Today's News and Commentary

About Covid-19

Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19–Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January–September 2021: From the CDC: “Among COVID-19–like illness hospitalizations among adults aged ≥18 years whose previous infection or vaccination occurred 90–179 days earlier, the adjusted odds of laboratory-confirmed COVID-19 among unvaccinated adults with previous SARS-CoV-2 infection were 5.49-fold higher than the odds among fully vaccinated recipients of an mRNA COVID-19 vaccine who had no previous documented infection (95% confidence interval = 2.75–10.99)…
All eligible persons should be vaccinated against COVID-19 as soon as possible, including unvaccinated persons previously infected with SARS-CoV-2.” [Emphasis added]

COVID-19′s global death toll tops 5 million in under 2 years: “Together, the United States, the European Union, Britain and Brazil — all upper-middle- or high-income countries — account for one-eighth of the world’s population but nearly half of all reported deaths. The U.S. alone has recorded over 745,000 lives lost, more than any other nation.”

Sanofi-GSK COVID-19 Shot Will Cost Around $11: “Sanofi is planning to price its recombinant protein-based COVID-19 vaccine developed with a GlaxoSmithKline (GSK) adjuvant at approximately $11 a dose.
Phase 3 trials on a reformulated version of the Sanofi-GSK vaccine candidate began in May and the companies are now also assessing booster jabs. Full trial results are expected by year’s end.”

About hospitals and health systems

How CHS, HCA, Tenet and UHS fared in Q3: A good summary of the reports from these four systems. Profitability is picking up even as hospitals repay Medicare advances.

Cost of Caring: From the AHA. A few highlights, though the entire monograph is worth reading:

  • “In recent years, health care spending growth has largely been driven by increased use and intensity of services.”

  • The highest cost for hospitals is still wages and benefits (at 56% of the total).

  • The AHA makes its case that insurance premiums are not rising because of hospital expenses: “Hospital price growth averaged 2.0% annually from 2010 until the beginning of the COVID-19 pandemic. Health insurance premiums, however, have increased 4.4% per year on average since 2010.”

About healthcare quality

Cardiovascular Safety Communications After US Food and Drug Administration Approval of Contemporary Cancer Therapies: “In this evaluation of contemporary FDA-approved cancer therapeutics, more than 1 in 4 required a cardiotoxic effects safety warning, including more than 40% targeted and immune-based drugs. In postmarketing, the median time to CVD warning issuance was nearly 5 years, a value 40% longer than noncardiac warnings. This pattern remained, even after accounting for the presence or absence of preceding safety reports.”

Watch Out for These Diagnostic Pitfalls: “…researchers looked both at where the diagnosis went wrong as well as the contributing factors that made the diagnosis harder than usual. They ended up analyzing 836 diagnostic cases…
The Top 10 missed diagnoses, in order of frequency from highest to lowest, were:

Colorectal cancer
Lung cancer
Breast cancer
Myocardial infarction
Prostate cancer
Stroke
Sepsis
Bladder cancer
Pulmonary embolism
Brain hemorrhage
In terms of where things went wrong in the process, failure to order a needed test was the most frequent issue, followed by failure to consider the correct diagnosis, failure to or delay in follow-up for an abnormal test result, failure to heavily weigh a critical piece of the patient's history, and failure or delay in ordering a referral.”

About health insurance

Tracking Health Insurance Coverage in 2020-2021: From HHS:

  • “Recent survey data suggest a stable uninsured rate in 2020 despite the pandemic and related recession, with estimates ranging from 8.6 percent to 9.7 percent of the population (28.0 million to 31.6 million people).

  •   Examination of other available data sources provides insights about changes in coverage by source and the overall stability of insurance rates in 2020. Administrative data over the same period suggest that increases in Medicaid and Marketplace enrollment roughly offset decreases in employer coverage, potentially explaining the survey findings.

  •   More recent administrative data in 2021 show ongoing gains in Medicaid (1.7 million between January and April 2021) and Marketplace coverage (1.6 million between August 2020 and August 2021), which suggest that the uninsured rate may be lower now than it was in early 2021.

  •   Uninsured rates continue to be higher in certain populations, including Latinos (18.3 percent) and Blacks (10.4 percent), people with incomes below the poverty level (17.2 percent), and residents of states that have not expanded Medicaid (17.6 percent).”

ACA Marketplaces Became Less Affordable Over Time For Many Middle-Class Families, Especially The Near-Elderly: “In 2015 half of this middle-class population would have paid at least 7.7 percent of their income for the lowest-cost bronze plan; in 2019 they would have paid at least 11.3 percent of their income. By 2019 half of the near-elderly ages 55–64 would have paid at least 18.9 percent of their income for the lowest-cost bronze plan in their area. The American Rescue Plan Act temporarily expanded tax credit eligibility for 2021 and 2022, but our results suggest that families with incomes of 401–600 percent of poverty will again face substantial financial burdens after the temporary subsidies expire.”

About healthcare IT

Wearable device signals and home blood pressure data across age, sex, race, ethnicity, and clinical phenotypes in the Michigan Predictive Activity & Clinical Trajectories in Health (MIPACT) study: a prospective, community-based observational study: “Wearable technology has rapidly entered consumer markets and has health-care potential; however, wearable device data for diverse populations are scarce. We therefore aimed to describe and compare key wearable signals (ie, heart rate, step count, and home blood pressure measurements) across age, sex, race, ethnicity, and clinical phenotypes…”
Among the findings: “Blood pressure and resting heart rate varied by sex, age, race, and ethnicity, with higher blood pressures in males and lower heart rate in participants aged 65 years or older (p<0·0001). Participants took 7511 steps per day (SD 2805) and walked 6009 metres per day (SD 2608), varying across demographic and clinical subgroups.”

DATA PROTECTION REPORT 2021: Among the findings:
Average cost of a data breach has grown from $7.91m in 2018 to $9.05m so far in 2021.
More than 50% of business leaders said they do not have a response plan to a breach.
40% of breaches are caused by external partners and almost 25% by employee error.

About the public’s health

Fetal Mortality Drops to Historic Low of 5.70 Per 1,000 in 2019: “The fetal mortality rate at 20 or more weeks of gestation in the United States was 5.70 per 1,000 live births or fetal deaths in 2019, down 3 percent from 2018, according to the Oct. 26 National Vital Statistics Reports, a publication from the U.S. Centers for Disease Control and Prevention.”

