Today's News and Commentary

About health insurance/insurers

 ‘Site-neutral’ payments for chemotherapy could save Medicare billions “At issue is how Medicare pays for drugs delivered by medical providers, such as chemotherapy for cancer or infusions used to treat autoimmune diseases. Under current law, Medicare pays two to three times as much for these treatments if they are given in a hospital rather than a doctor’s office. The medicines and the means of administering them are the same; only the price is different.”
The savings would be more than $3.7 billion over the next decade, according to the Congressional Budget Office. And beneficiaries’ co-payments would go down, too — by $40 a visit. The next thing that needs to happen is for the Senate to follow [the House’s vote that passed the measure].”

About the public’s health

California lawmaker introduces bill to remove artificial dyes from cereals, baked goods and other foods served in school “Assembly Bill 2316 would prohibit school cafeterias from offering foods containing six artificial food dyes that have been linked to hyperactivity and behavioral issues in some children. It would also outlaw titanium dioxide, a whitening agent used in candies and other products that is banned by the European Union because of concerns that it is potentially genotoxic, meaning it may damage DNA and cause cancer.
The bill, which was first shared with NBC News, would affect certain cereals, condiments and baked goods, among other foods, and it would make California the first state to ban the additives from schools. It was introduced by Democratic Assemblymember Jesse Gabriel.”

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.”

About healthcare IT

Why UnitedHealth, Change Healthcare were targeted by ransomware hackers, and more cybercrime will hit patients, doctors  “Cybersecurity researcher Jeremiah Fowler said on the dark web, medical records sell for $60 compared to $15 for a Social Security number and $3 for a credit card. Compounding that is the fact that there’s a chronic shortage of staffing, and as the Change Healthcare uproar has shown, there’s tremendous pressure to restore access quickly.”

UnitedHealth: Change's Pharmacy Network is back online “The company said Wednesday that all of its major pharmacy and payment systems are up again and "99% of pre-incident claim volume is flowing." The cyberattack was first announced on Feb. 21, and has caused major disruption in claims processing nationwide over the past three weeks.”

Today's News and Commentary

About Covid-19

On 4-year anniversary of the WHO declaring COVID a pandemic, a look at the virus by the numbers “Since the pandemic began, more than 1.18 million Americans have died from COVID-19, according to CDC data. The U.S. crossed the 1 million markon May 12, 2022.
During the week of March 2, there were 576 weekly deaths, which is the lowest number recorded since summer 2023 and several times lower than the peak of 25,974 weekly deaths recorded the week ending Jan. 9, 2021.”

About hospitals and healthcare systems

 Change Healthcare attack costing hospitals $2B a week: Report “Provider claims to payers have dropped by more than a third in the wake of the Change Healthcare cyber attack, according to a March 13 news release from Kodiak Solutions. 
Kodiak's revenue cycle analytics software monitors patient financial transactions from more than 1,850 hospitals and 250,000 physicians nationwide.
The cash flow effects of those delayed claims have ranged from $1.84 billion in the first week to $2.53 billion in the lastest full week when compared with the average weekly estimated cash value of claims from Jan. 1 through Feb. 17, according to the release. Change Healthcare, which processes 1 in 3 healthcare claims in the U.S., was hacked by a ransomware group on Feb. 21.
Through March 9, the total estimated cash flow impact for hospitals reporting data to Kodiak is $6.3 billion in delayed payments, according to the release.”

About pharma

 AstraZeneca inks $800M buyout of French biotech to snag phase 3 rare disease drug “AstraZeneca is paying $800 million to expand into rare endocrinology, snagging itself a phase 3 candidate through the acquisition of French biotech Amolyt Pharma. The deal features $250 million in milestones tied to a regulatory event.
Buying Amolyt will give AstraZeneca control of eneboparatide, a PTHR1 agonist that the biotech moved into phase 3 in June. Eneboparatide is designed to produce sustained and stable levels of calcium, which falls to low levels in patients with hypoparathyroidism, while preventing kidney disease and restoring bone turnover.”

Appeals court affirms Arkansas law against drugmakers' 340B contract pharmacy restrictions “A federal appellate court upheld an Arkansas law prohibiting drugmakers from restricting 340B drug discounts for providers using contract pharmacies, potentially setting up other states to pass similar legislation.
The ruling was handed down Tuesday by the U.S. Court of Appeals for the Eighth Circuit’s three-judge panel. The judges disagreed with a pharmaceutical industry group’s argument that Arkansas’ 340B Drug Pricing Nondiscrimination Act passed in 2021 is preempted by existing federal law outlining the program, which requires drug manufacturers to sell drugs at a discount to safety-net providers.”
 

About the public’s health

Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance? “The high and rising rates of maternal mortality in the United States are a consequence of changes in maternal mortality surveillance, with reliance on the pregnancy checkbox leading to an increase in misclassified maternal deaths. Identifying maternal deaths by requiring mention of pregnancy among the multiple causes of death shows lower, stable maternal mortality rates and declines in maternal deaths from direct obstetrical causes.” 

GE HealthCare launches philanthropic foundation aimed at maternal health “GE HealthCare has set up its own philanthropic arm and given it the goal of helping to bring precision medicine to underserved communities, with a first focus on improving maternal mortality.
The company pointed to a recent report from the United Nations and World Health Organization showing that a person dies every two minutes due to pregnancy or childbirth and that statistics have estimated about 287,000 maternal deaths worldwide in 2020.
Incorporated as a separate charitable organization, the GE HealthCare Foundation will also work to address an international shortage of primary care clinicians, nurses and midwife professionals.”

About healthcare IT

The buzz at HIMSS '24? 6 takeaways FYI

Europe one step away from landmark AI rules after lawmakers' vote  “The legislation will regulate high-impact, general-purpose AI models and high-risk AI systems which will have to comply with specific transparency obligations and EU copyright laws.
It restricts governments' use of real-time biometric surveillance in public spaces to cases of certain crimes, prevention of genuine threats, such as terrorist attacks, and searches for people suspected of the most serious crimes.”

Microsoft, 16 health systems to operationalize AI under new partner network “Sixteen health systems, Microsoft and other healthcare technology organizations are the latest to band together and hammer out best practices and standards for AI in care.
Calling itself the Trustworthy & Responsible AI Network (TRAIN), the latest provider-tech AI collaboration aims to improve the quality and trustworthiness of novel AI capabilities coming to healthcare.”

About health technology

A Cell-free DNA Blood-Based Test for Colorectal Cancer Screening In the quest for “liquid” biopsies and diagnoses, avoidance of colonoscopy has high priority. The results of this technology show: “In an average-risk screening population, this cfDNA blood-based test had 83% sensitivity for colorectal cancer, 90% specificity for advanced neoplasia…” However, it only had “13% sensitivity for advanced precancerous lesions,” meaning it wasn’t that good at early detection.

Today's News and Commentary

About Covid-19

COVID-19 Rebound After VV116 vs Nirmatrelvir-Ritonavir Treatment “Viral load rebound and symptom rebound are both common and not significantly different after a standard 5-day course of treatment with either VV116 or nirmatrelvir-ritonavir for mild-to-moderate COVID-19.”

About health insurance/insurers

Primary Care Physicians In Medicare Advantage Were Less Costly, Provided Similar Quality Versus Regional Average “Assessing primary care physician costliness based on the gap between observed and predicted costs for their traditional Medicare patients, we found that the average primary care physician in MA networks was $433 less costly per patient (2.9 percent of baseline) compared with the regional mean, with less costly primary care physicians included in more networks than more costly ones. Favorable selection of patients by MA primary care physicians contributed partially to this result. The quality measures of MA primary care physicians were similar to the regional mean. In contrast, primary care physicians excluded from all MA networks were $1,617 (13.8 percent) costlier than the regional mean, with lower quality. Primary care physicians in narrow networks were $212 (1.4 percent) less costly than those in wide networks, but their quality was slightly lower. These findings highlight the potential role of selective contracting in reducing costs in the MA program.”

Medicare Index Report for 2024 Coverage “Highlights
--Average premium for Medicare Advantage plans is unchanged year over year: $9 is the average monthly premium among Medicare Advantage selected by eHealth customers during the AEP for 2024 coverage, a figure unchanged from the previous year.

--Demand for $0-premium Medicare Advantage plans is stable: For the second year in a row, 84% of those selecting Medicare Advantage plans at eHealth during AEP chose plans with a $0 monthly premium.

--Average deductible for Medicare Advantage plans drops below $100: For the first time since eHealth began tracking it, the average annual deductible for Medicare Advantage plans selected by eHealth customers during AEP fell below $100 (to $95).

--Average Part D plan premium is down but average deductible is up: $29 is the average monthly premium for stand-alone Medicare Part D plans selected by eHealth customers during AEP, down 9% from the year prior ($32); meanwhile the average deductible for Part D plans increased 14%, from $389 to $445.

--Average premium for Medicare Supplement plans is up this year: Though enrollment in Medicare Supplement (Medigap) plans is not governed by AEP, the average premium for plans selected by eHealth customers during this period is up 9% year over year, from $173 to $189 per month.”

About pharma

The efficacy of GLP-1s, compared FYI

Eli Lilly partners with Amazon Pharmacy for home delivery of its weight loss, diabetes and migraine drugs “Eli Lilly is partnering with Amazon's pharmacy unit to offer home delivery for diabetes, migraine and obesity medications, including GLP-1 weight loss drug Zepbound.
The drugmaker launched its direct-to-consumer service, LillyDirect, in January to provide consumers access to telehealth and pharmacy services and the ability to get some medications directly from the company via online pharmacies.
Lilly selected Aazon Pharmacy to serve as a third-party dispensing provider for LillyDirect Pharmacy Solutions, delivering prescribed Lilly medications directly to a patient’s home, according to an Amazon Pharmacy blog post.” 

About the public’s health

 Adolescent Δ8-THC and Marijuana Use in the US “In this nationally representative 2023 survey, 11.4% of 2186 US 12th-grade students self-reported Δ8-THC use and 30.4% self-reported marijuana use in the past year. Δ8-THC use prevalence was higher in the South and Midwest US and in states without legal adult-use marijuana or Δ8-THC regulations. Marijuana use prevalence did not differ by cannabis policies.” 

About healthcare IT

 FBI Internet Crime Report 2023 Once again, healthcare entities top the list of targeted organizations.

Today's News and Commentary

Breaking down Biden's $7.3T proposed budget for 2025: Here are his top health priorities Good summary of budget allocations for healthcare.

