Today's News and Commentary

About Covid-19

FDA authorizes Moderna and Johnson & Johnson boosters and says people can get a shot different from their original dose: “The decision by the Food and Drug Administration paves the way for boosters of all three authorized shots to be available to a wide swath of the U.S. population and promises to ease the logistics of the booster campaign for pharmacies and clinics offering vaccines.”

Booster shots could soon be recommended for people as young as 40, source says: “‘I believe it will happen,’ the source familiar with the plan told CNN's Elizabeth Cohen, adding that there is ‘growing concern within the FDA’ that US data is beginning to show more hospitalizations among people under age 65 who have been fully vaccinated.”

J&J says COVID-19 vaccine added $502 million to Q3 sales: The article also has a breakdown of other revenue-producing products.

About healthcare IT

Patients say telehealth is OK, but most prefer to see their doctor in person: In “a poll by NPR, the Robert Wood Johnson Foundation and the T.H. Chan School of Public Health at Harvard that surveyed patients in August and September. Around 42% of respondents said someone in their household had used telehealth. Of those, 82% reported satisfaction, yet nearly two-thirds — 64% — would have preferred to see their nurse or doctor in person.”

A survey of U.S. public perspectives on facial recognition technology and facial imaging data practices in health and research contexts: “Our findings indicate that while a majority of research participants might be comfortable with facial images and facial recognition technologies in healthcare and health-related research, a significant fraction expressed concern for the privacy of their own face-based data, similar to the privacy concerns of DNA data and medical records. A nuanced approach to uses of face-based data in healthcare and health-related research is needed, taking into consideration storage protection plans and the contexts of use.”

Public Health Data Exchange, Health Equity Require Team Effort: “RWJF… announced $50 million in funding for a range of initiatives centered on a national interoperability infrastructure for public health data exchange. Funding will address the following:

  • A grant of $11.5 million to transform local data ecosystems to eliminate systemic racial, structural, and bureaucratic barriers in public health data;

  • A grant of $10 million to support community-academic partnerships with historically black colleges and universities in the Gulf Coast region to expand the interpretation of data to transform local public health data systems; and

  • A grant of $10 million to advance policies to promote more meaningful, nuanced data disaggregation beyond broad racial/ethnic categories to raise awareness about the need to address health disparities.”

Microsoft links with Cerner, Epic to unveil 5 telehealth capabilities: “Microsoft has unveiled several capabilities for virtual healthcare visits, which can be used through Epic and Cerner EHR, according to an Oct. 19 Microsoft Teams blog post.”
For example: “Patients and clinicians can launch telehealth visits through the Microsoft Teams EHR connector for Cerner. Clinicians can launch visits from Cerner PowerChart. The Microsoft Teams EHR connector is also available for patients whose providers use Epic [and] Microsoft will allow clinicians to have scheduled queuing for virtual visits.”

CMS Selects 4 States for ACO-Based Rural Telehealth Delivery Model: “The Centers for Medicare & Medicare Services will provide funding to the University of Alabama at Birmingham (UAB), South Dakota’s Department of Social Services, Texas’ Health and Human Services Commission and the Washington State Healthcare Authority to implement the Community Health Access and Rural Transformation (CHART) model. Those organizations will develop telehealth and other services through an ACO transformation tracks that leverages value-based payment models.”

About health insurance

Three articles in the news today about administrative simplification in healthcare. The first one is from McKinsey and the other two appeared in JAMA Network.

Administrative simplification: How to save a quarter-trillion dollars in US healthcare
Administrative Simplification and the Potential for Saving a Quarter-Trillion Dollars in Health Care
Administrative Expenses in the US Health Care System:Why So High?

Bipartisan senators fire warning shot against any cuts to Medicare Advantage: “The group of 13 senators—including seven Democrats, five Republicans and one independent—wrote a letter Friday to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure on building progress for the program. But the senators warned Brooks-LaSure of any cuts to the program.”

ACA extras would cost $553B, extend coverage to 4 million people, budget office says: “A letter from the Congressional Budget Office found that expanding the ACA — including tax credits, eligibility and Medicaid programs in holdout states — would cost $553 billion. 
The price tag would extend coverage to 4 million people, according to the Oct. 19 letter.”

Q3 report shows Anthem profits up 580%: 5 things to know: “The insurer recorded $1.51 billion in profits, anchored by an 16 percent increase in operating revenue to $35.5 billion.”

About the public’s health

Incidence of Cigarette Smoking Relapse Among Individuals Who Switched to e-Cigarettes or Other Tobacco Products: “In this cohort study of a representative sample of US adults, 9.4% of respondents who smoked cigarettes became recent former smokers 1 year later. Switching to any tobacco product including e-cigarettes was associated with an 8.5% increase in relapse to smoking over the next year; this increase in relapse was similar to that seen in individuals who switched to other tobacco products…
Switching to e-cigarettes is not associated with relapse prevention for cigarette smoking in US adults.”[Emphasis added]

Today's News and Commentary

About Covid-19

Renewal of Determination That A Public Health Emergency Exists: “As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective October 18, 2021, the January 31, 2020, determination by former Secretary Alex M. Azar II, that he previously renewed on April 21, 2020, July 23, 2020, October 2, 2020, and January 7, 2021, and that I renewed on April 15, 2021 and July 19, 2021, that a public health emergency exists and has existed since January 27, 2020, nationwide.”
The renewal extends the state of emergency for at least another 90 days.

F.D.A. to Allow ‘Mix and Match’ Approach for Covid Booster Shots: “The Food and Drug Administration is planning to allow Americans to receive a different Covid-19 vaccine as a booster from the one they initially received, a move that could reduce the appeal of the Johnson & Johnson vaccine and provide flexibility to doctors and other vaccinators.
The government would not recommend one shot over another, and it might note that using the same vaccine as a booster when possible is preferable, people familiar with the agency’s planning said. But vaccine providers could use their discretion to offer a different brand, a freedom that state health officials have been requesting for weeks.”

Efficacy of interferon beta-1a plus remdesivir compared with remdesivir alone in hospitalised adults with COVID-19: a double-bind, randomised, placebo-controlled, phase 3 trial: “Interferon beta-1a plus remdesivir was not superior to remdesivir alone in hospitalised patients with COVID-19 pneumonia. Patients who required high-flow oxygen at baseline had worse outcomes after treatment with interferon beta-1a compared with those given placebo.” This study highlights the benefits of treatments for Covid-19 under specific clinical conditions.

Pfizer, Moderna will rake in a combined $93 billion next year on COVID-19 vaccine sales: report: “The messenger RNA shot producers are projected to break the bank next year, generating combined sales of $93.2 billion, nearly twice the amount they are expected to rake in this year, says Airfinity. The health data analytics group puts total market sales for COVID-19 vaccines in 2022 at $124 billion, according to data seen by The Financial Times.”

Assessment of Out-of-Pocket Spending for COVID-19 Hospitalizations in the US in 2020: “In this cross-sectional study of 4075 COVID-19 hospitalizations in 2020, 71.2% of privately insured patients and 49.1% of Medicare Advantage patients had cost sharing for any hospitalization-related service, including those billed by clinicians; 4.6% of privately insured and 1.3% of Medicare Advantage had cost sharing for facility services billed by hospitals, with mean out-of-pocket spending of $3840 and $1536, respectively…
The findings suggest that out-of-pocket spending for COVID-19 hospitalizations may be substantial if insurers allow cost-sharing waivers to expire.”

Pfizer vaccine 93% effective at preventing hospitalizations in 12-18 year olds, CDC says: “Pfizer's COVID-19 vaccine was 93 percent effective at preventing hospitalizations from the virus in children ages 12 to 18 in a real-world study conducted by the CDC, the agency said Oct. 19.”

About health insurance

‘An Arm and a Leg’: Hello? We Spend 12 Million Hours a Week on the Phone With Insurers: An interesting podcast with the message in the headline. Dan Weissmann is a great interviewer.

UnitedHealth launches employer virtual primary care service: “UnitedHealthcare is expanding its telehealth offerings for employers with a new virtual primary care service that offers access to doctors with low or no co-pays for routine visits on their phones or via computer…
UnitedHealth is partnering with telehealth provider Amwell, which will provide the platform for virtual care as well as the clinical services through its medical group. The virtual primary care program will initially be available for employers in 11 states including Colorado, Texas and Maryland, as well as Washington, DC.”

Estimated Medicare Spending on Cancer Drug Indications With a Confirmed Lack of Clinical Benefit After US Food and Drug Administration Accelerated Approval: “Between 2017 and 2019, Medicare Parts B and D cumulatively spent at least $569 million on the 10 cancer drug indications with a confirmed lack of OS [overall survival] benefit after AA[accelerated approval]. Approximately $224 million of this spending was for indications that were either voluntarily withdrawn by the manufacturers or recommended by the ODAC for withdrawal. These results suggest that spending on the remaining 4 AA indications may continue to increase unless the FDA revokes these indications.”

AMERICAN CUSTOMER SATISFACTION INDEX:Insurance and Health Care Study 2020-2021: Start with pages 4-6. Note that Hospitals are two points lower than the US Postal Service.

About healthcare IT

Third-party health apps are vulnerable to hacks, report finds: A reminder: “Third-party health apps that pull patient data from electronic health record systems are vulnerable to hacks, according to a new report. The electronic health records themselves, which are housed at health centers and subject to the federal privacy law HIPAA, are well protected. But as soon as a patient gives permission for their data to leave the health record and head toward a third-party app — like programs that track people’s medications, for example — it’s easy for hackers to access. 
Hospitals and health care systems are a major target for hackers, and attacks have only escalated over the past few years. Patient health data is some of the most valuable information to hackers: each record can be worth hundreds of dollars on the dark web, in part because they can’t be changed easily and it’s harder to detect when the data is used fraudulently. Credit card numbers, on the other hand, can easily be changed and are only worth a few dollars.”

Finances Stymie Patient Data Sharing, Interoperability at FQHCs: “Federally qualified health centers (FQHCs) and other safety-net providers face interoperability challenges that limit their patient data sharing capabilities, according to a new whitepaper published by CareAdvisors…
The majority of safety net providers, including community hospitals, FQHCs, and community health clinics, have been excluded from patient data sharingopportunities due to a lack of resources for investment in EHR systems such as Epic and Cerner that interoperate with other providers.”

Man gets 7-year prison sentence for 2014 UPMC database hack: The article highlights the potentially severe penalties for hacking: “A Michigan man was sentenced to seven years in prison for his role in the hacking and theft of data belonging to more than 65,000 UPMC employees, the Justice Department said Oct. 18. 
Justin Sean Johnson, 30, of Detroit, was charged in June 2020 and sentenced Oct. 15, 2021, to 60 months' incarceration for conspiracy to defraud the U.S. and 24 months for aggravated identity theft for hacking into the Pittsburgh-based health system's human resource server databases in 2013 and 2014…”

About healthcare devices

Hearing aids without a prescription or an exam? The FDA takes big step toward making that happen.: “More than four years after Congress ordered the agency to allow over-the-counter hearing aids, it took the first step Tuesday to broaden access to more accessible and affordable devices for millions of patients with mild to moderate hearing loss. The agency’s proposal would create a new category of over-the-counter hearing aids and supersede state-level regulations that require patients to go through physicians or audiologists to get prescriptions and fittings for them.”

About the public’s health

US flu cases up 23 percent from 2020: “The U.S. has seen 23 percent more flu cases this year compared to last year’s influenza season, though flu activity is still below normal pre-pandemic years, according to data collected by the Walgreens Flu Index.
According to the flu index, which includes data through the week ending on Oct. 9, Nevada leads the U.S. in the number of flu cases reported this year, followed by Mississippi and Texas.”

About healthcare providers

Grand Rounds Health and Doctor On Demand Rebrand as Included Health: “-Grand Rounds Health and Doctor On Demand… announced their combined integrated virtual care and navigation company will be called Included Health.”

Today's News and Commentary

About Covid-19

Covid Weekly Tracker Review: From the CDC: “The current 7-day moving average of daily new cases (84,555) decreased 12.5% compared with the previous 7-day moving average (96,666). A total of 44,615,528 COVID-19 cases have been reported as of October 13, 2021.”

CDC data: Unvaccinated 11 times more likely to die from COVID-19 than fully vaccinated: “Unvaccinated people have an 11 times higher risk of dying from COVID-19 than fully vaccinated people, according to new data posted by the Centers for Disease Control and Prevention (CDC). 
The data run through August and are from 16 health departments representing about 30 percent of the U.S. population, the CDC said. 
In addition, the data show that unvaccinated people have a six times higher chance of testing positive for COVID-19 than fully vaccinated people do.”

U.S. Moves Pandemic Data Tracking to CDC, Reversing Trump: “The Biden administration is moving the U.S. government’s largest public-health tracking system back to the Centers for Disease Control and Prevention, undoing a much-criticized move by the Trump administration to shift custody of critical data from the nation’s top epidemiological agency.
According to a document obtained by Bloomberg News, the Department of Health and Human Services on Oct. 1 signed off on a recommendation to move the system, designed to track pandemic data, out of the management of its own Office of the Chief Information Officer and into CDC’s oversight.”

Antibody tests can’t give answers you want about covid-19 immunity.: A reminder: “Both the Centers for Disease Control and Prevention and the Food and Drug Administration advise against using antibody tests to determine one’s level of immunity against covid-19, the disease caused by the coronavirus. So does the Infectious Disease Society of America, which represents infectious-disease specialists.”

‘I hope you die’: how the COVID pandemic unleashed attacks on scientists: “Dozens of researchers tell Nature they have received death threats, or threats of physical or sexual violence.”

WTO member nations again fail to agree on Covid-19 vaccine patent waiver: “The council of the WTO agreement on Trade-Related Aspects of Intellectual Property Rights (Trips) met recently to try to make progress on the issue, but the agency said the council had not reached a consensus. Further talks are also scheduled for October 26.”

About pharma

FDA approves first interchangeable biosimilar for Humira: “The FDA said Oct. 18 it has approved Cyltezo, the first interchangeable biosimilar for AbbVie's best-selling drug Humira. 
Cyltezo, made by Boehringer Ingelheim, is the second interchangeable biosimilar drug approved by the FDA, following the approval of Mylan's Semglee in July. It is the first interchangeable monoclonal antibody approved. “

Lupin Pharmaceuticals Recalls All Irbesartan Tablets Over Potential Impurity: “Lupin Pharmaceuticals is recalling all batches of its irbesartan and irbesartan/hydrochlorothiazide tablets in the U.S. over concerns the blood pressure drugs may contain N-nitrosoirbesartan, a likely carcinogen.”

About the public’s health

Biden administration moves to curtail toxic ‘forever chemicals’: “The Environmental Protection Agency said it will move with urgency to set enforceable drinking water limits on certain polyfluoroalkyl and perfluoroalkyl substances, or PFAS, more commonly known as “forever chemicals,” which do not break down naturally and have turned up in the water supplies of communities around the country.
The agency also will require manufacturers to provide detailed data about entire classes of compounds they produce, and plans to designate some of them as hazardous chemicals under the nation’s Superfund law.”

About medical devices

FDA Designates Osteoarthritis Microspheres a Breakthrough Device: “The microspheres are delivered in a minimally invasive procedure to reduce blood flow to the periarticular tissue of the joints, limiting the inflammatory process.
The microspheres have other applications, such as blocking blood flow to hypervascular tumors, arteriovenous malformations and uterine fibroids.”

About health insurance

Walmart unveils employer market team-up with Transcarent: “Walmart is teaming with Transcarent to make it easier for self-funded employers to access its healthcare services.
This is the first time Walmart has made such an agreement to offer its prices on pharmaceuticals and other healthcare services to employers. The partnership aims to allow employers to leverage the retail giant's size and scale to offer more convenient care and cost-effective health and wellness options.”

Today's News and Commentary

About Covid-19

FDA panel backs half-dose Moderna booster for the elderly and others at high risk: “An FDA advisory committee voted unanimously Thursday to recommend Moderna's COVID-19 vaccine as a booster for people 65 and older and others at high risk.
The Vaccines and Related Biological Products Advisory Committee backed emergency authorization for booster doses at least six months after completion of the original two-shot Moderna series.
The booster won't be identical to the first two shots, though. The committee signed off on Moderna’s plan for a 50-microgram, or half-dose, for the booster compared to the 100-microgram dose used in the original two-shot series.”

Johnson & Johnson wins FDA panel backing for a second dose of its COVID shot but don’t call it a ‘booster’: “Vaccines and Related Biological Products Advisory Committee (VRBPAC) recommended unanimously for an emergency use approval for a second dose of the J&J vaccine, provided the first shot came at least two months ago. While the recommendation covered all adults, there was much discussion as to whether the second dose should be called a booster or not.”

Abbott Molecular, Inc. Recalls Alinity m SARS-CoV-2 AMP Kit and Alinity m Resp-4-Plex AMP Kit for Potential False Positive SARS-CoV-2 Test Results: The headline is the story.