About pharma

Merck Announces Withdrawal and Refiling under the Hart-Scott-Rodino Act and Extension of Tender Offer to Acquire Acceleron Pharma Inc.: “Merck has elected to withdraw its Premerger Notification and Report Form, which was initially filed on October 14, 2021, to provide the Federal Trade Commission (the "FTC") with additional time for review, and expects to refile such form on or about November 1, 2021. Following the refiling, the waiting period applicable to the pending acquisition will expire at 11:59 p.m., Eastern time, on or about November 16, 2021. The acquisition is expected to close in the fourth quarter of 2021.”

Today's News and Commentary

About Covid-19

FDA authorizes Pfizer-BioNTech vaccine for children 5 to 11: “The Food and Drug Administration’s emergency clearance is for a two-shot regimen administered three weeks apart. The dose, 10 micrograms, is one-third that used for adolescents and adults. In a clinical trial of 5- to 11-year-olds, the vaccine was almost 91 percent effective at preventing covid-19, the illness caused by the virus. The vaccine’s safety was studied in about 3,100 children who received the shot and had no serious side effects, the agency said.”

Community transmission and viral load kinetics of the SARS-CoV-2 delta (B.1.617.2) variant in vaccinated and unvaccinated individuals in the UK: a prospective, longitudinal, cohort study: “Vaccination reduces the risk of delta variant infection and accelerates viral clearance. Nonetheless, fully vaccinated individuals with breakthrough infections have peak viral load similar to unvaccinated cases and can efficiently transmit infection in household settings, including to fully vaccinated contacts. Host–virus interactions early in infection may shape the entire viral trajectory.”

Supreme Court upholds vaccine mandate for Maine health-care workers that does not include religious exemption: “The Supreme Court Friday turned down a request from a group of Maine health-care workers to block a state coronavirus vaccination mandate that does not contain an exception for religious objectors.
Three conservative justices dissented from the decision. While the majority did not give a reason for denying the request, Justice Neil M. Gorsuch wrote that the workers deserved an exemption.”

Federal rule in the works could force unvaccinated workers to pay for their COVID-19 tests: “A federal vaccination mandate currently under review for private companies could allow employers to make workers who refuse to get the shot pay for required COVID-19 testing and masks.”

About pharma

J&J to Pay $297 Million to Settle Texas Opioid Lawsuits: “Johnson & Johnson (J&J) has agreed to pay $297 million to Texas by year’s end to settle claims over the company’s alleged role in the state’s opioid epidemic if enough local governments approve the settlement.
The proposed deal is independent from a proposed $26 billion national opioid settlement negotiated with the three largest U.S. drug distributors — McKesson, Cardinal Health and AmerisourceBergen — and drugmaker J&J, who agreed to pay $5 billion over nine years under its terms.”

Why do placebos work? Scientists identify key brain pathway: The study used functional MRI readings:
Both the placebo and nocebo[when patients are told a placebo has harmful side effects] influenced activity in the brainstem, the researchers report this week in The Journal of Neuroscience. The placebo effect increased activity in an area called the rostral ventromedial medulla, which relays pain information, and decreased activity in the periaqueductal gray, which helps the body suppress pain. The nocebo effect induced the opposite change. (The findings may seem counterintuitive, but multiple areas of the brainstem act in complex ways when it comes to creating the sensation of pain, the authors say.)”

About healthcare IT

FDA releases ‘guiding principles’ for AI/ML device development: “The FDA, along with its U.K. and Canadian counterparts, said the principles are intended to lay the foundation for Good Machine Learning Practice…
The principles are:  

  1. The total product life cycle uses multidisciplinary expertise.

  2. The model design is implemented with good software engineering and security practices.

  3. Participants and data sets represent the intended patient population.

  4. Training data sets are independent of test sets.

  5. Selected reference data sets are based upon best available methods.

  6. Model design is tailored to the available data and reflects intended device use.

  7. Focus is placed on the performance of the human-AI team.

  8. Testing demonstrates device performance during clinically relevant conditions.

  9. Users are provided clear, essential information.

  10. Deployed models are monitored for performance, and retraining risks are managed.”

Hacker breached Massachusetts systems' emails for 6+ months; 200,000+ individuals affected: “Worcester-based UMass Memorial Health began notifying more than 200,000 patients and health plan participants that a hacker breached employee email accounts containing their personal information, according to data the health system shared with HHS…”

About the public’s health

US lowers cutoff for lead poisoning in young kids: “The more stringent standard announced Thursday by the Centers for Disease Control and Prevention means the number of children ages 1 to 5 considered to have high blood lead levels will grow from about 200,000 to about 500,000. 
Some experts think the change was overdue. The CDC last changed the definition nine years ago and pledged to consider an update every four years. But work on a revision hit obstacles during the Trump administration, said Patrick Breysse, who heads the CDC’s National Center for Environmental Health.”

No chocolate or ice cream ads for kids as Spain tackles obesity: A lesson for the US?
”Spain will ban advertising of unhealthy foods and drinks like chocolate, biscuits and ice cream aimed at children to help fight obesity in young people, the consumer affairs minister said on Thursday.”

About health insurance

Molina sees 22% dip in net income despite revenue growth in Q3: “Molina Healthcare's total revenue was up over $2 billion from 2020's third quarter, currently sitting at $7 billion.
However, profits were down this quarter, with the insurer reporting a net income of $143 million. This is a 22 percent decrease from 2020's $185 million in profits during the same quarter.”
Most insurers have remained profitable this year due to a reduction in elective procedures.

The More Things Change, the More They Stay the Same: An Analysis of the Generosity of Employment-Based Health Insurance, 2013–2019: From EBRI: “In this paper we explore trends in actuarial value — or relative generosity of health plans — in the employment-based health coverage market since the implementation of the major coverage provisions of the Affordable Care Act (ACA) in 2014. Because there is a concern that workers would migrate to lower actuarial value (AV) plans in the exchanges if the Biden Health Care Plan were adopted, it is also important to know whether workers are already enrolling in lower AV plans in the employment-based market as a result of the ACA. In our analysis, we observe:

  • Both average and median AV were about 83 percent in each year from 2013 to 2019.

  • There were differences in average AV by plan type. The average AV for enrollees in health maintenance organizations (HMOs)/exclusive provider organizations (EPOs) was highest. This was followed by the AV of enrollees in fee-for-service plans. Preferred provider organization (PPO) and point of service (POS) enrollees saw an average AV of 85 percent and 84 percent, respectively. Not surprisingly, plans linked to spending accounts had the lowest AVs.

  • Average AV increased for every type of health plan between 2013 and 2019.

  • We did not find that demographics significantly affected plan choice.

