Today's News and Commentary

About Covid-19

Americans are afraid their vaccine passports could be hacked: ”A new Harris Poll reveals that 80% of Americans are worried that getting a COVID-19 digital passport could put their personal data at risk.
Among the majority of Americans who have cybersecurity concerns about the new digital vaccine credentials, the survey found that slightly more than half were uneasy about the potential for identity theft. On top of that, less than half of Americans believe that either businesses or the government are prepared to defend passport apps against a potential cyber attack.”

U.S. FDA allows Lilly's COVID-19 drug to be taken without remdesivir: “The U.S. health regulator expanded the emergency use authorization for Eli Lilly’s COVID-19 drug baricitinib, saying it could now be used without taking Gilead’s drug remdesivir along with it, Lilly said on Thursday.
In November, the U.S. Food and Drug Administration (FDA) approved Lilly and Incyte’s arthritis drug, baricitinib, in combination with remdesivir, to treat COVID-19 patients.”

‘The war has changed’: Internal CDC document urges new messaging, warns delta infections likely more severe: The Washington Post obtained this internal CDC document. “The data and studies cited in the document played a key role in revamped recommendations that call for everyone — vaccinated or not — to wear masks indoors in public settings in certain circumstances, a federal health official said. That official told The Post that the data will be published in full on Friday. CDC Director Rochelle Walensky privately briefed members of Congress on Thursday, drawing on much of the material in the document.”

CDC study shows three-fourths of people infected in Massachusetts covid-19 outbreak were vaccinated: “Critically, the study found that vaccinated individuals carried as much virus in their noses as unvaccinated individuals, and that vaccinated people could spread the virus to each other. The CDC was criticized this week for changing its mask guidance without citing unpublished data. The report released Friday contains that data.”

Physicians who post COVID-19 vaccine misinformation may lose license, medical panel says: “The Federation of State Medical Boards warned July 29 that physicians and other healthcare professionals could be at risk of losing their medical licenses if they spread COVID-19 vaccine misinformation on social media, online and in the media. 
FSMB, a nonprofit that represents all U.S. state medical boards, said any clinicians who create or spread vaccine misinformation or disinformation risk disciplinary action by state medical boards, including suspension or revocation of their medical license.”

Marshfield Clinic lab plays vital role in CDC’s COVID-19 effort: “History books written about the COVID-19 pandemic won’t be complete unless they mention the pivotal role played by the Marshfield Clinic Research Institute, which is part of Wisconsin’s Marshfield Clinic Health System. The institute’s scientists test and process some 10,000 swabs a week, helping the Centers for Disease Control and Prevention (CDC) both track the progression of the disease and prove the effectiveness of the mRNA vaccines…
The lab has built a national reputation as a leader in respiratory infectious disease research through its participation in the flu vaccine effectiveness network and its collaboration with the CDC during the H1N1 flu pandemic of 2009—which some describe as the ‘dress rehearsal’ for the COVID-19 pandemic…”

About health insurance

Insurers push back on CMS' proposals to extend ACA open enrollment, bring back standardized plans: “Insurers pushed back at the Biden administration’s efforts to extend the Affordable Care Act’s open enrollment period by another month and require them to post standardized plan options.
Several insurers and advocacy groups commented on the proposals outlined in the Centers for Medicare & Medicaid Services’ Notice of Benefit and Payment Parameters, which outlines ACA marketplace exchange regulations for the 2022 coverage year. Insurers worried that extending the open enrollment period could lead to adverse selection and raise premiums for consumers.”

CMS: Part D premiums projected to increase nearly 5% in 2022 to $33: “The average Part D premium is projected to increase by nearly 5% from $31.47 to $33 in 2022.
Thursday’s announcement comes as Congress and the Centers for Medicare & Medicaid Services are making moves to address drug prices on Part D, the program’s prescription drug benefit.”

CMS releases 4 final payment rules: 16 things to know: “CMS on July 29 released its annual final payment rules for hospices, inpatient psychiatric facilities, inpatient rehabilitation facilities and skilled nursing facilities.” This article is a good summary. Here is the CMS statement.

Medicare Advantage:Beneficiary Disenrollments to Fee-for-Service in Last Year of Life Increase Medicare Spending: From the GAO: “We found that Medicare Advantage beneficiaries in the last year of life disproportionately disenrolled to enroll in fee-for-service, indicating possible issues with their care. Shifting end-of-life costs to fee-for-service increased Medicare spending by hundreds of millions of dollars.
We recommended monitoring end-of-life Medicare Advantage disenrollments to identify and address potential quality of care concerns.”

New bill aims to boost Medicare access to chronic care services: ”New legislation aims to eliminate the cost-sharing requirement for Medicare beneficiaries to get chronic care management services and reimburse providers for 100% of the payment.
The legislation, reintroduced Thursday, intends to boost access among seniors to chronic care management services that include creating a care plan and medication reconciliation and adherence.”

About pharma

Kaiser health plan files 'pay for delay' suit against Merck over cholesterol drugs: “Kaiser Foundation Health Plan's suit claims that the insurer paid hundreds of millions more for cholesterol drugs Zetia and Vytorin because the companies agreed to delay the launch of generic competitors…
The lawsuit is the latest challenge to so-call ‘pay for delay’ arrangements, which allow drugmakers to extend the length of their patent monopolies on certain pharmaceuticals. Pharma companies argue these arrangements are critical to allowing them to recoup research and development costs.” And in a related story:
Senate takes aim at pharma's patent schemes, pay-for-delay deals in renewed drug pricing crackdown: On Thursday the Senate Judiciary Committee “voted unanimously to advance four pieces of legislation which would help rein in the cost of prescription drugs.
The new laws take particular aim at the tactics used by drug companies to extend patent protections and stifle competition from cheaper generic and biosimilar drugs. The legislation, which would enhance the Federal Trade Commission's ability to initiate enforcement actions against drug companies, now moves to the Senate floor for a vote.”

AbbVie posts new data on drug that could replace glasses or contacts for age-related far-sightedness: “AbbVie has shared full results from a phase 3 trial it is hoping will persuade the FDA to approve a medicine solution for age-related far-sightedness, which is typically treated with contacts or glasses.
The study of AGN-190584, or pilocarpine formulation, showed significant improvements in the vision of patients with age-related far-sightedness after 30 days of dosing.”
This article provides a great case study for marketing a new therapeutic alternative. What about people who like to make a “fashion statement” with their glasses?

Prothena rolls out preclinical data for anti-amyloid Alzheimer's candidate to rival Biogen's Aduhelm: “In preclinical data presented Monday, Prothena said its fully humanized antibody targeting the N-terminus of amyloid-beta achieved greater avidity, or binding, than Aduhelm. The preclinical data showed the antibody could clear two main types of amyloid-beta plaque in the brain…
With its stronger binding potential, PRX012 may be able to be delivered at a lower dose and be administered subcutaneously [compared to Aduhelm which is given intravenously]…
Pricing information was not supplied.

Creditors Show Support for Purdue Pharma’s Bankruptcy Plan: “If preliminary voting sticks, Purdue Pharma’s controversial bankruptcy plan that settles with thousands of cities and states over the company’s role in the opioid epidemic will be accepted when the final tally is made public Aug. 2.
More than 95 percent of the 120,000-plus votes submitted are in favor of the bankruptcy proposal and nearly 97 percent of almost 5,000 state and local governmental creditors voted to accept the plan, the company said.”

AstraZeneca ups annual forecast following Alexion purchase: Details are in the article.

About healthcare devices

FDA dishes out Class I label to Philips' recall of faulty CPAP machines and other ventilators: “A recall of Philips’ ventilators for at-home and clinical use was given the FDA’s most serious classification after the devices were found to put users at risk of inhaling or swallowing dangerous pieces of debris.
The FDA handed down its Class I label several weeks after Philips initiated the recall in mid-June. Patients and healthcare providers using the company’s continuous and non-continuous ventilators—including CPAP and BiPAP machines to treat sleep apnea—are urged to stop using the devices immediately and contact Philips to replace the component.
At the root of the issue is the polyester-based polyurethane foam built into Philips’ ventilators to help reduce sound and vibrations. Over time the foam can potentially break down, sending specks of black debris and dangerous chemicals into the air pathway.”

Prescient Imaging Gains 510(k) Clearance for Portable PET Scanner: A real point-of-care breakthrough: “Hawthorne, Calif.-based Prescient Imaging has received 510(k) clearance from the FDA for its portable positron emission tomography (PET) scanner BBX-PET.
The device, which can be wheeled to the point of care, is cleared for obtaining PET images of parts of the human body, including the head. Potential uses include scans in neurology, geriatric psychiatry and radiation oncology centers.”

About healthcare IT

447,000 patients exposed after phishing attack on Florida practice: “Orlando (Fla.) Family Physicians began notifying 447,426 patients that it was the victim of a phishing attack on its employee email accounts…
Exposed data may include names, health insurance information, Social Security numbers, passport numbers and medical-related information.”
The attack targeted email accounts of several employees.

IU Health launches 'hack' lab to test medical device security: At Indiana University a “new lab is testing the cybersecurity of about 15 devices, including anesthesia and electrocardiogram machines, infusion pumps and patient monitors. The security team is essentially trying to hack the devices…“

Today's News and Commentary

About Covid-19

The C.D.C. now says fully vaccinated people should get tested after exposure even if they don’t show symptoms.: “‘Our updated guidance recommends vaccinated people get tested upon exposure regardless of symptoms,’ Dr. Rochelle P. Walensky, the agency’s director, said in an email to The New York Times…
Fully vaccinated people should wear a mask in public indoor spaces after exposure, the agency said. Three to five days later, they should be tested for the virus.
If the results come back negative, they can stop wearing masks indoors. If results are positive, the infected should isolate at home for 10 days.”

Bipartisan Senate infrastructure deal will not touch COVID-19 relief funds but delays Part D rebate rule: “A bipartisan group of senators announced an agreement on major pieces of the roughly $1 trillion infrastructure package. The deal will not touch COVID-19 provider relief funds to help pay for the package. However, in a major win for pharmacy benefit managers, it will delay a rule to get rid of the safe harbor for Part D rebates…”

J&J says U.S. FDA agrees to extend shelf life of its COVID-19 vaccine: “The U.S. Food & Drug Administration extended the shelf life for Johnson & Johnson's single-shot COVID-19 vaccine to six months from four-and-a-half months, the company said late Wednesday.”

White House tells agencies to mandate masks in federal buildings in hot spots: “Numerous U.S. federal agencies on Wednesday mandated masks at federal buildings in COVID-19 hot spots in line with instructions issued by the White House Office of Management and Budget (OMB), according to an OMB email seen by Reuters.
The move followed guidance issued by the Centers for Disease Control and Prevention (CDC) on Tuesday that vaccinated people should wear masks indoors in areas with substantial or high COVID-19 community transmission.
The White House said masks are required indoors in federal buildings for all employees and visitors, whether or not vaccinated, in those areas.”

Covid-19 Breakthrough Infections in Vaccinated Health Care Workers: “Among 1497 fully vaccinated health care workers for whom RT-PCR data were available, 39 SARS-CoV-2 breakthrough infections were documented. Neutralizing antibody titers in case patients during the peri-infection period were lower than those in matched uninfected controls… Higher peri-infection neutralizing antibody titers were associated with lower infectivity…Most breakthrough cases were mild or asymptomatic, although 19% had persistent symptoms (>6 weeks). The B.1.1.7 (alpha) variant was found in 85% of samples tested…No secondary infections were documented.”

About pharma

FDA Approves First Interchangeable Biosimilar Insulin: “The US Food and Drug Administration (FDA) has approved the first interchangeable insulin, Semglee (Mylan Pharmaceuticals), which can be substituted for glargine (Lantus, Sanofi) at the pharmacy without the need for a separate prescription.
The approval will allow Semglee to function like a generic drug in the market and may reduce insulin costs.”

Children’s Hospital of Philadelphia Researchers Develop “Dimmer Switch” to Help Control Gene Therapy: This discovery could have a huge impact on and create the next generation for gene therapies:
”In a major advancement in the field of gene therapy for rare and devastating diseases, researchers at Children’s Hospital of Philadelphia (CHOP) have developed a ‘dimmer switch’ system that can control levels of proteins expressed from gene therapy vectors. The system is based on alternative RNA splicing using an orally available small molecule and works effectively in tissues throughout the body, including the brain. The first research regarding this innovation was published today in the journal Nature.”

Eli Lilly bets $70M upfront and another $2B in biobucks for Kumquat's immuno-oncology small molecules: “The deal sees Lilly partner with Kumquat—run by a pair of serial entrepreneurs—to develop small molecules that stimulate tumor-specific immune responses, according to a statement. In return for the upfront payment, which consists of a cash payment and an equity investment, Lilly secures an option to a ‘certain number’ of drug candidates.”

July 2021 Pharmacy Market Outlook: Worth a quick read…the “bottom line” on cost is that the total weighted average drug price inflation estimate for 2022 is 3.10%.

About health insurance

Sign-Up Window for Free COBRA Coverage for Many Laid-Off Workers Closes This Week: “Under the American Rescue Plan Act that President Joe Biden signed in March, COBRA premiums for laid-off workers are covered in full by federal funding for six months from April through September…
For people… who lost their jobs before April 1, the window to take advantage of the subsidized coverage is closing. They have 60 days from the date their employer notified them of the COBRA subsidy to sign up for it — that’s July 31 if their employer notified them at the end of May. People notified earlier may have already missed their opportunity.”

About healthcare IT

Most Americans Want to Share and Access More Digital Health Data: One of the biggest impediments to interoperability has been peoples’ reluctance to have a unique identifier. According to this Pew Foundation survey, this sentiment has changed: “By a roughly 2-to-1 margin, respondents were comfortable with their health providers scanning patient fingerprints or assigning individuals a unique number or code to ensure that different EHR systems correctly match records for the same person, a long-standing challenge of data exchange.”

Parent of 1,000-physician network acquires digital health firm: The trend of cross-functional healthcare organizations’ consolidation continues: “The parent company of Catalyst Health Network, a 1,000-physician network based in Plano, Texas, acquired digital health company MediBookr, according to a July 27 news release.”

About hospitals and health systems

14 hospitals, systems sue HHS over graduate medical education payments: A group of 14 hospitals and health systems, including Michigan Medicine in Ann Arbor and Hospital for Special Surgery in New York City, is suing HHS over a calculation used to determine payments for physician training programs, according to court documents.
In the July 26 lawsuit, the hospitals claim they have been underpaid for several years due to a regulation implemented by HHS.
The regulation at the center of the lawsuit changed the weight assigned to full-time equivalent residents and fellows in the calculation to determine direct graduate medical education payments. Under the regulation, if a resident's training time exceeds the number of years designated as the "initial residency period," the resident's time is weighted at 0.5. Additionally, the regulation established a cap on the number of full-time equivalents that a hospital may claim in a given fiscal year.”

Today's News and Commentary

About Covid-19

PPE is designed for men. Some health experts are hoping to change that.:Research conducted last year in the United Kingdom revealed respiratory equipment “poorly fit” 16.7% of female health workers compared to 7.6% of men. PPE — including gloves, goggles, face masks, visors, or protective suits — that doesn’t fit properly leaves users exposed to harmful substances or chemicals as well as infections.”

COVID vaccines have higher approval in less-affluent countries: “The analysis, reported on 16 July in Nature Medicine, found that 80% of individuals surveyed in ten low- and middle-income countries (LMICs) in Asia, Africa and South America were willing to receive a COVID-19 vaccine, compared with 65% in the United States. Upper-middle-income Russia is an outlier: only 30% of people there were willing to have the jab.”
So…which countries are more “developed”?

Estimating SARS-CoV-2 infections from deaths, confirmed cases, tests, and random surveys: “The extent of the virus’ spread remains uncertain due to biases in test data. We combine multiple data sources to estimate the true number of infections in all US states. These data include representative random testing surveys from Indiana and Ohio, which provide potentially unbiased prevalence estimates. We find that approximately 60% of infections have gone unreported. Even so, only about 20% of the United States had been infected as of early March 2021, suggesting that the country was far from herd immunity at that point.”

3rd Pfizer dose strongly protects against delta variant, data shows: “In slides the drugmaker posted ahead of an earnings call, Pfizer showed data that antibody levels against the delta variant were five times higher in people aged 18 to 55 after a third dose and 11 times higher in 65- to 85-year-olds.”

About the public’s health

The information keeps coming in regarding helpful and deleterious effects of dietary behavior. In the end, we are still left left with the ancient wisdom: παν μέτρον άριστον- everything in moderation.
Moderate drinking linked to lower heart attack risk, study says: “Drinking a bottle or two of wine a week may be associated with decreased risk of heart attack, stroke, angina or death among those with cardiovascular disease, according to a study published Monday in BMC Medicine.
Researchers found that people who drink up to 105 grams of alcohol per week -- roughly six to eight drinks -- had lower risks of heart problems than those who didn't drink.”

New study finds drinking too much coffee can shrink your brain, increase dementia risk significantly: “…participants who consumed more than six cups of coffee each day had a 53-percent increased risk of dementia and smaller total brain volumes.”
However, last month, this article concluded: “New studies show why coffee is so beneficial for your health: “A new study finds that drinking three to five cups of coffee daily is associated with a reduced risk of several chronic diseases.”

Seqirus says it can supply 60 mln doses of influenza vaccines for U.S. flu season: “Vaccine maker Seqirus, a part of Australia-based biotech company CSL Ltd, said on Tuesday it has started shipping its influenza vaccines to the United States and can supply about 60 million doses of its shots for the upcoming flu season.”
Predications about the prevalent strain may be tricky this year since rates of influenza have been very low due to isolation/prevention measures that Covid-19 prompted.

About pharma

Remember when Harvoni and Sovaldi entered the Hepatitis C treatment market at a list price of $84,000 for a single course of treatment? This article explains a 97% efficacious treatment that costs $100:
From US$84,000 to US$100: Malaysia a step closer to eliminating hepatitis C with new, affordable drug: “The development of Ravidasvir was initiated by Malaysia’s Ministry of Health and the Geneva-based Drugs for Neglected Diseases initiative (DNDi). The clinical studies were funded by Malaysian and Thailand health authorities, as well as other agencies, companies and organisations.”
Again, we should ask the question: Which countries are more “developed”?

J.D. Power: Number of patients seeking health, wellness services at pharmacies on the rise: “J.D. Power released its 2021 U.S. Pharmacy Study on Wednesday, where it found that 51% of customers at retail pharmacies used health and wellness services in the past year.
By comparison, 48% said the same in 2020's report and 43% said they used such services in 2019, J.D. Power said.”
This growth has significance for public health (delivery of vaccines, health messages, etc.) but also as an important marketing channel.

These two stories are opposite ends of the same issue- pharma companies covering patients’ out-of-pocket expenses so those firms can charge insurers high prices.
Humana follows federal footsteps, sues Regeneron over Eylea pricing: “Humana is right behind the federal government in suing Regeneron for allegedly inflating its macular degeneration drug, Eylea, and using a ‘sham’ charity to pay out kickbacks to cover cost-sharing obligations, according to the lawsuit. 
Filed July 22, the Humana lawsuit is strikingly similar to accusations coming out of the U.S. Attorney for the District of Massachusetts in 2020, which alleged that Regeneron paid tens of millions of dollars in kickbacks for Eylea. This was largely done through making donations to a third-party foundation that would ensure the money went exclusively toward Eylea copays.
Humana's lawsuit notes the insurer has paid out over $900 million in claims for Eylea, so it is seeking upward of $2.7 billion in damages.”
Pfizer court fight could legalize Medicare copays and unleash ‘gold rush’ in sales: “Among other court arguments, Pfizer initially claimed that current regulation violates its speech protections under the First Amendment, essentially saying it should be allowed to communicate freely with third-party charities to direct patient assistance.”

