

Judge strikes down AHA's bid to halt CMS' site-neutral payment cuts for 2020: In September, U.S. District Court Judge for the District of Columbia Rosemary Collyer ruled that CMS could not impose site-neutral payments on hospitals. (Site neutral payments do not increase hospital compensation just because a service was performed there.) However, that ruling only applied to 2019. Yesterday she ruled that starting Jan. 1 the cuts can continue. “The ruling means that hospitals could face a 60% reduction in Medicare payments for off-campus hospital outpatient departments.”

Moody's: Insurers' 2020 outlook stable, though political, legal risks loom: “Moody’s projects health insurers will continue to see strong earnings growth amid stable economic and demographic trends, with financial growth likely in the mid- to high-single digits. That’s slightly below 2019, with some headwinds coming from the potential reinstatement of the Affordable Care Act’s (ACA's) health insurance tax and from the cost of an aging population. 
Moody’s also estimates that medical costs will continue to increase, though the industry has made strides in mitigating those expenses. Short-term trends, such as growth in Medicare Advantage enrollment and the growing number of pricey specialty drugs, could negate some of those gains.” The report was issued before the above story about elimination of the health insurance tax as part of the federal budget negotiations.

U.S. government extends deadline to sign up for Obamacare insurance plans: Because of online glitches, CMS has extended the ACA enrollment deadline to tomorrow. With a surge in signups the past couple days and the extension, enrollment totals may be on track to match recent years’ numbers.

CVS subsidiary accused by DOJ of fraudulent billing: “The federal government has joined a lawsuit alleging Omnicare, a subsidiary of CVS Health, fraudulently billed Medicare, TRICARE and Medicaid for thousands of drugs. 
The Department of Justice on Tuesday joined the whistleblower suit (PDF) that charges Omnicare dispensed hundreds of thousands of drugs to elderly patients at thousands of long-term care facilities between 2010 and 2018.”

About healthcare quality and safety

Top Hospitals: The Leapfrog Group just issued its annual top hospital report. Some very interesting omissions of academic medical centers nationwide.

About healthcare IT

CMS Made an Estimated $93.6 Million in Incorrect Medicare Electronic Health Record Incentive Payments to Acute-Care Hospitals, or Less Than 1 Percent of $10.8 Billion in Total Incentive Payments: The headline speaks for itself. Reasons for the errors are in this report from the Office of the Inspector General of HHS.

About pharma

Inaccessible Insulin: The Broken Promise of Eli Lilly’s Authorized Generic: “To assess the impact of authorized generics, like ‘Insulin Lispro,’ on patients’ access to insulin, the Offices of U.S. Senator Elizabeth Warren and U.S. Senator Richard Blumenthal conducted a national telephone survey of pharmacies to determine if they had access to and were providing patients with the lower-cost authorized generic version of Humalog insulin. The investigation found that, contrary to the promises made by Eli Lilly, the vast majority of patients who seek to use this less expensive drug are not able to obtain it at their local pharmacy. Specifically, a 50-state survey of 190 chain and 196 independent pharmacies reveals that:
…In 83% of pharmacies surveyed, the less expensive, authorized generic promised by Eli Lilly was not in stock and available for consumers…
Pharmacies are unaware of and not adequately informing consumers about the availability of Eli Lilly’s authorized generic insulin. In many cases, consumers cannot get the generic version of a drug if they do not know to ask for it…”

Today's News and Commentary

About the public’s health

Characteristics of Americans With Primary Care and Changes Over Time, 2002-2015: “From 2002 through 2015, a decreasing proportion of Americans had an identified source of primary care, especially Americans who were younger, less medically complex, of minority background, or living in the South…” The reasons are detailed and can be addressed by proper structural reforms.

FDA clears Boston Scientific's disposable duodenoscope, the world's first: “The FDA has cleared its first fully disposable duodenoscope, following years of reports of infections being transmitted between patients by the notoriously difficult-to-clean devices…” The cost has not been released.

The Next Vaping:Big Tobacco claims to have created a safer cigarette. Is unleashing it a big mistake?: A store in a retail mall in Atlanta is the first to offer a Philip Morris International product that is an electrified cylinder that can be kept in your pocket. The “IQOS” device is “the first in what’s expected to be a new class known as ‘heated tobacco’ or ‘heat not burn’ products. They’re not vaping or smoking, but another way of inhaling the addictive stimulant nicotine.” The product is available only to those over 21 who claim to be smokers. What as-yet unknown side effects will this version of nicotine delivery system cause?

Georgia Is Funneling Millions of Dollars to Fake Abortion Clinics: In 2017, the Georgia law “Positive Alternatives for Pregnancy and Parenting Grant Program” went into effect to fund “crisis pregnancy centers. (CPCs).” By June 2020, these centers will have received at least $6.7 million in funding. Vice reports that the CPCs  “are nonprofits that are typically religiously affiliated and claim to provide free, legitimate medical services but actually use deceptive language on their websites and in their advertisements to get pregnant people considering abortion to walk through their doors. Once there, staff members and volunteers who typically lack medical training give the client faith-based misinformation about abortion, dissuade them from terminating their pregnancy, or tell them they have more time to think about it.”

About health insurance

Out-Of-Network Billing And Negotiated Payments For Hospital-Based Physicians (Health Affairs, full article access requires subscription): “Using data for 2015 from a large commercial insurer, we found that at in-network hospitals, 11.8 percent of anesthesiology care, 12.3 percent of care involving a pathologist, 5.6 percent of claims for radiologists, and 11.3 percent of cases involving an assistant surgeon were billed out of network. The ability to bill out of network allows these specialists to negotiate artificially high in-network rates. Out-of-network billing is more prevalent at hospitals in concentrated hospital and insurance markets and at for-profit hospitals. Our estimates show that if these specialists were not able to bill out of network, it would lower physician payments for privately insured patients by 13.4 percent and reduce health care spending for people with employer-sponsored insurance by 3.4 percent (approximately $40 billion annually).” Unfortunately Congress is unlikely to act soon on this fixable, serious problem.