  • We did find variation in AV by industry. Workers in retail trade, agriculture, forestry, fishing, construction, finance, insurance, and real estate are in the lowest AV plans.

    As opposed to group coverage, health insurance purchased in the individual market tends to be somewhat less generous in benefits, on average.”

In other words, employer-sponsored health insurance has remained as generous as it was when the ACA was implemented.

About healthcare regulations

HHS Moves to Undo Trump’s Retrospective Review of Agency Rules: “The Health and Human Services Department on Thursday moved to withdraw or repeal a last-minute Trump administration rule that would have caused health regulations to expire if they weren’t reviewed every 10 years.
The HHS released a proposal that would do away with the rule, (RIN 0991-AC24), which was published in the Federal Register on Jan. 19, one day before President Joe Bidentook office. Under the rule, the HHS would have had five years to assess regulations that are more than 10 years old, and the department could have extended that deadline one time per regulation, for up to a year.
The final rule exempted certain Food and Drug Administration regulations and annual Affordable Care Act rules, in addition to procedural rules, regulations issued jointly with other agencies, and regulations around internal management.”



Today's News and Commentary

About Covid-19

Cheap antidepressant shows promise treating early COVID-19: “The pill, called fluvoxamine, would cost $4 for a course of COVID-19 treatment. By comparison, antibody IV treatments cost about $2,000 and Merck’s experimental antiviral pill for COVID-19 is about $700 per course. Some experts predict various treatments eventually will be used in combination to fight the coronavirus.”

The impact of school opening model on SARS-CoV-2 community incidence and mortality: “After controlling for case rate trends before school start, state-level mitigation measures and community activity level, SARS-CoV-2 incidence rates were not statistically different in counties with in-person learning versus remote school modes in most regions of the United States. In the South, there was a significant and sustained increase in cases per week among counties that opened in a hybrid or traditional mode versus remote…”

Thermo Fisher Scientific’s Saliva-Based COVID-19 Test Gets EUA: “The saliva collection devices are self-contained systems that provide sample consistency and long-term stability. The samples can be shipped and stored at ambient temperatures with no degradation in quality, the company said.
Thermo Fisher’s SDNA saliva collection devices protect DNA and RNA transcripts postcollection to help ensure accurate test results from 2 mm of saliva.”

Tennessee lawmakers aim to protect physicians who use unapproved COVID treatments: “Tennessee state Reps. Debra Moody and Chris Todd have proposed legislation that would prevent punishment of physicians who recommend treatments for COVID-19 that have not been approved by the FDA to treat the disease…”

More Than 8 in 10 Unvaccinated Americans Don’t Want a COVID Vaccine: “New data from the COVID Behaviors Dashboard, developed by the Johns Hopkins Center for Communication Programs, show that 83 percent of those who remain unvaccinated against COVID-19 in the United States have little or no interest in ever getting a vaccine.  
The findings, collected from more than one million people surveyed in the United States in September, suggest that many Americans have made up their minds, leaving them and those around them at higher risk of dying from COVID-19…”

Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States: The latest from the CDC. Among the recommendations is one that immunocompromised people may need a 4th dose.

Merck signs pact to broaden generic manufacturing of COVID-19 pill: “Merck & Co has signed a licensing agreement with the United Nations-backed Medicines Patent Pool (MPP) that will allow more companies to manufacture generic versions of its experimental oral antiviral COVID-19 treatment…”

About health insurance

Kaiser defrauded Medicare of $1B, Justice Department alleges: “Oakland, Calif.-based Kaiser Permanente and various affiliates defrauded Medicare of about $1 billion by adding diagnoses to patients' medical records to increase reimbursement, the Justice Department alleged in a complaint filed Oct. 25. 
The Justice Department alleges that Kaiser physicians submitted inaccurate diagnosis codes for Medicare Advantage beneficiaries from 2009 through 2018.”

Association of Expanded Health Care Networks With Utilization Among Veterans Affairs Enrollees: “Individuals who lived 40 or more miles away from a VA facility were automatically eligible for an expanded health care network through non-VA practitioners (VA community care); those living less than 40 miles away from a VA facility were not automatically eligible…
In this study, expanded network access was associated with increased total health care utilization among affected enrollees in the VA.”
The results are probably not a surprise, but gives the magnitude of the accessibility problem for veterans.

Aetna launches Gene-Based, Cellular and Other Innovative Therapies (GCIT) designated network: “Aetna , a CVS Health company (NYSE CVS), announced the launch of its designated Gene-based, Cellular, and Other Innovative Therapies (GCIT) network. This network is designed to enable members' access to new therapies that treat and potentially cure rare genetic diseases, while helping to manage the high cost of these therapies. Aetna's national GCIT network includes access to more than 75 designated GCIT service providers that have demonstrated quality and value in the delivery of GCIT services…
Beginning January 1, 2022, Aetna's designated GCIT network will provide three gene therapy services, including Luxturna, Spinraza and Zolgensma for the treatment of inherited retinal disease and spinal muscular atrophy. The GCIT network is included as a standard medical benefit in all Aetna fully insured plans and is also available to self-insured plans.”
If all pending treatments are FDA approved, Aetna expects these gene therapies will add an extra $45 trillion to healthcare prices between 2020 to 2024.”
In a related article: NIH, FDA and 15 private organizations join forces to increase effective gene therapies for rare diseases: “The newly launched Bespoke Gene Therapy Consortium (BGTC), part of the NIH Accelerating Medicines Partnership (AMP) program and project-managed by the Foundation for the National Institutes of Health (FNIH), aims to optimize and streamline the gene therapy development process to help fill the unmet medical needs of people with rare diseases.

UnitedHealthcare alleges TeamHealth exaggerated ER care: “Health insurance company UnitedHealthcare is suing TeamHealth, a company that staffs hospital emergency rooms, alleging TeamHealth billed for more expensive ER services that didn't match the care doctors actually provided…
UnitedHealthcare analyzed ER claims and records from TeamHealth, saying they found 62% of TeamHealth's claims involving the highest-paying ER codes were unjustified by notes in medical records.”

Medicare Punishes 2,499 Hospitals for High Readmissions: “In its 10th annual round of penalties, Medicare is reducing its payments to 2,499 hospitals, or 47% of all facilities. The average penalty is a 0.64% reduction in payment for each Medicare patient stay from the start of this month through September 2022. The fines can be heavy, averaging $217,000 for a hospital in 2018, according to Congress’ Medicare Payment Advisory Commission, or MedPAC. Medicare estimates the penalties over the next fiscal year will save the government $521 million. Thirty-nine hospitals received the maximum 3% reduction, and 547 hospitals had so few returning patients that they escaped any penalty.”
Look Up Your Hospital: Is It Being Penalized By Medicare?