About medical devices

Boston Scientific tops expectations with 53% sales growth over 2020: “The company posted net sales of about $3.08 billion for the second quarter of 2021, or a 53.6% gain over the same three months of the year before, when the first major wave of COVID-19 swept through the U.S.
Each of Boston Scientific’s three main business segments increased their revenues by more than half. Medical and surgical tools, including endoscopy and urology devices, delivered $948 million and 64.6% growth; meanwhile, heart rhythm, electrophysiology and neuromodulation hardware topped $866 million, an increase of 65%. 
Finally, the company’s cardiovascular division brought in $1.26 billion, a 51.4% boost over 2020’s second quarter—which, when adding up all three segments, only amounted to about $2 billion total.”

About health insurance

Humana boosts guidance as it posts $588M in Q2 profit: “Humana brought in $588 million in profit for the second quarter of 2021, down 67.8% from its haul in the prior-year quarter.
This echoes its peers' quarterly performance. Insurers posted sky-high profits in the second quarter of 2020 as healthcare utilization plummeted under the pandemic, raking in so much cash that Congress began a probe of their finances.”

Physician, wife indicted in connection with Medicare billing scam: “According to the indictment, the couple collected genetic samples from Medicare patients and sent them to clinical laboratories in exchange for kickbacks of up to $5,000. The employees collected DNA swabs for these tests, for which they received payment. 
The tests were not conducted by necessity… Medicare was billed over $1.3 million for the tests.”

About healthcare quality

Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction [HFrEF]: Not all good ideas work: “Among patients with HFrEF in hospitals randomized to a hospital and postdischarge quality improvement intervention vs usual care, there was no significant difference in time to first heart failure rehospitalization or death, or in change in a composite heart failure quality-of-care score.”

Using Consistently Low Performance to Identify Low-Quality Physician Groups: “A subset of physician groups that was consistently low performing could be identified by considering performance measures across multiple years. Considering the consistency of group performance could contribute a novel method to identify physician groups most likely to benefit from limited resources.”

Prevalence, Cost, and Variation in Cost in US Children’s Hospitals: “This cohort study found that major depressive disorder, scoliosis, acute appendicitis with peritonitis, asthma, and dehydration were high in prevalence, costs, and variation in cost. These results could help identify where future comparative effectiveness research in hospital pediatrics should be targeted to improve the care and outcomes of hospitalized children.”

About healthcare IT

Teladoc stock tumbles on growing losses as telehealth giant expects deficits to continue: “The wider losses were due to expenses related to the large-scale acquisition of Livongo and InTouch Health. ‘The larger net loss was primarily attributable to increased stock-based compensation,’ Chief Financial Officer Mala Murthy said during the company's second-quarter earnings call Tuesday.
The company saw continued improvement with its adjusted earnings before interest, taxes, depreciation, and amortization, or EBITDA, which came in at $67 million for the quarter compared to $26 million a year ago and ahead of consensus estimates at $62.9 million…”

IBM Report: Cost of a Data Breach Hits Record High During Pandemic: “Industries that faced huge operational changes during the pandemic (healthcare, retail, hospitality, and consumer manufacturing/distribution) also experienced a substantial increase in data breach costs year over year. Healthcare breaches cost the most by far, at $9.23 million per incident – a $2 million increase over the previous year.”

Apple Watch’s data ‘black box’ poses research problems: “A Harvard biostatistician is rethinking plans to use Apple Watches as part of a research study after finding inconsistencies in the heart rate variability data collected by the devices. He found that the data collected during the same time period appeared to change without warning.”

Today's News and Commentary

About Covid-19

CDC urges vaccinated people in high-transmission areas to resume wearing masks indoors as delta variant spreads: “The agency advised that vaccinated people who live in high-transmission places wear masks in indoor public spaces, according to three people familiar with the guidance. It also recommended that vaccinated people with vulnerable household members, including young children and those who are immunocompromised, wear masks indoors in public spaces.
The agency also called for universal masking for all teachers, staff members and students in schools, regardless of their vaccination status.”

Moderna says it plans to expand Covid vaccine trial for kids 5 to 11, will seek FDA OK as early as year-end: “The U.S. drugmaker is expanding the trial, which began in late March, to increase the likelihood of detecting potential rare side effects, the company said, declining to say how many children it ultimately hopes to enroll.”

Safety Evaluation of the Second Dose of Messenger RNA COVID-19 Vaccines in Patients With Immediate Reactions to the First Dose: “This multisite US study supports the safety of Pfizer-BioNTech or Moderna vaccine second dose administration in patients who report immediate and potentially allergic reactions after the first dose. Although mild symptoms were reported in 20% of patients with second dose administration, all patients who received a second dose safely completed their vaccination series and could use mRNA COVID-19 vaccines in the future when indicated.”

About healthcare IT

Epic pays hospitals that use its EHR algorithms, report finds: ”Verona, Wis.-based EHR giant Epic gives financial incentives to hospitals and health systems that use its artificial intelligence algorithms, which can provide false predictions, according to a July 26 STAT News investigation. 
For its report, STAT interviewed several health systems that use any of Epic's 20 algorithms. Employees of several major systems told the publication they were concerned about Epic's algorithm for predicting sepsis, claiming that the tool routinely fails to identify the condition in advance and frequently triggers false alarms, according to the report. Some hospitals reported benefits for patients after refining the model, but the process took at least a year.”

Anthem and Humana enter into multimillion agreement with SS&C for API cloud platform: “Anthem, Humana and SS&C Technologies have entered into a joint venture named DomaniRx to develop a claims adjudication and pharmacy benefits manager cloud platform, according to documents filed by SS&C Technologies with the Securities and Exchange Commission.
SS&C Technologies holds an 80.2% interest, and Humana and Anthem each hold a minority interest, according to the agreement filed with the SEC on July 15. 
The parties have committed up to an aggregate of approximately $925 million in the form of cash, property and/or services to support the development project, according to the filing.  
This amount includes $138,300,000 in initial cash contributions, certain assets of the parties, including a nonexclusive license to the claims processing platform known as RxNova, an assignment to a services agreement the company has with Humana, and up to approximately $400 million in cash, other property interests, and/or services.”

Poverty and Access to Internet, by County: This AHRQ interactive page makes the point that internet access should be considered a social determinant of health. See Yesterday’s blog for the case that connectivity should also be a vital sign. Here is an article from today’s JAMA Network that references this AHRQ page: Internet Access as a Social Determinant of Health

About health insurance

The future of accountable care organizations and Medicare’s other payment models: This morning, I listened to an excellent presentation by Harvard Professor Michael Chernew, who is also the chair of MedPAC. I highly recommend it! And in a related article: The Little-Known Agency That’s Trying To Boil The Ocean—A Look At CMMI’s Decade Of Trying To Change Medicare & Medicaid: Former Senate majority leader and cardiac surgeon, Bill Frist, discusses the Center for Medicare and Medicaid Innovation, its initiatives, what works and what does not work.

Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Spending Above the Catastrophic Threshold Over Time: “In 2019, nearly 1.5 million Medicare Part D enrollees had out-of-pocket spending above the catastrophic coverage threshold. Looking over a five-year period (2015-2019), the number of Part D enrollees with out-of-pocket spending above the catastrophic threshold in at least one year increases to 2.7 million, and over a 10-year period (2010-2019), the number of enrollees increases to 3.6 million.” As usual with KFF, the article has helpful graphics.

Florida physician sentenced in $20M healthcare fraud scheme: “Richard Davidson, MD, 42, of Delray Beach, was sentenced about 10 months after entering a guilty plea. He admitted that he and his conspirators established a conglomerate of durable medical equipment companies that they used to submit illegal claims to Medicare. Mr. Davidson said they placed the companies in the names of straw owners, which enabled them to submit high volumes of illegal durable medical equipment claims to Medicare, according to the Justice Department.” Note: As usual, this large fraud was committed against a federal, fee-for-service program.

Centene posts $535M loss in second quarter of 2021: “Centene Corporation posted a $535 million loss in the second quarter of 2021, down from its $1.2 billion haul in the prior-year quarter.
Despite the loss, the company is the black for the first half of the year, according to its earnings report released Tuesday morning, with $164 million in profit through the first two quarters. By comparison, Centene boasted $1.3 billion in profit for the first half of 2020.”

About pharma

FDA generic drug approvals falling, analysis finds: “In the first half of 2021, the FDA gave full approval to 343 generic drugs and gave 72 tentative approvals. In the first half of 2020, it gave full approval to 361 generic drugs and gave 92 tentative approvals. 
The agency has seen a steady decline in new generic drug sumbisisons from drugmakers, Politico reported. In the first half of this year, the FDA received an average of  66 generic drug submissions per month, down from a high of 94 per month in 2017.”

Jury Orders Novartis to Pay $178 Million for Patent Violation: “A jury in the U.S. District Court for the Northern District of California has ordered Novartis to pay $177.8 million to Plexxikon, a subsidiary of Daiichi Sankyo, for infringing on two of the Japanese company’s patents.
Novartis’s Tafinlar (dabrafenib) is a kinase inhibitor indicated for treating patients with unresectable or metastatic melanoma with the BRAF V600E gene mutation. It competes with Zelboraf (vemurafenib), another BRAF inhibitor that was discovered by Plexxikon and licensed to Roche.”

About the public’s health

Many articles in the news the past week about health disparities and racism:
What US News' equity analysis reveals about racial gaps in hospital care: 5 takeaways: For example: “Only 29 percent of hospitals treated a proportion of Black patients comparable to or higher than their community's Black population. This figure sat at 18 percent for Hispanic patients and 5 percent for Asian/Pacific Islander patients.”
Changes in Racial and Ethnic Disparities in Access to Care and Health Among US Adults at Age 65 Years: “In this cross-sectional study that uses a regression discontinuity design, eligibility for Medicare at age 65 years was associated with marked reductions in racial and ethnic disparities in insurance coverage, access to care, and self-reported health.”
From the AMA: Defining racism is key to helping doctors advance health equity: The article, along with a video and reference to an action plan, has a useful glossary of terms.
Racial and Ethnic Disparities in Outpatient Visit Rates Across 29 Specialties: “Racial and ethnic minority groups are markedly underrepresented in the outpatient practices of most medical and surgical specialties. Disparities persisted after accounting for several social determinants of access to care.
Several factors may underlie these findings. Racial/ethnic minority groups are more likely to reside in areas with a shortage of physicians and less likely to receive specialty referrals from primary care physicians. The history of racism in health care may lead non-White patients to distrust the health care system, suppressing utilization. Physicians are less likely to grant appointments for patients with Medicaid or without insurance, who are disproportionately members of racial/ethnic minority groups. A higher burden of end-stage kidney disease and nearly universal Medicare coverage for patients with this disease may explain the high nephrology visit rates for individuals of racial/ethnic minority groups.”
I copy most of the Discussion section since the article is available by subscription-only. If you can get the original, the differences by specialty and race displayed in the chart are interesting.

Fauci Wants to Make Vaccines for the Next Pandemic Before It Hits: “The idea is to make ‘prototype’ vaccines to protect against viruses from about 20 families that might spark a new pandemic. Using research tools that proved successful for Covid-19, researchers would uncover the molecular structure of each virus, learn where antibodies must strike it, and how to prod the body into making exactly those antibodies.”

BioNTech says it will create an mRNA-based vaccine to prevent malaria: The headline is the story.

WHO reports progress in the fight against tobacco epidemic: “More than four times as many people are now covered by at least one WHO-recommended  tobacco control measure as compared with 2007. The six MPOWER measures are monitoring tobacco use and preventive measures; protecting people from tobacco smoke; offering help to quit; warning about the dangers of tobacco; enforcing bans on advertising, promotion and sponsorship; and raising taxes on tobacco.
Some 5.3 billion people are now covered by at least one of these measures - more than four times the 1 billion who were covered in 2007.”

About hospitals and health systems

Best Hospitals by Specialty: The annual US News report. “Of the nearly 5,000 hospitals analyzed and 30,000 physicians surveyed, only 175 hospitals ranked in at least one of the specialties.” Here are the top 10 overall:

Despite raising guidance for 2021, UHS still has concerns about COVID's strain on labor markets: “Universal Health Services has followed in the wake of other outperforming for-profit health systems during the second quarter of 2021, reporting $325 million in profits and a 17.1% year-over-year increase in net revenues as patients returned to its hospitals and behavioral health services.
But while the strong performance allowed UHS to increase its forecast for the remainder of 2021—it now predicts net revenues for the year will fall between $12.12 billion and $12.36 billion—executives warned investors that continued acceleration of recent COVID-19 case trends could take a bite out of its sunny forecast.”

Today's News and Commentary

About Covid-19

‘A tipping point’: Government officials, health groups move to require coronavirus vaccines for workers: “The Department of Veterans Affairs, which runs one of the nation’s largest health systems, announced Monday it would mandate coronavirus vaccines for its front-line workers, becoming the first federal agency to do so and signaling what some experts said could be a national pivot to such requirements.
Faced with the explosive growth of a new virus variant, the state of California and the city of New York rolled out similar mandates. And an array of hospitals from coast to coast, including the prestigious Mayo Clinic, declared they would require staff to get vaccinated, following a joint plea from the nation’s major medical groups.”

Single AstraZeneca Vaccine Dose Highly Effective Against Delta Variant, Study Says: “Canadian researchers found that one dose of the AstraZeneca’s COVID-19 vaccine, Vaxzevria, was highly effective at preventing hospitalization or death caused by the Delta variant.
A single dose was found to be 87 percent effective against the Delta variant, 90 percent effective against the Alpha variant and 82 percent effective against the Gamma/Beta variant, said researchers from the Canadian Immunization Research Network.”

UK Researchers Endorse Eight-Week Separation of Pfizer Vaccine Doses: “Although the authorized dose interval for the vaccine is three weeks, a study commissioned by the UK’s Department of Health and Social Care found that a 10-week interval between doses produced more antibodies and T-cells against infection.
However, given concerns about the rapidly spreading Delta variant, an 8-week window was deemed preferable by the researchers from Oxford and Newcastle universities.”

Families of men in notorious syphilis study speak up for vaccination: “A short-form documentary featuring the descendants of the men involved in the U.S. Public Health Service Syphilis Study at Tuskegee sets the record straight on what happened, what has changed and what current generations can learn from the experience to build confidence in public health within Black communities, especially as it relates to the COVID-19 vaccines.”

About health insurance

Healthcare for older immigrants sees momentum among states: “Illinois is among a handful of Democratic-run states extending health insurance coverage to adult immigrants in the country illegally, including seniors. The state, which became the first to offer a Medicaid-like program for older immigrants last year, used a new budget to expand the program. California followed suit, including coverage for those 50 and over in the latest budget. And Oregon’s governor signed a plan this week offering benefits to low-income immigrants over 19. New York advocates are banking on the momentum to do the same.”

Gig Workers Paying 54% Less For Health Insurance, New Data Shows: “According to new data from Stride, a benefits platform for independent workers, health insurance enrollment increased sixfold in April compared to the same time last year. Year to date, nearly as many people have signed up for health insurance as did during the annual open enrollment period at the end of 2020, the company reported.
Of rideshare and delivery drivers who have signed up for health insurance since March, 60% have enrolled in higher-tier Marketplace plans—Silver, Gold, and Platinum—a 33% jump since before the ARP became law. The higher the metallic tier, the more generous the coverage.
At the same time, the costs for coverage have gone down for these workers. The average premium for rideshare and delivery drivers dropped by more than half, from $171 in March to an average of $80 since then.”

A look at SCAN's new medical group for homeless patients: “SCAN Group, which owns SCAN Health Plan, is launching a new medical group that aims to provide specialized care to patients struggling with homelessness.
The new medical group, Healthcare in Action, will serve SCAN's members and is seeking partnerships with other health plans. The group will provide "street medicine" to seniors, which is one of the fastest-growing homeless populations.”

Medicaid Benefits No Barrier to Green Cards, Agency Chief Says: “The CMS is releasing an informational bulletin to the state Medicaid agencies reaffirming that the receiving benefits under the Medicaid program or the Children’s Health Insurance Program will have no bearing on an applicant’s immigration status…”

AHIP, Other Stakeholders Support Medicare Value-Based Care Bill: “In a joint letter to the four representatives who introduced the bill in the House of Representatives, payer and provider organizations have thrown their support behind the Value in Health Care Act of 2021 which seeks to bolster Medicare value-based care.
Signees included AHIP, Premier, and the National Association of Accountable Care Organizations (ACOs).”

About healthcare IT

Connectivity, digital tools becoming the ‘sixth vital sign’ in health care: A fascinating, but obvious concept. People rely so much on the internet (clinical information, appointment booking, insurance information, etc.) that we should make connectivity a standard question.

About the public’s health

Marlboro Maker CEO Says The Company Plans To Stop Selling Smokes In The U.K.: “Tobacco giant Philip Morris International says it will stop selling cigarettes in the United Kingdom within the next decade — including the company's iconic Marlboro brand.
‘It will disappear,’ the company's CEO Jacek Olczak said in an interview… ‘The first choice for consumers is they should quit smoking. But if they don't, the second best choice is to let them switch to the better alternatives.’”

About diagnostics

PerkinElmer inks massive $5.25B deal for reagent producer BioLegend: “PerkinElmer aims to cement itself as a major provider of reagents and consumables for precision medicine and diagnostic test development through a $5.25 billion deal for BioLegend, a global producer of antibodies and other research tools.
In what will become the company’s largest acquisition ever, PerkinElmer will hand over $2.2 billion in stock to BioLegend shareholders, with the remainder made up of cash-on-hand and newly issued debt, as well as bridge financing from Goldman Sachs. The deal is slated to close before the end of this year.”

Today's News and Commentary

About Covid-19

The Delta Variant Will Drive A Steep Rise In U.S. COVID Deaths, A New Model Shows: “The current COVID-19 surge in the U.S. — fueled by the highly contagious delta variant — will steadily accelerate through the summer and fall, peaking in mid-October, with daily deaths more than triple what they are now.
That's according to new projections released Wednesday from the COVID-19 Scenario Modeling Hub, a consortium of researchers working in consultation with the Centers for Disease Control and Prevention to help the agency track the course of the pandemic.”

Biden administration sends more cash to hard-hit areas as Delta variant surges: “The White House is directing $100 million of additional spending and deploying dozens of federal health workers to shore up vaccine outreach and Covid-19 tracking in rural and heartland states as the Delta variant continues to surge.
The new steps come as new cases and hospitalizations continue to spike while vaccination rates have stalled at 68 percent of adults, with uptake far lower in some parts of the SouthThe more transmissible Delta variant now accounts for 83 percent of cases nationwide.”

US hospitals in scramble to make room amid rising COVID-19 case count, dwindling bed capacity: The article has snapshots from four states where some facilities are facing capacity strains.

Study Claims J&J Vaccine Much Less Effective Against Delta, Lambda Variants: “Johnson & Johnson’s (J&J) single-dose vaccine is far less effective against the Delta and Lambda strains of the SARS‑CoV‑2 virus than against the original coronavirus, researchers at New York University (NYU) reported.”

3 states responsible for 40% of COVID-19 cases: “Florida, Texas and Missouri accounted for 40 percent of new COVID-19 cases reported nationwide this week, Jeff Zients, the White House's COVID-19 response coordinator, said July 22.
’The data is clear: The case increases are concentrated in communities with low vaccination rates,’ Mr. Zients said during a news briefing, pointing to the three states.”