About the public’s health

US reaches record high of more than 96,000 drug overdose deaths in a 12-month period, CDC data show: “Reported drug overdose deaths in the United States hit a new high of more than 96,000 in the 12-month period ending March 2021, according to data released Wednesday by the US Centers for Disease Control and Prevention's National Center for Health Statistics.”

About pharma

6 drug shortage predictions for 2022 and beyond: A good summary of how regulatory and financial trends may shape the future of drug shortages in healthcare.

Biden set to pick former FDA head Robert Califf to lead agency: reports: “US President Joe Biden is close to nominating former FDA Commissioner Robert Califf to lead the agency once again, according to reports Thursday citing anonymous sources. If nominated and subsequently confirmed by the US Senate, Califf would replace acting Commissioner Janet Woodcock who stepped into the role, from her position as long-time director of the FDA's Center for Drug Evaluation and Review (CDER), when Biden took office in January.
It would also mark Califf's second run at heading the agency, after the cardiologist served as FDA Commissioner for about a year between 2016-2017, at the end of former President Barack Obama's time in office.”

About healthcare professionals

Nursing schools see applications rise, despite COVID burnout: “Nationally, enrollment in bachelor’s, master’s and doctoral nursing programs increased 5.6% in 2020 from the year before to just over 250,000 students, according to the American Association of Colleges of Nursing.
Figures for the current 2021-22 school year won’t be available until January, but administrators say they have continued to see a spike in interest.”

Biden admin to invest $100M to address health care worker shortage: “The Biden administration announced Thursday that it will direct $100 million to the National Health Service Corps to help address the health care worker shortage.
Pulled from funding in the American Rescue Plan, the $100 million represents one of the nation’s biggest investments in a program that helps place primary care doctors in communities that have difficulty recruiting and retaining them. It's a five-fold increase from previous years, the Department of Health and Human Services said.”

About health insurance

US News names best Medicare Advantage plans for 2022: “The report uses data from the CMS' annual star rankings, which were released Oct. 8. The U.S. News report defines its best plans as those that have at least three out of five stars by CMS and average 4.5 or more stars in the state.”

Medicare Open Enrollment Period Kicks Off Today: From CMS: “The Medicare Open Enrollment period occurs every year from October 15 through December 7, with coverage changes taking effect January 1. During this time, people can find a plan that better meets their needs, saves money, or both.”

About hospitals and health systems

CMS requests corrective action plan from 32 hospitals over undisclosed prices: “Of the 32 hospitals that received corrective action plan requests, which is the second step in CMS' compliance process, six hospitals are now in compliance with the rule after addressing citations outlined in warning letters, according to CMS. In April 2021, CMS began sending warning letters to hospitals not in compliance with the regulation. As of late September, CMS has sent 316 warning notices to hospitals out of compliance with the rule.”

Goldman Sachs Asset Management and Charlesbank Capital Partners Complete Acquisition of MDVIP Primary Care Network: Change in ownership for this concierge medicine network: “ MDVIP, the national leader in personalized membership-based healthcare, today announced that the Private Equity business within Goldman Sachs Asset Management ("Goldman Sachs") and funds affiliated with Charlesbank Capital Partners ("Charlesbank") have completed the acquisition of MDVIP from Leonard Green & Partners and Summit Partners. The transaction gives Goldman Sachs and Charlesbank majority ownership of the company. Financial terms were not disclosed.
MDVIP leads the market in membership-based medicine with a national network of approximately 1,100 primary care physicians serving 362,000 patients.”

Fitch: Hospital credit downgrades outpace upgrades in Q3: “As of the end of the third quarter, 88.5 percent of the nonprofit hospital and health system sector had stable rating outlooks, while 6.5 percent had positive rating outlooks and 4.2 percent had negative rating outlooks, an Oct. 11 Fitch Ratings report showed.
Fitch upgraded six hospital ratings and downgraded seven in the third quarter.”

About diagnostics

Quanterix’s Alzheimer’s Blood Test Designated a Breakthrough Device: “The FDA has granted a Breakthrough Device designation to Quanterix’s Simoa phospho-Tau 181 (pTau-181) blood test for Alzheimer’s disease.
The assay measures the concentration of the pTau-181 protein in human serum and plasma using the company’s HD-X immunoassay system. The protein is a biomarker that suggests brain changes from Alzheimer’s, according to the National Institutes of Health.”



Today's News and Commentary

About Covid-19

J&J COVID-19 shot gets better boost from Moderna or Pfizer in NIH study: “People who got Johnson & Johnson Inc’s  COVID-19 vaccine as a first shot had a stronger immune response when boosted with vaccines from Pfizer Inc/BioNTech SE or Moderna Inc, a study run by the National Institutes of Health showed on Wednesday.
The study, which is preliminary and hasn't been peer reviewed, is the latest challenge to J&J's efforts to use its COVID-19 vaccine as a booster in the United States.”
In a related article: FDA scientists' analysis of J&J COVID-19 booster data raises red flags: “U.S. Food and Drug Administration scientists said on Wednesday they did not receive enough data in time to do their own analysis of Johnson & Johnson's application for a booster dose of its COVID-19 vaccine, but the agency's review of company studies raised some red flags.
Advisers to the FDA will meet on Oct. 15 to assess the risks and benefits of a booster shot of J&J's vaccine, which is currently given as a single dose.
In its review, FDA scientists repeatedly noted the limitation of small sample sizes of many of the company's studies.”

FDA panel recommends Moderna booster for people 65 and older and adults at high risk of exposure or severe illness: “An independent advisory panel to the Food and Drug Administration on Thursday unanimously recommended a booster dose of the Moderna coronavirus vaccine for people 65 and older and adults who are at high risk of severe illness or are exposed at work.”

Biden's vaccine mandate for companies nears as proposed rule sent to White House: “The U.S. Labor Department on Tuesday submitted to the White House the initial text of President Joe Biden's plan to require private-sector workers to be vaccinated against COVID-19 or get tested regularly.
The department's Occupational Safety and Health Administration submitted the proposed rule for review. Some details could change, a source familiar with the matter told Reuters. The move indicates the proposed standard could be released soon.”

Johns Hopkins, Stanford and 30+ others join social media initiative to improve vaccine uptake: “The Vaccine Confidence Fund on Oct. 14 selected 33 organizations to receive grants totaling more than $7 million for projects exploring how technology and social media can increase vaccine confidence…
The Vaccine Confidence Fund was launched in June by nonprofit Global Impact, Facebook and Merck.”

Vaccination could have prevented 90,000 deaths over four months, study says: Approximately 90,000 covid-19 deaths could have been avoided over four months of this year if more U.S. adults had chosen to be vaccinated, according to a study published Wednesday, as the disease caused by the coronavirus became the second-leading cause of death in the United States.
The estimate by researchers backed by the Peterson Center on Healthcare and the Kaiser Family Foundation focused on deaths of U.S. adults from June 2021 — when the report says coronavirus vaccines became widely available to the general public — through September.”

Why Many Black Americans Changed Their Minds About Covid Shots: From The NY Times, a very insightful investigation into programs that turned around this disparity.

About Hospitals and health systems

Mayo Clinic, Kaiser Permanente recruit 11 health system partners for new hospital-at-home advocacy coalition: “Following up on their big-ticket strategic investment into at-home acute care company Medically Home, Mayo Clinic and Kaiser Permanente are headlining a new advocacy movement backed by nearly a dozen other health systems from across the country.
Called the Advanced Care at Home Coalition, the partners are joining their voices to convince Capitol Hill to extend telehealth, remote and in-home care flexibilities implemented throughout the COVID-19 public health emergency.
The organizations said they will also be petitioning the Center for Medicare & Medicaid Innovation (CMMI) to test and establish a new delivery model for advanced care at home.”

Ascension, CommonSpirit and Trinity see finances rebound: The headline is the story; the article has the details.

Partnerships, Mergers, and Acquisitions Can Provide Benefits to Certain Hospitals and Communities: The claim from the AHA is that mergers and acquisitions saved many financially challenged hospitals: “An analysis of AHA and Kaufman Hall data suggests that almost 40% of hospitals may be financially challenged or distressed prior to an M&A transaction…
Approximately 20% of hospitals (92 total) in Kaufman Hall’s database of 463 transactions between 2015 and 2019 cited financial distress as a key driver for the transaction. Some of these distressed hospitals had struggled financially for several years preceding the merger, but others saw rapid and significant declines in performance that triggered a decision to merge.
 More than one-third of the hospitals citing financial distress (31 of 92) had declared bankruptcy, a clear sign of imminent closure.
The 31 transactions involving bankrupt organizations included 34 hospitals in total; only 6 of these hospitals have subsequently closed. More than 80% were saved from bankruptcy and remain operational today.”

How hospitals can use Z codes to track social determinants of health: “Z codes, which are ICD-10-CM codes used to identify non-medical factors that may affect a patient's health status, are a useful way to track social determinants of health and capture standardized data for Medicare beneficiaries. However, they are underused, with Z codes reported from only 1.59 percent of beneficiaries in 2019, according to a new CMS report.”

About pharma

Johnson & Johnson Places Talc Injury Claims in Bankruptcy: “Johnson & Johnson placed into bankruptcy its liabilities for tens of thousands of claims linking talc-based products to cancer, hoping to drive a settlement of personal-injury claims that are expected to grow for decades to come…
Thursday’s bankruptcy also confirms the fears of injury lawyers, who had voiced worries that J&J would put talc claims into chapter 11 to stop jury verdicts, protect assets and pressure plaintiffs to accept settlements.”

Walgreens makes $5.2B investment in VillageMD, becomes majority owner: Walgreens said Oct. 14 it has agreed to make a $5.2 billion investment in VillageMD, which will make it the majority owner. 
The investment will increase Walgreens' ownership stake in the primary care company from 30 percent to 63 percent. VillageMD will remain an independent company with its own management and board. 
Walgreens has said its goal is to open at least 600 primary care clinics within its stores in more than 30 U.S. markets by 2025, and 1,000 by 2027.”

About health insurance

Double-digit growth dots UnitedHealth Q3 results: 10 things to know: Details about the parent (UnitedHealth Group) and its two subsidiaries.

Medicare Advantage [MA] vs. Traditional Medicare[TM]: How Do Beneficiaries’ Characteristics and Experiences Differ?: This Commonwealth Fund study is worth reading. A few takeaways:
MA plans had healthier beneficiaries in the past, but now MA and TM programs have patients with similar characteristics. Patient experience scores are similar as are many quality measures; however, MA plans provide more consistent primary care availability and continuity of care.

About the public’s health

Voluntary Sodium Reduction Goals: Target Mean and Upper Bound Concentrations for Sodium in Commercially Processed, Packaged, and Prepared Foods: Guidance for Industry: From the FDA:
”This guidance is intended to provide measurable voluntary short-term (2.5-year) goals for sodium content1 in commercially processed, packaged, and prepared foods2 to reduce excess population sodium intake, while recognizing and supporting the important roles sodium plays in food technology and food safety…
Average sodium intake in the U.S. is approximately 3,400 milligrams/day (mg/day) (Ref 3). The Dietary Guidelines for Americans, 2020-2025…advises individuals 14 years and older to limit their consumption to 2,300 mg/day…”

Today's News and Commentary

About healthcare IT

As the telehealth market shakes out, Teladoc, Amwell feeling pressure from new entrants, more specialization: The article is a good review of telehealth usage trends and increased competition from newer companies.

Withings goes head-to-head with Apple, nabbing FDA OK for smartwatch to detect afib, sleep apnea: “Withings’ FDA clearance covers its clinically validated ECG and pulse oximeter features. In addition to detecting indicators of abnormal heart rhythms and respiratory disorders, respectively, their readings are also combined with movement and pulse measurements in an algorithm that can detect breathing disturbances while a wearer is sleeping, a possible sign of sleep apnea.
Beyond its medical-grade features, the ScanWatch is equipped with all the typical trappings of a smartwatch. It automatically tallies steps, calories burned and elevation gained throughout the day and maps out workout routes using embedded GPS tech. Throughout a workout, the watch uses real-time readings of heart rate and exercise pace, along with the user’s age, gender and weight, to calculate VO2 max, a measure of the amount of oxygen consumed per minute…
The ScanWatch starts at $279, comparable to Apple’s price-conscious option, the Apple Watch SE, and about $120 less than the new, fully decked-out Apple Watch Series 7.”

Analysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover: “In this study, physician productivity and EHR use metrics were associated with physician departure. Prospectively tracking these metrics could identify physicians at high risk of departure who would benefit from early, team-based, targeted interventions. The counterintuitive finding that less time spent on the EHR (in particular inbox management) was associated with physician departure warrants further investigation.”

About health insurance

EmblemHealth Study Finds that the Healthcare Industry Needs to Do More to Educate Consumers on Value-Based Care: “The national study found that only one in four consumers are aware of the term ‘Value-Based Care’ and of those, only a quarter can define it accurately.”

Physician groups warn nearly 10% in Medicare cuts could stall shift to value-based care, force staff cuts: “Providers are facing 9.75% in cuts to Medicare reimbursements in the next year. This includes 4% in cuts due to go into effect under the PAYGO law, which calls for Congress to install a series of cuts across the federal government if spending reaches a certain threshold…
A survey conducted of 92 AMGA members… found that if the cuts were to go into effect, 42.7% will install hiring freezes and 36.8% will eliminate services. Another 22.2% will no longer accept Medicare patients.”

Southern states have low insurance coverage, high costs, new report finds: “Southern states have the highest number of adults who skip care due to cost and some of the highest rates of uninsured people, a new analysis by NiceRx found…”
Texas ranks first in percent uninsured and second (after Mississippi) in the most people avoiding doctor visits because of cost.”

Urban Institute: Making enhanced ACA subsidies permanent could extend coverage to nearly 1M: “‘If the [American Rescue Plan Act’s] enhanced subsidies were made permanent, we find that the number of uninsured children would fall by approximately 303,000, and the number of uninsured parents would fall by about 686,000,’ the analysis said. ‘The number of uninsured young children would fall by about 67,000 and about 267,000 parents of young children would gain coverage.’
The enhanced subsidies ensured anyone with an income below 150% of the federal poverty level didn’t pay any premiums for coverage. Anyone with 400% above the poverty level would also qualify for subsidies and not pay more than 8.5% of their income on healthcare, a major change from the current law where those consumers would not be eligible for any subsidies.”

Biden admin allows Colorado to make gender-affirming care an essential health benefit: “Colorado's approach discourages a "one-size-fits-all" approach to transgender care, CMS said in an announcement, and would allow access to a greater range of benefits than many currently can receive. Treatments available will include eye and lid modifications, facial tightening, facial bone remodeling for facial feminization, breast and/or chest construction and reduction and laser hair removal.
Essential health benefits in Colorado's benchmark plan will also include mental health care access and coverage for 14 prescription drug classes, CMS said.”

7 in 10 Medicare Beneficiaries Report That They Did Not Compare Their Coverage Options During a Recent Open Enrollment Period: “Other key findings include:

• The share of beneficiaries who said they did not compare their options was higher among beneficiaries who are Black (74%) and Hispanic (79%), ages 85 and older (84%), with low incomes (85%), and those enrolled in both Medicare and Medicaid (87%).

• When it comes to Part D drug coverage, 81 percent of Medicare Advantage drug plan enrollees and 72 percent of Medicare stand-alone drug plan enrollees said they did not compare drug coverage offered by their current plan to other plans.

• Nearly half (47%) of all beneficiaries with Medicare said they had never visited the official Medicare website for information, 53 percent reported they had never called the 1-800-MEDICARE helpline and 31 percent said they did not read the Medicare & You handbook.”

Your Free Cancer Screen Shows Trouble: What If You Can't Afford the Follow-Up?: The theme of this article, which quotes two research studies, is that while proven cancer screens are free to the patient, followup diagnostics and treatments may have significant costs which patients find unaffordable. The cost can lead to care delay or avoidance.

About Covid-19

WHO announces new expert group to investigate origins of the coronavirus and other outbreaks: “The World Health Organization on Wednesday named 26 scientists to a new advisory body devoted to understanding the origins of the coronavirus and other future outbreaks, marking a significant change in approach for the world’s top global health body to one of the most politically sensitive issues of the pandemic.
The group includes scientists from the United States and China, as well as 24 other nations, and will be formalized after a brief period of public consultation.”

FDA staff doesn’t take stance on Moderna Covid booster shots, says two doses are enough to protect against severe disease: “FDA scientists on Tuesday declined to take a stance on whether to back booster shots of Moderna’s Covid-19 vaccine.
They said data shows two doses are still enough to protect against severe disease and death in the U.S.”

A judge says New York must allow religious exemptions, for now, to its health care worker vaccine mandate.: “A federal judge ruled on Tuesday that New York State health officials must allow employers to grant religious exemptions to a Covid-19 vaccine mandate for health care workers while a lawsuit challenging the mandate makes its way through the courts.
The judge’s order at least temporarily thwarts part of Gov. Kathy M. Hochul’s effort to require vaccination for all health care workers.”

Philip Morris-backed group to launch world’s first plant-based Covid vaccine: “A unit of a Japanese company backed by Philip Morris International is planning to launch the world’s first plant-based Covid-19 vaccine that is potentially cheaper and easier to transport and store than conventional jabs. Toshifumi Tada, head of vaccine business development at Mitsubishi Tanabe Pharma, said its subsidiary Medicago would apply for Canadian approval for its vaccine candidate that is made from a plant from the tobacco family by the end of this year.”