Drug pricing, most Medicare expansions are out of Biden's economic bill: A good summary of the latest compromises.

About the public’s health

HHS pledges more effort, resources toward harm reduction for drug users: “Health and Human Services Secretary Xavier Becerra outlined the Biden administration’s strategy for curbing drug overdoses Wednesday, committing more federal support for harm reduction techniques such as distribution of clean syringes and test strips used to check street drugs for hidden fentanyl.
The four-part strategy also includes measures to prevent drug addiction, in part by continuing to reduce the inappropriate prescribing of opioids; expanding medication-based treatment, which research has shown to be the most effective approach; and improving support for people recovering from substance use disorder.”

Phthalate and novel plasticizer concentrations in food items from U.S. fast food chains: a preliminary analysis: “A selection of popular fast food items sampled in this study contain detectable levels of replacement plasticizers and concerning ortho-phthalates. In addition, food handling gloves contain replacement plasticizers, which may be a source of food contamination. These results, if confirmed, may inform individual and regulatory exposure reduction strategies.”

􏰑Federal Trade Commission Cigarette Report 2020: Cigarette sales increased by 800 million units from 2019 to 2020, the first increase in twenty years. Advertising and promotional expenses also increased during that time. Of note is the report did not include vaping products.

About hospitals and health system

CHS sees profit rise, faces lawsuit over Quorum bankruptcy: “Franklin, Tenn.-based Community Health Systems, which operates 83 hospitals in 16 states, saw revenues decline in the third quarter of this year but ended the period with higher net income. The hospital operator released its third-quarter earnings two days after being sued over the 2020 bankruptcy of a company it spun off…
CHS released its quarterly earnings a few days after being sued over the 2020 bankruptcy of Quorum Health, a company it spun off in 2016. The complaint, filed Oct. 25, alleges actions by CHS and Credit Suisse Group burdened Quorum with more than $1.2 billion in debt. CHS tapped Credit Suisse as an adviser during the spinoff…”

About healthcare IT

TransUnion divests RCM unit in $1.74B deal: “nThrive, a healthcare revenue cycle management software-as-a-service platform, has signed a definitive agreement to acquire TransUnion Healthcare, the healthcare data and analytics business of TransUnion.”

About pharma

In the Midst of COVID-19 Crisis, 7 out of 10 Big Pharma Companies Spent More on Sales and Marketing than R&D: “The AHIP analysis examined the 10 largest pharmaceutical companies by revenue in 2020. Using pharmaceutical companies’ own annual reports and other financial filings…
Of the 10 drug manufacturers examined, 7 of them spent more on selling and marketing expenses than they did on research and development. For this group of 10 companies alone, selling and marketing expenses exceeded R&D spending by $36 billion, or 37%. Moreover, this use of dollars occurred during a year dedicated to the development of new treatments and vaccines to overcome the COVID-19 crisis.”
The article has some company specifics.

Today's News and Commentary

About Covid-19

Moderna says its COVID-19 vaccine protective, safe in young children: “Moderna Inc said on Monday its COVID-19 vaccine generated a strong immune response in children aged six to 11 years and that it plans to submit the data to global regulators soon.”

FDA review appears to pave the way for Pfizer-BioNTech vaccine for children 5 to 11: “The review found that for four scenarios that were weighed, “the benefits of the Pfizer-BioNTech COVID-19 Vaccine 2-dose primary series clearly outweigh the risks.” But in one, when the virus was at its lowest levels, there could be more hospitalizations related to a rare heart side effect associated with the vaccine than the number of hospitalizations prevented from covid-19, the illness caused by the virus.
Even then, the review found, “the overall benefits of the vaccine may still outweigh the risks under this lowest incidence scenario”because of how hospitalized cases of the two conditions differ. The vaccine-related myocarditis cases have tended to resolve in a few days, unlike covid-19 infections, which can lead to death.”

White House: We don’t have ‘unlimited rights’ to Moderna vaccine recipe: Despite significant federal support…”The Biden administration has concluded that it lacks the authority to share details of Moderna’s vaccine process, two senior administration officials told The Washington Post, after a months-long legal review.”

US will require foreign travellers to get WHO-authorised vaccines: “Under the rules, which will take effect in two weeks’ time, anyone who has been inoculated with one of the seven vaccines authorised by the WHO will be allowed to enter the US by land or air. They include the Sinovac and Sinopharm vaccines, which were developed in China, despite the lack of data about their effectiveness against the Delta variant of the coronavirus…
Children under the age of 18, people with allergies to any of the vaccine ingredients and visitors from countries where less than 10 per cent of the population has been vaccinated will all be exempt from the new mandate.”
Policy-makers at all governmental levels (in most places) in this country are trying to get everyone immunized with effective vaccines. How did this travel policy get approved???

EEOC Issues Updated Covid-19 Technical Assistance: “The U.S. Equal Employment Opportunity Commission (EEOC) today posted updated and expanded technical assistance related to the COVID-19 pandemic, addressing questions about religious objections to employer COVID-19 vaccine requirements and how they interact with federal equal employment opportunity (EEO) laws…
The key updates to the technical assistance are summarized below:

  • Employees and applicants must inform their employers if they seek an exception to an employer’s COVID-19 vaccine requirement due to a sincerely held religious belief, practice, or observance.

  • Title VII requires employers to consider requests for religious accommodations but does not protect social, political, or economic views, or personal preferences of employees who seek exceptions to a COVID-19 vaccination requirement.

  • Employers that demonstrate ‘undue hardship’ are not required to accommodate an employee’s request for a religious accommodation.”

Senate confirms Biden pick to lead OSHA as vaccine rule nears: “The U.S. Senate on Monday voted along party lines to confirm California workplace safety chief Doug Parker to lead the Occupational Safety and Health Administration (OSHA), filling the post for the first time in more than four years.”

The Ridiculous Practice That Stopped Some Nurses From Working in a Pandemic: The article provides examples of how non-compete clauses are restricting nurses from practicing in needed areas.