About hospitals and healthcare systems

Healthgrades Announces 2024 Top Hospitals in Patient Experience and Patient Safety FYI

About pharma

 US proposes scrapping biosimilar interchangeability requirement “In an effort to boost uptake of biosimilars in the US, the government’s budget for 2025 includes a provision that would allow substitution without the need for an interchangeable designation from the FDA. According to the budget documents, the move would ‘deem all approved biosimilars to be interchangeable with their respective reference products.’”

About the public’s health

 WHO HIV drug resistance – brief report 2024 “Levels of observed DTG resistance in real world populations receiving ART appear to be higher than anticipated from clinical trials. WHO recommends that countries routinely implement standardised surveillance of HIVDR to follow the prevalence and patterns of resistance among people not achieving suppressed viral load.”

About healthcare IT

 Healthcare continues to make gains in data exchange with 49% jump in electronic prior authorization “At the end of 2023, 1.29 million prescribers were using e-prescribing, a nearly 5% increase from 2022, and 83.2% of these clinicians were also enabled for electronic prescribing for controlled substances (EPCS), according to Surescripts' latest national progress report…”

Today's News and Commentary

About quality and safety

Top 10 Patient Safety Concerns 2024  “The [ECRI] List for 2024

1. Challenges Transitioning Newly Trained Clinicians from Education into Practice

2. Workarounds with Barcode Medication Administration Systems

3. Barriers to Access Maternal and Perinatal Care

4. Unintended Consequences of Technology Adoption

5. Decline in Physical and Emotional Well-Being of Healthcare Workers

6. Complexity of Preventing Diagnostic Error

7. Providing Equitable Care for People with Physical and Intellectual Disabilities

8. Delay in Care Resulting from Drug, Supply, and Equipment Shortages

9. Misuse of Parenteral Syringes to Administer Oral Liquid Medications

10. Ongoing Challenges with Preventing Patient Falls”

About health insurance/insurers

Medicare announces emergency funds for doctors affected by Change Healthcare hack “Federal health officials on Saturday said they would offer emergency funding to physicians, physical therapists and other professionals that provide outpatient health care, following a cyberattack that crippled the nation’s largest processor of medical claims and left many organizations in financial distress.
The Centers for Medicare and Medicaid Services also announced that it would make advance payments available to suppliers that bill through Medicare Part B, which serves a wide array of health-care organizations.”

United’s surreptitious surgery center buying spree “UnitedHealth Group is so big that it doesn’t have to publicly announce a vast majority of its acquisitions. But a STAT analysis of company financial documents shows the health care conglomerate quietly acquired dozens of outpatient facilities in 2023, with a particular focus on surgery centers. 
And it’s not adding random surgery centers, either. There seems to be an explicit strategy: Many of UnitedHealth’s new centers sit in geographic areas where the company is the biggest Medicare Advantage player, based on the latest insurance market share data. That overlap reinforces how UnitedHealth is looking to funnel more of its insurance members toward providers that it owns, with the overarching goal of capturing more profit.
One of the biggest undisclosed transactions came this past December, when UnitedHealth bought National Cardiovascular Partners from Fresenius Medical Care. The only mention of NCP is buried within UnitedHealth’s annual report for investors, where the company listed “NCP Investment Holdings, Inc.” as a new subsidiary. Fresenius confirmed to its investors in January that it sold NCP, which operates 21 cardiac cath and vascular labs. But Fresenius never disclosed the buyer and erased NCP information from its website. And wouldn’t ya know it: NCP’s facilities are located in places like Phoenix and large metro areas in Texas where UnitedHealth has the biggest MA market share.”

 CBO’s Approach to Estimating the Budgetary Effects of the No Surprises Act of 2021 “In CBO’s estimation, prohibiting surprise billing:
 Reduces insurers’ spending for previously covered out-of-network care;
 Increases spending on previously uncovered out-of-network services—both directly (by increasing what is covered) and indirectly (because patients consume more care); and
 Reduces negotiated prices for all in-network care. Setting the benchmark amount for payment disputes at the median in-network rate reduces in-network prices.”

Tunneling and Hidden Profits in Health Care “This study examines “tunneling” practices through which health care providers covertly extract profitby making inflated payments for goods and services to commonly-owned related parties. While incentivesto tunnel exist across sectors, health care providers may find it uniquely advantageous to do so. Maskingprofits as costs, thereby obscuring true profitability, may dissuade regulators from imposing stricterquality standards and encourage public payers to increase reimbursement rates. Likewise, tunnelingeffectively “shields” assets from malpractice liability risk, by moving them off the firm’s balance sheet.Using uniquely detailed financial data on the nursing home industry, we apply a difference-in-differencesapproach to study how firms’ stated costs change when they start transacting with a related party,allowing us to infer by how much these payments are inflated. We find evidence of widespread tunnelingthrough inflated rents and management fees paid to related parties. Extrapolating these markups to allfirms’ related party transactions, our estimates suggest that in 2019, 63% of nursing home profits werehidden and tunneled to related parties through inflated transfer prices.”
Comment: This research raises n important issue in evaluating insurance company medical loss ratios. If a company creates a related subsidiary and pays excess fees, the higher MLR will protect it from penalties.
This issue was discussed in a paper last year from USC- Brookings:Medicare Advantage spending, medical loss ratios, and related businesses: An initial investigation. The authors found: “Transfer prices among related parties for multi-entity health care enterprises are typically not publicly available…. the increased health cost spending reduces profits from MA business, but transactions with related parties can still represent profits to the parent company, especially if higher transfer prices allow the plans to evade the MLR regulations.” The authors estimates this effect over several years.

About hospitals and healthcare systems

From -6.8% to 12.2%: 34 health systems ranked by operating margins FYI

Hackensack Meridian hospitals first to attain Joint Commission's new sustainability certification “Four Hackensack Meridian Health (HMH) hospitals are the first in the country to achieve the Joint Commission’s sustainable healthcare certification. 
The voluntary program for hospitals went into effect at the start of this year and provides a framework to help organizations tackle decarbonization efforts. Attaining the certification means the hospitals have met rigorous standards and elements of performance to accelerate the sector’s sustainability efforts, according to a joint press release.”

About pharma

The top 10 drugs losing US exclusivity in 2024 FYI

Colorado isn’t giving up on its drug importation dream “The FDA has rebuffed Colorado’s appeals for help with its drug importation plan.”

About the public’s health

 Except for flu, US respiratory virus levels continue to ebb “Last week, 20 jurisdictions reported high or very high respiratory illness activity, down from 26 the previous week, the CDC said in its latest respiratory virus snapshot. Emergency department visits for flu, COVID, and respiratory syncytial virus (RSV) all declined last week.” 

Measles outbreak threatens US status of ‘eliminating’ virus “The rash of measles outbreaks around the country has sparked concerns that the U.S. risks losing its status as a country where the disease has been eliminated, a distinction held since 2000.
As of last week, 41 measles cases have been confirmed across 15 states and New York City, according to the Centers for Disease Control and Prevention (CDC). That puts the nation already on track to surpassing the 58 total cases that were detected in 2023.”

Today's News and Commentary

Remarks of President Joe Biden — State of the Union Address As Prepared for Delivery This link is to the entire speech.
Biden's State of the Union: 13 healthcare takeaways A good summary of the health topics in the speech.

Large health system vs. payer profits in 2023 FYI

About health insurance/insurers

Cigna to help health plans limit costs amid boom in weight-loss drugs “Cigna's Evernorth unit will offer its clients a guarantee that it will limit annual increases in GLP-1 drug costs at 15%, a spokesperson said. The company aims to achieve this through various measures, including helping people with obesity and diabetes get lifestyle modification and coaching support.
Evernorth will also take on a financial risk with the guarantee, the spokesperson said.
This, in turn, would help ensure access to the drugs for appropriate patients, according to Cigna.”

What to Know About How Medicare Pays Physicians The following is a summary of the latest changes: “The 3.4% decrease to the conversion factor finalized for 2024 reflects the following adjustments to these three factors: (1) a -2.18% budget neutrality adjustment, (2) a 0% statutory increase under MACRA for 2024, and (3) -1.25% reduction in temporary payments provided by Congress for 2024 under the Consolidated Appropriations Act of 2023.
The combined impact of these changes is a -1.25% decrease in overall payments under the physician fee schedule relative to 2023, according to CMS. Payment changes are expected to vary by specialty, however. For example, clinicians most directly impacted by service-specific changes, such as those in primary care and behavioral health, are projected to see a net increase in payments, while clinicians in radiology, physical and occupational therapy, and some surgical specialties are projected to see the largest net decrease.
Congress is expected to vote on pending legislation which would mitigate the 3.4% decrease to the fee schedule conversion factor, a change which is expected to result in a modest increase to physician payment rates across all specialties, relative to current law.”
Comment: This monograph is an excellent source of information about the history and methodology behind Medicare physician payments.

About hospitals and healthcare systems

 UnitedHealth offers timeline on restoring Change Healthcare's key systems “nitedHealth Group late Thursday detailed a timeline for restoring Change Healthcare's systems, which have been down for more than two weeks following the cyberattack.
The company noted that electronic prescribing services were previously restored, and that claim submission and payment transmission services were restored as of Thursday. It added that it had taken steps to ensure patients could access prescriptions in the meantime, such as having Optum Rx pharmacies send out the medications based on the date.
Change's electronic payment functionality will be back online March 15, UHG said, and it expects to begin testing connectivity to claims network and software beginning March 18. It expects to restore service that week.”

About pharma

F.D.A. Delays Action on Closely Watched Alzheimer’s Drug “Eli Lilly’s donanemab was expected to be approved this month, but the agency has decided to convene a panel of independent experts to evaluate the drug’s safety and efficacy.” 

Mark Cuban's drug company inks first health system partnership to sell directly to Community Health Systems “Mark Cuban Cost Plus Drug Company has found its first national health system buyer for hospital drugs currently in short supply.
Franklin, Tennessee-based for-profit Community Health Systems has signed onto a partnership with the billionaire-backed manufacturer to purchase pharmaceuticals like epinephrine and norepinephrine for its affiliate hospitals in Texas and Pennsylvania. The products are often used in emergency departments and intensive care units, with epinephrine currently listed on the Food and Drug Administration’s list of ongoing drug shortages.”

Gilead, Merck & Co.’s oral once-weekly HIV therapy maintains viral suppression “Results for the primary endpoint showed that at week 24, only one participant in the Sunlenca-islatravir group had a viral load >50 copies/mL which was subsequently suppressed by week 30, whereas none of the Biktarvy-treated participants exceeded this threshold. Meanwhile, participants switched to the Sunlenca-islatravir combination maintained high rates of HIV suppression at week 24 comparable to Biktarvy, with rates of 94.2% in both the groups.
In terms of safety, there were no occurrences of serious adverse events in either of the groups. Gilead and Merck noted that the trial will continue through week 48, with longer-term data expected to be presented at future scientific conferences.”