About healthcare IT

Cigna to expand AI-enabled medication management solution: “An artificial intelligence system that tracks chronic disease treatment will soon be available to all Cigna and Express Scripts employer clients…
Health Connect 360 relies on medical, pharmacy, lab and biometric data and analytics tools from both Cigna and Express Scripts to track patients' medication adherence, trigger alerts regarding health data and missed medications, and offer personalized recommendations to address any gaps in care. This information can also be automatically fed into EHR systems.”

Krounda Medical fined $85K for failing to give patient access to EHR data: The fines levied by the HHS Office for Civil Rights (OCR) are usually for unauthorized data leaks. This instance shows the breadth of possible penalties. In only the second case of its kind, the OCR found that Korunda medical group failed to provide requested medical records to a third party, and “also failed to provide them in the requested electronic format and charged more than the reasonably cost-based fees allowed under HIPAA…”

Prevalence and Factors Associated with Family Physicians Providing E-Visits: “Fewer than 10% of family physicians provided e-visits. Physicians in HMO and VA settings (ie, capitated vs noncapitated models) were more likely to provide e-visits, which suggests that reimbursement may be a major barrier.”

Today's News and Commentary

About pharma

House passes Speaker Nancy Pelosi’s drug pricing bill: But the bipartisan Senate version is different and a reconciliation is not expected before year’s end.

About health insurance

Billions in Estimated Medicare Advantage Payments From Chart Reviews Raise Concerns: The HHS Inspector General is concerned about the inaccuracy of risk adjusted payments to Medicare Advantage organizations (MAOs). The calculations, supported solely through chart reviews, “raise potential concerns about the completeness of payment data submitted to CMS, the validity of diagnoses on chart reviews, and the quality of care provided to beneficiaries.” One obvious problem is “that over 99 percent of chart reviews… added diagnoses” while deletions are not being made. Another finding is that “CMS based an estimated $2.7 billion in risk-adjusted payments on chart review diagnoses that MAOs did not link to a specific service provided to the beneficiary―much less a face-to-face visit.” Better review of these conditions is recommended.

Medicare to Make Good on Millions in Back Payments to Hospitals: “The American Hospital Association estimates that hospitals were shorted some $380 million in Medicare payments in 2019 under the “site neutral” payment policy implemented by the Centers for Medicare & Medicaid Services.”

About the public’s health

Grocers Amp Up Customer Health, Wellness Programs: “Of the respondents, 85% reported employing registered dietitians, with 70% of those at the corporate level and 27% of those at the regional level. One in three grocery stores reported having an in-store clinic for shoppers.”

Today's News and Commentary

About the public’s health

America’s Health Rankings: The United health Foundation released its rankings of the health of individual states. Notice the geography of the healthiest versus least health states.

Top 10 health-related questions consumers asked Google in 2019: An interesting list…do the questions correlate with what professionals target? For example, # 3 is: “How to get rid of hiccups.”

Senate confirms oncologist Stephen Hahn as FDA commissioner: The headline speaks for itself.

Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study: “Antibiotics were prescribed during 13.2%… of the estimated 990.8 million ambulatory care visits in 2015. According to the criteria, 57% (52% to 62%) of the 130.5 million prescriptions were for appropriate indications, 25% (21% to 29%) were inappropriate, and 18% (15% to 22%) had no documented indication. This corresponds to an estimated 24 million prescriptions without a documented indication. Being an adult male, spending more time with the provider, and seeing a non-primary care specialist were significantly positively associated with antibiotic prescribing without an indication. Sulfonamides and urinary anti-infective agents were the antibiotic classes most likely to be prescribed without documentation.”

Home is now the most common place of death in the U.S.: Not really a public health issue for patients, but certainly affects those caring for them. Knowing preferences can help our health system structure appropriate supportive resources.

About healthcare professionals

2019 Fall Applicant, Matriculant, and Enrollment Data Tables: The American Association of Medical Colleges published its 2019 data on medical schools. Matriculation is up 1.1% and for the third year in a row, women comprise the majority of matriculants. Those three years have added up- for the first time, women are now the majority of all medical students.

Military Health System in the Crosshairs: The military healthcare system will now be divided between taking care of battlefield casualties and all other healthcare needs (including the Tricare system for families of active service and retirees.)

US Geographical Variation in Rates of Shoulder and Knee Arthroscopy and Association With Orthopedist Density: Unlike treatment of some other conditions, the differences in rates of performance of these orthopedic procedures are not explained by density of those professionals.

Primary Care Physicians’ Role In Coordinating Medical And Health-Related Social Needs In Eleven Countries (Health Affairs, subscription required for entire article): “Compared to physicians in other countries, substantial proportions of US physicians did not routinely receive timely notification or the information needed for managing ongoing care from specialists, after-hours care centers, emergency departments, or hospitals. Primary care practices in a handful of countries, including the US, are not routinely exchanging information electronically outside the practice. Top-performing countries demonstrate the feasibility of improving two-way communication between primary care and other sites of care.”

About pharma

Walmart will continue accepting paper prescriptions in 2020, but for how long?: The message in the headline updates a previous blog post.

About health insurance

New IRS rule will help lower drug costs for those with chronic conditions: In order for someone to enroll in a Health Savings Account plan, they must be subject to an IRS-determined deductible. Recognizing the financial burdens of chronic diseases, the “IRS recently released formal guidance that allows insurers who sponsor high-deductible health plans (HDHPs) linked to health savings accounts (HSAs) to cover 14 essential services used to treat chronic diseases like diabetes and asthma before patients hit their deductibles.” Notice that the guidance “allow insurers.” We will need to see if they structure the benefits to help out these members.

Today's News and Commentary

About healthcare IT

DOJ to review Google's $2.1B deal to buy Fitbit amid data privacy concerns, according to media reports: The headline speaks for itself.

Top health industry issues of 2020: Will digital start to show an ROI?: This report is the 14th annual PwC review of where healthcare is going. It is more than just IT, but tat is the headline’s theme. Always worth a read.