HHS extends shelf life of Eli Lilly's COVID-19 antibody drug: “HHS has extended the shelf life of Eli Lilly's COVID-19 antibody cocktail drug for six more months. 
The drug, a combination of monoclonal antibodies etesevimab and bamlanivimab, can now be refrigerated for 18 months instead of 12…”

About health insurance

Lower premiums, more choices on Obamacare exchanges for 2022 as Democrats battle to extend generous subsidies: “The average premium for the benchmark silver plan in 2022 will decline by 3% a month for the 33 states that are participating in the federal exchange, healthcare.gov, according to the report, issued by the Centers for Medicare & Medicaid Services.
This is the fourth year in a row that premiums have dropped, as insurers are better able to price their policies based on enrollees' health care needs and as the marketplaces become more competitive. The average benchmark plan premium is 10% lower for a 27-year-old and 9% lower for a family of four than in 2018, before subsidies, for example.”
In a related posting from CMS: Marketplace 2022 Open Enrollment Fact Sheet

10 ZIP codes with the highest uninsured rates: FYI

Aetna to shift to digital payments, remittances by September 2022: “Aetna has set a September 2022 goal to move to digital payments, remittances and explanation of benefits statements.
The move began last month, and the payer is encouraging providers to use its Availity provider portal for explanation of benefits statements and direct deposit or virtual credit cards for payments, according to an October newsletter.”

Coalition of employers launches PBM: “A nonprofit coalition of large, private employers has launched a new pharmacy benefit manager named EmsanaRx. 
The Purchaser Business Group on Health, which includes nearly 40 employers, said the new PBM will increase transparency and flexibility for employers. 
The group said EmsanaRx will address the "lack of accountability of the PBM industry to its employer clients, who largely lack access to information about drug costs, true discounts and administrative fees that contribute to huge profits…
The group said EmsanaRx will offer a fixed price per prescription and direct guidance from a dedicated clinical pharmacist account manager partnering with employers to design their own pharmacy network and modify their formulary.”

About the public’s health

Vaping marijuana by teens doubles in last seven years, with potentially harmful consequences, study says: “Marijuana vaping by school-aged youth doubled between 2013 and 2020, a new study found, with reported use within the last 30 days rising seven-fold during the same time period.”

Trends in Mortality Among Pregnant and Recently Pregnant Women in the US, 2015-2019: “All-cause mortality rates for recently pregnant women increased 4.4% annually from 2015 to 2019, mostly attributable to causes other than pregnancy-specific complications, including drug/alcohol poisoning, and the APCs for all-cause and drug/alcohol poisoning mortality rates were greater for recently pregnant women than for the total female population of childbearing age.”

About hospitals and health systems

FTC tightens reins on merger control: 6 things to know: “The Federal Trade Commission announced Oct. 25 it is restoring its practice of requiring companies that previously pursued an anticompetitive merger to get prior approval for future transactions.”
For example: “The FTC is reinstating the prior approval practice after the commission voted in July to repeal a 1995 policy statement that prevented the agency from imposing these merger restrictions.”

UHS grows to 360 hospitals, posts $218M profit in Q3: “King of Prussia, Pa.-based Universal Health Services reported higher revenue but a lower profit in the third quarter of 2021. 
The hospital chain's revenues increased 8.4 percent year over year to $3.2 billion in the third quarter of this year. The company's 360 acute care and behavioral health hospitals contributed to the growth.”
Non-Covid-19 related care contributed to the revenue growth.

About diagnostics

FDA Designates Biological Dynamics’ Pancreatic Cancer Test a Breakthrough Device: “he FDA has designated Biological Dynamics’ liquid biopsy assay, Exo-PDAC (pancreatic ductal adenocarcinoma), as a breakthrough device.
The assay is designed to detect PDAC, an aggressive and lethal form of cancer early in the course of the disease in high-risk adults.”

About healthcare IT

Amazon’s Latest Healthcare Venture: Bringing Alexa To The Patient’s Bedside: Amazon announced its latest venture: integrating and scaling its famous Alexa systems into senior living communities and large healthcare systems…
For senior living facilities, the idea is to develop a stronger sense of community and connectedness: the initiative aims to ‘tailor resident experiences by customizing community information like activity schedules and meal menus. Care team members can communicate more efficiently with residents using Alexa communication features, which enable them to make Announcements, voice and video calls, or send direct audio messages to other Alexa-enabled devices throughout the property.’
For hospital systems, efficiency and communication are key factors: ‘patients can communicate with their care staff, control devices in their room, or stay informed and entertained with news and music, just by asking Alexa. Healthcare providers can communicate with patients quickly and easily with features like calling and Drop In—without the need to enter patient rooms. This enables hospitals to increase productivity, conserve medical supplies and protective equipment, such as masks, gloves, and gowns, and free up staff time to provide more personalized care.’”

Today's news and Commentary

About health insurance

Patient and Payer Incentives to Use Patented Brand-Name Drugs vs Authorized Generic Drugs in Medicare Part D: “The results of this cross-sectional study suggest that authorized generic drugs for insulin and direct-acting antiviral agents may lower out-of-pocket spending for patients but are unlikely to provide savings for Part D plans or Medicare. Instead, these drugs allow manufacturers to offer products at a lower list price without materially lowering net prices or profits.”

Blue Shield of California, Google Cloud to develop real-time claims processing platform: “Together, the companies will create a real-time claims processing platform leveraging automation, artificial intelligence and machine learning technologies. The platform will be designed to streamline the back-end billing processes between Blue Shield of California and the providers it contracts with.
The solution will extract clinical data from the provider’s EMR and then codify that record into a digital claim for billing, said Lisa Davis, senior vice president and chief information officer at Blue Shield of California. The payer will adjudicate that claim and send back a claim settlement decision to the provider, which will be shared with the patient in near real time.”
Currently, the provider bills the payer based on coding criteria. This method, if proved accurate, would remove the subjectivity of billing, reduce administrative cost and decrease turnaround time for adjudication of claims.

A $1,775 Doctor’s Visit Cost About $350 in Maryland. Here’s Why.: An excellent account of the Maryland rate-control system.

About the public’s health

Cost-effectiveness Evaluation of the 2021 US Preventive Services Task Force Recommendation for Lung Cancer Screening: “This economic evaluation found that the 2021 USPSTF recommendation for lung cancer screening was cost-effective; however, alternative screening strategies that maintained a minimum cumulative smoking exposure of 20 pack-years but included individuals who quit smoking within the past 25 years may be more cost-effective and warrant further evaluation.”

CNN Investigation: Tens of millions of filthy, used medical gloves imported into the US: “A months-long CNN investigation has found that tens of millions of counterfeit and second-hand nitrile gloves have reached the United States, according to import records and distributors who bought the gloves -- and that's just the tip of the iceberg. Criminal investigations are underway by the authorities in the US and Thailand.
Experts describe an industry riddled with fraud, with one of them -- Douglas Stein -- telling CNN that nitrile gloves are the "most dangerous commodity on Earth right now."