Novo Nordisk's Wegovy wins FDA nod for heart health benefits “US regulators have approved a label expansion for Novo Nordisk's weight-loss drug Wegovy (semaglutide) to include reduced risk of major adverse cardiovascular events (MACE), including heart attacks and strokes. The decision could potentially broaden insurance coverage for the GLP-1 agonist and similar treatments for obesity.”

About healthcare IT

 Charges for emails with doctors and other healthcare providers “The typical cost for an email messaging claim was $39 in 2021, including both the portion paid by insurance and that paid by patients. Although the health plan covered the full cost for most of these claims (82%), those patients with at least some out-of-pocket costs typically paid $25.” 

About healthcare personnel

 Projecting Health Workforce Supply and Demand An excellent source of information from HRSA. One of the main findings is: “Over the next 15 years (through 2036), NCHWA projects an overall shortage of 139,940 physicians.” This number includes about 68,000 primary care physicians. 

Today's News and Commentary

About health insurance/insurers

 NeueHealth reports a nearly quarter-billion net loss during Q4 earnings “NeueHealth posted a $242 million net loss during its fourth-quarter earnings March 6, as the insurtech attempts to turn a corner after a tumultuous 2023.
The company recorded a net loss of $1.2 billion last year, but it achieved $292 million in revenue last quarter, up 29% year-over-year, and $1.2 billion in full-year consolidated revenue, a 55% increase year-over-year. Earnings per share came in at a loss of $30.47, though that jumps to $19.54 in the black once it excluded discontinued operations.
NeueHealth rebranded from Bright Health in January, attempting to put its past troubles in the rearview mirror.”

About hospitals and healthcare systems

UPMC reports almost $200M operating loss as expenses rise “Pittsburgh-based UPMC, a 40-hospital system, has reported a 2023 operating loss of $198.3 million (-0.7% operating margin) on revenue of $27.7 billion. 
Those figures compare with a $162.1 million operating gain on revenue of $25.5 billion in 2022. Expenses in 2023, totaling $27.9 billion, were approximately 10% up on 2022. That included a 13.6% jump in insurance claims expenses. 
The healthcare system's measure of inpatient activity grew 3% over the previous year while average outpatient revenue per workday rose 10% and average physician revenue per weekday grew by 9%.”

Mayo Clinic closed out 2023 with $18B in revenue, 6% operating margin “Rochester, Minnesota-based Mayo Clinic reported revenue of $17.9 billion in 2023, outpacing expenses by over $1 billion and resulting in what the health system called a “mission-sustaining” 6% operating margin.
The revenue figure, which compared with $16.3 billion in 2022, included investments totaling $536 million which were used to support current operating activities, the health system recently reported in financial disclosures.
The organization saw its net medical service revenue grow 8.8% year over year to $15.1 billion.
Though revenue outpaced expenses, the health system's expenses were up 7.4% compared to 2022, totaling $16.9 billion for the year. Mayo Clinic said it welcomed 14,000 new staffing roles into the system in 2023, up almost 5% from 2022.”

Trauma Center Hospitals Charged Higher Prices For Some Nontrauma Care Than Non–Trauma Center Hospitals, 2012–18 “Hospitals serving as trauma centers are often endowed by regulators with monopoly power over trauma services in their geographic areas, and this monopoly power may spill over to nontrauma services. This study focused on the growing number of designated trauma centers and how trauma center status affects hospital prices for other, nontrauma services. We found that hospitals designated as trauma centers charged higher prices for nontrauma inpatient admissions and nontrauma emergency department visits when compared with hospitals that were not designated as trauma centers, even after controlling for potential confounders.” 

About pharma

 Drugmakers take Biden health-care win to court today “A federal judge in New Jersey accepted Bristol Myers Squibb, Novo Nordisk, Novartis and Johnson & Johnson’s request to present oral arguments jointly, citing the “overlapping nature” of their claims. Notably, each defendant manufactures one of the 10 drugs selected for Medicare’s inaugural round of price negotiations.”

Another day, another win for Novo in obesity, as early oral med appears to beat Wegovy “Novo Nordisk appears to have blown its own drug Wegovy out of the water. The Danish pharma reported early results for a next-gen oral weight loss drug called amycretin, showing 13.1% weight loss after 12 weeks.
Reporting the early phase 1 results during a capital markets day Thursday, Novo was sparse on details but still generated significant excitement.
Amycretin is a GLP-1 and amylin receptor agonist that Novo is hoping will show additive benefits with a differentiated mode of action from its comparable GLP-1 drug semaglutide, marketed as Wegovy for weight loss and Ozempic for diabetes. The therapy is dosed once daily—which could prove to be a huge improvement over the weekly injections of Wegovy and competitor Zepbound, which is marketed by Eli Lilly.”

Medicare Part D Plans Greatly Increased Utilization Restrictions On Prescription Drugs, 2011–20 “We examined trends in the prevalence of utilization restrictions on non-protected-class compounds in Medicare Part D plans during the period 2011–20, including prior authorization and step therapy requirements as well as formulary exclusions. Part D plans became significantly more restrictive over time, rising from an average of 31.9 percent of compounds restricted in 2011 to 44.4 percent restricted in 2020. The prevalence of formulary exclusions grew particularly fast: By 2020, plan formularies excluded an average of 44.7 percent of brand-name-only compounds. Formulary restrictions were more common among brand-name-only compared with generic-available compounds, among more expensive compounds, and in stand-alone compared with Medicare Advantage prescription drug plans.”

Boehringer Ingelheim to cap asthma inhaler out-of-pocket costs at $35 “Facing criticism over its pricing, Boehringer Ingelheim plans to cap out-of-pocket costs at $35 a month for its entire line of inhalers that are used to combat asthma and chronic obstructive pulmonary disease.
The program, which begins on June 1, is directed at Americans with commercial health insurance, but also at those who lack insurance and, therefore, must pay cash for their inhalers. In taking this step, the company cast its efforts as a bid to assist ‘vulnerable’ patients at a time when an increasing number of people are complaining about the cost of prescription drugs.”

About the public’s health

Do the associations of daily steps with mortality and incident cardiovascular disease differ by sedentary time levels? A device-based cohort study “Any amount of daily steps above the referent 2200 steps/day was associated with lower mortality and incident CVD risk, for low and high sedentary time. Accruing 9000–10 500 steps/day was associated with the lowest mortality risk independent of sedentary time. For a roughly equivalent number of steps/day, the risk of incident CVD was lower for low sedentary time compared with high sedentary time.” 

Cancer-causing chemical found in Clinique, Clearasil acne treatments, US lab reports “High levels of cancer-causing chemical benzene were detected in some acne treatments from brands including Estee Lauder's Clinique, Target's Up & Up and Reckitt Benckiser-owned Clearasil, said independent U.S. laboratory Valisure.
Valisure has also filed a petition with the U.S. Food and Drug Administration, calling on the regulator to recall the products, conduct an investigation and revise industry guidance, the New Haven, Connecticut-based lab said on Wednesday.”

Plastics, Fossil Carbon, and the Heart “In this issue of the [New England Journal of Medicine], the results of the prospective study by Marfella et al. on the asso- ciation of microplastics and nanoplastics with cardiovascular outcomes further expand our understanding of the health hazards posed by plastics. This study, which included 312 patients who underwent carotid endarterectomy, showed that microplastics and nanoplastics were detect- able in the excised plaque of 58% of the patients. The presence of microplastics or nanoplastics in carotid artery plaque was associated with a sub- sequent risk of nonfatal myocardial infarction, nonfatal stroke, or death from any cause that was 2.1 times that in patients whose plaques did not contain microplastics or nanoplastics. Patients with microplastics or nanoplastics in their plaque tissue also had elevated expression of circulating inflammatory markers…
Previous investigations have detected micro- plastics and nanoplastics in multiple tissues, including colon, placenta, liver, spleen, and lymph node tissues. Animal studies indicate that micro- plastics and nanoplastics can cause toxic effects at multiple sites, potentially by inducing oxidative stress…
What can physicians and other health professionals do? The first step is to recognize that the low cost and convenience of plastics are deceptive and that, in fact, they mask great harms, such as the potential contribution by plastics to outcomes associated with atherosclerotic plaque. We need to encourage our patients to reduce their use of plastics, especially unnecessary single-use items. We need to inventory our own and our institutions’ use of plastics and identify areas for reduction. We need to express our strong support for the United Nations Global Plastics Treaty. We need to argue for inclusion in the treaty of a mandatory global cap on plastic production, with targets and timetables, restrictions on single-use plastics, and comprehensive regulation of plastic chemicals.”

Today's News and Commentary

Issue Request for Public Input as Part of Inquiry into Impacts of Corporate Ownership Trend in Health Care “The Justice Department’s Antitrust Division, Federal Trade Commission (FTC) and Department of Health and Human Services (HHS) jointly launched a cross-government public inquiry into private-equity and other corporations’ increasing control over health care.
Private equity firms and other corporate owners are increasingly involved in health care system transactions and, at times, those transactions may lead to a maximizing of profits at the expense of quality care. The cross-government inquiry seeks to understand how certain health care market transactions may increase consolidation and generate profits for firms while threatening patients’ health, workers’ safety, quality of care and affordable health care for patients and taxpayers.
The agencies issued a Request for Information (RFI) requesting public comment on deals conducted by health systems, private payers, private equity funds and other alternative asset managers that involve health care providers, facilities or ancillary products or services. The RFI also requests information on transactions that would not be reported to the Justice Department or FTC for antitrust review under the Hart-Scott-Rodino Antitrust Improvements Act.”

About Covid-19

A reminder:
USPS will stop accepting orders for free COVID tests on March 8 “Two government-run efforts to distribute free COVID-19 tests and to offer free courses of Pfizer's Paxlovid antiviral are set to end Friday, as trends of the virus have largely slowed.
The Administration for Strategic Preparedness and Response, or ASPR, will stop accepting orders to ship COVID-19 tests to all households through the U.S. Postal Service, an agency spokesperson confirmed, marking an end to this season's round of shipments.”

Updated COVID shot expected this fall, says CDC director “Researchers are working on selecting a strain for the upcoming version, and will probably wait until May to pick one to target with vaccines, Centers for Disease Control and Prevention Director Mandy Cohen said in an interview at Bloomberg’s offices in Washington.” 