About healthcare professionals

U.S. Physician Employment Report 2019: There is a mismatch between the top paid specialties and those in greatest demand.

Private equity may be repeating mistakes with physician practice management companies: This article is a great summary about why physician practice management companies failed in the 1990s…and why current efforts are repeating the same mistakes.

About the public’s health

FDA can regulate e-cigarettes just like conventional cigarettes, appeals court says: The headline speaks for itself.

About pharma

Democrats, White House forge new North American trade deal: The healthcare aspect is that ”Democrats succeeded in tossing overboard a 10-year protection for manufacturers of new drugs, including so-called biologics, that had won reprieve from lower-cost competition in the original accord.”

Pelosi reaches deal with progressives to avert showdown over drug price bill: The compromise that speaker Pelosi reached is to “increase the minimum number of drugs subject to negotiation under the bill from 35 to 50 and…extend protections against drug price spikes to people on employer-sponsored health insurance plans, not just those on Medicare.”

Pelosi drug pricing plan would save $456 billion over 10 years: “The bill would also provide dental, vision and hearing benefits to Medicare beneficiaries, with the CBO putting the cost at $358 billion over 10 years. In all, the CBO estimates the bill would reduce the deficit by $5 billion over 10 years.” See the above article; the estimate is based on price control for 30 drugs.

Civica Rx to ship 8 critical drugs to member hospitals by year-end: The hospital-owned pharma company will add 8 more drugs to its portfolio to help avoid shortages. The drugs are ones that are in common use, like heparin and morphine.

Foreign Drug Inspections Decline as FDA Hiring Struggles Continue: “The US reliance on imported pharmaceuticals and ingredients is rising as foreign drug facility inspections decreased by about 10% from 2016 to 2018. Part of the reason for the decline: The US Food and Drug Administration (FDA) said it’s still struggling to hire new inspectors.”

Today's News and Commentary

About pharma

Sanofi exits diabetes, CV research in strategy shake-up as it prioritises key growth drivers Dupixent, vaccines: “The company said it would instead focus growth efforts on Dupixent (dupilumab) and vaccines, while also highlighting several potentially ‘practice changing’ therapies in its pipeline. ‘Additional core drivers include treatments for oncology, haematology, rare diseases, neurology, and [our] strong presence in China,’ Sanofi added.” In general, pharma companies are trimming their scope of investments in disease categories.

AMA urges Walmart to delay policy that restricts patients' access to critical drugs : “Walmart will only accept electronic prescriptions for controlled substances starting in 2020… But, the AMA said that a majority of physicians in the U.S. cannot provide electronic prescriptions for controlled substances, as 44 percent of them don't have the technology, hardware and certifications required.”

Patient Charity Settles DOJ Allegations it Helped MS Drugmakers Pay Kickbacks: “Orlando-based patient charity The Assistance Fund (TAF) agreed to pay $4 million to settle allegations that it helped pharmaceutical companies pay kickbacks to Medicare patients taking their multiple sclerosis drugs. TAF is the third foundation to settle allegations of kickbacks.”

About the public’s health

Federal Courts Have Diminishing Appetite For Claims Of Obesity Discrimination: “The U.S. Court of Appeals for the Seventh Circuit, which is based in Chicago, joined three other federal circuits earlier this year in a ruling that limits the protection of extremely obese workers under the Americans with Disabilities Act (ADA).
The ADA prohibits discrimination against employees and job applicants who have physical or mental impairments that substantially limit ‘major life activities.’
Four federal circuits now have ruled that obesity is not a qualified impairment under the ADA unless it is shown to be the result of an underlying “physiological disorder or condition.”  No federal circuit has issued a contrary ruling.”

Supreme Court rejects challenge to Kentucky abortion ultrasound law: “The Supreme Court on Monday rejected a challenge to a Kentucky law requiring doctors to describe ultrasound images and play fetal heartbeat sound to abortion seekers…The court rejected the case without comment or noted dissent by any of the justices…The law had been upheld by the 6th US Circuit Court of Appeals, but that ruling was on hold pending the Supreme Court appeal.” This case was significant for what it might portend as more abortion-related cases come before the court.

About health insurance

Improving Serious Illness Care in Medicare Advantage: New Regulatory Flexibility for Supplemental Benefits: This monograph from Duke is an excellent summary of the current status of supplemental benefits offered by Medicare Advantage plans.

Republicans, Democrats Diverge in Views of Own Healthcare: For example, in answer to the Gallup Poll question: “Are you generally satisfied or dissatisfied with the total cost you pay for your healthcare?”, 73% of Republicans said yes, while only 52% of Democrats answered affirmatively.

More Americans Delaying Medical Treatment Due to Cost: In a related story, 34% of Democrats said they or a family member delayed care in the past 12 months because of costs. The Republican figure was 15%.

About healthcare IT

Patients intrigued by digital health services, but still value face-to-face interactions: “When asked to consider a hypothetical health plan that offered these virtual visits and online services, 45% of respondents said they would be willing to pay more for them, averaging $25 per month across all respondents. 
But when required to prioritize, respondents ranked other aspects of healthcare interactions -- like high-quality interactions with their doctor -- much higher than access to digitized services.”

Oracle Health Sciences Participates in TOP Tech Sprint: “Oracle Health Sciences is once again participating in The Opportunity Project (TOP) Technology Sprint: Creating the Future of Health.
This year’s entry joins Oracle technology with de-identified precision oncology open data sets from the United States Department of Veterans Affairs and the National Cancer Institute. The demo will highlight how Artificial Intelligence (AI) and customer experience solutions could be used to connect cancer patients with available clinical trials and experimental therapies.”