Qiagen Gets CE Mark for Portable Tuberculosis Test Device: “The device uses blood samples to test for molecules released from T-cells that have come into contact with Mycobacterium tuberculosis, the pathogen that causes TB infections.
Qiagen says it will focus its marketing of the device on regions that face a high burden of TB and where access to laboratories and resources for testing are limited.”


About hospitals and health systems

Association Between Hospital Performance Metrics and Market Share: “The findings of this cross-sectional ecological study suggest that better hospital performance score was associated with larger market share for hip and/or knee replacement and AMI [acute myocardial infarction] procedures but not for CABG [coronary artery bypass graft] The effect size was greater for the elective procedure (hip and/or knee replacement) than for the nonelective procedure (AMI), suggesting that patients may be more able to choose their facility for elective procedures.”

About pharma

FDA withdraws more than 200 ANDAs over unsubmitted annual reports: “Almost two years after proposing to withdraw nearly 250 abbreviated new drug applications (ANDAs) after their manufacturers repeatedly failed to submit the necessary annual reports, the US Food and Drug Administration (FDA) on Thursday said it will withdraw 216 of those applications.”

FDA OKs Higher Numbers of Competitive Generic Therapies in Fiscal 2021: “CGT” is an FDA designation for drugs for which there is inadequate generic competition. Usually this means there’s not more than one approved drug for the indication.
In fiscal 2021, the FDA approved 53 ANDAs for CGT. That’s up from 35 in 2020. Applications were up significantly too. The number of CGT applications received throughout the fiscal year was 507, up from 390 in 2020.”

About Covid-19

CDC director on mask requirements: Need to continue until we can get 'cases down': “Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky on Friday said that mask requirements need to be continued until we can get coronavirus “cases down.”
…Walensky said it was ‘really encouraging’ that the surge in infections from the delta variant is ‘now coming down.’ She added that the U.S. is still averaging 75,000 new infections and 1,200 deaths every day.”

Biden administration takes new steps to boost availability of rapid coronavirus tests: “The Biden administration announced additional steps on Monday to increase the availability of rapid at-home coronavirus tests and bring down their cost.
The biggest change is a $70 million investment by the National Institutes of Health — using funds from the American Rescue Plan, which was passed earlier this year — to help manufacturers navigate the Food and Drug Administration’s regulatory process. The NIH program aims to speed up the authorization process for new tests by helping manufacturers produce the data regulators need. It will also identify rapid tests that have the potential to be produced and distributed on a large scale.”

About healthcare IT

The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world: “The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world argues digital transformations should be considered as a key determinant of health. But the Commission also presses for a radical rethink on digital technologies, highlighting that without a precautionary, mission-oriented, and value-based approach to its governance, digital transformations will fail to bring about improvements in health for all.”
Look at the comprehensive full report .

Today's News and Commentary

About Covid-19

CDC approves Moderna and J&J Covid vaccine boosters, allowing people to mix-and-match shots: The headline is the story. The approval comes on the heals of the FDA’s recommendation for the same measures.

Covid Live Updates: Pfizer and BioNTech Says Vaccine Is Highly Protective in 5- to 11-Year-Olds: “Pfizer reported data on Friday showing that its coronavirus vaccine had a 90.7 percent efficacy rate in preventing symptomatic Covid-19 in a clinical trial of children ages 5 to 11.
The company submitted the information to the Food and Drug Administration, which was expected to release its own analysis of the data later in the day.
Children in the trial received a dose of 10 micrograms, smaller than the 30-microgram dose given to adults. The company said that the dosage was safe, and that trial participants had seen only mild side effects.”

BNT162b2 [Pfizer–BioNTech] and ChAdOx1 nCoV-19 [AstraZeneca]Vaccine Effectiveness against Death from the Delta Variant: “In summary, we found that the BNT162b2 and ChAdOx1 nCoV-19 vaccines offered substantial protection against death from Covid-19 caused by the delta variant.”
In a related article: Delta variant subtype detected in the US:

Association Between COVID-19 Relief Funds and Hospital Characteristics in the US: “In this cross-sectional study among 952 hospital-level entities, wide ranges existed in CARES Act funding, with 24% of hospitals receiving less than $5 million in funding and 8% receiving more than $50 million. Academic-affiliated hospitals with higher pre–COVID-19 assets and hospitals that had higher COVID-19 cases received higher levels of funding, while critical access hospitals received lower levels of financial assistance.
CARES Act funds may have disproportionately gone to hospitals that were in a stronger financial situation prior to the pandemic compared with those that were not, but funds also went disproportionately to those that eventually had the most cases.”

About pharma

Continuous Manufacturing of Pharmaceuticals Bill Clears House: “The House of Representatives passed a bill in a bipartisan 368-56 vote this week that aims to promote innovation in continuous manufacturing, which is used to produce drugs more efficiently than the conventional batch production process.
The National Centers of Excellence in Advanced and Continuous Pharmaceutical Manufacturing Act would allocate $100 million in funding from fiscal 2022 to 2026.”
Another purpose of the bill is to reduce reliance on foreign suppliers.

Vertex’s Stem-Cell Therapy Slashed Need for Daily Insulin Infusion: “Vertex Pharmaceuticals said a patient with a 40-year history of Type 1 diabetes experienced a 91 percent reduction in daily insulin dose after an infusion of its VX-880 stem-cell-derived islet cell replacement therapy.
The cells quickly began functioning as normal islet cells. And with this positive news in hand, the company will continue its phase 1/2 program at several sites in the U.S. and Canada, with the goal of submitting an Investigational New Drug application to the FDA in 2022.”

About health insurance

Next Generation Accountable Care Organization (NGACO) Model Evaluation: “As of the fourth performance year, the Next Generation Accountable Care Organization (NGACO) model was associated with $667 million in gross savings in Medicare Parts A and B spending. After factoring in $909 million in shared savings and other payouts to NGACOs, however, the model was associated with $243 million in net losses. On average, NGACOs located in markets with higher per capita Medicare Parts A and B expenditures achieved higher spending reductions, as they had greater opportunities to improve efficiency. Some NGACOs operating in markets with lower Medicare expenditures had pathways to spending reductions. The amount of total spending reductions by NGACOs of differing organizational affiliation were similar, but there were notable differences in the care settings where reductions occurred. NGACOs primarily reduced spending in settings other than their own organizational setting. Physician practice- affiliated NGACOs reduced acute care spending, but did not reduce spending for professional services. By contrast, NGACOs affiliated with hospitals or integrated delivery systems (IDS) reduced spending for professional services.”