About health insurance/insurers

HHS Statement Regarding the Cyberattack on Change Healthcare “Today, HHS is announcing immediate steps that the Centers for Medicare & Medicaid Services (CMS) is taking to assist providers to continue to serve patients. CMS will continue to communicate with the health care community and assist, as appropriate. Providers should continue to work with all their payers for the latest updates on how to receive timely payments.

Affected parties should be aware of the following flexibilities in place:

  • Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic data interchange (EDI) enrollment for the switch. The MAC will provide instructions based on the specific request to expedite the new EDI enrollment. CMS has instructed the MACs to expedite this process and move all provider and facility requests into production and ready to bill claims quickly. CMS is strongly encouraging other payers, including state Medicaid and Children’s Health Insurance Program (CHIP) agencies and Medicaid and CHIP managed care plans, to waive or expedite solutions for this requirement.

  • CMS will issue guidance to Medicare Advantage (MA) organizations and Part D sponsors encouraging them to remove or relax prior authorization, other utilization management, and timely filing requirements during these system outages. CMS is also encouraging MA plans to offer advance funding to providers most affected by this cyberattack.

  • CMS strongly encourages Medicaid and CHIP managed care plans to adopt the same strategies of removing or relaxing prior authorization and utilization management requirements, and consider offering advance funding to providers, on behalf of Medicaid and CHIP managed care enrollees to the extent permitted by the State. 

  • If Medicare providers are having trouble filing claims or other necessary notices or other submissions, they should contact their MAC for details on exceptions, waivers, or extensions, or contact CMS regarding quality reporting programs.

  • CMS has contacted all of the MACs to make sure they are prepared to accept paper claims from providers who need to file them. While we recognize that electronic billing is preferable for everyone, the MACs must accept paper submissions if a provider needs to file claims in that method.”

Comment: Strongly encouraging and issuing guidance does not help providers get paid.

The Medicare Advantage Quality Bonus Program New Ideas and New Conversations Really good summary from The Urban Institute.
“Based on a review of the literature and interviews with six prominent experts in quality measurement and Medicare performance, we suggest a revised structure for ensuring adequate administrative performance and quality in MA. We recommend the following policies be implemented to replace the QBP:

1. Implement enhanced, more stringent Centers for Medicare & Medicaid Services oversight of MA plans to ensure adherence to their contractual obligations on various administrative responsibilities, concentrating on areas of demonstrated substandard performance, like prior authorization and claims denials.
2. Use a limited number of validated quality measures to identify exceptional and poor MA plan performance in areas of interest. These measures would be focused on prevention activities and, where possible, patient-reported outcomes and patient experiences with their health plan. Measurement would be limited to identifying exceptionally strong and poor performance, not broadly rating or ranking MA plans, and need not be made public.
3. Replace the current regime of external performance measurement that provides overly generous rewards without penalties with a program that encourages or requires MA plans to implement quality improvement projects or adopt continuous quality improvement methods.”

 The state canceling $2B in medical debt “Up to 1 million residents in Arizona may have their medical debt forgiven through a new program the state's governor announced March 4. 
Arizona Gov. Katie Hobbs said the state has partnered with RIP Medical Debt, a nonprofit that buys and eliminates debt, to cancel approximately $2 billion in residents' medical debt. Through the partnership, Arizona will make up to $30 million in COVID-19 relief funds available for the nonprofit to use for debt purchasing.”

About pharma

 Gilead tries new triple-target T-cell engagers in $1.5B-plus Merus collab “Gilead and Merus have inked a partnership worth more than $1.5 billion to discover trispecific T-cell engagers, the companies announced Wednesday. In exchange for $56 million in upfront cash plus a $25 million equity investment from Gilead, Merus will lead early-stage research on two programs, with the potential for a third.” 

About the public’s health

 FDA advisory panel recommends a streamlined flu vaccine for next fall “Experts who advise the Food and Drug Administration on vaccine-related issues voted unanimously on Tuesday to recommend that the FDA approve trivalent flu vaccines for the 2024-2025 season, instead of the quadrivalent, or four-in-one, shots that have been the industry standard for the past decade or so.
The Vaccines and Related Biological Products Advisory Committee — VRBPAC, as it’s known — has been pushing for the removal of one of the influenza B components in flu vaccines, the portion that targeted B/Yamagata viruses, for some time now. B/Yamagata viruses haven’t been detected anywhere in the world since late March 2020, when Covid pandemic lockdowns and social distancing appeared to have halted circulation of this family of lineage of flu B.”

PrEP Discontinuation In A US National Cohort Of Sexual And Gender Minority Populations, 2017–22 “We found a high annual rate of discontinuation (35–40 percent) after PrEP initiation. Multivariable analysis with 6,410 person-years identified housing instability and prior history of PrEP discontinuation as predictors of discontinuation. Conversely, older age, clinical indication for PrEP, and having health insurance were associated with ongoing PrEP use. To promote sustained PrEP use, strategies should focus on supporting those at high risk for discontinuation, such as younger people, those without stable housing or health insurance, and prior PrEP discontinuers.”

About healthcare IT

 GE HealthCare, Vanderbilt AI models predict immunotherapy responses among cancer patients “GE HealthCare said its artificial intelligence programs were able to help predict cancer patients’ responses to immunotherapies by finding patterns within routinely collected clinical data.
Developed through a yearslong collaboration with Vanderbilt University Medical Center (VUMC), the models were able to parse electronic medical records and digest real-world information such as diagnosis codes and certain medication regimens; additional, manually entered inputs included the patient’s smoking history and the number of previous immune checkpoint inhibitor drugs they had taken.
According to the company, the algorithms were able to deliver 70% to 80% accuracy in forecasting efficacy outcomes and the likelihood of unwanted side effects—across a range of different cancer types, including melanoma and lung or genitourinary cancers—by analyzing deidentified demographic, genomic, tumor, cellular, proteomic and imaging data collected from more than 2,200 VUMC patients.”

About health technology

 FDA Clears First Over-the-Counter Continuous Glucose Monitor “U.S. Food and Drug Administration cleared for marketing the first over-the-counter (OTC) continuous glucose monitor (CGM). The Dexcom Stelo Glucose Biosensor System is an integrated CGM (iCGM) intended for anyone 18 years and older who does not use insulin, such as individuals with diabetes treating their condition with oral medications, or those without diabetes who want to better understand how diet and exercise may impact blood sugar levels. Importantly, this system is not for individuals with problematic hypoglycemia (low blood sugar) as the system is not designed to alert the user to this potentially dangerous condition.”

About healthcare finance

 Healthcare M&A: 10-point status update A good update on this activity.

Morningstar Indexes Selected by IMX Health for First Healthcare Futures Exchange Product Offering “ Morningstar, Inc…. announced that the Intelligent Medicine Exchange (“IMX”), the first futures and options exchange focused on the healthcare economy, has aligned with Morningstar Indexes to offer its first futures product. The IMX exchange was designated by the Commodity Futures Trading Commission in January of this year.
Healthcare represents nearly 20% of U.S. GDP but until IMX there was no dedicated derivatives market specifically focused on managing healthcare risk.
The new futures product from IMX Health will be based on the Morningstar US Healthcare Index, which measures the performance of approximately 170 U.S. public healthcare companies representing biotechnology, pharmaceuticals, research services, home healthcare, hospitals, long-term care facilities and medical equipment and supplies. This market capitalization-weighted index is designed for optimal tradability and liquidity. Among the largest current holdings in the index are household names like UnitedHealth, Eli Lilly, and Johnson & Johnson.”

Today's News and Commentary

Congress reaches spending deal with doc pay bump, delayed DSH cuts and more Good summary of the health provisions.

White House turns to health care in Biden’s latest move against ‘corporate greed’ “The White House plans to announce a new federal task force focused on easing health care costs, according to three people with direct knowledge of the matter.
The move comes as President Joe Biden seeks new ways to show voters he’s cracking down on the so-called corporate greed that he has increasingly blamed for high prices — a message he is expected to highlight during his State of the Union address on Thursday.”

About Covid-19

U.S. suspending free COVID test distribution once again “Orders for free tests placed on or before Friday will be delivered, per HHS.

About health insurance/insurers

Mounting headwinds in Medicare Advantage market haven’t stopped growth From a Chartis Report: “The following changes are shaping the market:  

  • Enrollment trends: Half of Medicare-eligible individuals are now in Medicare Advantage plans. The market grew by 1.7 million beneficiaries (+5.4%), slowing down from the previous year’s record growth of 2.7 million (+9.4%). Notably, for-profit carriers like United, Humana, and Aetna collectively captured 1.4 million new members: 86% of the total market’s growth.

  • Special Needs Plan (SNP) growth: SNP enrollment has surged, adding 1.2 million members. Nearly 7 in 10 new Medicare Advantage enrollees opted for SNPs. This growth is particularly pronounced in Chronic Condition SNPs (C-SNPs). The top 5 plans now represent 77% of the SNP market.

  • Plan options and preferences: The number of plan options are roughly flat from the previous year, with the average senior having access to 44 plans. In contrast, the trend of the past five years has been 80% growth. Preferred provider organizations (PPOs) have increased, constituting 43% of all plans offered, up from 31% in 2019.

  • Market dynamics and quality: Medicare Advantage enrollment and social vulnerability are related. Counties with higher vulnerability scores show greater penetration rates (53%) compared to counties with lower scores (45%). Meanwhile, quality remains a concern as plans struggle to maintain quality scores. Average star ratings continued their decline and this year approximately one-quarter of beneficiaries are enrolled in a plan with less than four stars.

  • Market outlook and executive sentiment: Health plans face recent market challenges, including declining payment rates, growing medical cost pressures, and an expanding regulatory burden. But 79% of plan executives express optimism about the next five years, expecting neutral or positive overall outcomes. 84% anticipate membership growth equal to or greater than the current year, indicating confidence in the stability and growth potential of the market.”

About hospitals and healthcare systems

 Nonprofits Aspirus Health, St. Luke's Duluth close 19-hospital merger “Wausau, Wisconsin-based Aspirus Health and Duluth, Minnesota-based St. Luke's have closed their merger and are now a 19-hospital entity spread across Minnesota, Wisconsin and Michigan's Upper Peninsula…” 

Providers losing $100M daily over Change Healthcare hack: Report “Some larger health systems are bleeding over $100 million daily because of the interruptions to the Optum subsidiary's payer systems, cybersecurity company First Health Advisory told multiple news outlets.”