Nanotechnology offers alternative ways to fight COVID-19 pandemic with antivirals: “Compared with traditional small molecules or antibodies that inhibit viral replication or cellular entry, nanotechnology offers drug developers virus binders, cell-membrane decoys or viral-envelope inhibitors that may complement conventional antiviral therapies.”
This article is a fascinating look into the subject of the headline.

Healthcare has lost half a million workers since 2020: “During the COVID-19 pandemic, the U.S. has seen healthcare workers leave their jobs, and the latest jobs report from the Bureau of Labor Statistics showed another decline…
Overall, employment in healthcare is down by 524,000 since February 2020, with nursing and residential care facilities representing about four-fifths of the losses, the bureau said. 
Reasons for the decline include workers quitting.
Since mid-February 2020, nearly 1 in 5 healthcare workers, or 18 percent, have quit their jobs, according to poll results from Morning Consult, a global privately held data intelligence company.”

About the public’s health

U.S. FDA gives marketing nod to an e-cigarette for the first time: “The U.S. Food and Drug Administration (FDA) on Tuesday allowed British American Tobacco Plc to market its Vuse Solo e-cigarettes and tobacco-flavored pods, making it the first-ever vapor product to get clearance from the health regulator.
The FDA said the approval came after analysis of data from the manufacturer that showed that using Vuse's tobacco-flavored products could help users reduce exposure to harmful chemicals emitted by combustible cigarettes.”

Phthalates and attributable mortality: A population-based longitudinal cohort study and cost analysis: “Phthalate exposures were associated with all-cause and cardiovascular mortality.
Further studies are needed to corroborate observations and identify mechanisms.
Extrapolating to 55–64 year olds, we identified >90,000 attributable deaths/year.
The results suggest $39.9–47.1 billion in lost economic productivity/year.”
According to the CDC: “Phthalates are a group of chemicals used to make plastics more durable. They are often called plasticizers. Some phthalates are used to help dissolve other materials. Phthalates are in hundreds of products, such as vinyl flooring, lubricating oils, and personal-care products (soaps, shampoos, hair sprays).”

Today's News and Commentary

About health insurance

Anesthesiologists ask for investigation on alleged UnitedHealth anti-competitive actions: “The American Society of Anesthesiologists called on the Justice Department Oct. 7 to have its Antitrust Division investigate alleged anti-competitive behavior from UnitedHealth Group. 
The letter alleges UnitedHealth Group's termination of contracts with anesthesiologists is forcing them to work out-of-network, thereby incentivising patients to use the company's own anesthesiologists, according to an Oct. 7 news release.
The group also claims that UnitedHealth Group's vertical integration allows it to steer UnitedHealthcare members toward the anesthesiologists under Optum, which it also own…
’Unfortunately, a small number of groups, many of which are private equity-backed, are working to protect their ability to continue charging egregiously high rates,’ a UnitedHealthcare spokesperson told Becker's. ‘The real reason many of them no longer participate in our network is because they expect to be paid double or even triple the median rate we pay other physicians providing the same services…’”

US to join suit against Tennessee health system alleging $800M in fraud: “The lawsuit claims physicians at West Clinic were given kickbacks for referrals of cancer patients for hospital admissions, chemical infusions, radiation and certain outpatient procedures.
The lawsuit claims the scheme took place from 2012 to 2018 and that Methodist Le Bonheur paid more than $400 million in kickbacks to West Clinic. Additionally, the lawsuit claims the scheme resulted in $800 million in fraudulent claims being submitted to Medicare.”

Introducing the new Ochsner Health Plan -- offering Medicare Advantage!: “This October, Louisiana residents eligible for Medicare will have the opportunity to enroll in Medicare Advantage benefit plans offered by the all-new Ochsner Health Plan…
Ochsner Health Plan will work collaboratively with Ochsner Health’s participating providers…”

PopHealthCare launches new national medical group, Emcara Health: “Emcara Health, is backed by support from GuideWell, which is also the parent company of Blue Cross and Blue Shield of Florida, or Florida Blue. The company is aiming to become a market leader in home care through its slate of services, including a 24/7 Home-Based Advanced Primary Care offering, aimed at seniors and adults.”

About hospitals and health systems

Dana-Farber reverses trustee investment policy: “Two longtime Dana-Farber Cancer Institute trustees have resigned, and the Boston-based institute will no longer permit board member investment in hospital startups after a recent Boston Globe investigation revealed that some trustees had opportunities for personal enrichment through investing in hospital-grounded startups…
The newspaper's investigation revealed that at least nine trustees have leadership positions in venture capital and investment firms that hold shares in startups grounded in Dana-Farber research. One trustee, entrepreneur and venture capitalist, Marc Cohen, launched five startups grounded in Dana-Farber research between 2008 and 2021. For one of these startups, C4 Therapeutics, Mr. Cohen's shares had increased by approximately $85 million as of September…
Dana-Farber is the only hospital the Globe contacted that explicitly supported trustees who invest in its startups.”

About healthcare IT

Best Buy to acquire Current Health to help make home the center of health: “Best Buy has signed an agreement to acquire Current Health, a leading care-at-home technology platform that brings together remote patient monitoring, telehealth, and patient engagement into a single solution for healthcare organizations. 

About pharma

The Public Weighs In On Medicare Drug Negotiations: “…the latest KFF Tracking Poll finds large majorities support allowing the federal government to negotiate and this support holds steady even after the public is provided the arguments being presented by parties on both sides of the legislative debate (83% total, 95% of Democrats, 82% of independents, and 71% of Republicans)…
While 85% of adults ages 65 and older report having some type of insurance that helps pay for prescription drugs, one in five older adults still report difficulty affording their prescription drugs, including 17% of older adults with some type of prescription drug coverage. The share who report difficulty affording prescription drugs increases to more than one in four among adults 65 and older who take four or more prescription drugs.”

Today's News and Commentary

About health insurance

CMS: Medicare Advantage plans with 4 or more stars skyrocket in 2022 compared to 2021: “Nearly 70% of Medicare Advantage (MA) plans that offer prescription drug coverage will have a star rating of four or more stars in 2022, a massive increase from 49% of plans in 2021, new federal data show.”

Cigna to sell its life, accident and supplemental benefits business in 7 countries to Chubb for $5.75B: “Cigna will divest its life, accident and supplemental benefits business in seven countries to insurance company Chubb in a deal valued at $5.75 billion, the insurer announced late Thursday.
Those business lines operate in Hong Kong, Indonesia, Korea, New Zealand, Taiwan and Thailand, as well as a joint venture in Turkey. The two companies expect the deal to close in 2022, pending regulatory approvals and closing conditions…
The insurer said it plans to put the proceeds largely toward share repurchases.”

About Covid-19

Merck seeks FDA approval for antiviral COVID pill: “The emergency use authorization application comes after the company this month released the results of a clinical trial, in which the drug was shown to reduce the risk of hospitalization or death from COVID-19 by around 50%.
In June, the Biden administration agreed to buy about $1.2 billion worth of molnupiravir. The company said it expects to produce 10 million total doses of the drug by the end of 2021.”

Updated COVID-19 Treatment Guidelines Panel’s Statement on the Prioritization of Anti-SARS-CoV-2 Monoclonal Antibodies for the Treatment or Prevention of SARS-CoV-2 Infection When There Are Logistical or Supply Constraints: “The purpose of this statement is to provide guidance on which individuals might receive the greatest benefit from anti-SARS-CoV-2 mAb therapy when logistical or supply constraints make it impossible to offer the therapy to all eligible patients, and triage becomes necessary. Only when it becomes necessary to triage the use of the anti-SARS-CoV-2 mAbs, the Panel suggests:

  • Prioritizing the treatment of COVID-19 over PEP of SARS-CoV-2 infection; and

  • Prioritizing anti-SARS-CoV-2 mAb therapy for unvaccinated or incompletely vaccinated individuals and vaccinated individuals who are not expected to mount an adequate immune response (e.g., individuals who are immunocompromised or on immunosuppressive medications or individuals aged ≥65 years).”

About the public’s health

Landlord Behavior After Receiving Pediatrician-Generated Letters to Address Poor Housing Conditions:“Between April and October 2019, 233 of 2480 (9%) families who were screened for social determinants of health needs had poor housing conditions. Of these families, 127 (55%) requested and received a physician-generated letter advocating for housing repairs…
Of the 35 families (36%) who reported giving the letter to their landlords, 31 (89%) reported that the landlord acted to resolve the issue, and 26 (74%) reported complete resolution of the concern…[Emphasis added]
For the 149 families who had a subsequent follow-up visit, there was no significant difference in those without poor housing conditions between families who did vs did not receive letters (44 of 61 [72%] vs 63 of 88 [72%]).”

Appeals court reinstates Texas’s six-week abortion ban, two days after it was lifted: “The U.S. Court of Appeals for the 5th Circuit granted a request filed Friday afternoon by the Texas attorney general to temporarily suspend a judge’s order blocking the law, which has halted most abortions in the state…
A three-judge panel of the conservative-leaning court gave the Justice Department until 5 p.m. Tuesday to respond to the appeal.”

Former CDC director: Low sodium salt could save millions of lives: Nothing new, just a strong reminder of this easily-treatable problem.
”Eating too much salt can kill you. Excessive salt intake will cause an estimated 1.6 million deaths worldwide this year. Four out of five of these deaths will occur in low- and middle-income countries, and nearly half will be among people younger than 70.
These deaths from excessive salt intake are preventable. In most countries, daily salt intake is far above the 5-gram daily upper limit recommended by the World Health Organization; the global average, 10.1 grams of salt, is double this amount.”

About healthcare IT

ONC announces new interoperability program for federal partners: “The Office of the National Coordinator for Health Information Technology (ONC) has rolled out a new initiative that seeks to standardize the healthcare data sets federal agencies with specific needs that aren’t being addressed by the current baseline.
Called USCDI+, the initiative builds on the U.S. Core Data for Interoperability (USCDI), the first version of which was adopted as part of the ONC’s 21st Century Cures Act Final Rule.
This new process will support federal partners ‘who have a need to establish, harmonize and advance the use of interoperable datasets that extend beyond the core data in the USCDI in order to meet agency-specific programmatic requirements,’ ONC wrote in an announcement blog post.”

Teladoc takes its primary care service nationwide with Aetna slated to roll out in early 2022: “The telehealth giant piloted its virtual primary care program, called Primary360, in 2019 with the aim of early detection of chronic disease. The service now offers 70 distinct diagnoses such as hypertension and diabetes, Teladoc CEO Jason Gorevic said during a J.P. Morgan virtual presentation in January.
Teladoc says it has signed several Fortune 1000 employers onto the new primary care service, with other large employers and health plans such as Aetna launching nationwide in early 2022.
The company is pitching Primary360 as a way to expand access to primary care in the U.S.”

Today's News and Commentary

About Covid-19

New data show Medicare Advantage beneficiaries had lower hospitalization, mortality rates for COVID-19: “New data show that beneficiaries on Medicare Advantage (MA) have a 19% lower rate of hospitalizations for COVID-19 during the first nine months of the pandemic compared to traditional Medicare participants.
The data—released Thursday by MA advocacy group Better Medicare Alliance—also show that fewer MA beneficiaries died of COVID-19 compared with those on traditional Medicare.”

U.N. chief appeals for $8 bln to equitably vaccinate 40% of world in 2021: “UN Secretary-General Antonio Guterres appealed on Thursday for $8 billion to help vaccinate 40% of people in all countries against COVID-19 by the end of the year…”

AMA announces CPT update for pediatric COVID-19 vaccine candidate: “The provisional CPT codes will be effective for use on the condition that Pfizer’s two-dose regimen for the prevention of COVID-19 in children ages 5 to 11 receives approval or emergency use authorization from the U.S. Food and Drug Administration (FDA).”

40% of US hospitals have vaccination requirements, White House reports: “In about six months, about 2,500 hospitals, or 40 percent of them in the U.S. and Puerto Rico, have said they are requiring COVID-19 vaccinations for their employees.”
This number is incredibly low!

About health insurance

CMS Releases 2022 Medicare Advantage and Part D Star Ratings to Help Medicare Beneficiaries Compare Plans: “Today, the Centers for Medicare & Medicaid Services (CMS) released the 2022 Star Ratings for Medicare Advantage (Medicare Part C) and Medicare Part D prescription drug plans to help people with Medicare compare plans ahead of Medicare Open Enrollment, which kicks off on October 15.”

2019 HEALTH CARE COST AND UTILIZATION REPORT: From the Health Care cost Institute.
Highlights:
—”In 2019, per person spending reached $6,001. This represented a 2.9% increase from 2018 and was the lowest growth rate over the five-year period. The total includes amount paid for medical and pharmacy claims but does not reflect manufacturer rebates for prescription drugs.
—Average per person out-of-pocket spending totaled $829 in 2019.
—Average prices grew 3.6% in 2019. While that is the lowest rate of growth over the five-year period, consistent annual increases means that prices in 2019 were 18.3% higher than prices in 2015.
—Utilization declined 0.7% between 2018 and 2019, reversing the trend of utilization growth during the five-year period. This shift was largely attributable to a 4.9% decline in inpatient admissions in 2019.
—Prices accounted for the largest part (nearly two-thirds) of per-person spending growth between 2015 and 2019.”

About pharma

Sanofi, GSK, Pfizer and Boehringer must face Zantac class-action lawsuits, court rules: “This week, branded drugmakers GlaxoSmithKline, Sanofi, Pfizer and Boehringer Ingelheim lost an attempt to escape class-action lawsuits over their marketing of the decades-old drug.
In a federal court in Florida, Judge Robin Rosenberg denied requests by the companies to throw out lawsuits by former Zantac patients asking for medical monitoring and compensation for their financial losses. Lawsuits alleging personal injury from the drug can continue as well.”

Today's News and Commentary

About Covid-19

Pfizer, BioNTech ask FDA to authorize coronavirus vaccine for children 5 to 11: ”U.S. pharmaceutical firm Pfizer and its German partner, BioNTech, have asked the Food and Drug Administration to authorize their coronavirus vaccine for emergency use for children 5 to 11 years old, the companies announced Thursday.
An estimated 28 million children in the United States would be eligible for the shots if regulators give the green light — a process expected to take several weeks. The coronavirus vaccine would be the first available in this country for children younger than 12 years old.”

Covid-19 booster shots have outpaced the US rate of new vaccinations. And the millions still unvaccinated could trigger 'future waves,' expert warns: “An average of 384,963 booster vaccine doses are being given daily, while roughly 281,303 people are getting their first dose every day and about 292,927 people are becoming fully vaccinated each day, according to Wednesday's CDC data.”

3 Ways to Make Sure That Your N95 Isn't Counterfeit: Among the recommendations: “Check the labeling on your N95 respirator.
The following is printed on every NIOSH-approved respirator: the word ‘NIOSH’ in visible in block letters along with the Testing and Certification (TC) approval number and a model number. This information must be on the respirator itself and not just on the packaging.”

Clotting linked to AstraZeneca vaccine could relate to specific blood group, suggests study: “Researchers in the UK say they have identified the first genetic link which could make people vaccinated with AstraZeneca's COVID-19 vaccine Vaxzevria more predisposed to cerebral venous thrombosis (CVT), reported The Telegraph…
When adjusting for other factors, people with an AB blood type had a 5.6 times increased risk of CVT, the researchers said.
Blood groups A and B both had almost a three times increased risk of CVT compared to blood group O, according to the news source.”

About the public’s health

Federal judge blocks enforcement of Texas abortion ban; state will appeal: “U.S. District Judge Robert L. Pitman granted the Biden administration’s request to temporarily halt the law, clearing a path to restore access to abortion in the nation’s second-most populous state.”
But the Texas attorney general’s office quickly notified the court of its intent to appeal.CDC director warns the U.S. is at risk of a severe flu season this year: The “U.S. population may now have reduced immunity against influenza after seasonal flu cases reached an all-time low last year when large parts of the nation were shut down, Walensky told reporters during a White House press briefing.”

Characterizing the Chemical Landscape in Commercial E-Cigarette Liquids and Aerosols by Liquid Chromatography–High-Resolution Mass Spectrometry: Vaping is more dangerous than we thought. “Previous studies have focused on measuring known toxicants, particularly those present in traditional cigarettes, while fewer have investigated unknown compounds and transformation products formed during the vaping process…
Six potentially hazardous additives and contaminants, including the industrial chemical tributylphosphine oxide and the stimulant caffeine, were identified and quantified in the e-cig liquids and aerosols analyzed.”

A Hyde fight threatens Democrats' Medicaid ambitions: The Hyde Amendment bars using federal funds for abortions in most circumstances. Today’s The Health 202 in the Washington Post provides a great explanation of what is happening with that provision in current law making.

About healthcare IT

Medtronic releases urgent recall for insulin pump vulnerable to hackers: “Medtronic said hackers could potentially deliver or block doses of insulin, which poses a danger for the wearer, according to an October news release.”