Tennessee may have to repay more than $767 million in Medicaid funds: “Tennessee could be forced to repay the federal government $767.5 million in Medicaid funds that auditors said TennCare officials incorrectly claimed between 2009 and 2014, according to a U.S. Health and Human Services inspector general report released Thursday.
The report found that Tennessee did not comply with federal requirements for certain expenses that are supposed to be certified for eligibility for matching federal funds from Medicaid.”

Anthem BCBS, Kroger partner on health plans: “Anthem Blue Cross and Blue Shield is partnering with Kroger Health on Medicare Advantage plans that provide members with in-store benefits at Kroger locations.
The two plans — one HMO dual-eligible special needs plan and one PPO — provide members with a Healthy Groceries Card that gives them $75 a month to use at Kroger, according to an Oct. 21 news release.
Plans also include a quarterly over-the-counter product allowance and access to Kroger's 2,200 pharmacy locations. It also includes a Healthy Pantry benefit that gives members access to 12 monthly meetings with a Kroger Health dietician and delivers monthly healthy pantry staples to their door.”

BMA: Medicare Advantage Offers Lower Costs, Better Benefits Than FFS: “Medicare Advantage plans offer members additional benefits and require less spending from the federal government compared to fee-for-service (FFS) Medicare, according to a report commissioned by Better Medicare Alliance’s Center for Innovation in Medicare Advantage.
The management consulting company Milliman conducted the report by analyzing FFS Medicare and Medicare Advantage cost, enrollment, and benefit data from CMS records.
Milliman found that the federal government spends $949 per person per month on FFS Medicare, including administration costs. Meanwhile, the government spends a total of $943 per person per month on Medicare Advantage, which includes $110 in administration costs and $123 in additional benefits.
On a yearly basis, Medicare Advantage provides $32.5 billion in additional benefits while also offering beneficiaries lower out-of-pocket costs compared to FFS Medicare. Unlike FFS Medicare, Medicare Advantage plans feature an out-of-pocket spending limit.”

CMS Launches Webpage to Share Innovative State Actions to Expand Medicaid Home and Community-based Services: The “Centers for Medicare & Medicaid Services (CMS) launched a new ‘one-stop shop’ for state Medicaid agencies and stakeholders on Medicaid.gov to advance transparency and innovation for home and community-based services…Through this new webpage, state Medicaid agencies and stakeholders can access information about states' plans to enhance, expand, and strengthen home and community-based services across the country using new Medicaid funding made available by the American Rescue Plan Act of 2021 (ARP).”

UnitedHealth to repay providers shortchanged for COVID vaccine administration: “UnitedHealth Group has committed to reprocessing all of its commercial claims related to COVID-19 vaccine administration, after federal investigators confirmed the nation's largest insurer paid "millions" of providers 40% less than the Medicare rate for inoculating patients.”

Iowa privatizing Medicaid resulted in 891% more illegal care denials, report finds: “A report from Rob Sand, Iowa's auditor of state, found that privatizing the state's Medicaid program in 2016 resulted in an 891 percent increase in patients who were allegedly illegally denied care. 
According to the Oct. 20 report, the transition from a Human Services Department-administered program to a managed care system, called IA Health Link, has resulted in a significant shift in Medicaid members appealing a reduction or denial of care.”

Hospitals and health systems

Ascension, AdventHealth to Unwind AMITA Health Partnership: “After working closely together for nearly seven years, AdventHealth and Ascension have decided to unwind their AMITA Health partnership, the joint operating company serving the healthcare needs of residents of the greater Chicago area.
Leaders of both sponsoring organizations have determined that going forward separately is in their collective best interest in order to more nimbly meet the changing needs and expectations of consumers in the rapidly evolving healthcare environment.”
No further information is available about the breakup.

HCA's profit more than triples to $2.3B in Q3: “Nashville, Tenn.-based HCA Healthcare saw strong growth in revenue and profit in the third quarter of 2021 compared to the same period last year. 
The 183-hospital system posted revenue of $15.3 billion in the quarter ended Sept. 30, up 14.8 percent from the $13.3 billion recorded in the third quarter of 2020.

Oak Street Health Acquires Virtual Specialty Care Provider RubiconMD: Oak Street Health, Inc. ( a network of value-based primary care centers for adults on Medicare), today announced it has acquired RubiconMD, the leading technology platform providing access to specialist expertise. The deal enables Oak Street Health to integrate virtual specialty care into its existing care model, which significantly streamlines the referral process and better manages costs, enhances patient experience, and provides comprehensive care far beyond traditional primary care.
RubiconMD’s specialist network of over 230 specialists covers all major specialties, including Cardiology, Nephrology and Pulmonology. RubiconMD provides clinical insights from specialists on specific patient cases, enabling primary care providers to directly manage and coordinate more of a patient’s care needs.”

About healthcare IT

Frequent but fragmented: use of note templates to document outpatient visits at an academic health center: “Templates were used to document 89% of visits, with a median of 2 used per visit. Only 17% of the 100 230 unique templates were ever used by more than one person and most providers had their own full-note templates. These findings suggest template use is frequent but fragmented, complicating template revision and maintenance. Reframing template use as a form of computer programming suggests ways to maintain the benefits of personalization while leveraging standardization to reduce documentation burden.”

FCC awards $40M more in telehealth funding to 71 providers: “The program funds telehealth projects developed by providers across the U.S. This round of funding follows the FCC's $41.1 million disbursement to 72 providers in September. The FCC has committed grants to providers in every state, territory and Washington, D.C.” See the article for a list of grantees.

23andMe buys telemedicine specialist Lemonaid Health: “23andMe Holding Co. said Friday it agreed to pay $400 million for Lemonaid Health Inc., the on-demand platform for accessing medical care and pharmacy services, in a bid to add telemedicine and prescription drug delivery services… 23andMe CEO Anne Wojcicki said the company will combine its business of providing genetic profiles of consumers with giving patients and healthcare providers better information about health risks and treatments."

11 states ink data breach reporting laws after slew of ransomware attacks: The article has details for each of the states.

Today's News and Commentary

About health insurance

More Medicare Advantage Plans Will Offer Non-Medical Benefits in 2022: “…in 2022, the most commonly offered benefit of the 4 that Avalere analyzed is meals (68%), followed by transportation (39%), nutrition (30%), and in-home support services (11%). The percentage of plans offering these types of benefits will increase from 2021 to 2022, with the largest increases for nutrition and in-home support. Smaller increases will occur in the percentage of plans offering meals and transportation.”