Today's News and Commentary

About healthcare quality and safety

New rule on 'bad actors' means more work for practices: “Effective November 4, 2019… CMS will now require Medicare, Medicaid and Children’s Health Insurance Program (CHIP) providers and suppliers to disclose certain affiliations they may have with other providers and suppliers who are ‘bad actors,.’.. [who] may include providers or entities who have had previous negative interactions with CMS, such as having been previously sanctioned, experienced a payment suspension, been excluded from federal programs, had billing privileges denied, revoked, or terminated or an outstanding debt owed to the government (including federal student loans). It does not matter whether these particular issues were corrected by the affiliated person or entity, only that they occurred.”

Access, Quality, And Financial Performance Of Rural Hospitals Following Health System Affiliation [Health Affairs, subscription required] : “Following health system affiliation, rural hospitals experienced a significant reduction in on-site diagnostic imaging technologies, the availability of obstetric and primary care services, and outpatient nonemergency visits, as well as a significant increase in operating margins (by 1.6–3.6 percentage points from a baseline of −1.6 percent). Changes in patient experience scores, readmissions, and emergency department visits were similar for affiliating and nonaffiliating hospitals. While joining health systems may improve rural hospitals’ financial performance, affiliation may reduce access to services for patients in rural areas.”

About healthcare IT

Health system deploys cost calculator to offer patients price transparency: University Health Care System in Augusta, Georgia, has a website calculator that allows patients to enter some demographic data, the procedure code and their insurance policy number. They can then receive an estimate of their out of pocket expenses. The system claims to be 95% accurate.

10 largest data breaches of 2019: The headline speaks for itself. The top three breaches are by labs affecting a combined 21.8 million people.

AR and VR technology may eclipse use of 3D-printed models: While 3D printing has made significant strides in helping to guide treatments, this article explains how augmented and virtual reality may provide more benefits at a low cost.

About pharma

FDA Testing Levels of Carcinogen in Diabetes Drug Metformin: On the heels of the investigation of ranitidine for containing nitrosamines, the FDA is conducting similar studies on metformin. The difference this time around is that there are many substitutes for ranitidine, but metformin is the starting drug of choice for oral treatment of Type 2 diabetes.

What side effects? Problems with medicines may be vastly underreported to the FDA [Stat+, subscription required]: The headline speaks for itself. For some classes of drugs only about 1% of side effects are reported. Project question: How can we increase reporting of these events? Is it an IT issue or something else?

FDA Seeks to Speed Insulin Biosimilar Approvals with New Guidance: “…acting FDA Commissioner Brett Giroir highlighted the upcoming transition on March 23, 2020 of all approved New Drug Applications (NDAs) for biological products to approved Biologicals License Applications (BLAs), noting the change will mean that currently-approved insulin products can be listed as reference products for biosimilars and interchangeables products. 
’The availability of approved biosimilar and interchangeable insulin products is expected to increase access and reduce costs of insulin products,’ he said.”

Biotech companies defend prices of one-off gene therapy [Financial Times, subscription required]: Biotech companies are trying to justify the extreme prices for their newer treatments by pointing out that a lifetime of therapy is often given in a short period of time and gene therapy potentially provides a total cure. Further, some costs, like home care and lost wages, are often not included.

About the public’s health

US flu season arrives early, driven by an unexpected virus: “The U.S. winter flu season is off to its earliest start in more than 15 years…There are different types of flu viruses, and the one causing illnesses in most parts of the country is a surprise. It’s a version that normally doesn’t abound until March or April.”

About health insurance

House-Senate fix could break gridlock on 'surprise' medical bills: “Leaders of the House Energy and Commerce Committee and the chairman of the Senate health panel announced a deal Sunday they said would rely on ‘a new system for independent dispute resolution often called arbitration.’ The lawmakers didn't elaborate…
But while there was bipartisan desire to help consumers, nearly every health sector wanted somebody else to foot the bill when a patient inadvertently sees an out-of-network provider.”

Democrats open door to repealing ObamaCare tax in spending talks: Both major parties still need to agree on a permanent appropriations bill for this year. In order to garner bipartisan support for the funding, Democrats say they are open to repealing the ObamaCare's Cadillac tax, which has never gone into effect, but is scheduled to start in 2022. It “was meant to keep health care costs down by discouraging overly-generous ‘Cadillac’ health insurance plans.” This offer is not new, since earlier this year the House voted to repeal the measure (419-6).

Implementing a Statewide Healthcare Cost Benchmark: “Seeking methods to better understand and control healthcare costs, states are assessing how to build on Massachusetts’ benchmarking model, since adopted, in varying forms, by three other states: Delaware, Rhode Island, and Oregon. All four states share common elements of the program: establishing a statewide cost benchmark; collecting data to measure health spending against the benchmark; publishing health spending reports to identify systemic cost drivers; and using a variety of levers, including public hearings and performance improvement plans (PIPs), to enhance transparency and contain spending growth that exceeds the benchmark.”

Medicare Advantage [MA] rebates to hit new highs in 2020: “Medicare pays plans through bids, where plans submit bids that are compared to a benchmark amount. If a bid is lower than the benchmark, the plan gets a rebate. The benchmark is based on a formula that looks at traditional Medicare costs for the geographic area where the plan is based.
Rebates have been steadily increasing for MA plans from 2016 to 2020.” Rebates are also linked to quality performances.
These data speak to the overall strengths of the MA plans.

About medical devices

RightEye’s Parkinson’s Diagnostic Gets Breakthrough Status: “RightEye received a breakthrough designation from the FDA for the RightEye Vision System, a device that helps assess patients for Parkinson’s disease.
The device records and analyzes data on patient eye movement in search of persistent ocular tremors that are caused by the disease. The data can help doctors both diagnose the disease at an earlier stage, the company said.” If this device proves itself in continuous real-world use, it could be a real breakthrough in diagnosis and screening.

About healthcare professionals

Higher physician compensation driven by demand, not productivity: Higher physician compensation is driven by the increasing institutional demand to hire, not by physician productivity or value-based compensation.