About the public’s health

Mississippi's attorney general asks Supreme Court to overturn Roe v. Wade: “Mississippi’s attorney general urged the Supreme Court in a Thursday brief to overrule Roe v. Wade next term when the justices review Mississippi’s ban on virtually all abortions after 15 weeks of pregnancy.
Calling the court’s precedent on abortion “egregiously wrong,” Attorney General Lynn Fitch (R) explicitly set the dispute over Mississippi’s restrictive law on a collision course with the landmark 1973 decision in Roe that first articulated the constitutional right to abortion.”

Superbug’ fungus spread in two cities, health officials say: “U.S. health officials said Thursday they now have evidence of an untreatable fungus spreading in two hospitals and a nursing home.
The ‘superbug’ outbreaks were reported in a Washington, D.C, nursing home and at two Dallas-area hospitals, the Centers for Disease Control and Prevention reported. A handful of the patients had invasive fungal infections that were impervious to all three major classes of medications…
The fungus, Candida auris, is a harmful form of yeast that is considered dangerous to hospital and nursing home patients with serious medical problems. It is most deadly when it enters the bloodstream, heart or brain. Outbreaks in health care facilities have been spurred when the fungus spread through patient contact or on contaminated surfaces.”

About pharma

Pfizer Drops Lawsuit Against J&J Over Remicade Biosimilar Coverage: “Pfizer withdrew a 2017 lawsuit against Johnson & Johnson (J&J) that alleged the company used anticompetitive practices to stop insurance companies from covering Pfizer’s biosimilar of rheumatoid arthritis drug, Remicade (infliximab).  
Pfizer alleged that J&J violated antitrust laws by telling insurers it would withhold certain rebates on Remicade unless they limited their coverage of Pfizer’s biosimilar, Inflectra, which allowed J&J to corner the market on the drug.”
I wonder if President Biden’s pro-generic stance and fight against anti-competitive actions contributed to this decision.

About diagnostics

European Commission launches months-long antitrust investigation into Illumina’s $8B bid for Grail: “The European Commission has opted for a deeper probe into the DNA sequencing giant’s $8 billion proposal for the cancer blood test maker Grail, citing concerns that the vertical takeover of its former spinout could harm R&D efforts at competing diagnostic companies.”

About health insurance

Humana, Centene opioid recovery drug suits dismissed: “A district judge dismissed a pair of lawsuits from Humana and Centene against Indivior over alleged attempts to suppress competition of Suboxone, its opioid recovery drug. 
The lawsuits were thrown out because both insurers were considered indirect purchasers of Suboxone, voiding their standing to sue via the Racketeering Influenced and Corrupt Organizations Act, according to the court opinion.”


Out-of-pocket [OOP] costs for preventive care persist almost a decade after the Affordable Care Act: “We found that in addition to premium costs meant to cover preventive care, Americans with employer-sponsored insurance were still charged between $75 million and $219 million in total for services that ought to be free to them ($0.50 to $1.40 per ESI-covered individual and $0.75 to $2.17 per ESI-covered individual using preventive care). However, some enrollees still faced OOP costs for eligible preventive services ranging into the hundreds of dollars. OOP costs are most likely to be incurred for women's services (e.g., contraception) and basic screenings (e.g., diabetes and cholesterol screenings), and by patients in the South or in rural areas.”

UnitedHealthcare awarding $11.4M to social determinants programs in 18 states: ”The insurer first launched its Empowering Health program in 2018 and has since then awarded more than $40 million in grants, establishing partnerships with community organizations across 26 states.
UnitedHealthcare said that these investments have reached more than 6 million people.
The insurer will award $1 million to organizations in four states: Indiana, New York, Nevada and Mississippi. $900,000 will be made awarded to groups operating in Virginia, UnitedHealthcare said.”

As the Pandemic Eases, What Is the State of Health Care Coverage and Affordability in the U.S.?: A really good review of this topic from the Commonwealth Fund. For a quick overview of the results, scroll down and check the chart pack links on the left.

Today's News and Commentary

About Covid-19

Local officials across U.S. are starting to reimpose Covid mask rules as delta variant takes hold: It’s not just LA.
And in a related article: Public health officials have tools to beat back Covid again. Does anyone want to use them?: “… in a number of others states — those where resistance to Covid control measures ran high — elected officials have put some of public health’s tools off limits. North Dakota enacted legislation barring health authorities from requiring anyone to wear a mask, for any reason. Montana banned the practice of quarantining people who have been in contact with a person infected with a transmissible pathogen — robbing health authorities of one of the oldest known disease control techniques.”

Two doses of Pfizer, AstraZeneca shots effective against Delta variant: study: More evidence on effectiveness of these vaccines: “Wednesday's study found that two doses of Pfizer's shot was 88% effective at preventing symptomatic disease from the Delta variant, compared to 93.7% against the Alpha variant, broadly the same as previously reported.”

About healthcare IT

Length and Redundancy of Outpatient Progress Notes Across a Decade at an Academic Medical Center: “In this cross-sectional study of nearly 3 million outpatient progress notes written across 46 specialties at an academic medical center, median note length increased 60.1% from 401 words in 2009 to 642 words in 2018 while median note redundancy (ie, the proportion of text identical to the patient’s last note) increased 10.9 percentage points from 47.9% in 2009 to 58.8% in 2018. Both increases were significant.”
The other problem is someone else often has to read these notes, so wasted time literally adds up.

VA pausing Cerner's EHR deployment through 2021: An update to the continuing debacle.

Humana responds to possible data breach of 3rd-party app on Medicare Advantage: “Humana became aware of a possible data breach of an unaffiliated third-party app that targeted Medicare Advantage members and agents, a spokesperson confirmed with Becker's July 22. 
The app isn't owned or operated by Humana. The insurer said there wasn't any evidence to indicate that data was removed from its systems.”

About hospitals and health systems

10 numbers showing hospitals' financial recovery: “The COVID-19 pandemic caused significant revenue losses for hospitals as elective surgery volumes dwindled and reimbursement lagged. Despite this, hospitals recently have seen financial improvements. Here are 10 numbers that illustrate hospitals' financial recovery.”

Tenet posts $120M profit in Q2: “The for-profit hospital operator ended the second quarter of 2021 with revenue of $4.95 billion, up from $3.65 billion in the same period a year earlier. Tenet attributed the increase to several factors, including higher patient volumes. Same-hospital adjusted admissions were up 23.9 percent year over year in the second quarter. 
After factoring in expenses, Tenet reported net income of $120 million in the second quarter of this year, up from $88 million in the same period of 2020.”

About pharma

Apotex to Settle Drug Price Dispute With Texas for $26 Million: “Canadian generics manufacturer Apotex has agreed to pay the state of Texas $26 million to settle charges that the company reported inflated drug prices to the state’s Medicaid program for more than 30 years.”

Biogen execs blame critics, the media for spurring 'misinformation' as Aduhelm launch lags expectations: This article provides the “other side to the story.”

Pharma pushes back on Congress' flirtation with delaying rebate rule to help pay for infrastructure: “A bipartisan group of senators is exploring how to pay for a roughly $1 trillion infrastructure package and one of the reported methods is to delay a rule that would eliminate the safe harbor for Medicare Part D rebates. The rule, which creates a new safe harbor for discounts offered at the point-of-sale, is expected to go into effect on Jan. 1, 2023.”

Pfizer funnels $1B into protein degrader Arvinas, with more in biobucks on the table: “Pfizer is doubling down on Arvinas. Three years after the duo inked a discovery and development deal, they’re adding commercialization to the mix. Pfizer is forking over $650 million upfront and investing $350 million in Arvinas to develop and commercialize the latter’s protein-degrading breast cancer drug.”

Mount Sinai genomics spinout goes public under $500M merger deal: “Stamford, Conn-based Sema4, a genomics company spun out of Mount Sinai Health System, completed its merger with special purpose acquisition company CM Life Sciences, the organizations announced July 22.”

About diagnostics

Quest Diagnostics sees ‘faster than expected’ return in base testing business as routine healthcare rebounds: “Quest Diagnostics reported ‘faster than expected recovery’ in its base businesses during the second quarter,  the lab testing giant’s CEO, Steve Rusckowski, said Thursday.
The company posted $2.55 billion in net revenues, an increase of 39.5% over the same three months in 2020, when the first wave of the coronavirus pandemic began in earnest in the U.S. and prompted patients to defer trips to the clinic unless absolutely necessary.”

Abbott returns to pre-pandemic growth, clocking 11% sales bump from 2019 sans COVID testing revenues: “In total, Abbott raked in global sales of about $10.2 billion during the quarter, representing a 35% jump in organic growth from the same period in 2020. The diagnostics and medical devices segments fared especially well, registering organic raises of 57% and 45% year over year, respectively.
That growth in the diagnostics business stayed strong even with the removal of the $1.3 billion that flooded into the segment from sales of Abbott’s BinaxNOW, Panbio and other COVID testing kits. Sans those revenues, the company still clocked year-over-year organic growth of just over 37%.”

About health insurance

What country do you think this statement describes?:
”Under the current system, some people have to sell their homes to pay for spiralling [sic] care costs, while too many others without private means are not receiving the publicly funded care they need.”

Here is the answer.

Missouri Supreme Court rules in favor of Medicaid expansion: “Missouri's Supreme Court ruled that the state's August 2020 Medicaid expansion amendment did not violate the state constitution, reversing a lower court decision blocking the expansion.” The issue was whether an unfunded referendum by voters was still a requirement to implement the program.

CMS Announces Rate Changes; Physician Fee Schedule to Include RPM [Remote Patient Monitoring]: “CMS proposed updated payment rates for hospital outpatient and ambulatory surgical center services for calendar year 2022. Updates outlined in the proposal include:

  • Hospital price transparency for standard charges

  • Request for information for the Rural Emergency Hospital provider type outlined in the Consolidated Appropriations Act of 2021

  • Changes to the hospital outpatient prospective payment system and ambulatory surgical center services payment rates

  • Updates to the inpatient only list for covered inpatient services

  • Implementation of the Radiation Oncology Model

Updated payment rates for outpatient drugs and non-opioid medications are also outlined in the rule as well as changes to covered procedure lists. The current proposal is open for a 60-day comment period with the final rule set to be issued in November.”
The official document is: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Price Transparency of Hospital Standard Charges; Radiation Oncology Model; Request for Information on Rural Emergency Hospitals

Today's News and Commentary

About Covid-19

US renews 'public health emergency' declaration due to Covid-19 pandemic: “US Department of Health and Human Services Secretary Xavier Becerra signed a renewal of the determination that a "public health emergency" exists due to the Covid-19 pandemic.
The determination was last renewed in April and was set to expire -- as it is up for renewal every 90 days. This latest renewal is effective starting Tuesday and will continue for another 90 days.”

More than 91 million live in US counties with high Covid-19 infections. It's time to reset and put masks back on, expert says: “‘We are at a very different point in the pandemic than we were a month ago,’ Dr. Leana Wen told CNN on Tuesday. ‘And therefore, we should follow the example of LA County and say that if there are places where vaccinated and unvaccinated people are mixing, then indoor mask mandates should still apply.’"

COVID-19 Guidance for Safe Schools: The latest recommendation from the American Academy of Pediatrics includes this statement: “All students older than 2 years and all school staff should wear face masks at school (unless medical or developmental conditions prohibit use).

Growing number of Republicans urge vaccinations amid delta surge: “Senate Minority Leader Mitch McConnell (R-Ky.) was part of the rising chorus on Tuesday, stressing the need for unvaccinated Americans to receive coronavirus shots and warning that the country could reverse its progress in moving on from the pandemic.”
You heard about someone “getting religion,” now some Republicans are “getting science.”

About health insurance

New bill seeks to reverse slide in ACO participation with more shared savings: “New bipartisan House legislation aims to boost the amount of shared savings that accountable care organizations can receive from the federal government to halt a slide in participation that has occurred over the past two years…
The legislation would increase the size of shared savings that an ACO can get. It also will modify the risk adjustment process that determines whether ACOs reach spending thresholds to better reflect factors that providers in the program could encounter such as health or community risk variables.”
This legislation is a bad idea and just delays the demise of many poorly functioning ACOs. The reason these organizations are dropping out is because they cannot handle the move to risk arrangements that they must assume at the end of the shared shavings arrangements. The Medicare Advantage program is risk-based and has proven to be successful over many years- why keep the flawed ACO program alive when we have a better option?

BREAKING NEWS: CMS to Reinstate Inpatient-Only List: “In an unprecedented move, the Centers for Medicare & Medicaid Services (CMS) has proposed in the 2022 Outpatient Prospective Payment System (OPPS) Rule to put back on the inpatient only list all the procedures that they removed from the inpatient-only list starting this calendar year.
The agency has also put a halt to its three year-plan to completely eliminate the inpatient-only list. It appears that its motivation is to protect the safety of Medicare beneficiaries and take a more cautious approach to removing services from the inpatient only list looking at them on an individual basis rather than by class.”

Dignity Health, Anthem end contract: “Anthem claimed in a statement the relationship primarily fizzled out because the insurer refused to agree to rate increases that would continue to make San Francisco-based Dignity more expensive than other systems. The insurer said Dignity is nearly 30 percent more expensive than other California health systems. 
An Anthem spokesperson told Becker's that it is still negotiating with Dignity, but has made members aware of alternatives in the interim.”

Mississippi pharmacist pleads guilty to $180M+ insurance fraud scheme: “A pharmacist based in Bolton, Miss., pleaded guilty July 20 for his role in a health insurance fraud scheme totaling more than $180 million, according to the Department of Justice.
David ‘Jason’ Rutland, 42, a pharmacist and co-owner of various compounding pharmacies, admitted to his role in a scheme that defrauded federal and privately-owned insurers by distributing medically unnecessary compounded medications and adjusting prescription formulas to ensure the highest reimbursement without regarding efficacy, according to the Department of Justice.
The scheme also defrauded insurers by soliciting recruiters to procure prescriptions for high-margin compounded medications and paying those recruiters commissions based on the percentage of reimbursements paid by pharmacy benefit managers and healthcare benefit programs. Under the scheme, copayments to be paid by beneficiaries and members were systematically waived and reduced.”
The DoJ has found many similar cases over the years. What takes them so long to find such huge fraud?

About the public’s health

U.S. life expectancy falls to lowest level in almost 20 years due to COVID-19 -CDC: “Life expectancy in the United States fell by a year and a half in 2020 to 77.3 years, the lowest level since 2003, primarily due to the deaths caused by the COVID-19 pandemic, a U.S. health agency said on Wednesday…
Deaths from COVID-19 contributed to nearly three-fourths, or 74%, of the decline and drug overdoses were also a major contributor, the CDC said.”

More than 200 people in U.S. being monitored for possible monkeypox exposure, CDC says: More on this previously-reported story:
”More than 200 people in 27 states are being monitored for possible exposure to monkeypox after they had contact with an individual who contracted the disease in Nigeria before traveling to the United States this month, according to the Centers for Disease Control and Prevention. To date, no additional cases have been detected.”

A Federal Judge Has Blocked An Arkansas Law Banning Most Abortions: “A federal judge on Tuesday blocked an Arkansas law banning nearly all abortions in the state while she hears a challenge to its constitutionality.
U.S. District Judge Kristine Baker issued a preliminary injunction preventing enforcement of the law, which was set to take effect on July 28. The measure was passed this year by the majority-Republican Legislature and signed by GOP Gov. Asa Hutchinson.
The ban allows the procedure to save the life of the mother in a medical emergency and does not provide exceptions for those impregnated in an act of rape or incest.”

About pharma

How an Unproven Alzheimer’s Drug Got Approved: The quick answer is: “Much is still unknown, but an examination by The Times has found that the process leading to approval took several unusual turns, including a decision for the F.D.A. to work far more closely with Biogen than is typical in a regulatory review.”
This article is a well-done review of what happened in the approval process of this controversial drug.

Attorneys General propose a $26 billion global opioid settlement with the 'big three' drug distributors: “A group of states Attorneys General announced a proposed $26 billion global settlement Wednesday that, if approved, will resolve claims against the big three drug distributors McKesson Corporation, Cardinal Health Inc. and Amerisource Bergen Drug Corporation and opioid manufacturer Johnson & Johnson.”

Justice Department Blasts Purdue Pharma's Bankruptcy Plan: “The DOJ's U.S. Trustee program, which serves as a national watchdog over the federal bankruptcy system, said the deal is unconstitutional and illegal.
In a separate brief, the office of the U.S. Attorney for the Southern District of New York said the plan violated the "constitutional right to due process" for those with potential opioid claims.
Under a proposed settlement negotiated over the last year, members of the Sackler family who own the company would contribute roughly $4.3 billion from their private fortunes to help compensate people and communities harmed by Oxycontin.
In exchange, the Sacklers and a long list of their associates who haven't filed for bankruptcy would be granted so-called "third party releases," sheltering them from future opioid lawsuits.”

AstraZeneca closes mega $39B Alexion buyout despite antitrust fears, making a splash in rare diseases: Finally…” AstraZeneca’s mega $39 billion takeover of Alexion Pharmaceuticals has come to a close, delivering the British pharma a lucrative portfolio of immunology medicines and a towering presence in rare diseases. 
AZ on Wednesday announced the completion of its Alexion acquisition, a week after securing a pivotal nod from the U.K.’s Competition and Markets Authority (CMA).”

Johnson & Johnson eyes $2.5B in COVID vaccine sales as key immunology, oncology meds trounce expectations: “Johnson & Johnson is forecasting $2.5 billion in full-year sales of its one-shot COVID-19 vaccine, company executives said Wednesday on a call with analysts. The vaccine pulled in $164 million for the second quarter and $264 million during the first six months of the year, chief financial officer Joe Wolk said. With pandemic revenues in the mix, the company anticipates between $93.8 billion and 94.6 billion in total sales for 2021…
Outside of its COVID-19 vaccine, J&J did gangbusters across all of its businesses as the pandemic eased in parts of the world. Total second-quarter sales swelled roughly 27% to 23.3 billion, with growth recorded in pharmaceuticals, consumer health and medical devices. Medical devices specifically posted a 58.7% sales upswing after suffering some serious pandemic blows in 2020.”

Healthcare quality

Clinician Conceptualization of the Benefits of Treatments for Individual Patients: “In this survey study of 542 clinicians, most respondents significantly overestimated the benefits of common therapies. Clinicians who conceptualized a greater chance of benefits of therapy were more likely to treat similar patients in their practice.”

Do Black and White Patients Experience Similar Rates of Adverse Safety Events at the Same Hospital?: From the Urban Institute: “Our evidence shows that Black patients systematically experience higher rates of hospital-acquired illnesses or injuries related to surgical procedures relative to white patients treated in the same hospital.”
What measures can we consistently use to equalize/maximize hospital quality across all patients?

About healthcare professionals

Carbon Health banks another $350M to become 'largest primary care provider in the U.S.': “Over the course of the pandemic, Carbon Health has doubled its full-time staff from 800 to 1,600 employees, opened over 80 clinics in 12 states and expanded its virtual care services to 23 states, the startup said.
While Carbon Health services are currently available to more than three-quarters of those living in the U.S., the company said it’s looking ahead toward a goal line of 1,500 clinics by 2025 ‘to become the largest primary care provider in the U.S.’”