CHIME names 2021 'Most Wired' hospitals: “The College of Healthcare Information Management Executives has recognized 107 hospitals as achieving Level 9 status in its 2021 Healthcare's Most Wired program.”

VR can help underserved patients, but reimbursement challenges stymie broader adoption, study finds: “Studies have shown that VR can be an effective treatment for opioid-sparing pain management, but the majority of these studies were conducted among primarily White, relatively advantaged populations and in well-resourced settings, according to a research team from AppliedVR and S.O.L.V.E. Health Tech, a health equity incubation partner embedded within the University of California, San Francisco (UCSF)…
However, significant barriers exist to expand access to less-served and more diverse patient populations, according to the team's research published in the Journal of Medical Internet Research.
Healthcare providers, including users and non-users of VR, identified a lack of reimbursement for the technology as one of the biggest barriers for adoption…”

About hospitals and health systems

HCA shrinks Georgia footprint, sells 5 hospitals for $1.6B: “Though HCA's footprint in Georgia is smaller after selling the five facilities for a combined $1.58 billion, the company still operates five hospitals in the state. The system added a hospital in the southeast part of the state in May when it acquired Meadows Regional Hospital in Vidalia.”

Top 10 most trusted health system brands: “Johns Hopkins Medicine had the most trusted health system brand in the U.S., according to research released by branding agency Monigle.
In partnership with the American Hospital Association and Society for Health Care Strategy and Market Development, Monigle surveyed 30,138 respondents who were the healthcare decision-makers for their household.”
The whole report is interesting and worth downloading.

M&A Quarterly Activity Report: Q3 2021: “A total of 7 transactions involving 20 hospitals were announced in Q3. Total transacted revenue for the quarter was $5.2 billion; combined with Q1 and Q2, total transacted revenue for 2021 is now at $22.4 billion. Average seller size by revenue year-to-date was $659 million, more than double the average of $329 million over the past six years (2015–2020). Of note, the total revenue transacted year-to-date is nearly on par with that of years past, despite only half (or even less) of the total transaction volume. We believe that the trend of high average seller size will continue into Q4 as larger health systems look to partner to overcome adverse effects from the COVID-19 pandemic and seek strategic combinations that broaden their reach.”
In a related article: Chamber of Commerce, AHA press Congress to stay away from merger framework: “The U.S. Chamber of Commerce and the American Hospital Association (AHA) led a major effort to convince Congress to not change how the federal government scrutinizes mergers.
The letter (PDF), also signed by biotech and technology groups, urges Congress to provide more resources to federal agencies for antitrust enforcement rather than make any changes to the legal and regulatory framework for evaluating deals. The letter, dated Tuesday, comes as the Federal Trade Commission (FTC) has ramped up its scrutiny of hospital mergers over concerns they increase prices and decrease quality.”

Upcoding continues to drive cost recovery, according to industry executives: “According to the Market Surveillance and Transparency Committee of the Massachusetts Health Policy Commission, hospitals coded for about 2 out of 5 patients with the highest severity levels – the third and fourth severity levels – in 2020, up from about one in four patients in 2013….there was no corresponding increase in chronic disease prevalence, age or life expectancy to explain this increase, data from the Center for Health Information and Analysis show.
‘We ran a series of analyzes to see if there were any population-wide factors that could explain the rise in risk scores, but in fact they are not,’ – David Auerbach, senior director of research and spending at Massachusetts Health. The Policy Commission said Wednesday at its market surveillance meeting, noting that an aging population explains only about 0.5% of the 11.7% increase in risk assessment from 2013 to 2018. There have been no changes in life expectancy or the overall burden of chronic disease, it added.”

About health insurance

'Surprise Bill' Arbitrators Should Not Send Surprise Bills: Regulators: “Certified independent dispute resolution entities are supposed to arbitrate disputes between health insurers and health care providers over out-of-network emergency care bills and certain other out-of-network bills.
Some states already have comparable versions of the No Surprises Act arbitration system in place.
Federal officials believe typical arbitrators participating in the state No Surprises systems are charging $300 to $600 per arbitration.”
Specifically, the document says: “The certified IDR [Independent Dispute Resolution] entity may not charge a fee that is beyond the upper or lower limits for fees set forth in annual guidance published by the Departments as approved fixed fees, unless the IDR entity or certified IDR entity requests and can provide justification for the higher or lower fee, and the Departments provide written approval for the certified IDR entity to charge a fee beyond the upper or lower limits for fees set forth in guidance.”
The final amounts set may drive the amounts over which payers or providers choose to formally mediate.

Insurers, employers say New York prior authorization suspension will up healthcare costs: In a followup to a previously-reported post:
”New York insurers and employers are bracing for the impacts of Gov. Kathy Hochul's sweeping measures to address hospital staffing shortages by waiving prior authorizations, among other requirements. 
Lev Ginsburg, senior director of government affairs for The Business Council of New York State, told the Niagara Gazette that he anticipates the lack of a ‘check and balance’ provided by prior authorizations will drive up state healthcare costs.”

About pharma

FDA Revises Hospital and Health System Compounding Guidance to Help Preserve Patient Access to Compounded Drugs: “Compounded drugs can serve an important role for patients whose medical needs cannot be met by an FDA-approved drug. The FDA is continuing our efforts to help preserve access to compounded drugs for patients who have a medical need for them…
We are proposing a two-part compliance policy. The policy describes circumstances under which the agency generally does not intend to take action against a hospital or health system pharmacy, that is not an outsourcing facility, that compounds and distributes a drug without first receiving a valid prescription or order for an individual patient. These circumstances include that compounded drugs be administered only to patients within the hospital or health system and the drugs are used or discarded within 24 hours of leaving the pharmacy.”

Today's News and Commentary

About pharma

Nobel Prize in chemistry awarded to duo who made a tool to build molecules in an environmentally friendly way: “The Nobel Prize in chemistry was awarded Wednesday to two scientists who built a tool for constructing molecules in a cheap, environmentally friendly way, allowing researchers to more easily make products including pharmaceuticals.
David W.C. MacMillan of Princeton University and Benjamin List of the Max Planck Institute in Germany were awarded the Nobel for their development of a precise new tool for molecular construction known as organocatalysis…
The tool can be used to construct new drugs and chemicals, as well as molecules that can capture light in solar cells. The breadth of commercial and everyday products it can help create is enormous, ranging from clean energy to cosmetics.”

About health insurance

Maine launching state-run health insurance marketplace for 2022 enrollment: “Starting Nov. 1, people signing up for ACA insurance in Maine will go through the coverme.gov website rather than the federal government’s healthcare.gov website, where Maine people have bought Obamacare insurance since 2014. A total of 15 states, including all of New England except New Hampshire, have been using state-based marketplaces rather than the federal version.
The federal government also approved new state marketplaces for Kentucky and New Mexico on Monday. The open enrollment period goes from Nov.1 to Jan. 15, 2022, but consumers need to enroll by Dec. 15 to have coverage begin on Jan. 1. Enrollees who want to keep their current plans will be automatically re-enrolled.”

Willis Towers Watson: Employers expect health costs to rise by 5% in 2022: “Employers expect their health costs to rise by more than 5% in 2022 as concerns about the COVID-19 pandemic linger, according to a new survey from Willis Towers Watson.
Medical and pharmacy benefit costs are expected to increase by 5.2% next year, the report found, a slight decline from the 5.5% increase projected in 2021 but significantly higher than the 2.1% increase felt in 2020 as many people deferred healthcare services during the pandemic.
Including premiums, total costs per employee are expected to increase from $12,501 in 2020 to $13,360. Employer premium contributions are also set to go up, rising from $3,269 to $3,331.”

CMMI director hints at shift away from payment models for every episode of care, specialties: “The Biden administration wants to move away from creating value-based care payment models for every type of disease, episode of care or specialty groups to streamline its projects, a top official said.
Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler said during a briefing Tuesday hosted by the Alliance for Health Policy that more mandatory models are needed, including those that focus on the total cost of care.”

New York suspends prior authorizations, eases reporting requirements: “Tucked in an executive order to address staffing challenges in the state, New York Gov. Kathy Hochul has suspended prior authorization requirements for 30 days.
The order, signed Sept. 27, suspends requirements for prior authorization review for scheduled surgeries in hospital facilities, hospital admissions, hospital outpatient services, home healthcare services following a hospital admission and inpatient rehabilitation services following a hospitalization. 
Additionally, concurrent and retrospective review of claims are suspended for the duration of the order.”

CMS overpaid providers $636M for neurostimulator surgeries: OIG: “CMS should recoup $636 million in overpayments to hospitals and other providers from the improper billing of neurostimulator implantation surgeries, according to HHS' Office of the Inspector General.
An audit from the OIG found that more than 40 percent of healthcare providers didn't comply with Medicare requirements when billing for neurostimulator implantation surgeries.
The OIG audit covered $1.4 billion in Medicare payments to providers for 58,213 beneficiaries who had a neurostimulator implant surgery from 2016-17. The OIG randomly selected a sample of claims from 106 beneficiaries submitted by 102 providers. “

Medical Service Use and Charges for Cancer Care in 2018 for Privately Insured Patients Younger Than 65 Years in the US: “This cohort study found that the total estimated cost of cancer care for privately insured adults in the US was $156.2 billion. Patients with breast, colorectal, and prostate cancers had the greatest number of services performed, particularly for pathology and laboratory tests, and patients with breast, lung, and colorectal cancer incurred the highest costs, particularly for medical supplies and nonphysician services.”

About Covid-19

White House to announce $1 billion purchase of rapid, at-home coronavirus tests: “The administration said the plan to buy $1 billion worth of rapid, at-home coronavirus tests and other actions should address ongoing shortages and quadruple the number of tests available to Americans by December, according to a White House official and senior administration official with knowledge of the pending announcement.”

Vaccination-related employee departures at 24 hospitals, health systems: “Amid health system and state COVID-19 vaccination requirements, workers have been fired for noncompliance, and some have resigned or quit. 
Here are stats from 24 organizations, announced since June.”
In a related article: Demand for labor drives costs up, straining hospital profitability, report finds: “The surge of COVID-19 cases driven by the delta variant is creating a shortage of healthcare workers, leading to hospitals increasing wages and suspending elective surgeries. In turn, hospital profits are taking a hit, an Oct. 5 Moody's Investors Service report found.
The report also said it expects margins to decline because of wage inflation, expensive nursing agencies, increased attempts at recruitment and retention, and expanded benefit packages.
According to Moody’s not-for-profit medians for 2020, growth in salaries has surpassed hospitals' expense growth, a trend expected to continue for the rest of 2021 and into 2022.”

It's time to upgrade from cloth masks, experts say: “Misinformation surrounding masking has turned the topic into a binary for Americans: either you're masked or not — but experts say the public needs to start paying attention to the quality of their masks.  
In an Oct. 4 piece for The Atlantic, science editor Yasmin Tayag cited a study from Bangladesh linking surgical masks to an 11.2 percent decrease in COVID-19 symptoms and antibodies compared to a 5 percent decrease with cloth masks…
Linsey Marr, an environmental engineer and aerosol science expert, told Scientific American in a Sept. 30 piece that disposable masks may actually be worn until they become ‘visibly damaged or soiled.’ 
The Scientific American piece went on to say, contrary to the start of the pandemic, there is now a ‘cornucopia’ of high-filtration respirator-style masks. The most important considerations for mask effectiveness are filtration, fit and comfort.”

About the public’s health

WHO endorses use of first-ever malaria vaccine: “The World Health Organization on Wednesday endorsed the world’s first malaria vaccine for use in children. It said the vaccine could help save tens of thousands of lives each year.
The life-threatening parasitic disease kills more than 400,000 people a year, and the WHO says more than 260,000 of them are African children under age 5. Most cases and deaths caused by the disease, which is transmitted through bites of infected mosquitoes, occur in sub-Saharan Africa…
The vaccine, manufactured by the British-based pharmaceutical company GlaxoSmithKline, is only moderately effective. Findings from the pilot program showed the immunization reduced cases of severe malaria by about 30 percent, said Ashley Birkett, the head of malaria vaccine development at PATH, an international global health organization that helped fund the immunization.”

J&J’s RSV Shot Cut Disease Risk by 80 Percent in Older People: “Johnson and Johnson’s investigational vaccine against respiratory syncytial virus (RSV) reduced the risk of RSV-associated lower respiratory tract disease by 80 percent in older adults in a phase 2b trial.
J&J subsidiary Janssen released data showing that the CYPRESS study met both its primary vaccine efficacy endpoint and a secondary goal, reducing by 70 percent the risk of any symptomatic RSV-associated acute respiratory infection in adults aged 62 and older.”

Health of Women and Children Report 2021: From the UnitedHealth Foundation. Lots of good information about these two groups. One major area for improvement is the 16% increase in maternal mortality rate.



Today's News and Commentary

About Covid-19

J&J seeks US clearance for COVID-19 vaccine booster doses: “Johnson & Johnson asked the Food and Drug Administration on Tuesday to allow extra shots of its COVID-19 vaccine as the U.S. government moves toward expanding its booster campaign to millions more vaccinated Americans.
J&J said it filed a request with the FDA to authorize boosters for people 18 and older who previously received the company’s one-shot vaccine. While the company said it submitted data on several different booster intervals, ranging from two to six months, it did not formally recommend one to regulators.”

CMS: Employer plans can't deny benefits to unvaccinated customers but can offer premium discounts: “Employer group health plans cannot deny benefits to customers who have not gotten the COVID-19 vaccine but can offer premium discounts to customers who decide to get the shot, new guidance from the Centers for Medicare & Medicaid Services (CMS) said.
But plans that increase premiums on the unvaccinated will have that increase count toward whether that coverage is affordable under the Affordable Care Act (ACA).”

EMA panel backs broad use of Comirnaty as COVID-19 vaccine booster dose in adults: “The European Medicines Agency announced Monday that a booster dose of Pfizer and BioNTech's mRNA-based COVID-19 vaccine Comirnaty may be considered at least six months after the second dose for people aged 18 years and older. The regulator noted that the Committee for Medicinal Products for Human Use (CHMP) is currently evaluating data on a booster dose of Moderna's mRNA-based vaccine Spikevax.
According to the EMA, the committee looked at data showing a rise in antibody levels when a booster dose of Comirnaty is given approximately six months after the second shot in people from 18 to 55 years old. The agency added that the risk of inflammatory heart conditions or other very rare side effects after a booster is not known and is being monitored.”

AstraZeneca seeks FDA emergency nod for antibody to prevent COVID-19: “AstraZeneca announced Tuesday that it submitted an emergency-use authorisation (EUA) request to the FDA for AZD7442, its long-acting antibody combination, for prophylaxis of symptomatic COVID-19. The company, which noted that this is the first regulatory filing for AZD7442, is currently in talks with the US government regarding a supply agreement.”

FOR UNVACCINATED, REINFECTION BY SARS-COV-2 IS LIKELY: “Strong protection following natural infection is short-lived. 
’Reinfection can reasonably happen in three months or less,’ said Jeffrey Townsend, the Elihu Professor of Biostatistics at the Yale School of Public Health and a lead author of the study. ‘Therefore, those who have been naturally infected should get vaccinated. Previous infection alone can offer very little long-term protection against subsequent infections.’”

A year after COVID vaccine waiver proposal, WTO talks are deadlocked: “Trade sources on Monday say negotiations are deadlocked and directionless a year after South Africa and India introduced a proposal to temporarily waive intellectual property rights on COVID-19 vaccines and therapies at the World Trade Organization, as reported by the Financial Post.
Over 100 nations backing the waiver believe it will help save lives by allowing developing countries to produce COVID-19 vaccines. Yet, a handful of countries remain opposed. In May, Washington threw its weight behind the proposal, raising expectations of a breakthrough that has so far failed to materialize.”

Johnson & Johnson asks FDA to authorize booster shot: “Pharmaceutical company Johnson & Johnson on Tuesday asked the Food and Drug Administration to grant emergency use authorization for a booster dose of its one-shot coronavirus vaccine, becoming the third company to ask the Biden administration to approve additional doses.
The FDA’s expert advisory committee is scheduled to meet Oct. 14 and 15 to discuss whether to authorize both J&J’s and Moderna’s booster shots. The agency already has authorized a booster for people who received Pfizer-BioNTech’s two-shot regimen.”

More memory B cells exist in those fully vaccinated with previous SARS-CoV-2 infection, study says: “A new study by University of Minnesota Medical School researchers is revealing that some people who received an mRNA vaccination for COVID-19 have greater immune responses compared to others. While the vaccine induces strong immune responses against the virus in almost everyone, data shows those who were previously infected with the virus have even greater immune responses after vaccination compared to fully vaccinated people who never had COVID-19.”

Acute Myocarditis Following COVID-19 mRNA Vaccination in Adults Aged 18 Years or Older: “In this population-based cohort study of 2 392 924 individuals who received at least 1 dose of COVID-19 mRNA vaccines, acute myocarditis was rare, at an incidence of 5.8 cases per 1 million individuals after the second dose (1 case per 172 414 fully vaccinated individuals). The signal of increased myocarditis in young men warrants further investigation.”