Today's News and Commentary

TODAY’S MUST-READ

National Health Care Spending In 2018: Growth Driven By Accelerations In Medicare And Private Insurance Spending: Every year Health Affairs publishes a summary of national healthcare costs by category and explains changes, which usually have different causes from year to year. This open-access article is the latest update. One major take-away is: “Much of the faster spending growth in 2018 was associated not with expenditures for goods and services but instead with the net cost of health insurance (the amount of insurance spending attributed to nonmedical expenses, including administration, taxes, and underwriting gains or losses). The net cost of health insurance grew more rapidly in 2018, increasing 13.2 percent after growing 4.3 percent in 2017. The faster growth in 2018 was driven primarily by the health insurance tax, a fee that was reinstated in 2018 following a one-year moratorium in 2017.”

About health insurance

Americans Still Favor Private Healthcare System: According to a recent Gallup poll: “Americans continue to prefer a healthcare system based on private insurance (54%) over a government-run healthcare system (42%). Support for a government-run system averaged 36% from 2010 to 2014 but has been 40% or higher each of the past five years.”

ACA health coverage enrollments down 300K from same time last year: After a slow start, enrollment accelerated and it looked like it was on track to match last year’s numbers. The figures are now 300,000 behind the same time last year. “CMS reported that technical issues prevented some people from choosing a 2020 plan on the first day of open enrollment, which may have contributed to the lower sign-up total.”

MedPAC: Hospitals got $201B in Medicare payments last year, a 3.6% bump from 2017: “While payments to hospitals overall grew by 3.6% last year, payments for outpatient services increased by 7.2% under Medicare’s Outpatient Prospective Payment System. The reason for the hike was due to increases in physician-administered drugs in Part B and new and expensive drugs.
Another reason was hospitals shifting services from inpatient to outpatient departments…”

About pharma

House Republicans will unveil their own drug pricing bill as countermove to Nancy Pelosi: House Republicans met to craft their own drug pricing bill in anticipation of Speaker Pelosi’s release of her plan next week. In the meantime the bipartisan Senate bill, cosponsored by Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) is still on the table. We need to see how the details of all the proposals will get reconciled; but most policy experts do not see any law being passed before year’s end.

The top 15 biopharma M&A mistakes of the last decade: The article is an interesting overview of where biopharma companies “went wrong” in the last decades. Lots of material for case discussions.

About the public’s health

More than 6 million US middle and high schoolers used tobacco products in 2019, report says: The CDC survey “found that 1 in 3 high school students and around 1 in 8 middle school students are current tobacco users, meaning they had used the product at least once in the 30 days.
For the sixth year in a row, e-cigarettes were the most commonly used tobacco product among high school and middle school students. More than 55% of students reported using e-cigarettes only. Other tobacco products used by students included cigars, cigarettes, smokeless tobacco, hookahs and pipe tobacco.
More than 53% of high school students and more than 23% of middle school students reported ever trying a tobacco product.” Clearly we still have a big problem. The most successful strategy to lower smoking rates has been to increase prices (mostly through taxes).

About healthcare IT

Deep learning identifies colorectal cancer tumors with 100 percent accuracy: Combining visual inspection during colonoscopy with “deep learning,” called optical coherence tomography (OCT), can detect nearly 100% of tumors.

Today's News and Commentary

About hospitals and health systems

Hospital groups file lawsuit to stop Trump price transparency rule: The previous strategy was to delay implementation because of its complexity. Now, the American Hospital Association (AHA), among other hospital groups, is suing the Centers for Medicare and Medicaid Services (CMS) claiming that the transparency rule “violates the First Amendment by provoking compelled speech and reaches beyond the intended meaning of ‘standard charges’ transparency in the Affordable Care Act.”

About pharma

The most viable drug pricing bill in Congress is getting a makeover: “Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) are poised to unveil a 2.0 version of their Prescription Drug Pricing Reduction Act of 2019, which caps out-of-pocket costs for Medicare enrollees and requires drugmakers to pay rebates if they hike prices faster than inflation.” The White House supports this bipartisan effort.

About healthcare IT

The Pros and Cons of a National Patient Identifier (NPI) System: This article provides a good update on the NPI system. The pros basically center on enhanced interoperability, while the cons focus on privacy concerns.

Today's News and Commentary

About pharma

DOJ inks price fixing settlement with small generics player. Will others follow?: “Under a deferred prosecution agreement, Rising Pharmaceuticals admitted to price fixing and working with a competitor to rig the market on” hypertension drug Benazepril HCTZ. Seems like the DOJ’s strategy is to go after the smaller companies before finalizing agreements with such giants as Teva.

Amgen snags another Enbrel outcomes-based payment deal as it seeks to prop up aging blockbuster: One strategy companies are now using to extend revenue from drugs going off patent is inking deals with payers for outcome-based payments. In the latest of these deals, Amgen signed an outcomes-based contract for use of Enbrel with pharmacy benefits manager (PBM) Abarca.

Senate panel advances Trump’s nominee for FDA commissioner: The Senate Committee on Health, Education, Labor and Pensions approved Dr. Stephen Hahn to be the next Food and Drug Administration commissioner, sending his nomination to the full Senate. 

Comments on Pelosi drug pricing bill: The White House Council on economic advisors issued two cautions about Speaker Pelosi’s drug pricing bill. The first claim is that it will cost $1 trillion per decade due to lost innovations. The related concern is that by lowering drug prices and thus stifling innovation, the country will be deprived of 100 new drugs over that time. These figures don’t jibe with other estimates. For example, the “CBO analysis estimated Ms. Pelosi's bill would save Medicare $345 billion over seven years and result in eight to 15 fewer drugs hitting the market…” The assumption is that the forgone new drugs would be of significant public value, not “me-too” medications.

About the public’s health

HHS seeks to end HIV epidemic with Ready, Set, PrEP initiative: The U.S. Department of Health and Human Services announced a new initiative to help to to end the HIV epidemic by 2030: “The Ready, Set, PrEP program, which will make pre-exposure prophylaxis (or PrEP) medications available at no cost for qualifying patients…
HHS will initially be covering the costs of dispensing medication, but after March 30, 2020, CVS Health, Walgreens and Rite Aid will be donating their pharmacy dispensing services to the government agency, allowing consumers access to free PrEP medications either in person or via no-cost delivery by mail. Patients will also have access to counseling and steps to promote medication adherence.”