Today's News and Commentary

About Covid-19

Novavax’s Effort to Vaccinate the World, From Zero to Not Quite Warp Speed: “Looking forward has kept Novavax afloat for decades ― along with its deep ties to grant makers and federal agencies. With its focus on developing vaccines, including for the SARS and MERS pandemics… Novavax is ‘built for this moment.’ Still, the 34-year-old startup has never brought one to market.”
It differentiates itself fro other manufacturers in its “proprietary secret ingredient… Matrix-M, an immune booster. Executives say the additive ― derived from Chilean soapbark trees ― works so well that less of an antibody-producing antigen would be needed with it in a vaccine.”
The article is a good case history for what happened to this promising company.

States are sitting on millions of surplus Covid-19 vaccine doses as expiration dates approach:
”Several state health departments told STAT they have repeatedly asked the federal government to redistribute their supply to other countries, many of which are facing a third wave of the Covid-19 pandemic. Officials in Washington have rejected those requests, citing legal and logistical challenges.”

Vaccine offers 99% protection against death in Delta strain, finds NIV study: “Scientists from the National Institute of Virology conducted the largest study to date in India to understand why people got COVID-19 despite taking one or two vaccine doses…
This study indicated that a majority of the clinical cases in the breakthrough were infected with the Delta variant and only 9.8% cases required hospitalisation, while fatality was observed in only 0.4% cases…"

COVID-19 Antibodies Persist at Least Nine Months After Infection: “Testing of an entire Italian town shows antibody levels remain high nine months after SARS-CoV-2 infection, whether symptomatic or asymptomatic…
The team found that 98.8 percent of people infected in February/March showed detectable levels of antibodies in November, and there was no difference between people who had suffered symptoms of COVID-19 and those that had been symptom-free.”

Survey Shows Majority of Unvaccinated Americans Believe Microchips Are in Vaccines: “One in five Americans believe that the U.S. government is using the vaccine to plant microchip tracking devices into people, the survey found. A significant number of those who reject vaccines also cite the belief that inoculation in general causes autism.”

Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19: “It appears clear from evidence to date that government interventions, even more restrictive ones such as stay-at-home orders, are beneficial in some circumstances and unlikely to be causing harms more extreme than the pandemic itself.”

Judge: Indiana University can require COVID-19 vaccinations: ”In a ruling dated Sunday, U.S. District Judge Damon Leichty in South Bend rejected a request from eight IU students who sought to block the requirement while they pursue a lawsuit claiming that the university’s policy violated their constitutional rights by forcing them to receive unwanted medical treatment…
Leichty wrote that the students haven’t presented evidence showing they could prevail in the case, and that the Constitution ‘permits Indiana University to pursue a reasonable and due process of vaccination in the legitimate interest of public health for its students, faculty and staff.’”

About health insurance

'Gold Cards' Allow Texas Docs to Skip Prior Authorization: Health insurance contracts typically cover contingencies for behavior from the worst performers, thus penalizing high quality, efficient providers. This measure should be a start for benchmarking laws in other states to help solve the problems of prior authorizations.
”The law was passed in June and will take effect in September. It excuses physicians from having to obtain prior authorization if, during the previous 6 months, 90% of their treatments met medical necessity criteria by the health insurer. Through this law, doctors in the state will spend less time getting approvals for treatments for their patients.”

Will Humana Stock Continue Its Rally After A 10% Rise In A Month?: “Humana has benefited from higher Medicare Advantage premium income as well as increased healthcare services revenues. The company has seen a strong 29% growth in individual Medicare Advantage membership from 3.1 million members in 2018 to a little under 4.0 million members in 2020, aiding its premium revenue growth. Separately, Humana has been focused on enhancing its offerings for home-health services, and it recently announced its plans to acquire One Homecare Solutions, a home care provider. This acquisition comes just months after Humana announced the acquisition of the remaining 60% stake (Humana owned 40% earlier) in Kindred At Home, the largest home-based care provider in the U.S. These developments have boded well for HUM stock in the recent past.”
Large Self-insured Employers Lack Power to Effectively Negotiate Hospital Prices: “Self-insured employers cover more people than Medicare, Medicaid, or direct purchasers of private insurance.This study examined the ability of self-insured employers to negotiate hospital prices and the relationship between hospital prices and employer market power in the United States…
In most areas of the United States, self-insured employers lack market power to negotiate hospital prices….
Self-insured employers may consider building purchase alliances with state and local government employee groups to enhance their market power and lower negotiated prices for hospital services.”

About pharma

New York reaches $1.1B settlement with opioid distributors: “New York Attorney General Letitia James (D) released the settlement obtained with the McKesson Corporation, Cardinal Health Inc. and AmerisourceBergen Drug Corporation on Tuesday, saying the state is holding the distributors ‘accountable’ for their alleged role in the epidemic.
The three distributors will pay the $1.1 billion to New York state, with more than $1 billion of that being designated to opioid treatment, recovery and prevention. The payments will start in two months and continue over 17 years.
In exchange, New York will file to remove McKesson, Cardinal and AmerisourceBergen from its continuing opioid trial in Suffolk County State Supreme Court.”

Feds call on insurers to fully cover HIV prevention drug PrEP without cost-sharing: “The Biden administration issued guidance Monday directing most insurers to offer pre-exposure prophylaxis (PrEP) to beneficiaries at no cost.
The guidance released Monday by the Department of Labor comes after HIV patient advocacy groups have found that insurance plans have been slow to offer preventative drugs without cost-sharing obligations.”

With pandemic restrictions lifted, FDA restarts U.S. inspections and seeks to whittle its massive backlog: “While most of the lingering inspections covered sites that produce food products, delays have also hit the biopharma industry. Of the 857 outstanding inspections for human drugs as of May, the agency had 515 domestic inspections yet to complete and 342 overseas.
In all, 48 drug applications had been affected by site inspection delays, the FDA said.”

Scandal aside, Biogen's Aduhelm sales set to reach $1B next year and $6B+ by 2025: analysts: A survey of neurologists “suggests that Aduhelm could nab about 8% of Alzheimer's patients over the next six months.
While a small share of the total pool, that could lead to $3.8 billion in annual revenue…”

Biden’s July Executive Order Includes Drug Pricing Provisions. But Will They Do Enough?: “KHN has teamed up with our partners at PolitiFact to analyze Biden’s promises during the 2020 presidential campaign — and, so far, experts generally say the jury is still out on how meaningful these efforts will be.”
One strategy is to allow importation of cheaper drugs from other countries. This measure has always been a bad idea for several reasons. First, the documentation of the custody chain is not always accurate- imported drugs could be expired, adulterated or not stored under optimal conditions. Second, pharma companies can regulate what they sell abroad so that there will not be excesses available for resale to the US. Finally, why would other countries sell needed drugs to the US, when we can manufacture our own?
Read the report for more details.

About healthcare IT

Introducing new ways to help you find answers to your health questions: A new YouTube initiative: “Starting this week, you’ll see new features next to some health-related searches and videos. We’re adding new health source information panels on videos to help viewers identify videos from authoritative sources, and health content shelves that more effectively highlight videos from these sources when you search for specific health topics. These context cues are aimed at helping people more easily navigate and evaluate credible health information. People will still be able to find relevant videos from a range of sources in their search results.”

And from Amazon comes an expansion/repackaging of services they have been developing: Introducing AWS for Health – Accelerating innovation from benchtop to bedside: “To help customers accelerate their transformation, we are introducing AWS for Health, an offering of curated AWS services and AWS Partner Network solutions used by thousands of healthcare and life sciences customers globally. AWS for Health provides proven and easily accessible capabilities that help organizations increase the pace of innovation, unlock the potential of health data, and develop more personalized approaches to therapeutic development and care. AWS for Health simplifies the process for healthcare and life science enterprises and innovative startups to identify industry-leading, cloud-based solutions across 16 critical solution areas in Healthcare, Genomics, and Biopharma. For example, solutions offered in AWS for Health are helping customers create holistic Electronic Health Records to help clinicians make data-driven care plans, accelerate research and discovery to bring new therapies to market faster, and power population genomic initiatives to expand precision medicine accessibility.”

Walmart files to provide healthcare in 37 states as it pushes deeper into telehealth: “In April and May, Walmart filed to conduct its healthcare business in 16 states. In June and July, the retail giant added another 17 states, according to public documents. 
Aside from operating 20 medical clinics in Arkansas, Georgia and Illinois, Walmart in the last few months has been working to posture itself as a one-stop-shop for comprehensive medical care.”

Where the VA, Cerner EHR rollout stands: 11 updates in the past 21 days: If you are following this multi-year debacle, this article is a good summary.

About hospitals and health systems

Semi-Annual Hospital Price Transparency Compliance Report July 2021: “We estimate that only 5.6% of hospitals were compliant with the rule, and 94.4% were noncompliant, because one or more price transparency requirements were not met. The majority of noncompliant failures were the result of non-posting or incomplete posting of the negotiated prices clearly associated with all of the payers and plans accepted by the hospital. The second significant failure was due to a lack of publishing the full list of discounted cash prices.” And in a related article:
CMS proposes increasing penalties for hospitals not meeting price transparency rule: “The Biden administration wants to include a per-bed monetary penalty for larger hospitals that do not comply with a price transparency rule after several analyses have shown widespread noncompliance among facilities.
The administration included the provision in the proposed 2022 Outpatient Prospective Payment System (OPPS) proposed rule released Monday by the Centers for Medicare & Medicaid Services….”
In the past, penalties were less than the cost of compliance for many hospitals.

HCA sees revenue grow 30% to $14B in Q2: “Nashville, Tenn.-based HCA Healthcare saw its revenue grow 30 percent in the second quarter of 2021, as inpatient, outpatient and emergency department visits saw double-digit percentage growth year over year.
The for-profit healthcare system with 186 hospitals posted revenues of $14.4 billion in the quarter ending June 30, up from $11.1 billion recorded in the same period last year. The second quarter of 2021 results included a gain of $8 million from sales of facilities and $12 million in losses tied to the retirement of debt. “

Today's News and Commentary

The big story of the past week deals with FDA approvals. On the one hand, we have stories about the new, very expensive Alzheimer’s drug that was rapidly (and controversially) approved:
6 BCBS affiliates announce they won't cover Biogen's Alzheimer's drug: “Recently, affiliates in North Carolina, Pennsylvania, Michigan, New York and Kansas all made the announcement, with other plans like Highmark and Care Network of Michigan only allowing its use with prior approval. The announcements largely affect commercial plans.”
Biogen, ICER [Institute for Clinical and Economic Review] experts tussle over Aduhelm as cost watchdogs unanimously slap down new Alzheimer's drug: ”Is there enough evidence to show Biogen’s new Alzheimer’s drug Aduhelm provides a benefit to patients, physicians and society beyond the current standard care? The answer from a group of ICER experts, perhaps unsurprisingly, was "no."
During a daylong meeting Thursday that featured debate over the drug's cost and more, experts voted 15 to 0 that Aduhelm doesn't provide benefits above routine care.”
Cleveland Clinic and Mount Sinai Won’t Administer Aduhelm to Patients: “The rejection by the major medical centers is the latest fallout from the Food and Drug Administration’s approval of the drug on June 7, a decision that has also spurred congressional investigations.
Many Alzheimer’s experts and other scientists have said that it is unclear that the drug works to help slow cognitive decline and that in the best-case scenario, the evidence suggested only a slight slowing while also showing that Aduhelm could cause brain swelling or brain bleeding.”

On the other hand, we have the FDA dragging its feet on approving Covid-19 vaccines that have data on tens of millions of people. The latest update is:
FDA sets January deadline to decide on full approval of Pfizer, BioNTech vaccine: “Pfizer and BioNTech said Friday that the FDA has granted a priority review for an application seeking full approval of their vaccine BNT162b2 to prevent COVID-19 in people 16 years and older. According to the companies, the FDA has set a goal date for a decision in January 2022, although an agency official suggested one is likely to come within two months.”
Covid vaccines for kids under 12 expected midwinter, FDA official says: “Emergency authorization for Covid-19 vaccines in children under 12 could come in early to midwinter, a Food and Drug Administration official said Thursday, a move that could bring relief to many parents who have been unable to vaccinate their children. The agency hopes to then move quickly to full approval of the vaccine for this age group.”

The efficient approval process is important not only for COVID-19, but also for possible emerging pandemics. Here are the latest news items in this regard:
China reports its first death of a human from rare Monkey B virus: “A man in China has died after contracting a rare infectious disease from primates, known as the Monkey B [herpes] virus, Chinese health officials revealed in a report Saturday. The victim, a 53-year-old veterinarian based in Beijing, was the first documented human case of the virus in China.
According to the Chinese Center for Disease Control and Prevention, the man worked in a research institute that specialized in nonhuman primate breeding and dissected two dead monkeys in March.”
Rare case of monkeypox found in Texas resident who had traveled internationally: A case of monkeypox has been confirmed in a Texas resident who had flown to Atlanta from Nigeria on July 8, with a final destination of Dallas Love Field Airport on July 9, the Centers for Disease Control and Prevention said Friday. It is the first case of the virus seen in the United States in nearly two decades…
Monkeypox is related to smallpox, which was eradicated worldwide in 1980, thanks to the smallpox vaccine. Both illnesses cause a distinctive rash that lasts for about a month. Smallpox had a higher fatality rate than monkeypox.”

In other news:
About pharma

FDA allows drugmakers to sell generic Chantix, says cancer risk minimal: “The FDA is allowing drugmakers to distribute varenicline, the generic name for Pfizer's anti-smoking drug Chantix, even if the drug contains low levels of a carcinogen. The health benefits of quitting smoking outweigh the cancer risk from the carcinogen in the drug, the agency said. 
In late June, Pfizer halted global distribution of Chantix after finding that some pills contain elevated levels of the carcinogen N-nitroso-varenicline. Pfizer recalled nine lots of the drug, though the FDA said there was no immediate risk from taking the medication, since the increased cancer risk associated with the carcinogen in the drug would only come from long-term use.”

New Merck pneumonia vaccine OK’d in US weeks after Pfizer’s: “Merck said Friday that the Food and Drug Administration approved its shot, called Vaxneuvance, for people aged 18 and up. It protects against 15 of the roughly 100 pneumococcal strains, including those most responsible for severe disease.
Merck hasn’t disclosed its shot’s price or when it will be launched.”

Takeda, AbbVie, BMS, Sanofi, Lilly and others join growing tally of pharma's July price hikes: report: “So far this month, pharma companies large and small have driven up prices on 65 drugs, mostly brand name, by an average of 3.5%, according to GoodRx’s counting. That’s double the count from just two weeks ago and just shy of the July 2020 tally.
While smaller drugmakers dealing in rare disorders dominated the initial price jumps to start the month, a sprinkle of big pharma players such as Pfizer, Eli Lilly, Sanofi, AstraZeneca, Bristol Myers Squibb, Novartis and AbbVie have also gotten involved. Many of the price hikes are in the low single-digit percentages.”
Perhaps the companies are getting in increases before the federal government enacts price controls.

About health insurance

Estimated Plan Enrollment Outcomes After Changes to US Health Insurance Marketplace Automatic Renewal Rules: “The findings of this economic analysis suggest that a smart default policy could avoid defaulting lower-income marketplace enrollees to objectively inferior health care insurance plans and may lead to large reductions in lower-income enrollees’ deductibles, copayments, and maximum out-of-pocket amounts. Implementation of a smart default policy could enable marketplace administrators to reduce the prevalence of underinsurance among lower-income marketplace enrollees.”

About healthcare IT

Anthem study: Telehealth helped address pandemic health disparities, but gaps remain: “Hispanic patients took to telehealth for behavioral health needs in greater numbers than other racial groups last year, according to new data from Anthem.
The analysis includes data on Medicaid members in 14 states and found that while telehealth visits for mental health were in the single digits prior to the pandemic, use rose to account for nearly half (49%) of all Medicaid mental health visits in a six-month window last year…
Amid the pandemic, 40% of Hispanic members in the study had a telehealth visit, compared to 34% of white members.
In addition, 33% of Asian members and 28% of Black members had a telehealth visit for mental health needs, according to the study.”

Elekta software breach hits Advocate Aurora, Intermountain; 96,000 patients affected: “Advocate Aurora Health and Intermountain Healthcare are two of the latest health systems to report having been affected by a cybersecurity breach of cancer care software company Elekta. 
Milwaukee-based Advocate Aurora Health reported the breach to HHS July 16 as affecting 68,707 individuals, and Salt Lake City-based Intermountain reported the breach to Maine's attorney general as affecting 28,628 individuals.”


Today's News and Commentary

About Covid-19

U.S. officials say fully vaccinated don't need booster: “U.S. health officials, after meeting with vaccine maker Pfizer, reiterated on Monday that Americans who have been fully vaccinated do not need to get a booster shot, a spokesperson for the Health and Human Services Department said.”
In a related article: WHO: Rich countries should donate vaccines, not use boosters: “Top officials at the World Health Organization say there’s not enough evidence to show that third doses of coronavirus vaccines are needed and appealed Monday for the scarce shots to be shared with poor countries who have yet to immunize their people instead of being used by rich countries as boosters.”

Pfizer-BioNTech and Oxford AstraZeneca COVID-19 vaccine effectiveness and immune response among individuals in clinical risk groups: This article is a preprint of an English study.
”In most clinical risk groups, immune response to vaccination is maintained and high levels of VE [vaccine effectiveness] are seen with both the Pfizer and AstraZeneca vaccines. Reduced antibody response and vaccine effectiveness were seen after one dose of vaccine among the immunosuppressed group, however, after a second dose there is only a small and non-significant reduction in vaccine effectiveness. These findings would support maximising coverage with two doses in immunosuppressed individuals.”

Greece and France join Italy in making Covid-19 shots mandatory for health workers, telling the unvaccinated they won't get paid: Contrast these actions with our piecemeal approach.
”France and Greece both announced new vaccine requirements on Monday, following in the footsteps of Italy, which made vaccinations compulsory for health employees in April.
The UK government, which is pushing ahead with its unlocking plan despite strong warnings from experts, has previously said it will mandate shots for care home staff from October.”
In a related article: Germany won't make COVID-19 vaccination compulsory - Merkel: “Germany will not make vaccination against COVID-19 compulsory, Chancellor Angela Merkel said on Tuesday, adding that ensuring more Germans get vaccinated, sticking to distancing rules and testing should help prevent a fourth wave.”

About health insurance

CMS Proposes Physician Payment Rule to Improve Health Equity, Patient Access: This announcement is CMS’s annual Physician Fee Schedule (PFS) proposed rule, which ranges from telehealth to quality improvement initiatives. The final rule will come after the comment period suggestions are considered. Here are some highlights from MGMA:
—”Setting 2022 Medicare payment rates for physician services. For 2022, CMS is proposing a Conversion Factor of $33.5848 and $21.0442 for Anesthesia (a decrease of -3.75% and -2.39%, respectively, over final 2021 rates);
—Delaying the payment penalty phase of the Appropriate Use Criteria (AUC) program to Jan. 1, 2023 or the Jan. 1 that follows the end of the COVID-19 public health emergency (PHE), whichever is later;
—Allowing audio-only visits for the diagnosis, evaluation, or treatment of mental health disorders furnished to established patients in their homes past the COVID-19 PHE;
—Setting the 2022 MIPS performance threshold at 75 points, and the additional performance threshold for exceptional performance at 89 points; and
—Setting 2023 as the first performance year of the new MIPS Value Pathways (MVPs), with participation options including individual clinicians, single specialty groups, multispecialty groups, subgroups, and APM entities.”

CMS starts process to decide on covering pricey Alzheimer’s drug aducanumab: “The Centers for Medicare & Medicaid Services announced Monday it is opening a National Coverage Determination (NCD) analysis on the drug that will cost patients $56,000 a year. Advocates and experts have called for the agency to move quickly to decide whether to cover the drug.”