About pharma

 Ohio Fines CVS $1.5 Million Over Safety and Staffing Issues “CVS Health, the nation’s largest pharmacy chain with more than 9,000 locations, has been fined more than $1.5 million by Ohio regulators over problems connected to understaffing and patient safety, officials said.
The fines are part of a settlement of 27 cases involving various safety concerns that were uncovered during a series of inspections of 22 pharmacies between 2020 and 2023, the State of Ohio Board of Pharmacy said in a statement on Thursday.
The board said that it found, among other things, improper drug security, errors dispensing drugs, prescription delays, lack of general cleanliness, understaffing and failure to report losses of controlled substances.”

Mark Cuban says Cost Plus Drugs targeting generic meds in short supply as it opens manufacturing facilityMark Cuban Cost Plus Drug Company will begin manufacturing its own generic medications this week, starting with sterile injectables, founder and CEO Alex Oshmyansky, M.D., Ph.D., said Monday during a White House roundtable on lowering healthcare costs.
The company, which launched just two years ago, will first manufacture commercial batches of epinephrine and norepinephrine for patients in the intensive care unit…”

Drugmakers send counter offers for U.S. Medicare price negotiations, Biden says “The manufacturers of 10 high-cost drugs selected for the U.S. Medicare program's first-ever pricing negotiations have submitted counter offers to the U.S. government's initial proposal, U.S. President Joe Biden said on Monday.
The negotiation program, passed as part of 2022's Inflation Reduction Act, allows Medicare to negotiate prices for the high-cost drugs. Medicare covers Americans aged 65 and above.”

About the public’s health

Screen Time and Parent-Child Talk When Children Are Aged 12 to 36 Months Findings  This cohort study found a negative association between screen time and measures of parent-child talk across those early years. For every additional minute of screen time, children heard fewer adult words, spoke fewer vocalizations, and engaged in fewer back-and-forth interactions.
Meaning  This study suggests that screen time is a mechanism that may be getting in the way of children experiencing a language-rich home environment during the early years; interventions aiming to promote early use of language should include support to manage screen time.”

About healthcare IT

 Sixth Semi-Annual Hospital Price Transparency Report February 2024 “Our latest review, conducted three years after the Hospital Price Transparency Rule took effect, analyzed the websites of 2,000 U.S. hospitals and found only 34.5% of them (689) to be fully compliant with all requirements of the rule. Although the majority of hospitals have posted files, the widespread noncompliance of 65.5% of hospitals is due to files being incomplete or not having prices clearly associated with both payer and plan. Eighty-seven of the hospitals reviewed for this report had no usable standard charges file.”
Comment: Where is the federal enforcement?

About health technology

 Epigenetic silencing lasts long-term in mice, bolstering case for therapeutic use “Mouse data from a new study published Feb. 28 in Nature and sponsored in part by Chroma Medicine suggest that epigenetic gene silencing can suppress the target gene for nearly a year, providing new evidence for the lasting effects of these therapies…
Epigenetic silencing is similar to gene editing in that both methods act directly on a gene. However, unlike gene editing, epigenetic silencing doesn’t fundamentally change the underlying DNA sequence; it works by “decorating” a gene with compounds, often methyl groups, to stop it from functioning. That makes it possible to reverse epigenetic modifications, as well as to avoid the pitfalls of DNA breakage.”

About healthcare finance

 Healthcare real estate companies close $21B merger “Denver-based Healthpeak Properties has closed its $21 billion all-stock merger with Milwaukee-based Physicians Realty Trust. The companies will operate under the name Healthpeak Properties…
The combined company will feature a portfolio of 52 million square feet with footprints in more than 30 markets, including 40 million square feet of outpatient medical settings in high-growth markets such as Houston, Nashville, Tenn., Denver, Phoenix and Dallas with hospital and health system affiliations.”

Today's News and Commentary

7 healthcare trends we're watching now A thoughtful summary. Highly recommended.

About Covid-19

 Interim Effectiveness of Updated 2023–2024 (Monovalent XBB.1.5) COVID-19 Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalization Among Immunocompetent Adults Aged ≥18 Years — VISION and IVY Networks, September 2023–January 2024  The vaccine lowers urgent care visits and hospitalizations by about 50% compared to no vaccination.

About health insurance/insurers

 ObamaCare faces key hearing after Texas ruling “A federal appeals court is set to hear arguments Monday on the Biden administration’s appeal of a case that threatens the Affordable Care Act’s (ACA) promise of free preventive care to more than 150 million people.  
A federal judge in Texas last year ruled that the law’s mandate requiring employers and insurers to cover a host of preventive services, like certain cancer screenings and HIV prevention, was unconstitutional.”

Why Medicare is adding prior authorization requirements as others cut back “Medicare is taking the rare step of adding pre-treatment approval requirements before patients can get care at certain outpatient surgical facilities that have seen a sharp uptick in billings…
The new requirements apply to 40 services related to five procedures,including rhinoplasty, eyelid lifts and varicose vein treatments.”

Primary Care Physicians In Medicare Advantage Were Less Costly, Provided Similar Quality Versus Regional Average “Assessing primary care physician costliness based on the gap between observed and predicted costs for their traditional Medicare patients, we found that the average primary care physician in MA networks was $433 less costly per patient (2.9 percent of baseline) compared with the regional mean, with less costly primary care physicians included in more networks than more costly ones. Favorable selection of patients by MA primary care physicians contributed partially to this result. The quality measures of MA primary care physicians were similar to the regional mean. In contrast, primary care physicians excluded from all MA networks were $1,617 (13.8 percent) costlier than the regional mean, with lower quality. Primary care physicians in narrow networks were $212 (1.4 percent) less costly than those in wide networks, but their quality was slightly lower. These findings highlight the potential role of selective contracting in reducing costs in the MA program.”

About hospitals and healthcare systems

 Hospital Facility Prices Declined As A Result Of Oregon’s Hospital Payment Cap  “In October 2019, the Oregon state employee health insurance plan instituted a cap on hospital payments…
The cap was associated with a significant reduction in outpatient facility prices over the course of the first twenty-seven months of the policy (−$130.50 per procedure). We estimated $107.5 million (or 4 percent of total plan spending) in savings to the state employee plan during the first two years. The hospital payment cap successfully reduced hospital prices for enrollees in that plan.”

About pharma

 1 in 3 independent pharmacies to close this year: Survey “Thirty-two percent of independent pharmacy owners plan to shutter their businesses by the end of 2024, according to a February survey
Local pharmacies are facing a plethora of headwinds, including dwindling reimbursements and struggles with pharmacy benefit managers, the National Community Pharmacists Association said Feb. 27.”

AstraZeneca's challenge to IRA price negotiations is rejectedLess than three weeks after a Texas judge tossed a lawsuit by industry lobbying group PhRMA that challenged the constitutionality of the Inflation Reduction Act (IRA), a federal court in Delaware has done the same with a similar action brought by AstraZeneca.
The company brought the suit in August of last year after its diabetes, kidney and heart drug Farxiga was named one of 10 products that will face Medicare price negotiations in 2026. Several other companies with drugs on the list have also filed lawsuits.”

Retail pharmacies to begin selling OTC birth control within weeks “Almost eight months after the FDA approved Opill, the first over-the-counter birth control pill, it will soon be available for purchase without a prescription at pharmacies like CVS and Walgreens in weeks…”

Drugs like Ozempic and Wegovy could boost the US economy by a trillion dollars in a few years, Goldman Sachs predicts  “The US economy is set to reap considerable benefits from Americans taking popular medications used for weight loss, including Ozempic and Wegovy, Goldman Sachs analysts wrote in a recent research report…
The Wall Street bank estimates that GLP-1s could add 0.4% to America’s gross domestic product, a broad measure of all the goods and services produced in the economy, ‘in a baseline scenario where 30 million users take the drugs and 70% experience benefits,’ and as much as 1% if 60 million Americans take those drugs regularly.
The US economy overall was about $28 trillion in the fourth quarter, so if Goldman’s bullish case bears out, that means GLP-1 drugs alone could boost output by a trillion dollars over the next four years, more or less.”
Comment: On the other hand, consider how much the drugs could add to health care costs.

About healthcare personnel

 Private Equity–Acquired Physician Practices And Market Penetration Increased Substantially, 2012–21  “PE-acquired physician practice sites increased from 816 across 119 MSAs in 2012 to 5,779 across 307 MSAs in 2021. Single PE firms had significant market share, exceeding 30 percent in 108 MSA specialty markets and exceeding 50 percent in 50 of those markets. The findings raise concerns about competition and call for closer scrutiny by the Federal Trade Commission, state regulators, and policy makers.”

About health technology

 Health tech Q4 earnings recap FYI

In a first, fetal cell organoids generated from amniotic fluid, new study reports “…researchers working in the U.K. have discovered that some [amniotic fluid] cells are still alive, and they can be grown up into three-dimensional organoids — mini lung, kidney, and small intestines — providing a possible new tool to study and even diagnose congenital fetal diseases.”

Today's News and Commentary

About Covid-19

 Where Did Covid Come From? “In the four years since the SARS-CoV-2 virus was unleashed on the world, data have steadily accumulated supporting the hypothesis that it emerged from a laboratory. The latest information, released last month, makes a formidable case that the virus is the product of laboratory synthesis, not of nature.”
Comment: Excellent review of the evidence.

CDC eases isolation guidance for Covid and other respiratory illnessesThe Centers for Disease Control and Prevention is “sunsetting” its advice that people sick with Covid-19 isolate themselves for five days. The agency published new guidance Friday for Covid and other respiratory illnesses, suggesting people who are sick should stay at home until they are fever-free for 24 hours and their symptoms have been improving for the same period of time.
The new guidance recommends that in the five days that follow, recovering people should take measures such as masking and keeping a physical distance from others to try to reduce the risk that they will spread their illness.”

About health insurance/insurers

With Medical Debt Burdening Millions, a Financial Regulator Steps In to Help “In the past two years, the CFPB has penalized medical debt collectors, issued stern warnings to health care providers and lenders that target patients, and published reams of reports on how the health care system is undermining the financial security of Americans.
In its most ambitious move to date, the agency is developing rules to bar medical debt from consumer credit reports, a sweeping change that could make it easier for Americans burdened by medical debt to rent a home, buy a car, even get a job. Those rules are expected to be unveiled later this year.”

About hospitals and healthcare systems

 Cleveland Clinic back in the black “Cleveland Clinic posted an operating income of $64.3 million in 2023 after posting a $211.3 million loss in 2022, according to its financial report released Feb. 29. 
The health system had a 0.4% operating margin for the year ended Dec. 31 after posting a -1.6% margin in 2022, according to the report.”