Survey: 37 percent of Americans plan to skip flu vaccine this season: “A survey conducted by NORC at the University of Chicago found those who don't plan to get shots have concerns about the side effects of the vaccine or think it doesn't work very well.
Others said they never get the flu, don't like needles or are concerned they will get the flu from the vaccine.”
This public health problem creates a real opportunity for effective social marketing initiatives.

Today's News and Commentary

About pharma

Walgreens, Kroger sue drugmakers, allege $2.8B in overcharges for diabetes med: “According to the lawsuit, Assertio and Santarus entered into a pay-to-delay deal with Lupin in 2012 to ensure the generic drugmaker wouldn't release a cheaper version of the diabetes drug [Glumetza] until 2016.
The deal allegedly allowed the brand-name drugmakers to hike prices, leading to $2.8 billion in overcharges.”

U.S. considers easing drug protection to break deadlock over trade pact: Wall Street Journal:”The Trump administration is considering scaling back intellectual-property protections [from 12 to 10 years] for biologic drugs… to help win Democratic support for a new trade pact with Mexico and Canada…”

Astellas dives into gene therapy with $3-billion deal to buy Audentes Therapeutics: Another multibillion dollar transaction, as large pharma companies seek to add gene therapies to their portfolios. Other recent activity includes Novartis' $8.7-billion purchase of AveXis and Roche’s ongoing effort to complete its $4.3-billion acquisition of Spark Therapeutics.

About health insurance

Affordable Care Act open enrollment figures jump in Week 4: Early in the enrollment preriod signups were lagging behind last year. Now with “less than two weeks to enroll, both the number of new and renewing consumers increased this year over last.”

Trends in Peritoneal Dialysis [PD] Use in the United States after Medicare Payment Reform: Show me how someone is paid and I will tell you how they behave:
“In 2011, the Centers for Medicare and Medicaid Services (CMS) implemented the ESKD [End Stage Kidney Disease] prospective payment system (PPS), which altered payment for dialysis treatment by bundling dialysis, medications, and ancillary services into a single payment, adjusted for patient- and facility-level characteristics . The PPS also provided a training add-on for home dialysis. Because PD has historically been associated with lower costs than HD [hemodialysis], dialysis facility revenues under the PPS were expected to increase by $330 per month for PD and decrease by $117 per month for in-center HD. Thus, it was anticipated that the PPS would increase supply and use of PD across the country…In the initial years after Medicare payment reform, late PD use increased significantly, as more patients initiated dialysis with PD and more patients switched from HD to PD. Our results suggest that Medicare’s PPS for dialysis may be achieving one of its intended goals in the initial years of payment reform implementation.”

OIG expects to recover $5.9B in fraud investigations, doubling last year's haul: “The Office of Inspector General (OIG) recovered $5.9 billion from fraud investigations during fiscal year 2019, according to a semiannual report (PDF) to Congress released Monday.” When was the last time you heard of private insurers being bilked for that kind of money?

ACOs saved Medicare $755M from 2013 to 2017, new analysis finds: “The analysis found that net federal savings for the Medicare Shared Savings Program (MSSP), which oversees the 518 ACOs in the program, was $755 million from 2013 to 2017.” The savings were not evenly spread across organizations.

No Itch to Switch: Few Medicare Beneficiaries Switch Plans During the Open Enrollment Period: “Overall, a small share of MA-PD [Medicare Advantage- Prescription Drug Plans] and PDP [Free-standing Prescription Drug Plans] enrollees without low-income subsidies (8% and 10%, respectively) voluntarily switched to another plan during the 2016 annual open enrollment period for the 2017 plan year... more than one in three (35%) Medicare beneficiaries living in the community said it is very or somewhat difficult to compare Medicare options, and this share increased among beneficiaries in fair or poor self-reported health (44%) and with five or more chronic conditions (40%). In 2017, nearly half (45%) of people on Medicare living in the community said they rarely or never review or compare their Medicare options; the share was substantially higher among beneficiaries ages 85 and older (57%).” Since prices and out of pocket provisions can change substantially from year to year, there needs to be a way to reach to to seniors to help them make correct decisions. The online tools are there, they just need to be able to use them.

Reconciliation limitations led CMS to overpay hospitals $500M: “Hospitals were overpaid by roughly $502 million from 2011 to 2014, according to a report from the Office of Inspector General (OIG), which blamed the overpayment on CMS limitations on the reconciliation period.
Sixty hospitals were paid $502 million more in net outlier payments than they were owed, the report found…
According to OIG, the payment errors were not found by CMS because they didn’t meet the reconciliation requirements of a 10% threshold of cost reports. Hospitals charged higher prices than the rate of cost increases below the 10% threshold, which meant their cost-to-charge ratio (CCR) didn’t trigger reconciliation. CMS set this threshold because the agency believed it would capture the outlier payments that were substantially inaccurate.”

Today's News and Commentary

About healthcare quality and safety

Patient Photo on Health Record Curtails Medication Errors: The headline speaks for itself.

About pharma

Mylan and Biocon Launch Trastuzumab Biosimilar, Ogivri™ (trastuzumab-dkst), in the U.S.: This drug is a biosimilar to often-used breast cancer drug Herceptin.

About healthcare IT

A consumer-centered future of health: The findings are from Deloitte’s 2019 global health care consumer survey, focusing on consumer’s views of IT use. Among the findings:

• “Increasing use of technology and willingness to share data: A growing number of consumers are using technology for measuring fitness, ordering prescription drug refills, and monitoring their health… Many consumers are willing to share their health data in various scenarios.

• Interest in and use of virtual care: Consumers appear to be warming up to the idea of virtual health. More than half of those who have seen a care provider virtually report being satisfied and would likely have another virtual visit.