Physician sentenced for defrauding 3 insurance companies out of $17 million: “A Florida physician pleaded guilty and was convicted for defrauding Cigna, Blue Cross Blue Shield and Humana out of over $17 million. 
Max Louis Citrin was investigated by the Palm Beach County Sober Homes Task Force after allegations that he was improperly prescribing drugs to sober home residents. State Attorney Dave Aronberg said Mr. Citrin copied and pasted patient symptoms to fraudulently bill companies for unnecessary allergy testing and treatment.”

Humana quietly funded 40 Iora primary care clinics: “Health insurer Humana quietly funded 40 of Iora Health's 47 primary care clinics, according to a Securities and Exchange Commission registration statement…
The filing also showed the Humana-funded clinics exclusively served Humana members until July 2020.”

About the public’s health

Heart risk ‘calculators’ overlook increased risk for people of South Asian ancestry: “When compared to individuals of European ancestry, South Asians had a more than two-fold risk of developing heart disease.
Risk calculators used by clinicians to guide decisions about preventing or treating heart disease do not always reflect the increased cardiac risks faced by people of South Asian descent.
To gain a better understanding of heart disease risks for those of South Asian ancestry and have more accurate assessment tools, more people of South Asian ancestry need to be included in research used to develop these tools.”

Human genome editing: recommendations: Guidelines from the WHO.

About healthcare IT

Could Gen Z Free the World From Email?: Not, strictly speaking, a healthcare article, but it has significant implications for the field. The whole article is worth reading but here is the “takeaway”:
According to a 2020 study from the consulting firm Creative Strategies, there’s a generational gap in primary work tools. The survey found that for those 30 and above, email was among the top tools they used for collaboration. For those under 30, Google Docs was the app workers associated most with collaboration, followed by Zoom and iMessage.”

Bayesian Health Launches with Research-Backed AI Platform Enabling Health Systems to Save Lives: A news release: “Bayesian's AI platform sits within the EMR, analyzing patient data with industry-leading AI/machine learning models. The platform sends accurate and actionable clinical signals within existing workflows when a critical moment is detected, helping physicians and care team members accurately diagnose, intervene, and deliver timely care.
With a research-first foundation of over 21 patents and peer-reviewed research papers, Bayesian's platform is based on technology licensed from the Johns Hopkins University. The platform is configured to scale within health systems, and targets high-priority areas with specific modules such as clinical deterioration, sepsis, pressure injury, and transitions of care.”

Telehealth: A quarter-trillion-dollar post-COVID-19 reality?: McKinsey’s take on telehealth.
Here are the highlights:

  • Telehealth utilization has stabilized at levels 38X higher than before the pandemic. After an initial spike to more than 32 percent of office and outpatient visits occurring via telehealth in April 2020, utilization levels have largely stabilized, ranging from 13 to 17 percent across all specialties. This utilization reflects more than two-thirds of what we anticipated as visits that could be virtualized.

  • Similarly, consumer and provider attitudes toward telehealth have improved since the pre-COVID-19 era…

  • Some regulatory changes that facilitated expanded use of telehealth have been made permanent, for example, the Centers for Medicare & Medicaid Services’ expansion of reimbursable telehealth codes for the 2021 physician fee schedule. But uncertainty still exists as to the fate of other services that may lose their waiver status when the public health emergency ends.

  • Investment in virtual care and digital health more broadly has skyrocketed, fueling further innovation, with 3X the level of venture capitalist digital health investment in 2020 than it had in 2017.4

  • Virtual healthcare models and business models are evolving and proliferating, moving from purely ‘virtual urgent care’ to a range of services enabling longitudinal virtual care, integration of telehealth with other virtual health solutions, and hybrid virtual/in-person care models, with the potential to improve consumer experience/convenience, access, outcomes, and affordability.”

About healthcare professionals

These specialties report the most pronounced gender pay gaps: “Gender disparities in both representation and salary are greatest among cardiology and gastroenterology, according to research published July 12 in JAMA Internal Medicine.
Highlights:
1. “Overall, women comprised about 40 percent of total full-time faculty across ranks. At the instructor and assistant levels, female representation was nearly equal at 47 percent and 46 percent, respectively. That figure dropped at higher ranks, sitting at 24 percent at the professor rank. 

2. Women were the majority in three specialties: general internal medicine, endocrinology and geriatrics. 

3. Women were least represented in procedural specialties such as pulmonology, critical/intensive care, gastroenterology and cardiology, which had the greatest imbalance as only 21 percent were women. 

4. The median annual salary across all ranks for women was within $25,000, except for chief. By specialty, women's salaries were at least 90 percent of men's for 10 of 13 internal medicine specialties. 

5. For cardiology, gastroenterology, and critical/intensive care, women's median salary did not reach 90 percent of men's. While these specialties paid better overall, they also ‘demonstrated the largest gender disparities in both representation and salary, particularly within the higher ranks of cardiology and gastroenterology.’”



Today's News and Commentary

About Covid-19

Check out this cartoon.

Israel starts administering third dose of Pfizer vaccine to at-risk adults: “Israel’s Ministry of Health on Monday began offering a third dose of the Pfizer vaccine to severely immunocompromised adults in what health experts say could be the first phase of an experiment to provide booster shots for older people and the most vulnerable.”

A Covid Test as Easy as Breathing: The article is a good review of Covid-19 diagnostic breath tests in use/underdevelopment.

'Surprising amount of death' will soon occur in these US regions from increased Covid-19 cases, expert says: “The US is averaging about 19,455 new cases over the last seven days, a 47% increase from the week prior, according to data from Johns Hopkins University. And a third of those, CNN Medical Analyst Dr. Jonathan Reiner said, come from five hot spots: Florida, Louisiana, Arkansas, Missouri and Nevada.”

FDA expected to announce new warning on Johnson & Johnson vaccine related to rare autoimmune disorder: “About 100 preliminary reports of Guillain-Barré have been detected after 12.8 million doses of Johnson & Johnson vaccine were administered, the Centers for Disease Control and Prevention said in a statement. These cases have largely been reported about two weeks after vaccination and mostly in men, many aged 50 years and older. Available data do not show a pattern suggesting a similar increased risk with the Pfizer-BioNTech and Moderna vaccines, after more than 321 million doses of those vaccines have been administered in the United States. The Guillain-Barré cases will be discussed as part of an upcoming meeting of CDC advisers, the agency said.”

Autoimmunity to Annexin A2 predicts mortality among hospitalised COVID-19 patients: ”Levels of anti-Annexin A2 antibodies at admission strongly predicted mortality among hospitalised COVID-19 patients. Given its critical protective function in the lung, Annexin A2 antagonism may play an important role in the pathophysiology of COVID-19…
This study investigated the possibility that COVID-19 patients have autoimmune antibodies to Annexin A2, a protective protein expressed in the lung and other organs. Since this phospholipid-binding protein is critical for fibrinolysis, lung elasticity, cell membrane repair, and integrity of the pulmonary vasculature, antagonism of Annexin A2 may explain many of the hallmark clinical features of severe COVID-19 cases.”

Republicans push to ban "discrimination" against unvaccinated people: “State Republican lawmakers around the country are pushing bills — at least one of which has become law — that would give unvaccinated people the same protections as those surrounding race, gender and religion.”

Quarter-dose of Moderna COVID vaccine still rouses a big immune response: “Two jabs that each contained only one-quarter of the standard dose of the Moderna COVID-19 vaccine gave rise to long-lasting protective antibodies and virus-fighting T cells, according to tests in nearly three dozen people1. The results hint at the possibility of administering fractional doses to stretch limited vaccine supplies and accelerate the global immunization effort.”

About healthcare IT

HHS Updates Interoperability Standards to Support the Electronic Exchange of Sexual Orientation, Gender Identity and Social Determinants of Health: “With this new update, health IT stakeholders nationwide will have clearer direction toward the standardized, electronic exchange of social determinants of health (SDOH), sexual orientation, and gender identity (SO/GI) among several other updated data elements. This lays the foundation for the provider community to start systemizing the capture and use of SDOH and SO/GI data in the clinical setting. While encouraged, this update does not require health professionals, such as doctors and nurses, to record this data or individuals to share such data. It does however set a path forward for health IT to build in support for exchanging these data as they become applicable to an individual's care.”

Class action filed after HHS warns 130 hospitals, health systems left millions' PHI exposed: “Two patients filed a class action against two radiology companies after more than 1 million patients who received care at hospitals nationwide may have been exposed because of vulnerabilities in medical imaging archiving software.”

About the public’s health

Handful of cities driving urban greenhouse gas emissions - study: “Just 25 big cities – almost all of them in China – accounted for more than half of the climate-warming gases pumped out by a sample of 167 urban hubs around the world, an analysis of emissions trends showed on Monday.
In per capita terms, however, emissions from cities in the richest parts of the world are still generally higher than those from urban centres in developing countries, researchers found in the study https://www.frontiersin.org/articles/10.3389/frsc.2021.696381/ full published in the open access journal Frontiers in Sustainable Cities.”

About pharma

Generics, Retailers Escape Zantac MDL With Preemption: “A Florida federal judge dismissed all claims against manufacturers of the generic form of the heartburn medication Zantac and retailers in sprawling multidistrict litigation alleging the drug contains a known carcinogen, finding that all claims are preempted by federal law. In a 49-page order filed Thursday, U. S. District Judge Robin Rosenberg dismissed claims that the generic makers and retailers failed to warn consumers about the dangers of ranitidine, the generic name for Zantac, saying federal law does not allow them to change the labels from what was approved for the brand name version of the drug.”

FDA Approves Drug to Reduce Risk of Serious Kidney and Heart Complications in Adults with Chronic Kidney Disease Associated with Type 2 Diabetes: “FDA has approved [Bayer Healthcare’s] (finerenone) tablets to reduce the risk of kidney function decline, kidney failure, cardiovascular death, non-fatal heart attacks, and hospitalization for heart failure in adults with chronic kidney disease associated with type 2 diabetes.”

European Parliament Strives to Grant EMA Expanded Authority: “The European Parliament has voted to expand the European Medicines Agency’s (EMA) authority to monitor the supply chain for drugs and medical devices.
The EU lawmakers specifically called for the creation of an EU database ‘aimed at detecting, predicting and preventing shortages of medicinal products,’ and acting as an information exchange between the EMA and national authorities in the EU member states.”

About hospitals and health systems

COMMUNITY BENEFIT: The Lown Institute, listed hospitals that contributed the most and least to their communities based on how much in tax breaks they get from their non-profit status. The overall message is: “72% of private nonprofit hospitals had a fair share deficit, meaning they spent less on charity care and community investment than they received in tax breaks.”

Intermountain Healthcare shutters 25 retail pharmacies, redirects consumers to CVS: “Intermountain Healthcare will be shutting down 25 retail pharmacies and handing off their prescriptions and inventories to CVS Pharmacy beginning in August, the companies announced this week…
In the announcement, leaders from both companies acknowledged that consumers are increasingly interested in retail pharmacies that can deliver additional services and convenient shopping options.”

Average amount generally paid ratio for hospitals, broken down by state: “The average amount generally paid ratio for hospitals across the U.S. is 39.4 percent, according to an analysis of 4,674 hospitals released by Hospital Pricing Specialists
The AGP® ratio is calculated by taking the sum of all claims that have been paid by health insurers divided by the sum of the gross charges for those claims. 
Based on the analysis, hospitals in Maryland have the highest AGP ratio at 81 percent and hospitals in Florida have the lowest ratio at 18.2 percent.”
These findings are one reason listing of gross charges for comparison shopping is not helpful to patients.

Today's News and Commentary

Biden zeros in on healthcare competition in executive order: 10 notes: More details about yesterday’s lead story. Here is the White House Fact Sheet. “The Order includes 72 initiatives by more than a dozen federal agencies…” Many of the actions start with the word “encourages,” so not much will change immediately.

About Covid-19

CDC says students vaccinated against the coronavirus can go maskless in fall: “The Centers for Disease Control and Prevention issued new guidelines for schools Friday that give students who have been vaccinated the option of going maskless this fall while their classmates who have not had shots continue to wear face coverings.
The much-awaited easing of pandemic rules for kindergarten through 12th grade follows the opening of vaccine eligibility this spring to anyone 12 and older.”

Pfizer to seek OK for 3rd vaccine dose; shots still protect: “Pfizer is about to seek U.S. authorization for a third dose of its COVID-19 vaccine, saying Thursday that another shot within 12 months could dramatically boost immunity and maybe help ward off the latest worrisome coronavirus mutant…
Hours after Pfizer’s announcement, U.S. health officials issued a statement saying fully vaccinated Americans don’t need a booster yet.”

Mapping the human genetic architecture of COVID-19: From Nature : “We formed a global network of researchers to investigate the role of human genetics in SARS-CoV-2 infection and COVID-19 severity. We describe the results of three genome-wide association meta-analyses comprised of up to 49,562 COVID-19 patients from 46 studies across 19 countries. We reported 13 genome-wide significant loci that are associated with SARS-CoV-2 infection or severe manifestations of COVID-19. Several of these loci correspond to previously documented associations to lung or autoimmune and inflammatory diseases3–7. They also represent potentially actionable mechanisms in response to infection. Mendelian Randomization analyses support a causal role for smoking and body mass index for severe COVID-19 although not for type II diabetes.”

Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 PandemicA Consensus Statement: “The 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide.”

BioNTech/Pfizer plan to trial Delta variant vaccine in August: FYI

About pharma

10 US Approval Decisions To Look Out For In Q3: List available with free trial. One novel introduction: “A pharmacokinetic issue and likely a divided advisory panel are the reasons for a delay with the FDA’s decision on approval of Provention Bio, Inc.’s teplizumab beyond its 2 July PDUFA date. If approved, teplizumab would be the first drug for type 1 diabetes prevention.”

House Dems' report slams drugmaker stock buybacks as Pelosi presses to give Medicare negotiating powers: “A new House oversight report found that 14 of the largest drugmakers in the U.S. spent $577 billion on stock buybacks and dividends from 2016 to 2020 as Democratic leadership presses to give Medicare drug negotiation powers.
The report (PDF), released Thursday from the House Oversight Committee, comes as Congress is exploring giving Medicare the power to negotiate for lower drug prices as part of an infrastructure package.”

Sanofi puts $1B-plus on the table for Eureka's multiple myeloma treatment candidate: “The French Big Pharma penned a licensing agreement with Eureka Therapeutics and Memorial Sloan Kettering [MSK] Cancer Center for the non-CAR use of a new, human binding domain that targets G Protein Coupled Receptor Family C Group 5 Member D (GPRC5D).
Eureka discovered the binding domain using its proprietary antibody discovery platform and was developed under a collaboration with MSK.”

Parexel snapped up, again, as Goldman Sachs, EQT spend $8.5B on the CRO: “The suitors and soon-to-be owners are the Swedish investment firm EQT Private Equity and the U.S. giant Goldman Sachs Asset Management, giving Pamplona a healthy return on the $5 billion it spent on the CRO [contract research organization] in 2017.”

FDA head calls for inspector general investigation of agency’s dealings with Biogen, maker of controversial new Alzheimer’s drug: “Woodcock said on Twitter she was requesting the review because of the ‘ongoing interest and questions’ about the approval of the drug, called Aduhelm, on June 7. She said the review would focus on interactions between representatives of Biogen and the FDA during the process that led to the approval.”

AbbVie, Biogen, Pfizer launch public database linking genes and diseases: Called “ Genebass database, for gene-based association summary statistics…” It will be maintained by the Broad Institute of MIT and Harvard.

Contraceptive mini-pill available over-the-counter without prescription for the first time: “Two types of the oral contraceptive pill will now be sold over the counter in the UK without a prescription.
Later this month, the progesterone-only pill (POP), or ‘mini pill’ as it’s also known, will be available from high-street pharmacies.
The specific brands of pill — called Hana and Lovima — will be accessible without the need to visit a GP, but pills with oestrogen will still require a consultation.”

Colorado Caps Insulin Costs for All Diabetics: “Colorado has become the second state — after Minnesota — to pass a law capping the price of insulin for both insured and uninsured diabetic patients, continuing a trend of states passing legislation to rein in the cost of the life-saving medicine — so far, mostly for people with health insurance — in response to what they see as inaction by Congress and the federal government.
Slated to take effect Jan. 1, 2022, the new law creates an insulin affordability program that will give eligible diabetics access to insulin for 12 months at a cost of no more than $50 for a 30-day supply and allow for a once-a-year emergency insulin prescription priced at $35 or less for a 30-day supply.”

Marlboro maker Philip Morris strikes deal for UK inhaler group Vectura: “One of the world’s largest tobacco groups, Philip Morris International, has struck a £1bn deal to buy a UK developer of inhalers, the next step in what the owner of the Marlboro cigarette brand said was its plan to become a ‘healthcare and wellness company’…
PMI has said it is focusing on respiratory drug delivery as part of its plan to generate at least $1bn in annual revenues by 2025 from what it calls Beyond Nicotine products.”

McKesson Corporation Enters Agreement to Sell Certain European Businesses to the PHOENIX Group: “McKesson Corporation… announced that it has entered into an agreement to sell its European businesses in France, Italy, Ireland, Portugal, Belgium, and Slovenia to the PHOENIX group. This transaction also includes McKesson’s German-based AG headquarters in Stuttgart, Recucare GmbH, its German wound-care business, its shared services center in Lithuania, and its 45% ownership stake in Brocacef, the company’s joint venture in the Netherlands. The transaction is expected to close in 2022, subject to customary closing conditions, including receipt of required regulatory approvals.
The remaining European businesses in the UK, Norway, Austria, and Denmark are not included in this transaction and will continue to be operated by McKesson.”

About health insurance

CMS pitches payment rules for 2022: 21 notes for hospital execs: “CMS has released its annual proposed payment updates for inpatient facilities, kidney care facilities, home health, skilled nursing facilities, hospices, inpatient psychiatric facilities and inpatient rehabilitation facilities.”
The article is a good summary of institutional payment rules for 2022.

As With The Medicare Plan Finder, CMS Efforts To Improve Physician Compare Have Not Worked: The author goes through examples of how the site is not working well.

About healthcare IT

Hospitals lack consistent cybersecurity plan for networked medical devices: “Even as hospitals continue to face cyberattacks that risk patient harm, Medicare lacks consistent oversight of networked device cybersecurity in hospitals, according to a report from the Department of Health and Human Services Office of Inspector General…
Large hospital systems could have around 85,000 medical devices connected to its network, which translates into a broad attack surface…”

Patient Experience in Virtual Visits Hinges on Technology and the Patient-Clinician Relationship: A Large Survey Study With Open-ended Questions: Be wary of studies like this one.
”Adults with a virtual visit between June 21, 2017, and July 12, 2017, were invited to complete a survey of 21 Likert-scale items and textboxes for comments following their visit.” First, the data is 4 years old, and relies on technology at least that old. Second, it is a study of those who actually were willing and did use the technology- a biased group.

VA Cerner rollout price tag climbs to $18.5B: The saga continues…
”The price tag of the Department of Veteran Affairs's Cerner EHR rollout could go up another $2.5 billion, according to a July 7 report by the Office of the Inspector General.
The cost was originally budgeted at $10 billion, then got a 60 percent increase to $16 billion. Now it could need a bump of $2.5 billion to account for IT infrastructure updates, the report said.”

About the public’s health

U.S. cancer death rates declining, report shows: “Death rates between 2014 and 2018 fell for 11 of the 19 most common cancers among men, and 14 of the 20 most common among women, according to the report from the American Cancer Society, Centers for Disease Control and Prevention, National Institutes of Health, and the North American Association of Central Cancer Registries.”