New study finds that a second dose provides optimal protection to individuals infected between doses: “Previously infected individuals who received one dose of the vaccine had much higher IgG antibody levels than fully vaccinated workers who were never infected. However, infection after the first dose (and before the second) did not increase IgG levels, and individuals infected after the first dose who never received the second had similar antibody levels to those who received one dose and were never infected.  Individuals in the cohort infected post-vaccination had IgG antibody levels at 21 and 50 days similar to those never infected who received the same number of doses and much lower than those infected pre-vaccination.”

NICE updates managing COVID guideline with new monoclonal antibody recommendations: “The new advice recommends offering a combination of casirivimab and imdevimab (known as Ronapreve, REGEN-COV, or REGEN-COV2, made by Regeneron Pharmaceuticals) to COVID-19 patients aged 12 and over who are in hospital. Eligible patients will need to be seronegative, meaning they do not have existing levels of SARS-CoV-2 antibodies in their system.
If patients do already have SARS-CoV-2 antibodies (seropositive) or their antibody status cannot be determined, then they should not be offered monoclonal antibody therapy, as they will receive no benefit from the treatment. In comparison, evidence shows that patients who are seronegative see a significant reduction in mortality when compared to normal care.”

J&J’s COVID-19 Shot Might Be Linked to Deep Vein Blood Clotting: “he European Medicines Agency (EMA)’s safety committee said Johnson & Johnson’s (J&J) COVID-19 vaccine might be associated with cases of deep vein blood clotting — such as the leg, arm or groin — and recommended adding the rare side effect to the shot’s product information.
The EMA’s Pharmacovigilance Risk Assessment Committee noted the very rare side effect is separate from the blood clots and low blood platelets previously seen in some recipients of the J&J and AstraZeneca COVID-19 vaccines, which previously prompted the expert panel to call for adding a warning to the labeling information for those products.”

FDA won't extend shelf life of J&J Covid vaccine doses, may extend life of millions of Moderna shots: “The government will not extend the shelf life of hundreds of thousands of unused Johnson & Johnson Covid vaccine doses, but may soon extend the life of millions of Moderna vaccine doses, according to an internal email obtained by NBC News.”

FCC Announces Latest Awards From COVID-19 Telehealth Program: “More than 70 healthcare organizations will received federal funds for new connected health projects through the Federal Communications Commission’s COVID-19 Telehealth Program.
The FCC this week announced a second round of approved applications for the program, which was relaunched this year after a successful run in 2020. The latest round of 72 awards accounts for more than $41 million in funding, following nearly $42 million in awards announced in August for 62 healthcare organizations.
‘The FCC has now approved a total of over $83 million in funding applications for Round 2 of its COVID-19 Telehealth Program,’ Acting FCC Chairwoman Jessica Rosenworcel said in a press release.” 

About health insurance

UnitedHealthcare, Anthem behind on billions of payments to hospitals: “The country's two largest insurers — UnitedHealthcare and Anthem — are behind on billions of dollars of payments to hospitals due to new reimbursement rules, claims issues and retroactive claims denials…
For instance, Richmond-based Virginia Commonwealth University Health alleged Anthem owes the provider $385 million, according to the Oct. 5 article. Over 40 percent of payments are more than 90 days old, violating state law dictating that insurers must pay claims within 40 days. 
The American Hospital Association told reporters that complaints span across the country. Between June 30, 2019, and June 30, 2021, Anthem's unpaid claims rose from 43 percent to 53 percent, accounting for $2.5 billion.”

Provider Performance and Experiences under the Merit-based Incentive Payment System: From the GAO:
Eight [of 11] stakeholders questioned whether the program helps to meaningfully improve quality of care or patient health outcomes. For example, they said that the design of the program may incentivize reporting over quality improvement, with providers choosing to report on quality measures on which they are performing well, rather than on measures in areas where they may need improvement. [Emphasis added] According to CMS, the MIPS Value Pathways (MVP)—a new way of meeting reporting requirements in 2023—will help to address some of these challenges by standardizing performance measurement across specific specialties, medical conditions, or episodes of care. The development of clinically cohesive sets of measures and activities should minimize providers’ selection burden in choosing measures and activities to report for each MVP, officials said.”

Centene to grow geographic footprint in Medicare Advantage by 26% for 2022: “Centene Corporation will increase its Medicare Advantage (MA) footprint by 26% in 2022, the insurer announced Monday.
The company plans to expand into 327 additional counties and three new states: Massachusetts, Nebraska and Oklahoma. That will bring its reach to 48 million potential beneficiaries across 36 states and 1,575 counties.
At present, Centene boasts 1.1 million MA members in 33 states.”

About hospitals and health systems

Jefferson Health, Einstein Healthcare finalize merger, create 18-hospital system: “More than three years after signing a letter of intent to merge, Jefferson Health and Einstein Healthcare Network have finalized the deal. 
The combination of the Philadelphia-based organizations brings together two academic medical centers and creates an integrated 18-hospital system with more than 50 outpatient and urgent care locations.”

About pharma

Henrietta Lacks' family sues biotech company over cells, says it "chose to use her body for profit": “The estate of Henrietta Lacks sued a biotechnology company on Monday, accusing it of selling cells that doctors at Johns Hopkins Hospital took from the Black woman in 1951 without her knowledge or consent as part of ‘a racially unjust medical system.’
The estate's federal lawsuit says Thermo Fisher Scientific Inc., of Waltham, Massachusetts, knowingly mass produced and sold tissue that was taken from Lacks by doctors at the hospital.”

U.S. Supreme Court rejects challenge to New York tax on opioid companies: “The U.S. Supreme Court on Monday cleared the way for New York to collect a $200 million surcharge imposed on opioid manufacturers and distributors to defray the state’s costs arising from the deadly epidemic involving the powerful painkilling drugs.
The justices declined to hear an appeal by two trade groups representing drug distributors and generic drug makers and a unit of British-based pharmaceutical company Mallinckrodt of a lower court’s decision upholding the surcharge.
The law’s challengers included the Association for Accessible Medicines, whose members include drugmakers Teva Pharmaceutical Industries and Mallinckrodt, and the Healthcare Distribution Alliance, which represents wholesale distributors.
The alliance’s members include the three largest drug distributors, McKesson Corp, AmerisourceBergen Corp and Cardinal Health. They recently proposed paying $21 billion to resolve lawsuits accusing them of fueling the epidemic.”

After settling criminal price-fixing case, Novartis' Sandoz inks $185M civil deal with feds: “Nineteen months after settling the criminal portion of a federal price-fixing lawsuit, Novartis' generics unit Sandoz is paying up to resolve civil allegations.
After agreeing to pay $195 million last March to resolve criminal claims related to its part in a price-fixing scheme, the company has now inked a civil deal worth $185 million.
Specifically, the civil portion of the lawsuit relates to illegal payments the companies received for the sale of goods at rigged prices, the feds say.”

Association of Statin Therapy Initiation With Diabetes Progression: “Statin use was associated with diabetes progression in patients with diabetes—statin users had a higher likelihood of insulin treatment initiation, developing significant hyperglycemia, experiencing acute glycemic complications, and being prescribed an increased number of glucose-lowering medication classes.”

About the public’s health

Red Cross asks for routine blood donations amid national shortage: “The national blood inventory is at its lowest level for this time of the year since 2015, according to the Red Cross. 
For certain blood types — O positive and O negative — there has been less than a half day’s supply available at times in September. However, the Red Cross said that blood and platelets of all types are needed by hospitals.”

Francis Collins to step down as NIH director by year's end: “National Institutes of Health Director Francis Collins plans to step down by the end of the year after nearly three decades at the agency, including 12 years at the helm, the agency announced Tuesday.
The 71-year-old physician-geneticist led the agency under three consecutive presidents — making him the first presidentially appointed NIH director to serve in more than one administration and the longest-serving NIH director.”

HHS Issues Final Regulation Aimed at Ensuring Access to Equitable, Affordable, Client-Centered, Quality Family Planning Services: “Today, the U.S. Department of Health and Human Services (HHS) issued a final rule to strengthen the Title X family planning program, fulfilling the Biden-Harris Administration’s commitment to restore access to equitable, affordable, client-centered, quality family planning services. For more than half a century, Title X family planning clinics have played a critical role in ensuring access to a broad range of family planning and preventive health services including breast and cervical cancer screening and STI/HIV testing for than 190 million low-income or uninsured individuals. Title X is the only federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services.”

That's Not Just Gum on the Soles of Your Shoes...: A VERY good reason to take your shoes off when you come in the house:
”In a worldwide analysis of more than 11,500 collected isolates, similar C. diff positivity rates (26%) were found in healthcare (23% in outdoor settings; 17% in public buildings) and non-healthcare (24% and 17%, respectively) settings, reported Jinhee Jo, PharmD, of the University of Houston in Texas, and colleagues.
Shoe soles had the greatest C. diff positivity rate at 45%, Jo said in a presentation at the virtual IDWeek. The most common strains were FP310 (11%) found only in non-healthcare settings, F106 (15%) in both settings, and F014-020 (16%) in both settings.”

About healthcare IT

Leading Health Systems Launch Graphite Health, a New Member-Led Non-Profit Company to Accelerate Digital Transformation of Health Care: “Graphite Health, a member-led company intent on transforming digital health care to improve patient outcomes and lower costs, launched today and announced its first three organizing members, SSM Health, Presbyterian Healthcare Services, and Intermountain Healthcare. Modeled on Civica Rx, a health utility company, Graphite Health will focus on health care interoperability challenges.
Building on a common data language, Graphite Health is creating a standardized, interoperable data platform that enables a secure and open marketplace to streamline the distribution of digital health solutions for both health systems and entrepreneurs. For entrepreneurs, the common data language addresses inefficiencies in data translation and supports the development of plug-and-play digital applications. In turn, health system members can implement trusted digital tools as easily as anyone can download an app from an app store to a smartphone. These improvements will lead to more convenience, better quality care, lower costs, and overall efficiency.”

Today's News and Commentary

Nobel Prize in medicine awarded to two U.S.-based scientists ‘for their discoveries of receptors for temperature and touch’

About Covid-19

COVID-19 deaths eclipse 700,000 in US as delta variant rages: “The U.S. death toll from COVID-19 eclipsed 700,000 late Friday — a number greater than the population of Boston. The last 100,000 deaths occurred during a time when vaccines — which overwhelmingly prevent deaths, hospitalizations and serious illness — were available to any American over the age of 12.”

Infectious SARS-CoV-2 in Exhaled Aerosols and Efficacy of Masks During Early Mild Infection: “SARS-CoV-2 is evolving toward more efficient aerosol generation and loose-fitting masks provide significant but only modest source control. Therefore, until vaccination rates are very high, continued layered controls and tight-fitting masks and respirators will be necessary.”

Covid-19 Charges at Hospitals Can Vary by Tens of Thousands of Dollars, a WSJ Analysis Finds: The variation across hospitals is not surprising. This paragraph is what I found most interesting: “At NewYork-Presbyterian Weill Cornell Medical Center in New York, the cost for a severe-respiratory patient was around $55,182 if the person were insured by CVS Health Corp.’s CVS Aetna, according to the hospital’s data. For UnitedHealth Group Inc.’s UnitedHealthcare, the hospital’s disclosed rate is $64,326, while the price listed in the hospital’s data for patients covered by Anthem Inc.’s Empire Blue Cross Blue Shield was $94,357.”

Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients: “Outpatients with COVID-19 who were on outpatient anticoagulation at the time of diagnosis experienced a 43% reduced risk of hospitalization. Failure to initiate anticoagulation upon hospitalization or maintaining outpatient anticoagulation in hospitalized COVID-19 patients was associated with increased mortality risk.”
Included in the study were “those prescribed any anticoagulant class including warfarin, a direct oral anticoagulant (DOAC, i.e., apixaban, rivaroxaban, dabigatran, edoxaban), or enoxaparin in the immediate 90 days prior to COVID-19 diagnosis were included.”

3rd vaccine dose has lowest side effect rate, Israel Health Ministry data shows: “Side effects, such as fatigue, weakness, and pain in the arm where the injection was administered, were all less common for the third dose in every age group.
The data showed that pain in the area of the vaccine was recorded at 42.7 per million in the third dose, compared to 222.9 and 514.3 in the second and first doses.”

The application is now open for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments.: HRSA is now accepting provider applications for $25.5B in relief aid.

FDA greenlights combination at-home test for COVID and influenza in children as flu season approaches: “Labcorp aims to tackle both infections with a single test following a new emergency authorization from the FDA for an at-home collection kit to gather samples from children as young as two years old.
The company said the combination test under its Pixel brand will be available at no upfront cost to people meeting certain clinical guidelines for screening, such as those who have been exposed to COVID-19 or currently have symptoms as well as those who have been directed to get a test by their healthcare provider.”

Justice Sotomayor rejects request to block New York City school vaccine mandate: “Justice Sonia Sotomayor on Friday denied a request from a group of New York City teachers to block the city's vaccine mandate for public school employees.
Sotomayor did not refer the request to the other Supreme Court justices, or comment on her action, likely signaling they agreed with her decision. In August, Justice Amy Coney Barrett likewise rejected an effort to block Indiana University's vaccine mandate.”

Researchers retract preprint study that miscalculated higher heart inflammation risk for Moderna, Pfizer COVID vaccines: “Scientists at The University of Ottawa Heart Institute have retracted the preprint study, which falsely calculated a 1 in 1,000 risk of heart inflammation for Moderna's and Pfizer-BioNTech's mRNA COVID vaccines.
The study authors have withdrawn the manuscript “because of a major error pertaining to the quoted incidence data,” the team said in a retraction statement on Sept. 24.”

About health insurance

Humana launching 72 new Medicare plans for 2022: “Humana is launching 72 new Medicare Advantage plans for 2022 across hundreds of additional counties, the insurer announced Friday.
This includes 42 new Medicare Advantage Prescription Drug plans, three MA-only plans, and 27 special needs plans, Humana said. The company will expand its HMO Medicare plans into 115 new counties and PPO Medicare plans into 162 new counties.
Humana also intends to bring its dual special needs plans to 268 new counties. The overall expansion will allow it to reach 4 million additional Medicare eligibles.”

Here's what major national payers are offering in Medicare Advantage for 2022: “Medicare Advantage (MA) open enrollment begins Oct. 15, and major national payers are outlining their plans for the coming year.
The market is one of the hottest in the insurance industry and is a key growth target for many insurers. Recent Kaiser Family Foundation data show that enrollment in MA plans has more than doubled over the past decade, reaching more than 26 million members, or about 42% of the Medicare population.
Options are growing for members as the market heats up; KFF found that for the 2021 plan year, beneficiaries had access to 33 different plans, the most ever.”

Blue Cross NC Reduces Lab Service Costs, Unnecessary Testing: “Blue Cross and Blue Shield of North Carolina (Blue Cross NC) achieved $112 million in savings on lab service costs and better-quality lab services for members in 2020 after partnering with a laboratory insights company.
The payer improved member health outcomes by reducing unnecessary lab testing and increasing clinical guideline adherence.
Healthcare professionals administer around 13 billion lab tests each year, making it one of the most common healthcare services in the country, the press release noted. Lab services can also contribute to high healthcare spending.”

About pharma

Pharmacies face 1st trial over role in opioid crisis: “In a bellwether federal trial starting Monday in Cleveland, Lake and Trumbull counties will try to convince a jury that the retail pharmacy companies played an outsized role in creating a public nuisance in the way they dispensed pain medication into their communities.
This will be the first time pharmacy companies, in this case CVS, Walgreens, Giant Eagle and Walmart, have gone to trial to defend themselves in the nation’s ongoing legal reckoning over the opioid crisis. The trial, which is expected to last around six weeks, could set the tone for similar lawsuits against retail pharmacy chains by government entities across the U.S.”

About the public’s health

Comparing Nations on Timeliness and Coordination of Health Care: Some summary of findings from the 2021 Commonwealth Fund International Health Policy Survey of Older Adults. On the positive side:

  • Older adults in the U.S. were the least likely to experience gaps in hospital discharge planning in the past two years.

  • Older adults in the U.S. were the least likely to report missed opportunities to review their prescribed medication lists with providers.

  • U.S. older adults with chronic conditions were most likely to have contact with health professionals in between visits.

    On the negative side:

  • U.S. seniors are more likely than their counterparts in other wealthy countries to experience economic hardship as a result of the pandemic, with Latino/Hispanic and Black seniors most affected. Nearly four in 10 older Latino/Hispanic adults and one in three older Black adults said they used up their savings or lost a job or source of income because of COVID-19, compared to 14 percent of older white adults.

  • Despite the near-universal coverage Medicare provides, U.S. older adults have comparatively high out-of-pocket health expenses and are much more likely to forgo care because of cost than are their counterparts in the other survey countries.