Tenet's hospital selling spree “Dallas-based Tenet Healthcare has started 2024 with a flurry of hospital sales. The for-profit system announced Feb. 1 it completed its $2.4 billion sale of three South Carolina hospitals to Winston-Salem, N.C.-based Novant Health. Also that day, Tenet announced it reached a definitive agreement to sell four Southern California hospitals and associated outpatient locations to Orange, Calif.-based UCI Health for $975 million. That deal is expected to close in the spring.”

About pharma

US judge rules against AstraZeneca in Medicare price talks challenge “AstraZeneca's attempt to stop Medicare from negotiating prices on its diabetes treatment Farxiga (dapagliflozin) was shut down in US federal court on Friday when a judge upheld a law mandating certain drugmakers to take part in price-capping negotiations with Medicare.”

CVS and Walgreens Will Begin Selling Abortion Pills This Month “The two largest pharmacy chains in the United States will start dispensing the abortion pill mifepristone this month, a step that could make access easier for some patients.
Officials at CVS and Walgreens said in interviews on Friday that they had received certification to dispense mifepristone under guidelines that the Food and Drug Administration issued last year. The chains plan to make the medication available in stores in a handful of states at first. They will not be providing the medication by mail.
Both chains said they would gradually expand to all other states where abortion was legal and where pharmacies were legally able to dispense abortion pills — about half of the states.”

AbbVie and OSE Immunotherapeutics Announce Partnership to Develop a Novel Monoclonal Antibody for the Treatment of Chronic Inflammation “AbbVie Inc. and OSE Immunotherapeutics SA, a clinical-stage immunotherapy company, today announced a strategic partnership to develop OSE-230, a monoclonal antibody designed to resolve chronic and severe inflammation, currently in the pre-clinical development stage.
OSE-230 is a first-in-class monoclonal antibody designed to activate ChemR23, a G-Protein Coupled Receptor (GPCR) target. Activation of ChemR23 may offer a novel mechanism for the resolution of chronic inflammation, modulating functions of both macrophages and neutrophils…
Under the terms of the agreement, AbbVie will receive an exclusive global license to develop, manufacture and commercialize OSE-230. OSE Immunotherapeutics will receive a $48 million upfront payment and will be eligible to receive up to an additional $665 million in clinical development, regulatory and commercial milestones. In addition, OSE Immunotherapeutics will be eligible to receive potential tiered royalties on global net sales of OSE-230.”

Sandoz settles for $265M in US generic drug price fixing fallout “Sandoz will pay $265 million to settle certain claims against the company alleging both product-specific and industry-wide conspiracies to fix generic drug prices in the US. The drugmaker said Thursday that the agreement, which contains no admission of wrongdoing, resolves all claims of the direct purchaser class plaintiffs against it and its Fougera Pharmaceuticals unit.”

Pfizer aims for 8 blockbuster cancer drugs by 2030 “‘Pfizer hopes to have at least eight blockbuster cancer drugs on the market by 2030 as it looks to build on the recent $43-billion acquisition of Seagen, which doubled the size of its oncology pipeline.’ Chris Boshoff, Pfizer’s chief oncology officer, noted that its cancer portfolio is expected to be ‘a critical driver of potential long-term sustainable sales and profit growth…through the end of the decade.’
Sales of the company’s current top-selling cancer drug Ibrance, as well as revenue from Astellas-partnered Xtandi, are set to come under pressure as both products start to lose market exclusivity in 2027. To counter this, the purchase of Seagen added a number of antibody-drug conjugates (ADCs), including Adcetris and Padcev, which are predicted to add a combined $3.1 billion in revenue this year.
Along with ADCs, Pfizer said that it will focus oncology development on small molecules and bispecific antibodies, including other immuno-oncology biologics, across four main cancer types. These comprise: breast cancer; genitourinary cancer, including prostate and urothelial cancers; haematology-oncology, including multiple myeloma and lymphomas; and thoracic cancers, which includes lung, and head and neck cancers.”

Biden-Harris Administration Issues Final Guidance to Help People with Medicare Prescription Drug Coverage Manage Prescription Drug Costs “Continuing the ongoing implementation of President Biden’s prescription drug pricing law, the Inflation Reduction Act of 2022, the Centers for Medicare & Medicaid Services (CMS) released the final part one guidance for the new Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan complements the Inflation Reduction Act’s other provisions that lower prescription drug and health care costs. The pieces of the law work together to lower drug costs and make them more manageable for people in Medicare.

  • As of January 1, 2024, people enrolled in Medicare Part D who have very high drug costs will, for the first time, no longer have to pay cost sharing for their prescription drugs in the catastrophic phase of the program.

  • Starting in 2025, all individuals with Medicare Part D will have their out-of-pocket prescription drug costs capped at $2,000.

  • On January 1, 2024, the law also expanded eligibility for full benefits under the Low-Income Subsidy program (LIS or “Extra Help”) under Medicare Part D. Nearly 300,000 people with low and modest incomes currently enrolled in LIS are now benefiting from the program’s expansion including lowering drug costs such as no deductible, no premiums, and fixed, lowered copayments for certain medications. An additional 3 million people could benefit from the Extra Help program now who are not currently enrolled.

  • The law also ensures people with Medicare Part D and people with Part B who receive insulin delivered through a pump pay no more than $35 for a month’s supply of each covered insulin product.

  • It also provides coverage without patient cost sharing of recommended vaccines for people who have Medicare Part D.”

About the public’s health

Alabama lawmakers pass legislation to protect IVF treatment “The Alabama legislature voted Thursday to protect providers and patients doing in vitro fertilization from criminal or civil liability if embryos they create are subsequently damaged or destroyed.
The fast action by both the House and Senate on bills to shield IVF came less than two weeks after the state’s Supreme Court ruled that frozen embryos are people and that individuals could be liable for destroying them.”

Deaths from Excessive Alcohol Use — United States, 2016–2021 “Average annual number of deaths from excessive alcohol use, including partially and fully alcohol-attributable conditions, increased approximately 29% from 137,927 during 2016–2017 to 178,307 during 2020–2021, and age-standardized death rates increased from approximately 38 to 48 per 100,000 population. During this time, deaths from excessive drinking among males increased approximately 27%, from 94,362 per year to 119,606, and among females increased approximately 35%, from 43,565 per year to 58,701.
What are the implications for public health practice? Evidence-based alcohol policies (e.g., reducing the number and concentration of places selling alcohol and increasing alcohol taxes) could help reverse increasing alcohol-attributable death rates.”

More than a billion people worldwide are obese, WHO study finds “More than a billion people globally are now considered obese, a condition linked to an increased risk of numerous serious health problems, according to updated estimates from the World Health Organization and an international group of researchers.
Obesity is so prevalent it has become more common than being underweight in most nations, including many low and-middle income countries that have previously struggled with undernourishment.”

IQVIA Study Highlights the Importance of Adult Vaccination in the US “The investigators found that rates for the flu vaccine in this [Medicaid] group are nearly 8%-10% lower than the general population, with that rate increasing to 30% when compared to individuals with Medicare coverage.”

Today's News and Commentary

About Covid-19

Cognition and Memory after Covid-19 in a Large Community Sample “Participants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain.” 

About health insurance/insurers

Change Healthcare cyberattack outage could persist for weeks, UnitedHealth Group executive suggests “The outage caused by the Change Healthcare cyberattack could last weeks, a top UnitedHealth executive suggested in a Tuesday conference call with hospital cybersecurity officers, according to a recording obtained by STAT.
UnitedHealth Group Chief Operating Officer Dirk McMahon said the company is setting up a loan program to help providers who can’t submit insurance claims while Change is offline. He said that program will last ‘for the next couple of weeks as this continues to go on.’”

MA Advance Notice Does Not Offset Rising Medical Costs and Could Lead to Reduced Healthcare Value for Beneficiaries Look at the two figures for state-by-state projected changes in monthly MA payments.

GAO: Billions wasted on federal health insurance program “The Office of Personnel Management, which oversees health insurance for 8 million federal workers and their families at a cost of more than $60 billion a year, has never checked the eligibility of those on its rolls, according to a report from the Government Accountability Office, which has been pushing OPM for years to improve its oversight. And that failure is costing taxpayers billions and raising premiums for millions of civil servants.”

Drawing the line on patient responsibility collection rates An excellent summary of the status of patient collections. In summary:Hospitals, health systems, and medical practices are collecting only about half of what patients owe them, and those relatively small dollar amounts are adding up to millions of dollars in lost revenue….
$17.4 B- Dollar value of total bad debt write-offs in 2023.”

About hospitals and healthcare systems

 Northwell Health, Nuvance Health unveil 28-hospital merger deal “Danbury, Connecticut-based Nuvance Health is joining Northwell Health, New York’s largest provider and private employer, under a strategic merger agreement unveiled Wednesday.
The deal, which still requires regulatory signoffs, would create a healthcare network of more than 28 hospitals, over 1,000 care sites, nearly 100,000 staff and 14,500 employed providers, the two nonprofits said in their joint announcement.”

Universal Health Services beats on earnings, revenues and projects 'conservative' earnings growth for 2024 “Universal Health Services (UHS) beat estimates for the fourth quarter and is forecasting higher, though still ‘conservative,’ full-year earnings for 2024.
The King of Prussia, Pennsylvania-based for-profit health system reported $216.4 million net income ($3.16 per diluted share) during the fourth quarter, an improvement over last year’s $174.8 million ($2.43 per diluted share) and $0.25 higher than the consensus estimate, according to numbers released after market close on Tuesday.
Net revenues for the quarter rose 7.4% year over year to $3.70 billion, which was also above the consensus estimate of $3.66 billion.”

FEBRUARY 2024 National Hospital Flash Report “Key Takeaways
1. Margins improved in January relative to previous years. While margins declined
slightly from December, they were higher in January relative to the same periods in 2022 and 2021.
2. Net revenue has not risen as fast as gross revenue. This might reflect payers negotiating more aggressively and a shift to value-based payment models.
3. Total expenses on a volume-adjusted basis have improved. Though there’s been continued growth in drugs and supply expenses, labor expenses have improved.” 

Hospital expenses per inpatient day across 50 states FYI. For example:
National average 
Nonprofit hospitals: $3,167
For-profit hospitals: $2,383 
State/local government hospitals: $2,857

About pharma

Bankrupt Endo To Pay $2B To Resolve Opioid Claims “Bankrupt drugmaker Endo International has agreed to pay approximately $2 billion to resolve criminal and civil allegations related to its sales and marketing of a powerful opioid, with a group of secured lenders set to operate the company under a new corporate structure.”

Association of Cannabis Use With Cardiovascular Outcomes Among US Adults “Cannabis use is associated with adverse cardiovascular outcomes, with heavier use (more days per month) associated with higher odds of adverse outcomes.”