• High levels of self-efficacy and prevention behaviors: People today seem more willing to tell their doctors when they disagree…

• Use of tools to make decisions about prescriptions and care: Consumers are interested in using tools to compare pricing and for user reviews. This tends to be highest in countries where consumers have more exposure to out-of-pocket spending…

• Interest in emerging technologies: Between 20 and 35 percent of people expressed interest in technologies leveraging robotics and artificial intelligence (AI) for health care, preventive care, monitoring, and caregiving.”

Today's News and Commentary

About healthcare IT

USDA Invests $42.5M in Rural Distance Learning and Telemedicine: “The U.S. Department of Agriculture says that it is investing $42.5 million in 133 distance learning and telemedicine projects in 37 states and two territories. The projects, which will be funded through the USDA Distance Learning and Telemedicine (DLT) grant program, could impact 5.4 million rural residents.”

I Invented the World Wide Web. Here’s How We Can Fix It (NY Times, subscription may be required): This editorial is by Sir Tim Berners-Lee who invented the WWW at CERN in Geneva, Switzerland. (See Chapter 8, Information Systems, in the book). He decries that “…prejudice, hate and disinformation are peddled online. Scammers use the web to steal identities, stalkers use it to harass and intimidate their victims, and bad actors subvert democracy using clever digital tactics. The use of targeted political ads in the United States’ 2020 presidential campaign and in elections elsewhere threatens once again to undermine voters’ understanding and choices.” To address these and other problems he explains the Contract for the Web.

About pharma

HHS Proposes ‘Most Favored Nation’ Approach to Lower Drug Prices: “An HHS proposed rule currently under review at the Office of Management and Budget would have the U.S. pay less than other developed countries for some Medicare drugs by using a “most favored nation” approach, HHS Secretary Alex Azar said.”

Qualitative study on the price of drugs for multiple sclerosis: Pharma executives say the high price of medications is needed to recoup R&D expenses. But this study of confidential interviews with insiders in those companies yields different explanations.
”Participants consistently stated that initial price decisions were dictated by the price of existing competitors in the market. Revenue maximization and corporate growth were drivers of price escalations in the absence of continued market penetration. Lower revenue predictions outside the United States also informed pricing strategies. The growing complexity and clout of drug distribution and supply channels were also cited as contributing factors. Although decisions to raise prices were motivated by the need to attract investment for future innovation, recouping drug-specific research and development costs as a justification was not strongly endorsed as having a significant influence on pricing decisions [emphasis added].”

About hospitals and health systems

Partners rebrands to Mass General Brigham: The headline speaks for itself.

About healthcare quality and safety

Association of the Work Schedules of Hospitalists With Patient Outcomes of Hospitalization: “Hospitalist schedules promoting inpatient continuity of care may be associated with better outcomes of hospitalization.” What a surprise!

About health insurance

The $11M dollar Medicare tool that gives seniors the wrong insurance information: The online tool that helps Medicare beneficiaries choose Part D drug plans recently underwent an $11million “improvement.” Yet this article provides many examples of how the new version provides incorrect information about plan choices. Having used the old tool for family members every year since it was available in 2005, I can vouch that it worked. If it isn’t broke…

Today's News and Commentary

About health insurance

Brigham Young University-Idaho reverses decision to reject Medicaid coverage for students: Bowing to public pressure, the BYU-Idaho campus reversed its policy to reject Medicaid coverage as evidence of health insurance for students. See yesterday’s story.

Proposed Rule Would Require Health Plans to Disclose Out-of-Pocket Costs by Providers: “In a proposed regulation to be published Nov. 27 in the Federal Register, federal agencies suggest a rule that would require employer-sponsored group health plans to provide plan enrollees with estimates of their out-of-pocket expenses for services from different health care providers. Plans would make this information available through an online self-service tool so enrollees could shop and compare costs for services before receiving care. 
Comments are due by Jan. 14, 2020, on the transparency-in-coverage rule issued by the departments of Health and Human Services, Labor and the Treasury.”

About the public’s health

CDC recommended that migrants receive flu vaccine, but CBP rejected the idea (Washington Post, subscription may be required): Customs and Border Protection refused to administer flu shots to immigrants. They obviously forgot the issue is not providing free care to non-citizens, but protecting the health of citizens.

About pharma

Trump draws ire after retreat on drug prices pledge: “President Trump is backing off his 2016 campaign pledge to negotiate drug prices for Medicare with pharmaceutical companies, drawing fire from Democrats after months of talks on the issue with Speaker Nancy Pelosi (D-Calif.).”

Generic drugmakers in talks to end long-running US antitrust probe: The headline speaks for itself.

Today's News and Commentary

About healthcare quality and safety

Superbugs should be entered as a cause of death on death certificates, say experts: It is hard to quantify a problem if the data is not being gathered. People who die from “superbugs” (antibiotic-resistant bacteria) have causes of death attributed to such “generic” reasons as sepsis. This article calls for more precise data capture.

About health insurance

University to Students on Medicaid: Buy Private Coverage, or Drop Out (NY Times, subscription may be required): Brigham Young University requires students to have health insurance to be eligible to enroll- a situation not unlike most universities and colleges. However, effective in 2020, its Idaho campus will not accept Medicaid as an insurer. The other part of the story is: “The policy change is likely to push more students into a health plan administered by Deseret Mutual Benefits Administration, which, like the university, is owned by the Church of Jesus Christ of Latter-day Saints.
That plan limits annual benefits and doesn’t cover birth control — provisions that would violate the Affordable Care Act, but for a little-noticed Obama-era exemption for universities that fund their own health plans.” The rule and unethical nature of these moves speak for themselves.

UnitedHealthcare to Open Member Medicare Services Centers in Select Walgreens Stores: This offering is for insurance enrollment and other such business issues. It is not a clinical center.