The lie of “expired” food and the disastrous truth of America’s food waste problem: “Forty percent of food produced in America heads to the landfill or is otherwise wasted. That adds up. Every year, the average American family throws out somewhere between $1,365 and $2,275…
There are two vital facts to know about date labels on foods in the US: They’re not standardized, and they have almost nothing to do with food safety…”
Read the article for more details.

About healthcare devices

St. Jude Medical, Alere pay combined $65M to settle DOJ claims they knowingly sold defective devices: “The U.S. Department of Justice (DOJ) collected two separate settlements from medical device makers after the government said they continued to sell defective products for years amid receiving reports of injuries and deaths linked to their hardware. 
Both settlements were announced July 8: St. Jude Medical agreed to pay $27 million, while Alere shelled out $38.75 million. Despite the hefty fines, neither serves as an admission of guilt.
The federal cases were each brought under the False Claims Act and stem from allegations that, by continuing to sell the potentially harmful products to healthcare facilities, where they were used to treat patients enrolled in federal healthcare programs such as Medicare, both companies played a role in securing government payments for devices they knew were defective.”

Avanos Medical Inc. to Pay $22 Million to Resolve Criminal Charge Related to the Fraudulent Misbranding of Its MicroCool Surgical Gowns: “According to court filings, Avanos falsely labeled the gowns as providing the highest [FDA-designated] level of protection against fluid and virus penetration…
In addition, according to court documents, an employee and an agent of Avanos obstructed a July 2016 FDA for-cause inspection of the company’s surgical gown business by making numerous false entries in four documents requested by FDA investigators.”

FDA Releases Final Guidance on its Unique Device Identification System: “The FDA has released a long-awaited final guidance on the form and content of its Unique Device Identification (UDI) system, which has been available in draft form for almost five years.
The UDI must be presented in two forms on device labels and packages — easily readable plain-text and a scannable automatic identification and data capture (AIDC) format.”

About healthcare quality

What Patients Think About Their Hospitals and Ambulatory Surgery Centers: An Analysis of Patient Experience Surveys: From the Leapfrog Group. Read the entire report for details. The “bottom line” is: “Leapfrog’s assessment of CAHPS survey results across different settings of care suggests that despite some positive responses, significant challenges persist, particularly related to communicating about patient understanding of medication protocols, clarity about treatment following discharge, and overall communication. For pediatric patients in hospitals, there are exceptionally troubling signs with parents’ ability to raise concerns about problems and mistakes regarding the care of their children. Outpatient surgical units and ambulatory surgery centers (ASCs) have positive results generally. Regardless, all facilities show signs of patient safety challenges that hospitals and ASCs should address with urgency.”

Today's News and Commentary

Biden to issue executive order to curtail noncompete clauses: This action will have a huge impact on healthcare, affecting both the product and service sectors. In the latter category, it is typical for physician contracts to have a restrictive covenant for a reasonable geographic area and time period. Without such a clause, a practice could help new physicians build their practices. When the practices are built, those physicians could leave with their patients. Stay tuned for legal challenges.
”The president’s order would encourage the Federal Trade Commission (FTC) to ban or limit noncompete agreements.
’Roughly half of private sector businesses require at least some employees to enter noncompete agreements, affecting over 30 million people. This affects construction workers, hotel workers, many blue-collar jobs, not just high-level executives. He believes that if someone offers you a better job, you should be able to take it. It makes sense,’ White House press secretary Jen Psaki said during a press briefing.”

About Covid-19

New study on delta variant reveals importance of receiving both vaccine shots, highlights challenges posed by mutations: “A peer-reviewed report from scientists in France, published Thursday in the journal Nature, found that the delta variant has mutations that allow it to evade some of the neutralizing antibodies produced by vaccines or by a natural infection. A single shot of a two-dose vaccine ‘barely’ offers any protection.
But the experiments found that fully vaccinated people — with the recommended regimen of two shots of the Pfizer-BioNTech or AstraZeneca vaccine — should retain significant protection against the delta variant. That echoes another report authored by a collaboration of scientists in the United States and published Wednesday in the New England Journal of Medicine.”
And in related articles:
Delta variant already dominant in U.S., CDC estimates show: “According to the [CDC]'s estimates the Delta variant became dominant in the country over the two weeks ended July 3, with 51.7% cases linked to the variant that was first identified in India.”
Vaccine Stocks Skid As Delta Variant Becomes More Prevalent U.S. Covid Strain: “Moderna stock toppled 4.9% and BioNTech's slipped 3.6%, while Novavax, which does not yet have an authorized vaccine, slumped 13.7%, the news source said.” Given the data on vaccine effectiveness and the companies’ research to develop new vaccines, this drop in stocks is puzzling.

Quidel recalls Lyra Covid test due to high risk of false negative results: “Quidel has received five complaints about the product, but there are currently no reports of injury or death from its use.”

Kynurenic acid may underlie sex-specific immune responses to COVID-19: “Males and females have different immune responses to SARS-CoV-2 infection, with male sex being a risk factor for mortality, particularly among older individuals. Cai et al. performed metabolomics analysis of serum from COVID-19 patients and uninfected health care workers and identified 17 metabolites that were associated with the disease. However, in male COVID-19 patients only, the amount of the tryptophan metabolite kynurenic acid (KA) correlated with age, inflammation, and disease outcome. KA inhibits glutamate release, and glutamate abundance was reduced in patients who deteriorated. Together, these findings indicate that KA is associated with sex-specific differences in immune responses to COVID-19, suggesting that it might be targeted in male patients.”

SEC claims Parallax Health Sciences, execs misled about COVID-19 tests, PPE: “Without admitting or denying the allegations, Parallax, its CEO Paul Arena, and CTO Nathaniel Bradley consented to judgments permanently enjoining them from future violations of the charged provisions and requiring them to pay penalties of $100,000, $45,000, and $40,000, respectively, according to the SEC…
In the SEC’s complaint filed in the U.S. District Court for the Southern District of New York, the commission says that Parallax issued several press releases over March and April 2020, falsely claiming that the company’s purported COVID-19 test would be ‘available soon.’ The company also said it had medical and personal protective equipment (PPE) — which was in particularly high demand at that early stage of the pandemic — for ‘immediate sale.’
The SEC’s complaint alleges that Parallax’s insolvency prevented it from developing the COVID-19 test. At the same time, company projections demonstrated that even with the funds, it would take more than one year to develop the test. Additionally, the SEC alleges that Parallax never had the medical equipment or PPE that it offered.”

About pharma

Biogen, FDA walk back controversial Aduhelm label after weeks of fierce criticism: “Following weeks of fiery criticism for its wide-labeled approval for Biogen’s Aduhelm for anyone with Alzheimer’s disease, the FDA is now narrowing the recommended window of patients to only those with milder forms of the memory-robbing disease. 
Biogen on Thursday said the FDA approved an updated label for Aduhelm, also known as aducanumab, that recommends the amyloid-beta targeting antibody for people with mild cognitive impairment or mild dementia, aligned with those included in Biogen’s late-stage trials. 
The FDA warns that there is ‘no safety or effectiveness data on initiating treatment at earlier or later stages of the disease than were studied.’”

OxyContin maker Purdue wins 15 states' support in controversial $4B bankruptcy plan: “Fifteen states, including Massachusetts and New York, have blessed OxyContin maker Purdue Pharma's controversial bankruptcy reorganization plan, a court filing in the U.S. Bankruptcy Court in White Plains, New York, shows.
Under the deal, Purdue would morph into a nonprofit and secure protection from future opioid litigation. The company's owners, the Sackler family, would pay more than $4 billion in a settlement covering thousands of cases linked to Purdue's role in the opioid crisis.“

Humira's reign as TV ad king is over as AbbVie shifts spending to Rinvoq and Skyrizi: “AbbVie had been ratcheting back the brand’s TV budget over the past few months, but, in May, it stopped spending in arthritis and psoriasis altogether. That left $13 million in ads for Crohn’s disease and ulcerative colitis, only big enough for fourth place, according to data from real-time TV ad tracker iSpot.tv.
Of course, that doesn’t mean parent drugmaker Abbvie is giving up on TV advertising. Quite the opposite: Its next-generation treatments Rinvoq, for rheumatoid arthritis, and Skyrizi for psoriasis are on the list at Nos. 2 and 8, respectively.”

Ex-Genentech staffers plead guilty to trade secrets theft as DOJ targets biotech partners for $101M Sanofi deal: “The two Genentech veterans stole confidential intellectual property related to the company’s top-selling cancer drugs Rituxan, Herceptin and Avastin, plus cystic fibrosis inhalation Pulmozyme, the government said. They then passed that info to Taiwanese firm JHL Biotech, now called Eden Biologics, to help it develop cheap copycats, according to the suit.”

About the public’s health

Dietary recommendations for prevention of atherosclerosis: The latest recommendations on healthy eating. See the Graphical Abstract for a summary.

Mortality Among Persons Entering HIV Care Compared With the General U.S. Population: “Overall 5-year mortality among persons entering HIV care was 10.6%, and mortality among the matched U.S. population was 2.9%, for a difference of 7.7 (95% CI, 7.4 to 7.9) percentage points. This difference decreased over time, from 11.1 percentage points among those entering care between 1999 and 2004 to 2.7 percentage points among those entering care between 2011 and 2017.”
We have certainly come a long way in HIV treatment. Now we can work more on prevention/cure.

Projecting the risk of mosquito-borne diseases in a warmer and more populated world: a multi-model, multi-scenario intercomparison modelling study: Yet another deleterious consequence of global warming: “Rising global mean temperature will increase the climatic suitability of both diseases [malaria and dengue] particularly in already endemic areas. The predicted expansion towards higher altitudes and temperate regions suggests that outbreaks can occur in areas where people might be immunologically naive and public health systems unprepared. The population at risk of malaria and dengue will be higher in densely populated urban areas in the WHO African region, South-East Asia region, and the region of the Americas, although we did not account for urban-heat island effects, which can further alter the risk of disease transmission.”

About hospitals and health systems

UVA Health acquires full ownership of 3-hospital joint venture from Novant Health: “Novant Health UVA Health System’s 260 inpatient beds will push UVA Health’s tally over the 1,000-bed threshold.
The academic health system is led by its 600-bed flagship hospital, UVA Medical Center. It also runs the 106-bed UVA Children’s Hospital, UVA School of Medicine, UVA School of Nursing and UVA Physicians Group.”

Hospital M&A activity shifts to regional partnerships: Kaufman Hall: “Total M&A revenue in the first and second quarter totaled $17.2 billion on 27 transactions. This is the second highest in recent years, according to the report. In 2020, revenue for the same period was $17 billion with 43 transactions. 
In the second quarter, M&A volume was below historic volume with 14 transactions. However the quarter saw a high number of transactions with revenues above $500 million.”

About healthcare IT

Monthly Telehealth Regional Tracker: The site provides monthly telehealth utilization data by region.

Ransomware attack on revenue cycle vendor exposes 1.2 million patients, employees: “A ransomware attack on Practicefirst Medical Management Solutions and PBS Medcode has left more than 1 million people exposed after hackers stole patient files…
An investigation discovered that hackers copied protected health information, exposing 1,210,688 people. Stolen data includes names, Social Security numbers, bank account information, treatment-related information and more.”

Sonde Health Vocal Biomarker Technology Optimized on Qualcomm Snapdragon Mobile Platforms: “Sonde Health announced that it will work with leading chipmaker Qualcomm Technologies, Inc. to optimize Sonde’s vocal biomarker technology for use with the flagship and high-tier Qualcomm® Snapdragon™ 888 and 778G 5G Mobile Platforms to help bring native, machine learning-driven vocal biomarker capabilities to mobile and IoT devices globally. The optimization has the potential to unlock several native health screening and monitoring applications on hundreds of millions of mobile devices that use these Snapdragon mobile platforms.”

About health insurance

Physicians push back against new Aetna cataract surgery policy: “Two professional organizations issued a joint statement voicing their opposition to Aetna's new policy that requires preapproval for all cataract surgeries.
The American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery critiqued the policy change, which makes Aetna the first major health insurer to make such a move. The policy was made effective July 1.
According to the statement, Aetna would deem less than 5 percent of cataract surgeries unnecessary.” 

Aetna, Optum call for rehearing after losing "dummy code" appellate trial: “Aetna and Optum issued a petition for a rehearing July 6 after a federal appellate court sided with a lawsuit that claimed the insurers used "dummy code" to make administrative fees appear to be billable medical charges.
In the petition, the insurers claim judges' decision to allow plaintiff Sandra Peters to sue would open the floodgates for litigation that wasn't proven to harm members. In June, judges ruled Ms. Peters did not need to provide evidence she suffered a loss to sue.”

About healthcare policy

MGMA 2021 mid-year policy update for medical groups: While focusing on medical groups, this article is a good summary of some major policy issues on the table.

Today's News and Commentary

About Covid-19

WHO recommends Roche, Sanofi drugs for COVID-19 to cut death risk: “The World Health Organization on Tuesday recommended using arthritis drugs Actemra from Roche and Kevzara from Sanofi with corticosteroids for COVID-19 patients after data from some 11,000 patients showed they cut the risk of death.”

Coronavirus in the U.S.: Latest Map and Case Count: There are still many states with increasing rates of infection.

Use of mRNA COVID-19 Vaccine After Reports of Myocarditis Among Vaccine Recipients: Update from the Advisory Committee on Immunization Practices — United States, June 2021: “Continued use of mRNA COVID-19 vaccines in all recommended age groups will prevent morbidity and mortality from COVID-19 that far exceed the number of cases of myocarditis expected. Information regarding the risk for myocarditis with mRNA COVID-19 vaccines should be disseminated to providers to share with vaccine recipients.”

Evaluation of Messenger RNA From COVID-19 BTN162b2 and mRNA-1273 Vaccines in Human Milk: “Vaccine-associated mRNA was not detected in 13 milk samples collected 4 to 48 hours after vaccination from 7 breastfeeding individuals. These results provide important early evidence to strengthen current recommendations that vaccine-related mRNA is not transferred to the infant and that lactating individuals who receive the COVID-19 mRNA-based vaccine should not stop breastfeeding. In addition, any residual mRNA below the limits of detection in our assay would undergo degradation by the infant gastrointestinal system, further reducing infant exposure.”

HHS takes N95 masks, portable ventilators off scarce medical supplies list: “HHS Secretary Xavier Becerra removed 17 items from the list, including N-95 Filtering Facepiece Respirators, portable ventilators and other specified personal protective equipment, supplies and equipment. HHS kept four items on the list, including medical gowns or apparel, certain laboratory reagents and materials, certain drug products, and syringes and hypodermic needles. These designated materials are subject to the hoarding prevention measures authorized under the executive order and the DPA. The action took effect July 1 and terminates Nov. 15, 2021.”

Israel, South Korea to Swap 700,000 Pfizer-BioNTech Covid-19 Vaccines: A great example of international cooperation: “Israel will ship about 700,000 expiring Pfizer/BioNTech coronavirus doses to South Korea, in what is set to be the world's first COVID-19 vaccine swap…
In return, South Korea, which has received just 20% of the 192 million doses it preordered, will send an identical number of doses back to Israel in September or October.”

About the public’s health

Effects of menthol use and transitions in use on short-term and long-term cessation from cigarettes among US smokers: “We compared the probability of 30+ day and 12-month abstinence from cigarette smoking by menthol use status using two cohorts of US adult cigarette smokers who attempted to quit smoking in the Population Assessment of Tobacco and Health…
hese results demonstrate that menthol impaired menthol smokers’ attempts to quit smoking but switching from menthol improved success. This suggests that removing menthol may improve menthol smokers’ success during quit attempts.”
Studies like this one provide the rationale for the FDA’s attempts to ban menthol in tobacco products.

Moderna's first seasonal flu vaccine slides into clinic as pharma giants crowd into mRNA: “Moderna is developing mRNA-1010 to protect against common flu strains as recommended by the World Health Organization. The company is hoping to improve on traditional flu shots which are typically about 40% to 60% effective. Most of these shots are developed using eggs, which Moderna said can cause unintended changes to the vaccine virus.”

About health insurance

Marketplace Premiums and Participation in 2021: From the Urban Institute, a current overview of state-level analysis of ACA marketplace premiums. Just a glance at the spread in the figures in Table 1 will reveal why complaints about price rises and affordability vary so greatly across states .

Expansions could be coming to Medicare: The debate is between extending benefits and lowering the age of eligibility. “The Committee for a Responsible Federal Budget has estimated that lowering the eligibility age to 60 would cost $200 billion over a decade.
In contrast, folding dental, vision and hearing coverage into the traditional Medicare program could cost $358 billion over the next 10 years — and possibly more.” [Emphases in the original.]

Nearly 1 in 5 deliveries could lead to a surprise medical bill, study finds: “The study found that nearly 20% of the families had one or more potential surprise bill for ‘delivery, newborn hospitalizations or both.’
Surprise bills could range based on the types of service provided. For instance, a delivery had one or more potential surprise medical bills with an average liability of $900.
However, a cesarean delivery had a potential liability of $1,825, the study said.”

Comparison of Spending on Common Generic Drugs by Medicare vs Costco Members: “Across more than 1.4 billion Medicare Part D claims for 184 products, the mean (SD) total prices were $12.02 ($18.47) and $24.32 ($41.07) for 30-day and 90-day prescription fills, respectively. Medicare overspent by 13.2% in 2017 and 20.6% in 2018 compared with Costco member prices for these prescriptions. Total overspending increased from $1.7 billion in 2017 to $2.6 billion in 2018.”
So much for Medicare being a prudent buyer.

Hospitals Often Charge Uninsured People the Highest Prices, New Data Show: This article was on the front page of the print edition of The Wall Street Journal today. The article claims that hospital “rates —and wide pricing differences—were confidential until Jan. 1, when a new federal rule required hospitals to make prices public.” Although specifics may only have become available then, this differential has been common knowledge for many years. The reason for the difference is not given until far down in the article: “Hospitals typically have a sticker price, often called the ‘chargemaster’ price, that can be the starting point for negotiations with insurers. Discounts off that sticker price tend to be steeper for those that bring large volumes of patients. Insurance plans offered under government programs like Medicare and Medicaid get even lower rates, tied to prices mandated by federal and state agencies.” In other words, hospitals aren’t out to soak the uninsured; instead they set prices high so their final discounted payments from insurers will be closer to what they want. The uninsured are unfortunate victims of this practice.

Health Insurance Deductibles and Health Care–Seeking Behaviors in a Consumer-Driven Health Care System With Universal Coverage: “In this cross-sectional study, high insurance plan deductibles were associated with forgoing of health care independent of socioeconomic status and preexisting conditions in a universal consumer-driven health care system with good population outcomes in Switzerland. Uncovering health care system design features that could lead to suboptimal population care may help decision makers improve their current health care system design to achieve better outcomes.”
Lesson: Universal coverage alone will not solve utilization problems. The underlying system needs to be properly designed as well.

About pharma

Six biopharma trends to watch in Q3: A good review of this issue.

Perrigo Completes Divestiture Of Generic Rx Business For $1.55 Billion: “Perrigo Company plc , a leading global provider of Consumer Self-Care Products, announced today that it has completed the previously announced sale of its Generic Rx Pharmaceuticals business to Altaris Capital Partners, LLC for $1.55 billion, with customary adjustments, completing Perrigo's transformation to a global consumer self-care company.”