Walgreens' VillageMD to close all Illinois clinics “Walgreens' VillageMD plans to close all its primary care clinics in Illinois in April, abandoning an expansion that was underway in its home state.
The six clinics that will close April 19 are all in the Chicago area, according to VillageMD's website. Five are standalone locations and one is attached to a Walgreens store. The one co-located clinic in Elk Grove opened just six months ago
the number of locations that have already closed or plan to close has exceeded 80 clinics.”

About the public’s health

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses The summary provides further evidence of the deleterious effects of ultra-processed foods. For example: “Overall, direct associations were found between exposure to ultra-processed foods and 32 (71%) health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes. Based on the pre-specified evidence classification criteria, convincing evidence (class I) supported direct associations between greater ultra-processed food exposure and higher risks of incident cardiovascular disease related mortality (risk ratio 1.50, 95% confidence interval 1.37 to 1.63; GRADE=very low) and type 2 diabetes (dose-response risk ratio 1.12, 1.11 to 1.13; moderate), as well as higher risks of prevalent anxiety outcomes (odds ratio 1.48, 1.37 to 1.59; low) and combined common mental disorder outcomes (odds ratio 1.53, 1.43 to 1.63; low).”

Certain types of ‘forever chemicals’ will no longer be used in US food packaging, FDA says
Certain kinds of greaseproofing “forever” chemicals called per- and polyfluoroalkyl substances, or PFAS, will no longer be used in food packaging in the US, the US Food and Drug Administration announced Wednesday.
The FDA’s food studies have shown that food packaging materials like fast-food wrappers, microwave popcorn bags and take-out pizza boxes were a major source of dietary exposure to certain types of PFAS, hormone-disrupting chemicals that may persist in the body and the environment.”

CDC braces for shortage after tetanus shot discontinued, issues new guidance “The Centers for Disease Control and Prevention is urging doctors to conserve shots of a kind of tetanus vaccine, as the agency braces for a potential shortage of those shots this year.
Doctors should switch from using the so-called Td vaccine – the immunization that protects against both tetanus and diphtheria infections – to giving the broader Tdap vaccine instead whenever possible, the CDC now says. In addition to tetanus and diphtheria, the Tdap vaccine also offers protection against pertussis, the infection also known as ‘whooping cough.’
This year's shortage risk stems from a decision by nonprofit vaccinemaker MassBiologics to discontinue production of its Td vaccine, branded as TdVax.”

Flu shots are doing OK vs. virus, US numbers indicate “The vaccines were around 40% effective in preventing adults from getting sick enough from the flu that they had to go to a doctor’s office, clinic or hospital, health officials said during a Centers for Disease Control and Prevention vaccines meeting Wednesday. Children who were vaccinated were roughly 60% less likely to get treatment at a doctor’s office or hospital, CDC officials said.
Officials generally are pleased if a flu vaccine is 40% to 60% effective.”

About healthcare IT

Ransomware group leader told hackers to attack hospitals, FBI, HHS say “The ransomware group linked to the cyberattack on Change Healthcare is also targeting hospitals, the FBI and HHS warned Feb. 27.
The BlackCat hacker gang has been focusing its attacks on the healthcare sector, with most of its 70 victims since December coming from that industry, according to the notice. The group's administrator encouraged affiliates to attack hospitals that month after the FBI infiltrated its operations.”

A Snapshot of Artificial Intelligence in Healtcare Based on research from Premier executives. It is interesting to contrast the priorities between the executive and physicians. The former see the best use of AI is in clinical care, while the latter see AI helping with administrative tasks. (See yesterday’s Blog post.)

Today's News and Commentary

About Covid-19

CDC recommends older adults get 2nd updated coronavirus shot “A CDC recommendation means that those who are eligible for a second shot will have that additional dose covered by insurance. Eligible consumers should be able to get the additional dose within a day or twofrom pharmacies or health-care providers stocking the vaccines. There are no supply shortages, CDC officials said.” 

About health insurance/insurers

U.S. Opens UnitedHealth Antitrust Probe “The Justice Department has launched an antitrust investigation into UnitedHealth, owner of the biggest U.S. health insurer, a leading manager of drug benefits and a sprawling network of doctor groups.
The investigators have in recent weeks been interviewing healthcare-industry representatives in sectors where UnitedHealth competes, including doctor groups, according to people with knowledge of the meetings.
During their interviews, investigators have asked about issues including certain relationships between the company’s UnitedHealthcare insurance unit and its Optum health-services arm, which owns physician groups, among other assets. 
Investigators have asked about the possible effects of the company’s doctor-group acquisitions on rivals and consumers, the people said.”

2023 Consumer Engagement in Health Care Survey An excellent annually-published report. Read the Key Findings sections.

About hospitals and healthcare systems

 World's Best Hospitals 2024 FYI. From Newsweek.

Mayo posts $1.1B operating income, 6% margin “Mayo Clinic saw financial and operational improvements in 2023 that lifted its net operating income to $1.1 billion, according to financial results released Feb. 27. 
The Rochester, Minn.-based system recorded revenue of $17.9 billion against expenses of $16.8 billion in 2023, resulting in net operating income of $1.1 billion and a 6% operating margin.
The latest results mark a comeback for Mayo, which has seen cyclical losses and gains in the past few years. It reported operating income of $595 million for 2022 compared to a $1.2 billion gain in 2021. Mayo cared for more than 1.3 million patients from more than 130 countries in 2023.”

Trinity Health nearly wipes last year's operating losses, grows revenue by over 11% “Livonia, Michigan-based Trinity Health brought its six-month operating losses down from last year’s $270.3 million (-2.6% operating margin) to $38.6 million (-0.3% operating margin) thanks to higher volumes and ‘several revenue and cost management initiatives…’
Though Trinity reports its financials on a year-to-date basis, the faith-based provider noted that the trajectory of its margins improved from a loss in the first fiscal quarter, ended Sept. 30, to a gain in its most recent, ended Dec. 31. Its six-month bottom line has also risen year over year from a $70.5 million loss to a $669.1 million net income.”

About pharma

 PBMs not complying with federal probe: FTC “In June 2022, the Federal Trade Commission launched a probe into the business practices of pharmacy benefit managers and how they affect drug affordability and access. No PBM has fully complied with the probe, FTC Chair Lina Khan said in a recent letter obtained by Axios.”

Spotlight On: Pharma’s fastest-growing drugs in 2023 FYI. Not a surprise, at the top spot is Ozempic.

Five Companies Won’t Delist Orange Book Patents Challenged by FTC, Three Others Will “While three of the companies warned of inappropriate Orange Book patent listings by the FTC are delisting all the challenged patents, according to the U.S. legislators who led the action, five others refused to delist.
The companies who refused to delist certain patents said all of their challenged patents were appropriately filed, and had never been used to stifle generics competition.”

About the public’s health

Emhoff unveiling $1.7B in new commitments to Biden anti-hunger initiative “Second gentleman Doug Emhoff unveiled nearly $1.7 billion in new commitments to the Biden administration’s efforts to end hunger by the end of the decade.
The list includes more than 140 commitments from nonprofits, insurers, health systems, local officials and academia. Sixteen cities across the country have pledged to create task forces and action plans to end hunger and reduce diet-related diseases by 2030.”

About healthcare IT

AI AND THE FUTURE OF HEALTHCARE Worth a read. For example, a couple findings:
—Investors spent $31.5B in healthcare AI-related technology between 2019 and 2022, and these technologies are expected to fuel more investments, and influence valuations and market value for healthcare organizations moving forward. Recent research finds that wider adoption of AI could lead to savings of 5% to 10% in US healthcare spending–roughly $200 billion to $360 billion annually in 2019 dollars.
—Only four in ten overall respondents indicate their organizations are reviewing or planning to review AI regulatory guidance. Despite this, a majority remain confident about regulators’ abilities to develop adequate safeguards.”

The Emerging Landscape of Augmented Intelligence in Health Care A good review for those who need an introduction to the topic. What I found most interesting is the data in Figure 5 (page 13). By far, physicians want AI to help with “administrative burdens.”

FTC’s Khan warns tech industry that agency will strictly enforce AI data privacy “Artificial intelligence tools will be vigorously regulated by the Federal Trade Commission (FTC), with an eye on consumer privacy, its Chair Lina Khan told an audience of tech executives and startup founders at a conference Tuesday.
‘We’re crafting easily administrable remedies with bright-line rules on the development, use and management of AI inputs,’ Khan said during a speech. “That means making clear that some data, particularly peoples’ sensitive health data, geolocation data and browsing data is simply off limits for model training.”

About healthcare personnel

Only 37% of Medical Practices Receive Value-Based Care Payments, Black Book Survey Reveals “While the shift towards value-based care (VBC) is underway, a recent Black Book survey reveals that only 37% of medical practices are currently receiving payments from upside-risk arrangements and shared savings, while 12% receive payments from full risk.
This leaves a significant portion, over 50%, still relying on traditional Fee-For-Service models.”

About health technology

Epigenetic silencing lasts long-term in mice, bolstering case for therapeutic useMouse data from a new study published Feb. 28 in Nature and sponsored in part by Chroma Medicine suggest that epigenetic gene silencing can suppress the target gene for nearly a year, providing new evidence for the lasting effects of these therapies.”

Today's News and Commentary

About Covid-19

 The Top COVID-19 Hot Spots in the U.S. FYI. Check the interactive map for your county.

About health insurance/insurers

Congress Sidesteps Site-Neutral Hospital Payment Reform in Upcoming Funding Package “In a move that has reignited the debate over healthcare affordability and equity, Congress has decided not to include a site-neutral hospital pay policy in the next government funding package. This decision has broad implications for how outpatient services are billed across the United States, potentially affecting the cost of healthcare for millions of Americans. At its core, the debate centers on whether hospitals should receive higher payments than standalone physicians’ offices for the same outpatient services, a practice that the site-neutral policy sought to eliminate.”

MA Advance Notice Does Not Offset Rising Medical Costs and Could Lead to Reduced Healthcare Value for BeneficiariesBRG forecasts how the three major impacts to 2025 payment could affect MA buy-down of premiums, cost sharing, and supplemental benefit offerings:
(1) Net risk scores will drop by 2.9% due to changes in normalization factors and the continued phase-in of the new risk model V28
2) Star rating changes will lower payment by 0.5%
(3) Growth factor will increase by 2.4%
One main reason why BRG expects a larger reduction than CMS estimates is that BRG expects medical inflation for MA plans to increase by 4% to 6% in 2025. Medical costs per MA member per month grew by an estimated 7.3% for the first nine months of 2023, based on analysis of NAIC1 statutory filing data for plans that represent 85% of MA lives. The fourth quarter of 2023 had similar growth for MA plans…”

About hospitals and healthcare systems

20 hospitals that won the most NIH money in 2023 — and how much they got FYI. Five of the top ten are in Boston.