Commercial Health Insurance Markups over Medicare Prices for Physician Services Vary Widely by Specialty: “In this study, we assess the variation across physician specialties in commercial markups over Medicare prices for professional services…
Our sample includes 17 physician specialties and approximately 20 services per specialty that represent about 40 percent of total professional spending. We find that family medicine, obstetrics and gynecology, dermatology, ophthalmology, and psychiatry had the lowest commercial markups relative to Medicare prices, averaging about 110 percent of Medicare rates or less. Nine specialties received commercial payments between 120 and 150 percent of Medicare rates, on average. These included gastroenterology, cardiology, general surgery, and orthopedics. Radiology and neurosurgery received commercial payment rates of 180 and 220 percent of Medicare rates, whereas emergency department and critical care specialties received commercial payment rates of 250 percent of Medicare rates. Anesthesia received the highest markup at 330 percent of Medicare rates. Our findings have important implications for debates over physician payment reforms, public option and single-payer policies, and Medicare payment reforms.”

About hospitals and health systems

Tenet's operating income hits $1B in Q3: “Dallas-based Tenet Healthcare saw many of its key financial metrics improve in the third quarter of 2021, according to its financial report released Oct. 20. 
In the third quarter ending Sept. 30, the for-profit hospital system saw its net operating revenue hit $4.9 billion, up 7.4 percent from the $4.6 billion recorded in the same period last year. 
Tenet saw revenue growth in its hospital and ambulatory divisions.”

About healthcare IT

Oak Street Health buys virtual care provider for $130M: “Oak Street Health, a Chicago-based network of primary care centers for Medicare patients, acquired virtual consult platform RubiconMD for $130 million, the company said Oct. 21…
Under the deal, Oak Street Health will integrate RubiconMD's virtual specialty care services into its existing care model.”

About pharma

Pfizer says its vaccine booster restores full protection against COVID-19: “Pfizer and BioNTech said Thursday that a late-stage trial of the drugmakers' COVID-19 vaccine booster showed it restored full protection against the disease. In a test involving 10,000 participants, the additional shot was 95.6% effective against the disease, according to the companies.”

Aduhelm is bombing: “Biogen sold $300,000 worth of Aduhelm in the third quarter, well below Wall Street's expectations, which prompted analysts at Raymond James to call the Alzheimer's drug ‘potentially the worst drug launch of all time’ amid Biogen's ‘persistent hyperbole about the drug's purported benefits.’..
Aduhelm's controversial approval and high price tag have shaped the market reaction. Health insurers are hesitant to cover Aduhelm until Medicare makes a decision next year, and doctors aren't embracingthe drug either.”

New initiative launches to attack problem of substandard generic drug distribution: “ARTiFACTS, creator of the world's first blockchain-based platform for scientific and academic research, today announced a partnership with the Distributed Pharmaceutical Analysis Lab (DPAL) at the University of Notre Dame to develop a prototype solution for tracking pharmaceutical chain-of-custody information in real-time using distributed ledger technology. Working with ARTiFACTS, DPAL will record all physical handling and research metadata starting from the point-of-purchase of prescription drugs and sustained throughout the testing, analysis and reporting requirements.”

About Covid-19

‘They rushed the process’: Vaccine maker’s woes hamper global inoculation campaign: Wonder what happened to Novavax?
”The U.S. government invested $1.6 billion in Novavax in 2020 — the most it devoted to any vaccine maker at the time — in hopes that it would offer the world another option for a safe and effective vaccine to help protect against Covid-19. But the company has consistently run into production problems. The methods it used to test the purity of the vaccine have fallen short of regulators’ standards and the company has not been able to prove that it can produce a shot that is consistently up to snuff, according to multiple people familiar with Novavax’s difficulties.”

COVID vaccine makers brace for a variant worse than Delta: “Over the past few months, all three companies have been running dress rehearsals by practising on known SARS-CoV-2 variants. This involves updating their vaccines to match variants such as Beta and Delta, testing them in clinical studies, tuning their internal workflows and coordinating with regulators. Their goal is to learn from these warm-up trials and smooth out kinks in their processes, so that they can move fast if, or when, a true escape variant emerges.”

In secret vaccine contracts with governments, Pfizer took hard line in push for profit, report says: “A report released Tuesday by Public Citizen, a consumer rights advocacy group that gained access to a number of leaked, unredacted Pfizer contracts, sheds light on how the company uses that power to ‘shift risk and maximize profits,’ the organization argues…
Public Citizen found common themes across contracts, including not only secrecy but also language to block donations of Pfizer doses. Disputes are settled in secret arbitration courts, with Pfizer able to change the terms of key decisions, including delivery dates, and demand public assets as collateral.”

Gates Foundation to spend $120 mln to speed access to generics of Merck COVID-19 pill: “The Bill & Melinda Gates Foundation said on Wednesday it would spend up to $120 million to kick-start development of generic versions of Merck & Co's oral COVID-19 treatment to help ensure lower-income countries have equal access to the drug.”

About health technology

In a First, Surgeons Attached a Pig Kidney to a Human, and It Worked: “Surgeons in New York have successfully attached a kidney grown in a genetically altered pig to a human patient and found that the organ worked normally, a scientific breakthrough that one day may yield a vast new supply of organs for severely ill patients…
[S]urgeons at N.Y.U. Langone Health took an astonishing step: With the family’s consent, they attached the pig’s kidney to a brain-dead patient who was kept alive on a ventilator, and then followed the body’s response while taking measures of the kidney’s function. It is the first operation of its kind.”

Largest ever global study of tuberculosis identifies genetic causes of drug resistance: “Using cutting-edge genomic sequencing techniques, researchers at the University of Oxford have identified almost all the genomic variation that gives people resistance to 13 of the most common tuberculosis (TB) drug treatments…
Using two key advances: a new quantitative test for drug resistance and a new approach which identifies all the genetic changes in a sample of drug-resistant TB bacteria the researchers have generated a unique dataset which the team has used to quantify how changes in the genetic code of M. tuberculosis reduce how well different drugs kill these bacteria that cause TB. These innovations, combined with ongoing work in the field, promise to profoundly improve how patients with TB are treated in the future.”

About the public’s health

The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future: The report is a comprehensive analysis of the health impact of global warming. In addition to such obvious harm as deaths due to excessive heat, other consequences include: “The number of months with environmentally suitable conditions for the transmission of malaria (Plasmodium falciparum) rose by 39% from 1950–59 to 2010–19 in densely populated highland areas in the low HDI group, threatening highly disadvantaged populations who were comparatively safer from this disease than those in the lowland areas…”

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).”