About hospitals and healthcare systems

HCA completes $400M purchase of majority stake in Brookdale Senior Living healthcare services: “HCA Healthcare has finalized its $400 million bid to purchase a majority stake in Brookdale Senior Living’s home health and hospice business as the hospital chain aims to branch out into the home health market.
The new venture adds 80 sites of care for the hospital chain. The nursing home giant Brookdale will retain a 20% equity stake in the healthcare services segment.”

About healthcare IT

Telehealth visits cut healthcare's carbon footprint in half, Kaiser Permanente study finds: Among the study’s findings: “Greenhouse gas emissions from transportation to and from outpatient visits, which increased by about 6 percent between 2015 and 2019, dropped sharply in 2020. 
Ambulatory visit carbon intensity, a new metric that measures the total greenhouse gas emissions associated with a given outpatient visit, dropped by 51 percent. “



Today's News and Commentary

About pharma

Analysis of Launch and Postapproval Cancer Drug Pricing, Clinical Benefit, and Policy Implications in the US and Europe: “During this economic evaluation study period, launch prices of cancer drugs were substantially higher in the US than in the assessed similar high-income European countries, a gap that increased in the years after approval. Cancer drug prices frequently increased faster than inflation in the US but decreased on inflation-adjusted terms in Europe. Price changes were not associated with clinical benefit in any country [emphasis added].”

Regeneron pinpoints gene variants that protect against obesity, launches search for new drugs: “A team at Regeneron Genetics Center has discovered mutations in the gene GPR75 that protect against obesity, they reported in Science. Now, drug developers at Regeneron are using the company’s VelocImmune technology, which generates antibodies from humanized mice, to find drugs that can mimic the protective properties of the GPR75 variants.”

Eli Lilly, Boehringer Ingelheim's Jardiance posts 'blockbuster' heart failure win, setting up 2021 filings: “Eli Lilly and Boehringer Ingelheim’s Type 2 diabetes med Jardiance has been shown to reduce the risk of death and hospitalization from heart failure in patients with preserved ejection fraction (HFpEF). If approved, Jardiance would become the only therapy to improve outcomes in all heart failure patients, regardless of ejection fraction status or whether they have Type 2 diabetes.
Market analysts at Cantor Fitzgerald warned investors not to overlook the news as it might be an indicator of big things to come for the med.”

Innovation on hold during the pandemic? FDA says no with 29 approvals in first half of 2021: “In 2020, the FDA approved 53 new drugs, the second-most in a single year, after 2018’s bounty of 59.
And the momentum has continued through the first half of 2021. With the FDA endorsing its 29th novel drug on June 30, the industry was slightly ahead of last year’s pace.”

Pharmas' return on $5B spent yearly on patient support programs? Only 3% are using them: survey: “Pharma companies spend more than $5 billion on patient support programs every year, but when it comes to uptake, only 3% of patients are actually using them, according to a new survey from Phreesia Life Sciences.
Taking into account people who have ever used any patient support program, the percentage ticks up a bit, but still only gets to 8%…
So why the low usage? Lack of awareness is one clear factor—fewer than one-fourth (23%) of patients said they were extremely or very familiar with patient support programs, while another 18% said they were somewhat familiar.
However, an even bigger culprit in the dismal usage number is low familiarity, said Liz Herbert, senior research manager at Phreesia. Patients may be aware of pharma's financial or educational programs, but many don’t know details. Nor do they know how, or even whether, they could benefit.”
Read the article for more details. What these figures do not tell is the amount of public relations good-will pharma companies garner by having the programs in place. Look at announcements for very expensive medications and you will always see a disclaimer that they will be provided free to those who cannot afford them.

Supreme Court agrees to hear hospital lawsuit challenging HHS' 340B cuts: “The case called American Hospital Association v. Becerra centers on the Medicare reimbursement rate paid for outpatient drugs and whether the Department of Health and Human Services singled out 340B-covered entities.
HHS traditionally set reimbursement rates for drugs based on the average sales price and applied it across all hospital groups. But the lawsuit said that practice changed in 2018 when HHS singled out 340B hospitals, the lawsuit argues.”

About Covid-19

Scientists identify long-sought marker for COVID vaccine success: “Participants who had higher levels of neutralizing antibodies — as well as ‘binding’ antibodies, which recognize the SARS-CoV-2 spike protein — tended to gain stronger, but not total, protection from a symptomatic infection, the Oxford team determined. The team used a model to estimate the antibody levels that corresponded to different levels of vaccine protection against COVID-19 in trials, ranging from 50% to 90% protection.”

Cambridge researchers spot antimalarial, arthritis drugs for COVID-19 repurposing: “The two drugs, antimalarial therapy proguanil and rheumatoid arthritis medication sulfasalazine, showed they could safety inhibit the replication of the SARS-CoV-2 coronavirus behind COVID-19 in both monkey and human cell lines, according to a new study published in Science Advances.”

COVID Falls From America's #1 Killer to #7 by June: ”The disease was the third leading cause of death for much of 2020, but became the leading cause of death in December 2020 and early 2021, reaching a peak of 3,136 deaths per day in January 2021 and far surpassing U.S. deaths from heart disease and cancer during that time.”

Israel Says Pfizer Vaccine Less Effective in Preventing Delta Variant Infection: “The Pfizer-BioNTech coronavirus vaccine has dropped to 64 percent effectiveness in preventing infection in Israel as the delta variant continues to spread across the country, the Health Ministry said on Monday…
The ministry added that the vaccine is 93 percent effective in preventing hospitalizations and severe symptoms.”

Scientists quit journal board, protesting ‘grossly irresponsible’ study claiming COVID-19 vaccines kill: “Several reputed virologists and vaccinologists have resigned as editors of the journal Vaccines to protest its 24 June publication of a peer-reviewed article that misuses data to conclude that ‘for three deaths prevented by [COVID-19] vaccination, we have to accept two inflicted by vaccination.”

Children and COVID-19: State-Level Data Report: “As of June 24, over 4.03 million children have tested positive for COVID-19 since the onset of the pandemic. Over 8,400 child cases were added to the cumulative total last week. This marks the lowest number of weekly cases reported in the past year, since May 2020.”

Efficacy of Portable Air Cleaners and Masking for Reducing Indoor Exposure to Simulated Exhaled SARS-CoV-2 Aerosols — United States, 2021: From the CDC: “A simulated infected meeting participant who was exhaling aerosols was placed in a room with two simulated uninfected participants and a simulated uninfected speaker. Using two HEPA air cleaners close to the aerosol source reduced the aerosol exposure of the uninfected participants and speaker by up to 65%. A combination of HEPA air cleaners and universal masking reduced exposure by up to 90%.”

CDC: 1K US counties have less than 30% of their population inoculated against COVID-19: “About 1,000 U.S. counties, mostly in the Southeast and Midwest, have COVID-19 vaccination coverage of less than 30 percent, CDC Director Rochelle Walensky, MD, said during a July 1 White House COVID-19 briefing.”

Bharat Biotech's COVID-19 vaccine shows 77.8% efficacy at final analysis: “Bharat Biotech announced that in the final analysis of a Phase III study of Covaxin, the coronavirus vaccine demonstrated an efficacy rate of 77.8%, slightly down from a rate of 80.6% reported at an earlier interim analysis…
Further results showed that Covaxin was 93.4% effective against severe symptomatic COVID-19, with 15 cases in the placebo group versus one in the Covaxin arm, and 63.6% effective against asymptomatic COVID-19. Bharat Biotech added that the vaccine was 65.2% effective against the Delta (B.1.617.2) variant.”

We tried out the first statewide vaccine passport: From MIT Technology Review: “When we tested New York’s Excelsior Pass, we found privacy concerns, technical glitches, and questions over who it’s really for.” Read the article for more specifics about usability problems…starting with downloading the app.

About hospitals and health systems

Tying CEO Compensation To Value-Based Purchasing Scores: “First, there is no association between CEO compensation and value delivered, even after adjusting for the number of hospital beds [emphasis added] (p = 0.10). In fact, the hospital with the worst value score has CEO compensation twice as high as the hospital with the third highest value. Second, there is huge variability in value delivered—even within this select group of major teaching hospitals that one would expect to deliver the highest level of care. There is a three-fold difference between the value delivered at the lowest-value hospital and the highest value, granted the highest-value hospital is an outlier (it is the highest-value teaching hospital in the whole country).”

HOSPITALS CUT 5.5K JOBS IN JUNE: Highlights:
”—Hospitals lost 5,500 jobs, and nursing homes lost 9,600 jobs in June.
—Those losses were slightly offset by 2,900 new jobs in ambulatory services.
—Since February 2020, hospitals have lost 102,000 jobs and nursing homes have lost 360,000 job losses.
—The ambulatory services sector has grown 75,400 jobs in that span.
—There were 15.9 million people attached to the healthcare sector workforce in June.”

Pandemic pivots Ochsner Health to new role: PPE manufacturer: “Ochsner Health is starting a new business to make personal protective equipment (PPE). Not only will Ochsner be making gloves, gowns, masks and N95 respirators, it will manufacture the materials used to make those items, such as the liquid nitrile needed for gloves and the spunbond meltblown spunbond (SMS) laminate fabric needed to make masks, gowns and bouffant hair covers.
Ochsner and Alabama-based construction contractor and property developer Trax Development started a joint venture, SafeSource Direct, with $150 million. SafeSource is putting $73 million toward retrofitting an 80,000-square-foot manufacturing facility that will also serve as a headquarters, and $77 million is going for the development of a new facility.”
Healthcare systems have gotten into the generic pharma business, so this next step is not a big surprise.

Ohio health system to pay $21M to resolve false claims allegations: “Akron (Ohio) General Health System, acquired by Cleveland Clinic in 2015, will pay $21.25 million to resolve allegations that it violated the False Claims Act, the U.S. Justice Department said July 2. 
The settlement resolves allegations that the health system, between August 2010 and March 2016, paid certain physicians in excess of fair market value to secure referrals of patients in violation of the Stark Law and submitted claims for services provided to the illegally referred patients in violation of the False Claims Act.”
It is still amazing that hospitals think they can get away with these well-known, illegal practices.

About the public’s health

WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention: FYI- published online today.

Ohio providers can deny care on moral grounds under new law: “Ohio physicians, hospitals and insurers can refuse to offer or pay for a medical service if it violates their moral or religious beliefs under a new provision…
The medical conscience clause is included in the state's $74.1 billion 2022-23 budget, which Gov. Mike DeWine signed July 1. 
The Ohio Hospital Association, Ohio Children’s Hospital Association, Ohio State Medical Association and Ohio Association of Health Plans issued a joint statement opposing the provision during the state's budget process.”

About healthcare IT

Microsoft advises customers to disable printing until cyber vulnerability fixed: “The Computer Emergency Response Team Coordination Center (CERT/CC), part of the Software Engineering Institute at Carnegie Mellon University, this week reported a critical remote code execution vulnerability impacting the Windows Print Spooler service that allows a remote authenticated attacker to execute arbitrary code with system privileges on a vulnerable system. Until Microsoft fixes the PrintNightmare vulnerability, for which the exploit code is publicly available, the company advises customers to disable printing services where possible.”

Ransomware Hackers Demand $70 Million to Unlock Computers in Widespread Attack: “The cyberattack that started to unfold Friday is estimated to have hit hundreds of mostly small and medium-size businesses and tens of thousands of computers. It quickly set off alarms in U.S. national security circles over concern that it could have far-reaching effects…
The hackers behind the latest incident are known as the REvil ransomware group. They are asking for $70 million to unlock all the affected systems but victims of the group can also pay amounts varying between $25,000 and $5 million directly to unlock their systems even if nobody pays the $70 million.”

Virginia payer Dominion National settles 9-year data breach for $2M: 5 details: “Vision and dental insurance provider Dominion National in April 2019 learned that an unauthorized third party had accessed some of its computer servers since August 2010. 
Data stored on the computer servers included current and former member enrollment and demographic information, Social Security numbers, members' postal and email addresses, birth dates, bank account and routing numbers and taxpayer ID numbers. 
The data breach affected 2.9 million individuals, according to the HHS data breach portal.”

Northwestern Memorial HealthCare and Renown Health Affected by Elekta Cyberattack: “The data breach was discovered by Stockholm-based Elekta, which provides a software platform used for clinical radiotherapy treatment for cancer and brain disorders. Elekta issued a statement confirming its first-generation cloud-based storage system was accessed by unauthorized individuals, which affected a subset of customers in North America…
In total, 42 healthcare systems are believed to have been affected by the breach. In some cases, affected facilities had to temporarily halt cancer procedures and arrange for patients to continue their treatment at alternative healthcare facilities.”

New Walgreens CEO Sees ‘Tech Enabled Healthcare’ In Future: However, “‘CEO Rosalind Brewer did not provide much of an update on her strategic vision for the company, only to highlight technology will be a key focus and pharmacy will remain the central anchor of the business,’ Mizuho Securities analyst Ann Hynes wrote in a report last week that followed Walgreens fiscal third quarter earnings that beat analysts’ expectations.”

H1 2021 Digital Health Funding: Another Blockbuster Year…In Six Months: “H1 2021 secured $14.7B in digital health funding, already surpassing all of 2020’s funding. The half closed with 372 deals and an average deal size of $39.6M, spearheaded by 48 mega deals which accounted for 59% of total H1 2021 funding. Public exit activity ballooned with 11 closed IPOs and SPACs, with another 11 SPACs expected to close in 2021.”

About insurers

Iowa insurer not required to cover COVID-19 losses, court rules: “A federal appellate court ruled in favor of Cincinnati Insurance Co. on July 2, finding that the insurer did not have to cover losses stemming from COVID-19 restrictions that an Iowa dental clinic faced.
The initial lawsuit against Cincinnati Insurance Co. came after it refused to compensate Oral Surgeons for nonemergency procedures that were canceled because of pandemic restrictions. That lawsuit fell in favor of the insurer, and the plaintiff appealed to the U.S. Court of Appeals for the 8th Circuit.”
One of these cases will be appealed to the Supreme Court; if heard, it could set a major precedent for the insurance industry.

Surprise billing rule also strikes down insurer ED policies: “A major rule that bans surprise medical bills also outlawed policies that let insurers retroactively deny emergency department claims…
UnitedHealthcare faced major blowback when it proposed a similar policy last month. The insurance giant said the goal of the policy was to encourage patients to get care at other sites such as an urgent care facility rather than going to the ED.
The policy was expected to go into effect July 1. However, UnitedHealthcare decided to delay the policy until at least the end of the COVID-19 public health emergency, which is expected to run through the rest of this year.”

Jury Convicts Medical Imaging CEO In $250M Health Fraud: “The CEO of several medical imaging companies was found guilty by a California federal jury Friday in connection with a $250 million scheme that involved bribes, kickbacks and fraud through the state workers' compensation system for medical services. Sam Sarkis Solakyan, 40, operated diagnostic imaging facilities throughout California and was found guilty of one count of conspiracy to commit honest services mail fraud and health care fraud, and 11 counts of honest services mail fraud. According to the U. S. Attorney's Office for the Central District of California, evidence presented at trial showed that Solakyan conspired with others from mid-2013 to November 2016…”

Today's News and Commentary

About health insurance

Medicaid expansion didn't lead to changes in hospitalizations in safety-net facilities: “The study found no significant changes in safety-net hospitalizations among Medicaid or uninsured patients in states that did and did not expand Medicaid. There were also no major changes among racial and ethnic minority groups or among low-income patients.”

CMS wants to reward dialysis providers for improving home dialysis among low-income beneficiaries: “The Centers for Medicare & Medicaid Services (CMS) released a proposed rule Thursday that updates payment rates for the End-Stage Renal Disease (ESRD) Prospective Payment System and makes changes to the quality incentive program and ESRD Treatment Choices Model. The goal of the changes is to encourage dialysis providers to decrease disparities in home dialysis and transplant rates, part of a larger effort by the Biden administration.”
And in a related article:
CVS, Anthem, Intermountain form coalition to push for regulatory changes for home dialysis: “Founding members of Innovate Kidney Care include Anthem, CVS Kidney Care, Home Dialyzors United (HDU), portable dialysis machine maker Outset Medical and kidney care startups Cricket Health and Strive Health….
The companies cite existing conditions for coverage that apply a one-size-fits-all set of requirements whether dialysis takes place in a clinic or at home. Due to these complex requirements, many organizations don't offer self-dialysis options, leaving large patient populations without access to these benefits.
Innovate Kidney Care is calling for the Centers for Medicare & Medicaid Services (CMS) to change the end-stage renal disease conditions for coverage to remove barriers to home dialysis training and support so more patients can benefit from the flexibility and personalization of home-based treatment.”

STATEMENT ON U.S. SUPREME COURT ORDER IN 340B MEDICARE CUTS LAWSUIT: “The U.S. Supreme Court announced today that it will review a Court of Appeals decision holding that the Centers for Medicare & Medicaid Services (CMS) had the authority to make payment cuts to many 340B hospitals under Medicare’s outpatient prospective payment system (OPPS).”

Walmart Unveils LGBTQ+ Health Care Platform: “Through a partnership with San Francisco-based health care company Grand Rounds, employees on a Walmart medical plan and their covered dependents can take advantage of Included Health, which was created especially for the LGBTQ+ community.”

Justices to Consider Narrowing Medicaid Payment Recovery Source: “The U.S. Supreme Court announced Friday that it will clear up a dispute over how state Medicaid agencies recoup health-care costs paid on behalf of beneficiaries who later recover compensation for the medical expenses from other people.
The case involves a ruling by the U.S. Court of Appeals for the Eleventh Circuit that allowed Florida’s Medicaid agency to recoup payments made for Gianinna Gallardo’s medical care from a settlement she reached with the person who caused her injuries.
Federal Medicaid law requires states to recover money paid out on behalf of beneficiaries whenever they can.”

ToAbout healthcare IT

Picture Archiving Communication Systems (PACS) Vulnerabilities: “Picture Archiving Communication Systems (PACS) are widely used by hospitals, research institutions, clinics and small healthcare practices for sharing patient data and medical images. In 2019, researchers disclosed a vulnerability in these systems that demonstrated if the systems were exploited there could potentially be an issue with exposed patient data. These systems, which can be easily identified and compromised by hackers over the Internet, can provide unauthorized access and expose patient records.”
This HHS report lists systems with “known vulnerabilities.”

Healthcare workers accuse Alexa of possibly recording protected info: “In a class action filed this week, healthcare workers alleged that their Amazon Alexa-enabled devices may have recorded their conversations – including potentially protected information.
Some of the plaintiffs, who include a substance abuse counselor and a healthcare customer service representative, say they work with HIPAA-protected information. Others say they have private conversations with patients…
The plaintiffs' complaints are twofold: They say that users may unintentionally awaken Amazon Alexa-enabled devices and that Amazon uses human intelligence and AI to listen to, interpret and evaluate these records for its own business purposes.”

About Covid-19

J&J's COVID-19 vaccine shows promise against Delta variant: ”An analysis of blood from eight patients showed that immune responses elicited by the vaccine against the Delta variant, first identified in India, were at a higher level than against the Beta variant, which was first identified in South Africa.”

A Revolutionary Solar Fridge Will Help Keep COVID Vaccines Cold In Sub-Saharan Africa: “Rather than store electricity in batteries to power them through the night, these so called "direct-drive" systems store coldness. They are so efficient and so well-insulated that they can stay cold for 3 days even if the solar panels aren't supplying power. And the lack of batteries makes them far simpler to operate and maintain.”
When will we get this cutting edge technology? Imagine uses such as in long-haul refrigeration train cars and trucks.