Obesity and Sex-Related Associations With Differential Effects of Sucralose vs Sucrose on Appetite and Reward Processing: “In this randomized crossover trial, both obesity and female sex were associated with differential neural food cue responsivity in reward processing areas following ingestion of sucralose (an NNS) compared with sucrose (nutritive sugar)…
  These findings suggest that female individuals and those with obesity have greater neural reward responses to NNS vs nutritive sugar consumption, highlighting the need to consider individual biological factors that might influence the efficacy of NNS.”
The diet sweetener did not satisfy food cravings and in women and obese people enhanced eating.

About healthcare personnel

US healthcare labor market: An update from Mercer showing the dimensions of healthcare personnel shortages. The map graphics are helpful in showing the magnitude and location of the greatest shortages in lower skilled personnel, primary care physicians and nurses.

About healthcare IT

JD Power Survey Sees Telehealth Falling Back Into the Same Old Rut: J.D. Power’s 2021 US Telehealth Satisfaction Survey, released this week, saw a surge in telehealth use from 7 percent in 2019 and 9 percent in 2020 to 36 percent in 2021, reflecting the shift to virtual care as the nation grappled with COVID-19. But the consumer advisory company’s third annual survey also saw a decrease in patient satisfaction, driven by complains over limited services (24 percent), lack of awareness on costs, confusing technology requirements and lack of information about care providers (all at 15 percent).”

Today's News and Commentary

About Covid-19

Fauci says data from NIH’s mix-and-match Covid vaccine booster trials will soon be ready:

  • “The National Institutes of Health is on the verge of concluding trials that mix initial vaccine doses from one manufacturer with booster shots from another manufacturer, Dr. Anthony Fauci said.

  • Data on J&J’s mix-and-match study could be ready within a week, while Pfizer’s trial might be completed by mid-October, he said. Moderna’s mix-and-match study data is already available.”

U.S. Judge upholds COVID-19 vaccine requirement for those with 'natural immunity': “A U.S. judge upheld the University of California’s COVID-19 vaccine requirement against a challenge by a professor who alleged he had immunity due to a prior coronavirus infection, in what appears to be the first ruling on the issue.
U.S. District Court Judge James Selna in Santa Ana, California, said the university system acted rationally to protect public health by mandating the vaccine and not exempting individuals with some level of immunity from an infection.”

Louisiana health system issues $200 monthly premium to employees with unvaccinated partners: “Louisiana-based Ochsner Health is charging employees up to $100 per bi-weekly pay period if their partners are unvaccinated.
The provider said the move is to manage the costs of COVID-19 for employees who become ill…
The surcharge goes into effect in 2022 and affects only spouses or domestic partners who are both covered by the employee's health insurance and qualify for vaccination. Ochsner previously mandated vaccinations for all employees.”

About pharma

Merck to buy Acceleron for about $11.5 bln in rare disease drug push: “The deal gives Merck access to Acceleron's rare disease drug candidate, sotatercept, which the company expects could bring in billions of dollars in sales, and comes as Keytruda moves toward the loss of market exclusivity in 2028.
The lung cancer treatment accounted for 36.7%, or $4.18 billion, of Merck's total sales in the second quarter.”

For 20 Top-Selling Drugs Worldwide, Big Pharma Revenue from U.S. Sales Combined Exceeded Revenue from the Rest of the World: “Key Findings:

  • U.S. sales of the 20 top-selling drugs worldwide totaled $101.1 billion while sales to the rest of the world totaled nearly $57 billion. In other words, the U.S. spent almost double what the rest of the world combined did on these top 20 drugs.

  • For 17 of the 20 top-selling drugs worldwide in 2020, pharmaceutical corporations made more money from U.S. sales than from sales to all other countries in the rest of the world combined.

  • For 11 of the 20 top-selling drugs worldwide, U.S. sales revenue was double revenue to the sales of the rest of the world or more.

  • 11 of the 13 pharmaceutical companies selling these top drugs made more money in the United States from these drugs than they did in the rest of the world combined.”

HHS ends Trump-era rule 340B targeting community health clinics: “The Health Resources and Services Administration has formally rescinded a proposed rule targeting community health clinics participating in the 340B Drug Pricing Program. The regulation, which the Trump administration proposed last year, would have required community health centers to pass the 340B discounts they get for insulin and Epi-Pens directly to patients.
HRSA is withdrawing the regulation due to ‘excessive administrative costs and the burdens that implementation would have imposed on health centers,’ the agency wrote in a notice published in the Federal register Thursday.”

Magnitude of the Placebo Response Across Treatment Modalities Used for Treatment-Resistant Depression in Adults: “In this systematic review and meta-analysis of 3228 patients with treatment-resistant depression in 50 randomized clinical trials, the placebo effect size was large and consistent across treatment modalities. Response and remission rates associated with placebo effect were comparable across modalities…
The findings of this study suggest a placebo effect size benchmark may be used to interpret the findings of past and future clinical trials.”

Hikma Buys Injectables Specialist Custopharm In $400m+ Deal: “Hikma has agreed to acquire US sterile injectables specialist Custopharm in a deal that includes a $375m upfront purchase price and a further $50m in milestone payments. The transaction is set to bolster Hikma’s near-$1bn injectables business that currently accounts for around two-fifths of turnover.”

Judge denies Pfizer's request to run 2 programs to subsidize patients for expensive heart drug: “Pfizer’s efforts to blunt the anti-kickback policies of the U.S. government took a hit Friday as a federal district court dismissed its plan to assist Medicare patients in paying for one of the company's most expensive drugs.
In ruling in favor of the Department of Health and Human Services (HHS), Southern District of New York Judge Mary Kay Vyskocil denied Pfizer clearance to run two programs that would reimburse patients for their pricey heart medications Vyndaqel and Vyndamax, which cost $225,000 annually.”

About health insurance

Biden administration announces rule on implementing ban on 'surprise' medical billing: This link is for a summary from The Hill. For a full explanation from CMS see this link.

Medicare appeals backlog trimmed by 79%: “HHS met its backlog goals for fiscal year 2021, reducing its Medicare appeals backlog by 79 percent at the administrative law judge level, according to a Sept. 28 status report. It's on track to meet the next reduction target as well.”

CMS official: Don't expect a lot of fully risk-based payment models going forward: “Centers for Medicare & Medicaid Services Chief Operating Officer Jon Blum detailed the agency’s vision for value-based care during the National Association of Accountable Care Organizations' fall conference Thursday.
‘I don’t think that CMS will be promoting models that have more risk just for the sake of having more risk,’ said Blum.
Although Blum said it is still important to have risk-based models, there are data that show downsides of full-risk payment models.
‘We know that when we [incentivize] risk we see some downsides to that,’ Blum said. ‘We see stronger incentives for more diagnosis code submissions, some of which might be appropriate, some of which not.’
Another concern is when you have ‘more transformation towards risk that tends to favor those who are better capitalized and can afford risk,’ he added.”

UnitedHealthcare maintains largest Medicare Advantage footprint with 2022 expansion: “UnitedHealthcare shared its plans to expand Medicare Advantage plans in 2022 to 276 counties, continuing its dominant market control. 
The expansion to another 3.1 million potential members means UnitedHealthcare reaches 94 percent of Medicare-eligible consumers nationwide…”

About healthcare IT

HHS releases HIPAA guidelines for vaccine, the workplace: 4 things to know: “Four things to know:

  1. HIPAA doesn't prohibit businesses or individuals from asking customers about their COVID-19 vaccination status. HIPAA only applies to covered entities, such as hospitals, payers and their business associates.

  2. HIPAA doesn't prevent individuals from disclosing their vaccination status to business owners or employees of an establishment.

  3. HIPAA doesn't block a covered entity or business from requiring its employees to disclose their vaccination status to their employers. HIPAA doesn't apply to employment records — even covered entities — when they are acting in their capacity as employers.

  4. HIPAA does prohibit a physician's office from disclosing protected health information, such as COVID-19 vaccination status, to a patient's employer.

To read more, click here.”

Amazon Adds More to Halo—Introducing Halo View, Halo Fitness, and Halo Nutrition: “Amazon announced expansions to Amazon Halo with three new additions to the Halo family: Halo View, a new health tracker with an AMOLED color display for at-a-glance access to Halo health metrics; Halo Fitness, a new service with hundreds of studio-quality workout classes; and Halo Nutrition, a new experience to help build healthy eating habits.”

About the public’s health

The rising cost of healthcare system complexity: From Accenture. The entire report is interesting, but the one portion that is highlighted in the media today is: “If people with low healthcare system literacy used the emergency room at the same rate as their more informed peers, Accenture estimates that the US healthcare system could save $47 billion every year in medical costs.
This cost saving assumes that their excess emergency room visits would shift to less expensive sites, such as primary care physician offices, urgent care centers, retail health clinics and telehealth visits.”

Today's News and Commentary

About Covid-19

How Accurate Are At-Home Covid Tests?: A good summary that answers the headline question.

NETWORK OF RIGHT-WING HEALTH CARE PROVIDERS IS MAKING MILLIONS OFF HYDROXYCHLOROQUINE AND IVERMECTIN, HACKED DATA REVEALS: “America’s Frontline Doctors, a right-wing group founded last year to promote pro-Trump doctors during the coronavirus pandemic, is working in tandem with a small network of health care companies to sow distrust in the Covid-19 vaccine, dupe tens of thousands of people into seeking ineffective treatments for the disease, and then sell consultations and millions of dollars’ worth of those medications. The data indicate patients spent at least $15 million — and potentially much more — on consultations and medications combined.”

Merck says research shows its COVID-19 pill works against variants: “ Laboratory studies show that Merck & Co's experimental oral COVID-19 antiviral drug, molnupiravir, is likely to be effective against known variants of the coronavirus, including the dominant, highly transmissible Delta, the company said on Wednesday.
Since molnupiravir does not target the spike protein of the virus - the target of all current COVID-19 vaccines - which defines the differences between the variants, the drug should be equally effective as the virus continues to evolve, said Jay Grobler, head of infectious disease and vaccines at Merck.
Molnupiravir instead targets the viral polymerase, an enzyme needed for the virus to make copies of itself.”

Avanos medical to pay $22 million to resolve criminal charge for fraudulent misbranding of PPE: “Avanos Medical Inc, which as its U.S. headquarters in Alpharetta, Georgia, is charged with one count of introducing misbranded surgical gowns into interstate commerce with the intent to defraud and mislead.
According to the Department of Justice, the company knowingly falsely labeled its MicroCool surgical gowns as providing AAMI Level 4 protection (the highest level) against fluid and virus penetration. Under the standards set by the American National Standards Institute (ANSI) and the Association for the Advancement of Medical Instrumentation (AAMI), the highest protection level for surgical gowns is reserved for gowns intended to be used in surgeries and other high-risk medical procedures on patients suspected of having infectious diseases.
Avanos admitted to selling hundreds of thousands of MicroCool gowns that were falsely labeled as AAMI Level 4 between late 2014 and early 2015, as well as directly lying to customers about the gowns’ protective capacities. In total, Avanos sold almost $9 million of misbranded MicroCool gowns.”

About health insurance

Medicare Advantage premiums are $2 lower per month in 2022: “The average premium for Medicare Advantage plans will be lower in 2022 at $19 per month, compared to $21.22 in 2021, according to the Centers for Medicare and Medicaid Services.
However, Part D coverage is rising to $33 per month, compared to $31.47 in 2021.
The agency released the 2022 premiums, deductibles and other key information for Medicare Advantage and Part D prescription drug plans in advance of the annual Medicare open enrollment.”

Majority of U.S. voters approve of giving Medicare drug price negotiation authority: “The [Morning Consult and Politico] poll found that 56% of registered voters either strongly or somewhat supported a drug pricing proposal that would allow for Medicare to negotiate drug prices for some products but could result in fewer drugs being introduced to the market.”

Opt-Out Litigants Fight BCBS' $2.67B Antitrust Settlement: “Individuals who opted out of Blue Cross Blue Shield's $2. 67 billion antitrust settlement have filed their own suit in Florida federal court, saying the deal doesn't compensate health plan subscribers enough for the Sherman Act violations they've alleged. The BCBS Association and Blues plans in regional markets reached the landmark agreement last year to resolve a massive antitrust case in Alabama federal court, but the deal is still awaiting the final stamp of approval from a judge in that district.”

 Physical Therapists And 2 Acupuncturists Charged In Over $20 Million Health Care Fraud Scheme: “U.S. Attorney Audrey Strauss said: ‘As alleged, the defendants perpetrated a multimillion-dollar health care fraud scheme in which they billed Medicare and other insurers for physical therapy and acupuncture services that were either not rendered in the manner purported or not rendered at all…’”

ICD-10-CM Official Guidelines for Coding and Reporting: From CMS for FY 2022
(October 1, 2021 - September 30, 2022). For those of you who are involved with billing/coding it is an essential document.

About healthcare quality

Low-Value Care at the Actionable Level of Individual Health Systems: ”This cohort study measured and reported the use of 41 individual low-value services and a composite measure of 28 services for 556 health systems serving a total of 11 637 763 Medicare beneficiaries across the US. Systems varied widely in the provision of low-value care; those with a smaller proportion of primary care physicians, without a major teaching hospital, serving a larger proportion of non-White patients, headquartered in the South and West, and serving areas with higher health care spending delivered more low-value care.”

About pharma

Eli Lilly Lowers Price of Insulin Again: “Eli Lilly has announced that it will drop the list price of its Insulin Lispro Injection by 40 percent in the U.S. as of Jan. 1, bringing the drug’s list price down to 2008 levels.
The move would bring down the price of Insulin Lispro Injection to $82.41 for individual vials and $159.12 for a pack of five pens.  This, the company said, is 70 percent less than the Lispro injection’s Humalog U-100 competitors…
Lilly said most people using Insulin Lispro Injection are unlikely to see a change in what they pay for their monthly prescription because they have fixed insurance co-pays or already use one of Lilly’s affordability programs. The greatest benefit, the company said, will be seen by people who face higher out-of-pocket costs, such as those without insurance and those with high deductible plans or co-insurance.”

About healthcare IT

Individuals’ Access and Use of Patient Portals and Smartphone Health Apps, 2020: From the ONC report issued this month:
“HIGHLIGHTS:

  • About six in 10 individuals nationwide were offered access to their patient portal and nearly 40 percent accessed their record at least once in 2020.

  • Nearly four in 10 patient portal users accessed their portal through a smartphone health app in 2020.

  • Individuals encouraged by their health care provider to use their patient portal accessed and used their portal at higher rates compared to those not encouraged.

  • About a third of patient portal users downloaded their online medical record in 2020 – this proportion has nearly doubled since 2017.”



Today's News and Commentary

About health insurance

COMPETITION in HEALTH INSURANCE: A comprehensive study of U.S. markets: A well-worth reading annual report from the AMA that has state and local data on the top two health plans in each area and their market shares. From a national viewpoint: “73% (280) of MSA-level markets were highly concentrated. In 91% of markets, at least one insurer had a market share of at least 30%, and in 46% of markets, one insurer had a share of 50% or more.”

AmeriHealth Caritas launches new subsidiary focused on the social determinants of health: “Philadelphia-based insurer AmeriHealth Caritas is launching a subsidiary aimed at addressing the social determinants of health.
Social Determinants of Life Inc. aims to invest in, deploy and support solutions to help people build resilience and improve their life outcomes, according to an announcement. Alongside the launch, the company unveiled its first investment—a $29 million series B in Wider Circle, a California-based startup that designs tech-enabled health programs and peer-to-peer social networks.”

NAACOS [The National Association of ACOs] CMS must provide upfront funds, raise benchmarks to help ACOs close health equity gaps: “‘ACOs are already beginning to do the work of addressing [social determinants of health] to improve quality and control costs for the patients they serve,’ according to the report. ‘However, they cannot be broadly effective or achieve desired outcomes without the proper funding and support.’
More funding is needed to support an expansion of ACO social services that can address social determinants of health, the paper said.”

Uninsured Adults Remain Unaware of ACA Coverage, Subsidy Options: “Nearly half of all uninsured, nonelderly Americans (48.2 percent) had heard of the Affordable Care Act marketplaces. Around seven in ten individuals in the nonelderly, uninsured population reported that they had not heard any information or only a little information about the health insurance subsidies that are available to qualifying uninsured groups.” See the Urban Institute report for more details.

7 hospitals tagged by OIG for billing errors this year: Worth a quick read to see what the problems were…and what to avoid in the future.

CMS' final payment rules take effect Oct. 1: 21 things to know: A lot to digest but it is a great summery of all the upcoming changes.

About Covid-19

YouTube is banning prominent anti-vaccine activists and blocking all anti-vaccine content: “YouTube is taking down several video channels associated with high-profile anti-vaccine activists including Joseph Mercola and Robert F. Kennedy Jr., who experts say are partially responsible for helping seed the skepticism that’s contributed to slowing vaccination rates across the country.
As part of a new set of policies aimed at cutting down on anti-vaccine content on the Google-owned site, YouTube will ban any videos that claim that commonly used vaccines approved by health authorities are ineffective or dangerous.”

N.Y. governor expands healthcare worker eligibility as hospitals suspend, fire unvaccinated staff: “New York Governor Kathy Hochul signed an executive order expanding healthcare worker eligibility requirements, an effort to head off potential staffing shortages fueled by the state’s new COVID-19 vaccination requirements.
The six-page order (PDF) allows out-of-state and out-of-country healthcare workers to practice in New York and lowers the barrier for those who have retired or are behind on registrations to rejoin the medical workforce during the course of ‘a statewide disaster emergency.’”