2020 Global Medical Trends Survey Report: Willis Towers Watson just released its annual report of employer-sponsored health insurance. “The cost of medical care is rising at a similar rate to previous years, a rate that remains relatively stable. The global trend is for a projected 6.8% increase in 2020 where in 2019 it was 6.7%. The most dramatic rise is in the Middle East and Africa, where costs are expected to jump to 9.3% from 8.5%. The European rate of increase will remain stable at 4.3%, and in Latin America medical costs are projected to decrease from 12.2% to 11.7%.” Of course individual countries can vary widely from regional averages. Of significance is that within the next five years, “27% of health insurers predicted that mental and behavioral conditions will be among the three most common conditions, and 26% predict that they will be among the three most expensive.” Also, pharmacy “services cost increases appear to be slightly moderating compared with prior years outside of the U.S.”

2 physician payment model advisers abruptly resign from MACRA committee: “Two members of a government advisory committee tasked with overseeing physician-focused payment models abruptly resigned out of frustration with federal agencies, according to their resignation letters.” Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, said: “I do not want to be part of a process that misleads physicians and other stakeholders into thinking that if they develop a good physician-focused payment model, go through the rigorous review process PTAC has established, and receive a positive recommendation, they will have a chance of seeing their work implemented.”

Moody's: Higher deductibles, surprise billing legislation will increase hospitals' bad debt: The headline speaks for itself.

About healthcare technology

Best inventions 2019: Check this Time Magazine list of best inventions, including a section on healthcare.

About healthcare IT

VA reports 235% increase in video telehealth visits in FY19: “The Department of Veterans Affairs, which already has the country’s largest telemedicine program, delivered more than 2.6 million episodes of telehealth care in Fiscal Year 2019.”

VA put millions of people, including doctors, at risk of identity theft, agency audit finds: “The Department of Veterans Affairs (VA) put millions of people, including medical professionals, at risk of identity theft by disclosing their Social Security numbers in copies of veterans' benefits claims, an agency audit found.
When responding to veterans' requests for copies of their medical benefits claims, the VA failed to redact personally identifiable information of other service members and doctors treating the veteran, according to a report from the VA Office of Inspector General (OIG). That information included names and Social Security numbers.”

Hospital alarms prove a noisy misery for patients: ‘I feel like I’m in jail.’ (Washington Post, subscription may be required): “Alarms have ranked as one of the top 10 health technological hazards every year since 2007, according to the research firm ECRI Institute. “ And according to the Joint Commission, “an estimated 85 to 99 percent do not require clinical intervention.” So why are devices measuring irrelevant information? What information do we really need to monitor patients to make sure they are safe?

About the public’s health

Obesity declined among toddlers on food assistance after Obama-era reforms. But now enrollment is falling (Washington Post, subscription may be required): “In a report released this week, researchers found the obesity rate among more than 12.4 million 2- to 4-year-olds enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) dropped from 15.9 percent in 2010 to 13.9 percent in 2016.” The reason? “Starting in 2009, WIC state agencies were required to provide food packages that hewed more closely to the U.S. Dietary Guidelines for Americans as well as infant feeding practice guidelines of the American Academy of Pediatrics. This led to increased availability of fruits, vegetables, whole grains and lower-fat milk for WIC enrollees.”

Trump Warns a Flavor Ban Would Spawn Counterfeit Vaping Products (NY Times, subscription required): The headline says it all. By analogy, maybe we should legalize heroin so we can eliminate its black market.

About pharma

Novartis to acquire The Medicines Company for USD 9.7 bn: This acquisition is today’s biggest business story. Novartis was looking to get into the next generation cholesterol-lowering space by adding adding inclisiran to its portfolio.

Medicine Price Index 2019: This report quantifies how much more we pay than other countries. It also gives examples of specific drugs.

Harvard, MIT spearhead $50M manufacturing center to speed cell, gene therapy R&D: Universities usually produce the product (or science behind it), leaving manufacturing to private companies. Now MIT and Harvard are partnering with other Massachusetts life sciences players to set up a new manufacturing center projected to open in 2021.

Miscellaneous

29 best-managed healthcare companies: “Twenty-nine healthcare companies made the Management Top 250, a ranking that measures corporate effectiveness developed by the Drucker Institute.” The top fourteen of these are product companies.

Today's News and Commentary

About healthcare IT

Google runs into data fears over $2.1bn Fitbit deal:Privacy concerns over access to non-regulated health information on 27m users (Financial Times, subscription required): Not long after Google announced its deal to buy Fitbit, legislators are calling for the deal to be called off because of privacy fears.

About healthcare professionals

Lawmakers introduce bill to fund more medical residency slots to combat physician shortage, opioid crisis: “Senate and House lawmakers introduced a bill that would fund 1,000 additional medical residency positions in the next five years to address an anticipated physician shortage and to combat the ongoing opioid crisis.
The Opioid Workforce Act of 2019 (S. 2892/H.R. 3414) would fund additional Medicare-supported graduate medical education positions in hospitals that have or are in the process of establishing approved residency programs in addiction medicine, addiction psychiatry or pain management.”

About hospitals and health systems

Hospitals' uncompensated care continues to rise: “Large hospitals with more than 250 beds saw their uncompensated/unreimbursed costs increase to $39.7 million in 2018, up from $33.2 million in 2015, growing at an average annual rate of 6.2%, according to Definitive data. Meanwhile, the average for hospitals with less than 25 beds reached $2.3 million in 2018, up from $1.8 million in 2015, increasing at an average annual rate of 8.5% a year. 
Uncompensated/unreimbursed costs at system-owned hospitals reached $15.6 million in 2018, up from $13.7 million in 2015. That compared to independent hospitals' average of $5.8 million in 2018, rising from $4.9 million in 2015. The average annual increase at system-owned hospitals was 4.6%, compared to 6% at independent facilities.”
Uncompensated care should not be confused with free or charitable care. Analysis of the reasons for the rise in these amounts revealed a major cause is increasing individual out-of-pocket expenses, like deductibles.

About the public’s health

Most Intended Home Births in the US Are Not Low Risk: 2016-2018: Although “natural” home births are sometimes preferred, this research provides some caution for the practice in the US. “Our study shows that well over 60% of all intended home births in the US are not low risk and have at least a single or several combined obstetric risk factors.”