EU officially launches digital vaccine passport: “The European Union’s digital COVID-19 certificate officially launched today. The certificate allows people to show proof of COVID-19 vaccination, a recent negative test result, or a past COVID-19 infection. 
The certificate, which includes a QR code and digital signature, can either be displayed on a digital device or printed out. People who have the certificate digital COVID-19 certificate have to get an additional COVID-19 test or quarantine when traveling in the EU. The certificate only recognizes COVID-19 vaccines authorized in the EU — that includes the AstraZeneca, Pfizer / BioNTech, Moderna, and Johnson & Johnson shots.”

About pharma

GSK, under pressure to perform, pens $2.2B deal with Alector focused on neuro R&D, Alzheimer's: “The deal is worth a meaty $700 million upfront with up to an additional $1.5 billion in milestone payments, if all goes to plan and the two meds get to the market. 
Those assets are formed of two monoclonal antibodies: AL001 and AL101, which belong to a new field of research known as ‘immuno-neurology’ that seeks to harness the body’s own immune system to fight neurodegenerative disease and that the pair hopes will have the same successes seen with immuno-oncology in cancer.”

About home health

Amedisys snaps up hospital-at-home provider Contessa Health in $250M deal: “Amedisys, a home health, hospice and personal care company, said the $250 million deal adds higher acuity, home-based care to Amedisys’ current service offering and significantly expands Amedisys’ total addressable market for in-home care services from $44 billion to $73 billion.
Contessa Health, founded in 2015, provides hospital-at-home and skilled nursing facility at-home services and partners with health systems and health plans including Mount Sinai Health System, Marshfield Clinic Health System, Ascension Saint Thomas, CommonSpirit Health and Highmark Health. The company has potential plans to expand to more than a hundred hospitals in 28 more states.”

About hospitals and health systems

Characterization of US Hospital Advertising and Association With Hospital Performance, 2008-2016: “In this cross-sectional study of more than 4500 acute care hospitals per year, almost half advertised their services to consumers, yet there was no clear association between advertising and objective performance measures. Hospitals that advertised were more likely to have more net assets and income.”

Today's News and Commentary

About Covid-19

CDC is leaving it up to states to set guidelines for mask-wearing, director says: “CDC Director Dr. Rochelle Walensky said Wednesday the U.S. agency is leaving it up to states and local health officials to set guidelines around mask-wearing even after the World Health Organization urged fully vaccinated people to continue the practice.”

EMA Lists Five Drugs as Preferred COVID-19 Therapeutics: “The European Medicines Agency (EMA) has issued a list of five preferred therapeutics for COVID-19 patients, including four monoclonal antibodies and Eli Lilly’s rheumatoid arthritis drug Olumiant (baricitinib).
The agency recommended antibodies from GlaxoSmithKline, Celltrion, Eli Lilly and Regeneron for use in early-stage patients at risk of progressing to severe COVID-19 and Olumiant for treatment of hospitalized COVID-19 patients on oxygen.”

COVID-19 Monoclonal Antibody Therapeutics Calculator for Infusion Sites: “ASPR [The HHS Assistant Secretary for Preparedness and Response], in partnership with the Johns Hopkins University Applied Physics Laboratory, has developed the COVID-19 Monoclonal Antibody Therapeutics Calculator for Infusion Sites (mAbs Calculator). The mAbs Calculator is a free, data-informed decision support tool that is based on a comprehensive simulation framework. The mAbs Calculator can be used to inform staffing decisions and resource investments needed for COVID-19 monoclonal antibody therapeutic infusion sites.”

FDA revokes emergency nods for KN95 respirators and disinfecting hardware as mask supplies rebound: “The agency said it is pulling all emergency authorizations for disposable masks that are not approved by the National Institute of Occupational Safety and Health (NIOSH), such as imported KN95 respirators.
Manufacturers of decontamination and bioburden reduction systems had already asked the agency to rescind their emergency use authorizations, the FDA said. Because supplies of NIOSH-approved respirators have increased significantly..”

White House launches ‘surge response’ teams to delta variant hot spots: “The White House-coordinated teams will include a mix of virtual support and on-the-ground personnel, helping deploy additional supplies as requested by local officials, such as testing or therapeutics. Staff will come from the CDC, the Federal Emergency Management Agency and the Office of the Assistant Secretary for Preparedness and Response in the Department of Health and Human Services. The White House also may ramp up paid promotions about the benefits of vaccination in areas that officials deem high risk.”

About pharma

ICER stands by view on Biogen's Aduhelm, says sharp price cut needed: “Biogen would need to drastically lower the price of its new Alzheimer's drug for treatment to be cost effective, according to a revised report from the Institute for Clinical and Economic Review, which affirmed the influential nonprofit group's earlier conclusion that the company's clinical trial evidence is insufficient to prove a health benefit.
Biogen priced Aduhelm, as the drug is now called, at an average list cost of $56,000 a year. Assuming a level of efficacy suggested by blending results from the company's two Phase 3 trials, one of which failed, ICER calculated treatment would be cost effective only at prices between about $3,000 and $8,400, a reduction of 85% to 95%.”

About health insurance

CD&R Sets Deal for Majority Stake in Vera Whole Health: Back to the future????
”Private-equity firm Clayton Dubilier & Rice LLC is buying a majority stake in Vera Whole Health Inc., officials with both companies said…
Vera, based in Seattle, has created a new model of employer- sponsored healthcare in which the employer or insurance provider pays a flat monthly per-patient fee that covers all of the employee’s healthcare needs. Under the company’s model, the primary- care physician is the leader of a team of healthcare providers who communicate with each other and oversee the patient’s health.”
I guess they never heard about Kaiser’s origins in the 1930s and capitated HMO plans.

HHS Announces Rule to Protect Consumers from Surprise Medical Bills: “Today, the Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued "Requirements Related to Surprise Billing; Part I," an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing…
Among other provisions, today's interim final rule:

  • Bans surprise billing for emergency services. Emergency services, regardless of where they are provided, must be treated on an in-network basis without requirements for prior authorization.

  • Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates.

  • Bans out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances.

  • Bans other out-of-network charges without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.”

Consumer protections in the rule will take effect beginning on January 1, 2022. 

About the public’s health

Healthiest Communities Rankings 2021: At the top was Los Alamos County, N.M. But five Colorado Counties were in the top 10. See the article for the components of the rankings and where your county ranks.

About healthcare quality

Leapfrog Decries CMS Patient Safety Measure Proposal in IPPS: “Patient safety organization The Leapfrog Group has joined more than 75 other healthcare organizations and individuals in speaking out against a proposed patient safety measure change included in the CMS Inpatient Prospective Payment System (IPPS) Inpatient Quality Reporting (IQR) Program.
The measure, ‘Deaths Among Surgical Inpatients with Serious Treatable Complications,’ measures the death rate among those receiving surgery on an in-patient basis when that death occurred due to a patient safety incident.”
It is not known why CMS is making this change.

About pharma

States Step Up Push to Regulate Pharmacy Drug Brokers: A good summary on what is happening with these efforts.

Today's News and Commentary

About health insurance

Justice Department Reports Record Number of Health Fraud Cases: “The Justice Department opened a record number of False Claims Act cases last year involving allegations of health-care fraud, and it’s zeroing in now on those who misuse electronic health records, contribute to the opioid epidemic, abuse senior citizens, manipulate Medicare’s managed care program, and improperly claim Covid-19 relief funds.
‘The department also opened over 900 new matters, including 580 new health fraud matters,’ Michael Granston, deputy assistant attorney general for the DOJ’s commercial litigation branch, said Tuesday during the American Health Law Association’s annual meeting.”

Special Affordable Care Act subsidies available for unemployed Americans starting July 1: “The benefit, part of the Democrats’ $1.9 trillion rescue package enacted in March, allows anyone who receives or is approved to receive unemployment compensation during the year to select policies for as little as $0 a month in premiums and with little cost-sharing requirements, after federal assistance. 
The subsidies are tied to the benchmark silver plan, so those who pick higher-level policies might have to pay a premium. The same goes for those who live in states that require plans to cover additional benefits, such as abortion, that are beyond the law’s essential health benefits.”

Without Extension of ARPA Benefits, Americans Could Face Higher Premiums in Exchanges: “Included in ARPA [American Rescue Plan Act], signed into law by President Biden on March 11, 2021, is a temporary increase in exchange premium tax credits for people already eligible for assistance under the Affordable Care Act (ACA). The law also extends eligibility to people with incomes over 400% of the federal poverty level (FPL), for 2021 and 2022. Under these provisions, approximately 18 million Americans now have access to lower-premium exchange plans – and approximately 8 million are newly eligible for lower premiums. Enhanced APRA tax credits are estimated to save current exchange enrollees an average of 25 percent of current premiums after subsidies. These ARPA tax credit enhancements are set to expire on December 31, 2022.”
The article has examples of what would happen if the Act is not extended.

California hospital beats suit over ER fee nondisclosure: “A California hospital was properly dismissed from a lawsuit alleging it violated state consumer protection laws by failing to disclose emergency room visit fees before treatment, a state appellate court ruled June 29.” 

Hospital chargemaster prices for generics up to 6,000% more than pharmacies, research finds: “Chargemaster prices for generic drugs in hospitals can be 6,000 percent higher than the price of the same drug in a pharmacy, according to an analysis by GoodRx, a pharmacy discount company. 
GoodRx analyzed chargemaster prices for 12 common generic drugs at 16 geographically diverse hospitals across the U.S. and compared the prices to cash prices at pharmacies. The company said cash prices are readily available and provide a good benchmark for the ‘fair’ price consumers should pay for a generic drug.”

33 Million Persons of All Ages Uninsured in 2019: “In 2019, 33.0 million (10.2 percent) persons of all ages were uninsured, according to a study published online June 29 in the National Health Statistics Reports, a publication from the U.S. Centers for Disease Control and Prevention.”
The problem with these data is that they are old. For example, 2019 figures do not take into account more recent Medicaid expansions and ACA enrollments.

Humana Ranked No. 1 Among Health Insurers for Customer Experience: “Humana ranked No. 1 among Health Insurers for customer experience (CX) quality in Forrester’s proprietary 2021 US CX Index™ survey… Along with this notable recognition, Humana also ranked the highest on clear communications and providing transparent prices, rates and fees amongst health insurers.”


About Covid-19

CureVac, the latest experimental coronavirus vaccine, proves just 48 percent effective overall, a disappointing result: “The company emphasizes that in people 60 and younger, vaccine was 77 percent effective against moderate to severe disease.”

Moderna's COVID-19 vaccine shows promise against Delta variant in lab study: “The study was conducted on blood serum from eight participants obtained one week after they received the second dose of the vaccine, mRNA-1273.”

Hepatitis C Antivirals May Fight SARS-CoV-2: “Sofosbuvir/ledipasvir (Harvoni) and nitazoxanide (Alinia) both appeared to clear SARS-CoV-2, the virus that causes COVID-19 in a preliminary trial, said Mohamed Medhat, lecturer in the department of gastroenterology and tropical medicine at Assiut University Hospitals in Assiut, Egypt.
Sofosbuvir/ledipasvir was particularly efficacious, said Medhat, who reported the results at the International Liver Congress 2021.”

Respiratory risk, not death, increased for adults with obesity in ICU with COVID-19: “In the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID), researchers analyzed the records of adults admitted to the ICU with COVID-19 at 68 U.S. hospitals. Although having a higher BMI was associated with a higher risk for acute respiratory distress syndrome and acute kidney injury requiring renal replacement therapy, there was no increased risk for mortality observed.”
This research offers different results than past studies, including lack of some previously reported inflammatory biomarkers associated with obesity.

About pharma

Takeda, Endo reaped 'many hundreds of millions' through Amitiza pay-for-delay deal, lawsuit claims: “For years, branded drugmakers have used settlements with generics companies to extend market exclusivity. These ‘pay-for-delay’ deals are often criticized as anti-competitive, and now Takeda and Endo are facing scrutiny for their prior accord.
A patent settlement between Takeda and Par Pharmaceutical—now part of Endo—in 2014 delayed generics to Japanese pharma’s constipation drug Amitiza and broke antitrust law, a new proposed class-action lawsuit claims.”

BIOTECHNOLOGY UPDATE: From the OECD, this monograph is an international perspective that includes different biotech sectors, such as health, agriculture and biofuels.

Sanofi commits €400 million annually to new mRNA vaccine unit: “According to Sanofi, [its] new research centre will look at developing mRNA vaccines beyond the coronavirus pandemic, bringing them into routine use against diseases with high unmet need. The company indicated that it expects to have a minimum of six clinical candidates by 2025.”

About healthcare IT

CMS interoperability rule becomes enforced June 30: 6 things to know: The article is a reminder that enforcement of this provision is starting and has some useful highlights.

About diagnostic devices

Philips and the Spanish National Center for Cardiovascular Research (CNIC) collaborate on a new ultra-fast cardiac MRI protocol for research purposes with the aim of benefitting clinical practice in the future: “Reducing the procedure time for full evaluation of heart anatomy and function from about one hour down to a few minutes, this new technique has the potential to increase patient access to precision diagnosis, improve patient comfort due to shorter scan times, and lower the cost of care…
The new technique (called ‘Enhanced SENSE by Static Outer-volume Subtraction (ESSOS)) makes use of the fact that during a breath-hold, everything within the patient’s chest remains static, except their beating heart. After an initial image of the static part (outer volume) has been captured this MRI data is temporarily removed. The MRI signal of the beating heart can now more easily be subtracted from subsequent scan data, allowing up to four times faster acquisition of a 3D image of the heart. This results in a net acceleration factor of up to 32. Once the dynamic information of the beating heart is reconstructed, the static outer volume images are added back to generate a full 3D cardiac image showing heart anatomy and function, and allowing review from different views with good image resolution. If needed, a second contrast-enhanced isotropic 3D single breath-hold scan can reveal the extent of damage to the patient’s heart muscle.”

Today's News and Commentary

About health insurance

Health Care Sharing Ministries: Last Week Tonight with John Oliver: John Oliver discusses how these Ministries are NOT insurance.

Impact of High-Deductible Health Plans on Emergency Department Patients With Nonspecific Chest Pain and Their Subsequent Care: The finding of reduced visit rates with these plans contrasts with older data that said copays do not dissuade emergency visits for heart attacks. Perhaps study differences are due to population selection or perceived severity of illness. Also, in the past, many plans waived out-of-pocket expenses if the patient was admitted.

CMS expanding home health value-based purchasing model nationwide in January 2022: “The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule Monday that accelerates the shift from paying for home health services based on volume to a system that gives incentives to home health agencies for higher quality care.The CY 2022 Home Health Prospective Payment System (HH PPS) proposed rule outlines nationwide expansion of the home health value-based purchasing (HHVBP) model, which was
developed as a pilot by CMS' innovation arm and began in January 2016.”

About Covid-19

SARS-CoV-2 mRNA vaccines induce persistent human germinal centre responses: Another research article that provides evidence of long-lasting immunity from the MRNA vaccines.

Three in 10 Americans Think Pandemic Is Over in U.S.: From Gallup:

  • “29% say pandemic is done; 71% say it is not

  • 62% say lives "somewhat" back to normal; 54% say lives not disrupted now

  • 40% do not expect their lives will ever be normal again”

Masks upgrade cuts infection risk, research finds: “The quality of face masks healthcare workers wear makes a huge difference to their risk of coronavirus infection, Cambridge University Hospitals NHS Foundation Trust research has found.
Wearing a high grade mask known as an FFP3 can provide up to 100% protection. 
By contrast, there is a far greater chance of staff wearing standard issue surgical masks catching the virus.”

New face mask prototype can detect Covid-19 infection: “Engineers at MIT and Harvard University have designed a novel face mask that can diagnose the wearer with Covid-19 within about 90 minutes. The masks are embedded with tiny, disposable sensors that can be fitted into other face masks and could also be adapted to detect other viruses.
The sensors are based on freeze-dried cellular machinery that the research team has previously developed for use in paper diagnostics for viruses such as Ebola and Zika. In a new study, the researchers showed that the sensors could be incorporated into not only face masks but also clothing such as lab coats, potentially offering a new way to monitor health care workers’ exposure to a variety of pathogens or other threats.”

Mixing Pfizer, AstraZeneca vaccines generates strong immune response against COVID-19: study: “Efficacy findings released Monday from the University of Oxford-led Com-COV trial suggest that mixed COVID-19 vaccine schedules using Pfizer/BioNTech's Comirnaty (BNT162b2) and AstraZeneca's Vaxzevria induced ‘high concentrations of antibodies’ against the SARS-CoV-2 spike IgG protein when given four weeks apart. ‘This means all possible vaccination schedules involving [these two] vaccines could potentially be used against COVID-19,’ the authors said after the results were published on The Lancet pre-print server.”

About pharma

: “Available exclusively through Walmart’s private ReliOn brand, the new offering includes analog insulin vials ($72.88) and FlexPen® ($85.88). These products will save customers between 58% to 75% off the cash price of branded analog insulin products, which translates to a savings of up to $101 per branded vial or $251 per package of branded FlexPens®.
The new private label ReliOn™ NovoLog® Insulin (insulin aspart) injection, manufactured by Novo Nordisk, is available in Walmart pharmacies this week, and Sam’s Club pharmacies in mid-July across the United States. ReliOn™ NovoLog® is a rapid-acting insulin analog used to control high blood sugar in adults and children with diabetes. Customers will need a prescription in order to purchase the products and should always consult with their doctor regarding their diabetes management.”

Four biotech companies are forming a coalition to advocate for manufacturing pharmaceutical products within the United States: “The Securing America’s Medicines and Supply coalition (SAMS) is composed of Coherus BioSciences, Teva Pharmaceutical Industries, Zymergen and iRemedy Healthcare Companies. The group aims to boost the U.S. supply chain while also fostering cooperation with U.S. allies to ‘near shore’ pharmaceuticals and medical supplies.”

About healthcare IT

How to Measure the Value of Virtual Health Care: “…the American Medical Association (AMA) and Manatt Health, a legal and consulting firm, have developed a framework for assessing the value of digitally enabled care…
The framework describes several environmental variables that impact distinct value streams, which collectively seek to capture the overall value derived from a specific digitally-enabled model. The environmental variables include practice type, payment arrangement, patient population, clinical use case, and virtual care modality…
Next, the framework includes six value streams: clinical outcomes, quality and safety; access to care; patient and family experience; clinician experience; financial and operational impact; and health equity. The impact of a digitally-enabled-care model should be measured on all these value streams — a Balanced Scorecard approach, if you will, to measuring and realizing the full potential of virtual care.”

About the public’s health

Current Gaps in Breast Cancer Screening Among Asian and Asian American Women in the United States: ”In the United States, recent data demonstrate that the burden of breast cancer among Asian women has increased each year over the past decade. We aim to characterize challenges faced by Asian and Asian American women in the United States related to cultural stigma, socio-economic status, and overall access to breast cancer care. An increased understanding of barriers to breast cancer prevention and treatment efforts is needed to develop more effective strategies aimed at reducing disparities in care among segments of this heterogenous population.'“

About physicians

COVID-19’s Impact On Acquisitions of Physician Practices and Physician Employment 2019-2020: This report, prepared by Avalere, confirms the continued trend of corporate acquisition of physician practices. Among the findings:
—48,400 additional physicians left independent practice and became employees of hospitals or other corporate entities – 22,700 of that shift occurred after the onset of COVID-19
—This represents a 12% increase in the percentage of employed physicians over the two-year study period
—Hospital and other corporate entities acquired 20,900 additional physician practices over the two-year period, resulting in a 25% increase in corporate-owned practices”
At the end of 2020, 69.3% of physicians were employed by hospitals or other corporate entities.