At the Vatican, a new mandate for employees — with no exemptions: “The Vatican City State said Tuesday that it would soon begin requiring all employees — including the highest members of the Catholic Church — to show proof of vaccination or of a recent negative coronavirus test. Those without the proper certificates, the Vatican said, will be considered unjustly absent’ — and will be paid no salary.
measures apply to a relatively small number of people, the firm stance also amounts to a symbolic message for Catholics across the world, some of whom have debated the question of vaccination exemptions on religious grounds.”

Intranasal Corticosteroids [INCS] Are Associated with Better Outcomes in Coronavirus Disease 2019: “INCS therapy is associated with a lower risk for COVID-19-related hospitalization, ICU admission, or death. Future randomized control trials are needed to determine if INCS reduces the risk for severe outcomes related to COVID-19.”

Highly-vaccinated, but more cases than ever: Singapore shows the world what ‘endemic’ COVID might look like: Interesting read and perhaps an aspiration of what the US could do if all the people were willing to cooperate.

About the public’s health

Nearly $1 billion in American Rescue Plan funds will renovate health centers: ”Health centers will use this funding for COVID-19-related capital needs, constructing new facilities, renovating and expanding existing facilities to enhance response to pandemics, and purchasing new equipment, including telehealth technology, mobile medical vans and freezers to store vaccines, HHS said. 
The funds will be awarded to health centers that serve medically underserved and other vulnerable populations and communities, which are disproportionately affected by COVID-19 and other health conditions. By constructing new facilities or renovating and expanding existing facilities, health centers will ensure that these communities will have more equitable access to high-quality primary healthcare.  
More than 91% of health center patients are individuals or families living at or below 200% of the Federal Poverty Guidelines and nearly 63% are racial/ethnic minorities.”

About healthcare IT

Assessment of the Feasibility of Using Noninvasive Wearable Biometric Monitoring Sensors to Detect Influenza and the Common Cold Before Symptom Onset: “In a cohort study of 31 participants inoculated with H1N1 and 18 participants with rhinovirus, infection detection and severity prediction models trained using data on wearable devices were able to distinguish between infection and noninfection with 92% accuracy for H1N1 and 88% accuracy for rhinovirus and were able to distinguish between mild and moderate infection 24 hours prior to symptom onset with 90% accuracy for H1N1 and 89% accuracy for rhinovirus…
This study suggests that the use of wearable devices to identify individuals with presymptomatic acute viral respiratory infection is feasible; because wearable devices are common in the general population, using them for infection screening may help limit the spread of contagion.”

FDA clears wireless, blood pressure-monitoring finger sensor from Caretaker Medical: “The FDA has cleared a next-generation system to continuously monitor patients’ blood pressure while they’re undergoing surgery without the use of inflatable cuffs or invasive arterial catheters.
Attached wirelessly around the patient’s finger, Caretaker Medical’s VitalStream device aims to catch the changes in blood pressure that may occur during an operation and alert surgeons to any sudden drops or deteriorations that may complicate the patient’s recovery.
By using a low-pressure finger sensor to measure each heartbeat, the noninvasive system can deliver ICU-grade patient tracking in a variety of settings with little training and integrate with a hospital’s monitoring and records systems.”

Health systems-backed Truveta lands investment from Microsoft, cloud partnership: “The software giant also is investing an undisclosed amount in Truveta, which is backed by 17 healthcare systems, including Providence, Novant Health, Northwell Health and Trinity Health.
Truveta has access to health data representing 15% of the U.S. through its health system partnerships. By tapping Microsoft's Azure cloud platform, Truveta and the technology giant will work together to build up Truveta’s customer base and health system membership.
Truveta will also become a Microsoft Cloud for Healthcare partner and enable Microsoft to build up its offerings for healthcare customers.”

Amazon taps VR, voice assistant startups and 8 others for inaugural digital health accelerator: “For its first healthcare accelerator program, Amazon's cloud division tapped a diverse group of startups working in virtual reality, voice assistant technology, remote monitoring and social determinants of health.
Amazon Web Services (AWS) announced in June a healthcare accelerator to help incubate early-stage digital health companies that can collaborate with the tech giant's healthcare customers and partners.
The aim, Amazon said, is to connect growth-stage digital health solutions with AWS’ healthcare provider organizations to accelerate care in the cloud and for potential pilots and collaborations between providers and companies.
The 10 companies were selected from 427 applications from 31 countries around the world by a panel from AWS and KidsX, a pediatrics digital health accelerator launched from Children's Hospital Los Angeles and a partner on AWS' accelerator program.”

About pharma

Mass General Brigham vetoes controversial Alzheimer's drug Aduhelm after internal review: “Mass General Brigham is the latest big-name health system to announce it will not be treating its patients with Biogen’s Aduhelm, the controversialAlzheimer’s disease drug cleared by the Food and Drug Administration in June.”

Amicus spins off gene therapy unit in $600M SPAC deal as CEO becomes chief at Caritas: “Amicus has endured a tough few years of pipeline flops and a roller coaster stock ride, but now it’s riding the special purpose acquisition company wave, spinning off its gene therapy unit in a $600 million deal.
The pact sees Amicus’ gene therapy business bought out by ARYA Sciences Acquisition Corp IV, a SPAC sponsored by Perceptive Advisors. Caritas gets around $400 million in funding to start with, while Amicus adds about $200 million in private funding from ‘leading biotechnology investors.’”

J&J Wins Multiplaintiff Mo. Talc Trial After High Court Setback: “A Missouri state jury on Monday rejected claims that Johnson & Johnson's flagship talcum powder caused the ovarian cancer in three women, the state's first multiplaintiff talc verdict since the U. S. Supreme Court passed on the company's challenge to such trials.”

Cherokee Nation Inks $75M Opioid Deal With Distributors: “The Cherokee Nation announced Tuesday that it's reached a $75 million settlement with AmerisourceBergen Corp. , Cardinal Health Inc. and McKesson Corp. over claims that the companies contributed to the opioid epidemic. According to a statement by the Cherokee Nation, the deal will see the funds distributed over 6½ years, and it represents the largest settlement in its history.”

About healthcare finance

Health-Care Deals Stay Strong in August Amid Covid-19 Surge: “Overall, August saw 252 deals, bringing the monthly average for the year to 243, a sharp increase over 2020’s average of 161…
The life sciences and health-care information technology sectors led the way during August, with 53 and 36 closed and announced transactions, respectively.”

Today's News and Commentary

About Covid-19

PFIZER AND BIONTECH SUBMIT INITIAL DATA TO U.S. FDA FROM PIVOTAL TRIAL OF COVID-19 VACCINE IN CHILDREN 5 TO <12 YEARS OF AGE: “Pfizer Inc. and BioNTech announced they have submitted data to the U.S. Food and Drug Administration (FDA) from the Phase 2/3 trial of their COVID-19 vaccine in children 5 to <12 years of age.
This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20210928005307/en/

Pfizer begins study of oral drug for prevention of COVID-19:”Pfizer Inc  said on Monday it has started a large study testing its investigational oral antiviral drug for the prevention of COVID-19 infection among those who have been exposed to the virus.”

About pharma

Merck & Co. rumoured to be Acceleron suitor: “Merck & Co. is in advanced talks to buy Acceleron Pharma, according to unnamed sources cited in The Wall Street Journal on Monday. The report follows rumours that surfaced late last week, and were first reported by Bloomberg, indicating that Acceleron was in advanced talks to be acquired by an unnamed buyer for about $180 per share in cash, or a total value of more than $11 billion.”

Gilead, Merck and others slapped with 'pay-for-delay' lawsuits over lucrative HIV and cholesterol meds: “In a new case, two of the nation’s largest pharmacy chains—CVS and Ride Aid—are going head-to-head with Gilead, Bristol Myers Squibb (BMS) and Teva for engaging in a ‘multifaceted scheme to suppress and delay’ generic rivals of Gilead’s HIV meds, according to a filing in the U.S. District Court in San Francisco on Wednesday. 
The pharmacy chains allege the band of drugmakers engaged in unlawful reverse-payment deals for a number of Gilead bellwether HIV meds, including Viread, Truvada, Atripla, Descovy and Vemlidy. Those deals resulted in drug purchasers overpaying for those drugs by ‘hundreds of millions of dollars,’ CVS and Rite Aid claim.”

Report Says DoD Reliance on Foreign Drugmakers Poses Security Risk: “The Department of Defense (DoD) is overly reliant on foreign drug supply chains, a problem that could spell big trouble not only for the military, but the entire country, says a new report from the DOD’s Office of the Inspector General (OIG).”

About the public’s heath

Individual- and Community-Level Factors Associated With Detectable and Elevated Blood Lead Levels in US Children: “This study suggests that, despite progress in reducing pediatric lead exposure, substantial individual- and community-level disparities persist.”

About healthcare IT

Walmart to deploy Epic EHR across health centers: “Epic's EHR will first be rolled out in four Walmart Health Centers opening in Florida in early 2022, according to a news release.

Today's News and Commentary

About Covid-19

This Lab Charges $380 for a Covid Test. Is That What Congress Had in Mind?: “At the drugstore, a rapid Covid test usually costs less than $20.
Across the country, over a dozen testing sites owned by the start-up company GS Labs regularly bill $380.
There’s a reason they can. When Congress tried to ensure that Americans wouldn’t have to pay for coronavirus testing, it required insurers to pay certain laboratories whatever “cash price” they listed online for the tests, with no limit on what that might be.
GS Labs’s high prices and growing presence — it has performed a half-million rapid tests since the pandemic’s start, and still runs thousands daily — show how the government’s longstanding reluctance to play a role in health prices has hampered its attempt to protect consumers.”
Although people have a choice of tests, the “free” Covid-19 testing program makes them care less about which one they they get.

In a matter of days, Pfizer CEO says they'll be ready to ask for approval of a Covid-19 vaccine for kids: “Pfizer/BioNTech plans to ask for authorization of a Covid-19 vaccine for some children under 12 soon, bringing the US one step closer to offering protection to a population that has grown particularly vulnerable as the fall season gets underway.
’It is a question of days, not weeks,’ Pfizer Chairman and CEO Albert Bourla told ABC News Sunday about when the company will submit data on children ages 5 to 11 to the FDA for consideration.”

New potential factor contributing to severity of COVID-19 identified: “CD47 is a so-called 'do not eat me' signal to the immune system's defences that protect cells from being destroyed. Virus-induced CD47 on the surface of infected cells is likely to protect them from immune system recognition, enabling the production of larger amounts of virus, resulting in more severe disease.
Well-known risk factors for severe COVID-19 such as older age and diabetes are associated with higher CD47 levels. High CD47 levels also contribute to high blood pressure, which is a large risk factor for COVID-19 complications such as heart attack, stroke, and kidney disease.
The data suggest that age and virus-induced high CD47 levels contribute to severe COVID-19 by preventing an effective immune response and increasing disease-associated tissue and organ damage.”

U.S. schools with mask requirements are seeing fewer outbreaks, the C.D.C. finds.: “One study, conducted in Arizona, where children returned to school in July, found that schools that did not require staff and students to wear masks were 3.5 times as likely to have a virus outbreak as schools that required universal masking.
A second study looked at infections among all children in 520 different counties across the United States, and found that once the public school year started, pediatric cases increased at a far higher rate in counties where schools did not require masks.”
Science is still unlikely to change the minds of masking opponents who see mandates as a personal rights infringement issue.

Sharp increase in employers favoring vaccine mandate: “More than half of U.S. employers, 54%, already have a COVID-19 vaccine mandate or are strongly considering one, according to a recent survey by McGriff, a subsidiary of Truist Insurance Holdings Inc.
The broker said Friday that the survey taken earlier this month shows that more employers were already leaning toward a mandate, whereas in a previous survey in January, only 3% of employers told McGriff they were planning on a vaccine mandate.
The Instant Insights COVID-19 vaccine mandate survey conducted by the McGriff Employee Benefits Division showed that 11% of the 315 employers surveyed had already implemented, or were in the process of implementing, a vaccine mandate.”
In a related story: U.S. court upholds hospital employee COVID-19 vaccine rule in test case: A federal judge on Friday ruled that a Cincinnati, Ohio-area healthcare provider could require its employees get vaccinated against COVID-19 or risk losing their job, in what appears to be the first ruling of its kind for a private employer in the United States.
The employees of St. Elizabeth Healthcare failed to establish that their individual liberties were being violated by the vaccine requirement of the hospital operator, which has the right to set employment terms, said U.S. District Judge David Bunning in Covington, Kentucky.”

Federal judge delays vaccine mandate for NYC teachers: “New York City schools have been temporarily blocked from enforcing a vaccine mandate for its teachers and other workers by a federal appeals judge just days before it was to take effect.
Workers in the nation’s largest school system were to be required to show vaccination proof starting Monday. But late Friday, a judge for the 2nd U.S. Circuit Court of Appeals granted a temporary injunction sought by a group of teachers pending review by a three-judge panel, which will take up the motion Wednesday.
Department of Education spokesperson Danielle Filson said officials were seeking a speedy resolution in court.”

WHO Adds REGEN-COV to List of Recommended COVID-19 Treatments: “The World Health Organization (WHO) has added Regeneron’s COVID-19 antibody cocktail, REGEN-COV (casirivimab/imdevimab), to its list of recommended treatments in updated clinical guidelines.
The world body also announced that it is in negotiations with Roche, which is distributing the cocktail through a deal with Regeneron. The WHO also highlighted the ‘high cost and low availability of the combination therapy’ as a barrier to access and said it is in discussions with Regeneron to donate REGEN-COV treatment courses.”

Transdermal vaccination via 3D-printed microneedles induces potent humoral and cellular immunity: “Microneedle patches designed to precisely deliver cargos into the intradermal space, rich in immune cells, provide a noninvasive and self-applicable vaccination approach, eliminating the need for hypodermic needles and trained medical personnel for vaccine administration. Here, we show that advanced 3D printing methods allow for the manufacturing of polymeric microneedles of controlled geometries (difficult to manufacture using traditional methods) designed to enhance vaccine component coating. Using model vaccine components, we demonstrated that 3D-printed microneedle delivery resulted in enhanced cargo retention in the skin, activation of immune cells, and more potent humoral and cellular immune responses as compared with traditional vaccination routes.”

About healthcare IT

FBI warns of Conti ransomware after 400 attacks: 5 things to know: “The FBI and Cybersecurity and Infrastructure Security Agency are warning of the increased use of Conti ransomware after more than 400 attacks on American and international organizations were reported….
During most Conti ransomware attacks, hackers steal files, encrypt servers and demand a ransom payment, according to a news release. Conti actors usually gain access to the network through spear phishing campaigns, stolen desktop credentials, phone calls and fake software promoted on search engines.

Amazon launches $40M health equity accelerator: “Amazon Web Services is committing $40 million over three years to its new global program to support equity in health outcomes…
Through the program, organizations can apply to receive Amazon Web Services credits and expertise to create products and services aiming to improve health outcomes for marginalized populations. This year's deadline for applications is Nov. 15.”

About pharma

Court Rules Takeda is Liable to Abbvie for Lupron Depot Damages: “Takeda has been unable to supply the drug — which is indicated to treat endometriosis, uterine fibroids, premature puberty and prostate cancer — to AbbVie Endocrine, an AbbVie subsidiary, since an FDA inspection of its plant in Hikari, Japan, in 2019 turned up problems.”

Judge Says FDA Must Rework Oversight of Compounding Pharmacies: “Judge Christopher Cooper of the U.S. District Court for the District of Columbia ruled last week that the agency violated procedure in producing the ‘standard Memorandum of Understanding,’ which establishes an agreement between individual state pharmacy boards and the FDA.
Congress required the FDA to develop this document in 1997 when it passed Section 503A of the federal Food, Drug and Cosmetic Act (FDCA), but it wasn’t finalized until last October.
Seven compounding pharmacies sued to challenge the final document, and Cooper has found in their favor to the extent that the FDA must now ‘either certify that it will not have a significant economic effect on small businesses or prepare a regulatory flexibility analysis.’”

Biogen used charity giving to illegally boost multiple sclerosis drug sales, Humana lawsuit says: “For years, federal prosecutors have gone after drug companies for allegedly using charity contributions as a way to boost sales. Biogen was among the pharma players to ink a federal settlement, but, now, insurance giant Humana is targeting the company’s charity giving with a new lawsuit. 
In a suit filed in Massachusetts Friday, Humana says Biogen sought to boost sales for multiple sclerosis drugs Tysabri, Avonex and Tecfidera by ‘seeding’ patients with free sample drugs then ‘sweeping’ them onto Medicare and other government insurance programs through its charity giving.” 

About health insurance

Aetna hit with class-action lawsuit alleging discriminatory policies for mental health treatment: “The complaint, which was filed this week in U.S. District Court in the Central District of California, alleges that Aetna illegally denied claims for mental health residential treatment services.
In 2019, the plaintiff, who has an Aetna insurance plan through his employer, Fox Entertainment Group, enrolled his 16-year-old son who has autism spectrum disorder in a mental health residential treatment center located in Utah, according to the complaint.
Aetna denied the plaintiff's claim for reimbursement for his son's treatment at the residential facility.
According to Aetna's letter to the plaintiff, as cited in the complaint, the insurer said it was denying coverage because the facility is not accredited by an agency such as The Joint Commission, the Committee on Accreditation of Rehabilitation Facilities, the American Osteopathic Association's Healthcare Facilities Accreditation Program or the Council on Accreditation.
Aetna also said the mental health residential treatment center is not covered under the terms of the plan because a behavioral provider is not actively on duty 24 hours per day for 7 days a week and the patient is not treated by a psychiatrist at least once per week but on an as-needed basis.”
Details about provisions for treatment in an accredited facility were not provided in the article.

Today's News and Commentary

About Covid-19

Pfizer booster now available to older Americans and those at higher-risk, including on the job, as CDC chief partly overrules panel: “In a rare move, CDC Director Rochelle Walensky late Thursday overruled her agency’s advisory panel and added a recommendation for boosters for people whose jobs put them at risk of infection.
The advisory panel had made a recommendation that largely mirrored an authorization issued a day earlier by the Food and Drug Administration, with a call for a third shot of the Pfizer-BioNTech vaccine for people 65 and older, nursing home residents and people 50 to 64 with underlying medical conditions six months after completing their second shot.”

Another judge rules against Tennessee governor letting parents opt out of school mask mandates: “A second federal judge on Friday batted down Tennessee Gov. Bill Lee’s (R) order letting parents exempt themselves from school mask mandates….
U.S. District Judge J. Ronnie Greer ruled Knox County Schools has to require face coverings to protect students with medical issues from the coronavirus, the news outlet reported. Greer’s order also blocks Lee’s policy from implementation while the lawsuit is ongoing.

About pharma

CMS official says Medicaid must cover Aduhelm as industry awaits national coverage decision: “The Centers for Medicare & Medicaid Services is advising state Medicaid programs that they must cover Biogen and Eisai's controversial Alzheimer's drug Aduhelm as an outpatient drug.
Biogen participates in Medicaid's drug rebate program. John Coster, director of pharmacy in CMS' Center for Medicaid and CHIP Services, said during a conference hosted this week by America's Health Insurance Plans that states can set their own medical eligibility criteria for the drug.
‘As I've said to states and others who have asked, Aduhelm is currently a covered outpatient drug,’ Coster said. ‘The manufacturer is a participating labeler in the program. The states can develop medical necessity criteria around that drug, or any other drug, but it is a covered outpatient drug.’”

Centene and Humana sue Merck over alleged drug deal: “Insurance companies Humana and Centene filed separate claims in New Jersey District Court on Wednesday. Both say [they overpaid ] Merck… hundreds of millions of dollars on cholesterol drugs Vytorin and Zetia due to the ‘pay-for-delay’ tactic. The complaints came just three months after the Kaiser Foundation Health Plan sued Merck, accusing the company of violating antitrust laws in many states by delaying the release of cheaper generic drugs.”

Facing class action lawsuit over insulin pricing, Novo Nordisk inks $100M settlement with disgruntled investors: ”After Novo Nordisk allegedly told investors it was resistant to industrywide insulin pricing pressures, some shareholders brought a class action lawsuit claiming they were misled. On Friday in a federal district court in New Jersey, Novo Nordisk agreed to a $100 million settlement with those disgruntled investors.”

About health insurance

What Has Become of the Affordable Care Act?: A really good summary of what has happened to the ACA since its passage.

Assessment of Costs and Care Quality Associated With Major Surgical Procedures After Implementation of Maryland’s Capitated Budget Model: “In this comparative effectiveness study of 525 262 Maryland patients who received surgery before and after implementation of Maryland’s all-payer model, lower complication rates were observed for coronary artery bypass grafting (11% decrease), carotid endarterectomy (2% decrease), hip arthroplasty (1% decrease), knee arthroplasty (<1% decrease), and cesarean delivery (1% decrease). Smaller estimated changes in hospital costs vs other states were also observed, with increases reduced by $6236 for coronary artery bypass grafting, $730 for carotid endarterectomy, $328 for hip arthroplasty, $415 for knee arthroplasty, $300 for cesarean delivery, and $745 for hysterectomy.”

CMS approves Clover Health's expansion into 101 new counties: “CMS gave Nashville, Tenn.-based Clover Health the go-ahead to expand into 101 new counties between five states — including Alabama, which it will be entering for the first time. 
The expansion nearly doubles Clover's reach, which swells to 209 counties…
In addition to Alabama, the insurer is entering counties in Georgia, New Jersey, South Carolina and Texas.”

CMS Reevaluating Hospital Outpatient Pay Rate Cut Exemptions: “CMS is reevaluating hospitals’ applications for exceptions from reimbursement cuts to their off-campus outpatient facilities following pushback from the industry.
In January, CMS rejected more than 60% of the mid-build exceptions, which is designed to preserve higher payments if hospitals document that their off-campus outpatient departments were under construction when the Bipartisan Budget Act passed in 2015.
Without the exception, reimbursement rates drop to 40% of the full outpatient prospective payments system rate. Hospitals would also be liable for overpayments issued starting Jan. 1, 2018, if they billed via OPPS.”

About the public's health

5000 alcohol-related cancer deaths could be prevented every year by doubling alcohol taxes in the European Region, says WHO/Europe: Another reminder that taxation is the best tool to control harmful behavior.

J&J Cleared of Responsibility for Woman’s Talc-Cancer Claim: “Johnson & Johnson isn’t responsible for a Pennsylvania woman’s cancer that she blamed on the company’s talc-based powders, a jury ruled in the company’s latest win in the nationwide litigation over its iconic baby powder.
Jurors in state court in Philadelphia concluded Friday J&J’s talc-based baby powder didn’t contribute to the onset of Ellen Kleiner’s ovarian cancer and the company doesn’t have to pay damages.
It’s J&J’s first win this year in cases targeting its well-known baby powder.”

A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease: The major kidney disease organizations recommend eliminating kidney function measures that were different for black patients because they lead to worse outcomes for those patients.

Cancer statistics for the US Hispanic/Latino population, 2021: “Compared to non-Hispanic Whites (NHWs), Hispanic men and women had 25%-30% lower incidence (2014-2018) and mortality (2015-2019) rates for all cancers combined and lower rates for the most common cancers, although this gap is diminishing.”
Read the article for more details.

About healthcare IT

Walmart, large employers launch virtual care service to tackle Black health disparities: “Walmart is partnering with virtual care company Grand Rounds Health and Doctor On Demand on a digital health program aimed at tackling health disparities among African American workers.
Walmart and a group of other large employers including Accenture, Best Buy, Genentech, Medtronic, State Farm and Target are spearheading a new initiative called the Black Community Innovation Coalition in partnership with the virtual care company.
Combined, the group employs more than 500,000 African American workers.
The companies say it's the first dedicated care concierge and healthcare navigation platform focused on improving the healthcare experience and advancing health equity for Black Americans. The goal is to create a culturally specific concierge service to engage workers of color on their health.”

UnitedHealthcare to make Apple Fitness+ available in fully insured employer plans: “Beginning Nov. 1, members in fully insured plans who already own an Apple Watch will be able to sign up for a yearlong Apple Fitness+ subscription for free. This covers about 3 million members across most states, UnitedHealthcare said.
Self-funded employers will have the option to add an ‘Apple Fitness+ bundle’ to their coverage next year, which will provide the subscription as well as a $25 digital Apple gift card to members.”

'Privacy Exception' No Cure for Doctors' Open Notes Headaches: “Some physicians are bridling at last week's federal advisory suggesting they can delay releasing bad news to patients' electronic health portals without violating the new federal law that requires it. Their patients just have to request the delay up front.
The framework for doing that is embedded in the "Privacy Exception," one of eight exceptions in the new Information Blocking or "Open Notes" rule. This one allows "actors" (i.e., clinicians) to withhold releasing health information to a patient if that release could harm the patient, according to a spokesman for the Office of the National Coordinator for Health Information Technology (ONC), which is administering the rule.”

About medical devices

GE Healthcare to Acquire BK Medical for ~ $1.45B:

  • “GE has signed an agreement to acquire BK Medical for $1.45B in cash and is eligible to receive a high-single-digit return on invested capital within 5yrs. The transaction is expected to close in 2022

  • The acquisition will allow GE Healthcare to expand its $3B ultrasound business from diagnostics into surgical & therapeutic interventions. The acquisition also accelerates its growth in precision health & adds capability in the surgical visualization segment

  • BK Medical provides ultrasound technology that can be used during surgery to guide clinicians. GE Healthcare anticipates BK Medical to deliver rapid revenue growth, margin expansion, and free cash flow growth



Today's News and Commentary

About Covid-19

FDA Authorizes Booster Dose of Pfizer-BioNTech COVID-19 Vaccine for Certain Populations: Yesterday the “U.S. Food and Drug Administration amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine to allow for use of a single booster dose, to be administered at least six months after completion of the primary series in:

  • individuals 65 years of age and older;

  • individuals 18 through 64 years of age at high risk of severe COVID-19; and

  • individuals 18 through 64 years of age whose frequent institutional or occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of COVID-19 including severe COVID-19.”

    Today, in a related story: A CDC Panel Backs Booster Shots For Older Adults, A Step Toward Making Them Available: “Advisers to the Centers for Disease Control and Prevention have recommended a third dose of Pfizer's COVID-19 vaccine for people 65 and older, as well as others at a high risk of severe illness.”

At Covid Summit, Biden Sets Ambitious Goals for Vaccinating the World: “President Biden, declaring the coronavirus an ‘all-hands-on-deck crisis,’ set out ambitious goals on Wednesday for ending the pandemic and urged world leaders, drug companies, philanthropies and nonprofit groups to embrace a target of vaccinating 70 percent of the world by next year…
Mr. Biden announced a series of actions, including the purchase of an additional 500 million doses of Pfizer’s vaccine at a not-for-profit price to donate overseas and $370 million to administer the shots. Vice President Kamala Harris announced that the United States would donate $250 million to a new global fund that aims to raise $10 billion to prevent future pandemics.”

Public Health Law after Covid-19: This article is an excellent summary of the recent rulings on the legality of governments’ public health actions.

Is The Worst Over? Modelers Predict A Steady Decline In COVID Cases Through March: “The delta surge appears to be peaking nationally, and cases and deaths will likely decline steadily now through the spring without a significant winter surge, according to a new analysis shared with NPR by a consortium of researchers advising the Centers for Disease Control and Prevention.”

Florida Students Are No Longer Required To Quarantine After Being Exposed To COVID: “A day after assuming his job, Florida's newly appointed surgeon general on Wednesday signed new protocols allowing parents to decide whether their children should quarantine or stay in school if they are asymptomatic after being exposed to someone who has tested positive for COVID-19.
The new guidelines signed by Dr. Joseph Ladapo also tweaked the state's prohibition against school mask mandates, prompting an administrative law judge to dismiss a lawsuit against the old rule that had been filed by various school boards.”

Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel: An update published yesterday: “Vaccine effectiveness for partial vaccination was 77.6% (95% confidence interval [CI], 70.9 to 82.7) with the BNT162b2 vaccine (Pfizer–BioNTech) and 88.9% (95% CI, 78.7 to 94.2) with the mRNA-1273 vaccine (Moderna); for complete vaccination, vaccine effectiveness was 88.8% (95% CI, 84.6 to 91.8) and 96.3% (95% CI, 91.3 to 98.4), respectively. Vaccine effectiveness was similar in subgroups defined according to age (<50 years or ≥50 years), race and ethnic group, presence of underlying conditions, and level of patient contact.”

Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial: “Early administration of inhaled budesonide reduced the likelihood of needing urgent medical care and reduced time to recovery after early COVID-19.”

Veklury® (Remdesivir) Significantly Reduced Risk of Hospitalization in High-Risk Patients with COVID-19: “Veklury demonstrated a statistically significant 87% reduction in risk for the composite primary endpoint of COVID-19 related hospitalization or all-cause death by Day 28 (0.7% [2/279]) compared with placebo (5.3% [15/283]) p=0.008. Results also showed an 81% reduction in risk for the composite secondary endpoint of medical visits due to COVID-19 or all-cause death by Day 28 for participants treated with Veklury (1.6% [4/246]) compared with placebo (8.3% [21/252]) p=0.002. In the study, no deaths were observed in either arm by Day 28.”

About hospitals and health systems

Prime-UnitedHealthcare Alignment Shows Price Transparency Data Will Impact Contract Negotiations: Price transparency is supposed to lower prices, however, many saw this result coming.
”Demanding more money from insurance giant UnitedHealthcare, Prime Healthcare hospitals in New Jersey have armed themselves with a new negotiating tool: price transparency data.
Effective January 1, federal rule requires hospitals to publicly disclose the prices they charge for medical care, including rates agreed with insurers. While compliance has been grim, Prime said it still sees itself being paid far less than many of its local counterparts. This has led to a scuffle that threatens network outreach to thousands of patients.”
In a related article: Parent Preferences for Transparency of Their Child’s Hospitalization Costs: “In this cross-sectional survey study of 526 parents of hospitalized children, 398 (76%) believed it was important to know the costs of their child’s care, and 397 (75%) wanted a hospital employee to discuss these costs. However, only 36 parents (7%) reported having a cost discussion during admission.
Meaning:  These findings suggest that most families desire cost transparency in the care of their hospitalized child, but cost conversations rarely happen in the inpatient setting.”

World's Best Specialized Hospitals 2022: FYI, from Newsweek.

About healthcare IT

The State of Digital Patient Access: “Kyruus assessed the top 20 US News and World Report ranked hospitals, evaluating them across four key categories representing the main stages of the digital patient access journey: Engage, Search, Match and Book” Read the report for results across these dimensions.

California woman sold Medicare tool that gave improper access to 500,000 patients' data, feds say: “ A California woman was sentenced Sept. 21 to three years of probation for her role in a multimillion-dollar Medicare fraud scheme that exposed the private data of more than 500,000 patients, according to the Justice Department. 
Stefanie Hirsch, 51, of Los Angeles, pleaded guilty Feb. 24 to violating HIPAA. Ms. Hirsch, who owned Medicare-enrolled wheelchair and scooter repair company El Medical, sold access to a Medicare eligibility tool that let Juan Perez Buitrago and Nathan LaParl improperly access patients' personal, medical and insurance information, the Justice Department said.”
In a related article: The Increasing Use of HIPAA Subpoenas in Federal Health Care Investigations: “Health Insurance Portability and Accountability Act (HIPAA) subpoenas are administrative subpoenas which, pursuant to 18 U.S.C. § 3486, allow DOJ prosecutors to compel the production of documents in any investigation involving a federal health care offense. And while compelling the production of documents can be similarly achieved with the issuance of a federal grand jury subpoena, the HIPAA subpoena provides federal prosecutors with the ability to do something that the grand jury subpoena cannot: share the gathered information with civil DOJ attorneys pursuing a parallel civil investigation. By opening the door to greater intra-departmental cooperation, the HIPAA subpoena is becoming the investigative tool of choice of certain US Attorney's Offices in health care investigations.”

About pharma

Garuda thinks it has cracked the code to off-the-shelf stem cell transplants—and investors are betting $72M to find out: “We know blood stem cell transplants are potential cures for serious diseases. The problem is, patients need cells from immune-compatible donors, creating a supply bottleneck that constrains use in some areas and blocks expansion into new diseases. Garuda Therapeutics thinks it may have come up with a fix for that problem—and has persuaded investors to bet $72 million on its vision.
Massachusetts-based Garuda landed the investment on the strength of its platform for generating off-the-shelf, self-renewing blood stem cells. Equipped with the platform, Garuda wants to eliminate the need for healthcare providers to find matched donor materials or use a patient’s own cells.”

HRSA intends to fine 6 drugmakers over 340B contract pharmacy violations: “Eli Lilly, Sanofi, AstraZeneca, Novartis, Novo Nordisk, and United Therapeutics all received letters dated Wednesday outlining the update. The six drugmakers were warned back in May by the HRSA that moves to restrict sales to contract pharmacies violated the 340B statute.”

About health insurance

Pain Doctor Convicted of Over $100 Million Health Care Fraud Scheme: “According to court documents and evidence presented at trial, Francisco Patino, 66, of Wayne County, excessively prescribed highly addictive opioids to his patients at his medical clinic in Livonia. In exchange for opioids, these patients would receive (or be billed as if they had received) facet joint or nerve block injections, both lucrative spinal injections. Although these spinal injections were purportedly intended to treat chronic pain, evidence at trial demonstrated that Patino injected patients without regard to medical necessity. Evidence also revealed that if patients refused to accept the injections, Patino would withhold their prescriptions for opioids. From January 2012 through July 2017, Patino billed Medicare for more of these injections than any provider in the country…
Patino also developed illegal kickback relationships with at least one diagnostic laboratory, under which he was paid in exchange for referring his patients’ samples to that lab.”