About pharma

 FDA Approves Humira Biosimilar Adalimumab-ryvk “The US Food and Drug Administration (FDA) has approved adalimumab-ryvk (Simlandi), the first interchangeable, high-concentration, citrate-free biosimilar to adalimumab (Humira), according to a press release published by Alvotech and Teva Pharmaceuticals.1 The tumor necrosis factor (TNF) inhibitor is approved for the treatment of a variety of autoimmune conditions, including rheumatoid arthritis (RA), juvenile idiopathic arthritis, Crohn’s disease, ulcerative colitis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, uveitis, and hidradenitis suppurativa.”
Comment: Humor sales have been strong despite the other available generics. Perhaps this one, being interchangeable, will make a dent in the brand’s sales.

US pharmacy outage triggered by 'Blackcat' ransomware at UnitedHealth unit, sources say “Hackers working for the 'Blackcat' ransomware gang are behind the outage at UnitedHealth's technology unit that has snarled prescription deliveries for six days, two people familiar with the matter told Reuters on Monday.
The problems began last week after hackers gained access to Change Healthcare's information technology systems and has led to disruptions at pharmacies across the United States.”
Comment: Change Healthcare says service should be restored in the next day or so.

Novo Nordisk joins protein degradation race in $1.4B+ deal with Neomorph “Novo Nordisk signed its first protein degradation deal Monday and is looking to take the molecular glue modality – most often used in oncology – into the cardiometabolic and rare disease spaces. The Danish drugmaker partnered with Neomorph in a multi-target deal worth $1.46 billion in biobucks…
Under the deal – the recently launched biotech’s first – Neomorph will lead discovery and preclinical activities against selected targets, and Novo Nordisk will have the right to exclusively pursue further clinical development and commercialisation of the compounds.”

About the public’s health

Biden-Harris Administration Announces New Funding to Increase Capacity for Behavioral Health Services “Today, the U.S. Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), announced $36.9 million in notices of funding opportunities for grant programs supporting behavioral health services across the country. Additionally, HHS, through the Centers for Medicare & Medicaid Services (CMS), issued guidance that allows states to expand the pool of behavioral health care providers eligible for enhanced federal Medicaid funding, which will better support this critical workforce as well as improve access to care. The guidance also allows states to claim federal dollars for nurse advice lines.”
The announcement also details the spend on each activity.

About healthcare IT

 HHS Delivers Reports to Congress on HIPAA Compliance, Enforcement “The HHS Office for Civil Rights (OCR) delivered two reports to Congress on HIPAA compliance and enforcement efforts logged by the department during the 2022 calendar year. HHS is required to submit these reports to Congress each year under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009…
OCR received more than 30,000 new complaints alleging HIPAA violations in 2022, and resolved more than 32,000 cases in the 2022 calendar year. OCR also completed 846 compliance reviews and required entities to take corrective actions or pay a monetary penalty in 80 percent of those investigations.
OCR has seen a 17 percent increase in HIPAA complaints received from 2018 to 2022 and a 107 percent increase in large breaches reported in that timeframe.”

Today's News and Commentary

About health insurance/insurers

ICYMI: Medicare Advantage fraud in DOJ's crosshairs after agency reports $2.7B in settlements “Under the False Claims Act, more than $1.8 billion in settlements and judgments was related to health-related matters in the last fiscal year, about two-thirds of the monetary fraud recoveries by the Department of Justice (DOJ).
Scams took place across the industry, affecting managed care providers, hospitals, pharmacies and long-term acute care facilities. The agency said Feb. 22 that $1.8 billion refers to recoveries ‘arising only from federal losses,’ but it often recovered more for state Medicaid programs.The total fraud figure jumps to more than $2.68 billion once including all other types of reported fraud.”

About hospitals and healthcare systems

25 unwound, canceled hospital deals FYI

 Cooper to begin estimated $2B expansion this year “Cooper University Health Care is preparing to begin the first phase of a projected $2 billion expansion this year, according to Fitch Ratings.
In late 2022, Cooper announced a long-term vision to update its Camden, N.J., campus. The vision comprises three independent phases, with an initial public price of about $2 billion. Fitch said the phased approach gives Cooper the flexibility to pause spending and the ability to reevaluate should market conditions or business strategies change.”

Hospitals show decline in Fitch’s early 2023 analysis, but should improve (a little)Overall, Fitch expects the 2023 operating margins to rise into positive territory, albeit barely. The 2023 margins are expected to rise to 0.5% to 0.7%, which remains below pre-pandemic levels.
In 2024, Fitch projects margins should move up to 1.6%.
Hospitals are seeing some relief in their labor costs, which have risen substantially since the COVID-19 pandemic.”

About pharma

Biotech's top money raisers of 2023Nearly $23 billion in venture capital flowed to biopharma across 613 deals in 2023. The dollar total is down 21% from 2022 and 42% from 2021, according to an annual report from HSBC. The trend was worse for biotechs hunting for their first deal.” 

Prices for new US drugs rose 35% in 2023, more than the previous yearPharmaceutical companies last year launched new U.S. drugs at prices 35% higher than in 2022, reflecting in part the industry's embrace of expensive therapies for rare diseases like muscular dystrophy, a Reuters analysis found.
The median annual list price for a new drug was $300,000 in 2023, according to the Reuters analysis of 47 medicines, up from $222,000 a year earlier. In 2021, the median annual price was $180,000, the 30 drugs first marketed through mid-July, according to a study published in JAMA.”

About the public’s health

 U.S. launches probe into possible fraud by organ collection groups “The probe involves U.S. attorneys in various parts of the country who are investigating organ procurement organizations in at least five states. Their team includes investigators from the Department of Health and Human Services and the office of Michael Missal, the inspector general of the Department of Veterans Affairs. They are seeking to determine, among other things, whether any of these groups have been overbilling the government for their costs.”

About healthcare IT

 Unveiling Inferno Testing Support for Payer Data Exchange API Standards “ONC has hit a new milestone in advancing interoperability across the care continuum. A new series of voluntary tests to support standards-based application programming interfaces (APIs) leveraging Health Level Seven® (HL7®) implementation specifications developed via the Da Vinci project and the CARIN Alliance are now available in the ONC-developed Inferno testing tool. The tests are open source, with the source code freely available for use by the public on GitHub.”

About healthcare personnel

 $1 Billion Donation Will Provide Free Tuition at a Bronx Medical School “Dr. Ruth Gottesman, a longtime professor at the Albert Einstein College of Medicine, is making free tuition available to all students going forward.”  

About healthcare finance

 Private equity firm offers $5.8 billion buyout of hospital billing company R1 RCM “R1 RCM, a large publicly traded technology company that helps hospitals and physicians collect money from insurers and patients, may be going private.
Private equity firm New Mountain Capital has offered to purchase R1 for $13.75 per share, or roughly $5.8 billion in cash, according to new financial disclosures filed Monday. New Mountain Capital is R1’s second-largest investor, owning nearly one-third of the company’s shares.”

Today's News and Commentary

About Covid-19

 Covid death toll in US likely 16% higher than official tally, study says “The Covid death toll in the US is likely at least 16% higher than the official tally, according to a new study, and researchers believe the cause of the undercounting goes beyond overloaded health systems to a lack of awareness of Covid and low levels of testing.
The second year of the pandemic also had nearly as many uncounted excess deaths as the first, the study found.”

Study shows 43% to 58% lower prevalence of long COVID among vaccinated people “A new study based on 4,605 participants in the Michigan COVID-19 Recovery Surveillance Study shows that the prevalence of long COVID symptoms at 30 and 90 days post-infection was 43% to 58% lower among adults who were fully vaccinated before infection.”

About health insurance/insurers

Former CMS administrator: 'I would like to see Medicare Advantage slowed or stopped' The headline is more dramatic than the interview, which is a more nuanced and thoughtful conversation with Donald Berwick, MD, MPP.

False Claim Act settlements, judgements hit record high in 2023There were a record high 543 False Claims Act settlements and judgements in 2023, according to a Feb. 22 Justice Department news release…More than $1.8 billion of those judgements and settlements involved the healthcare industry. 
The $1.8 billion reflects recoveries arising only from federal losses, but the Justice Department was also instrumental in recovering additional funds for state Medicaid programs, according to the report.”
In a related story:Pharmacy owners, doctors, marketers charged in alleged Texas-wide kickback scheme

In-network insurance claims jumped after surprise billing ban took effectFAIR Health used its database of roughly 42 billion commercial insurance claims to examine in-network claims between 2019 and the third quarter of 2023, capturing the period before and after enactment of the No Surprises Act and surprise billing laws in multiple states.

  • During that period, the share of in-network care increased from about 84% of all claims to 90% of claims nationally.

  • There was a particularly steep increase of 2.3% between the fourth quarter of 2021 and the first quarter of 2022, when the federal protections took effect.”

What Do Medicare Beneficiaries Value About Their Coverage? From The Commonwealth Fund:
“Survey Highlights

  • Whether enrolled in Medicare Advantage or traditional Medicare, about two in three beneficiaries overall said their coverage has fully met their expectations. Those who said it fell short of expectations pointed to a lack of coverage for needed services, high costs, or uncertainty about what benefits are covered.

  • Larger shares of beneficiaries in MA plans than in traditional Medicare reported they experienced delays in getting care because of the need to obtain prior approval (22% vs. 13%) and couldn’t afford care because of copayments or deductibles (12% vs. 7%). By other metrics, access to needed health care was similar. For example, more than a third of beneficiaries in each type of Medicare coverage said they had to wait over a month to see a doctor.

  • Three in five beneficiaries in MA plans and one-quarter in traditional Medicare said they were asked to undergo a health assessment, which most frequently resulted in a discussion with their doctor. Few said it resulted in any changes to their care plan or in more services or benefits being offered.

  • Seven in 10 beneficiaries in MA said they used some of their plan’s supplemental benefits in the past year; three in 10 did not use any. Four in 10 reported using their dental or vision benefits or an allowance for over-the-counter medications.”

About hospitals and healthcare systems

 Community Health Systems discloses DOJ investigation “Community Health Systems (CHS) disclosed in a Securities and Exchange Commission filing that it is being investigated by the Department of Justice. 
The company received a Civil Investigative Demand on Jan. 11 ‘for documents and information relating to a variety of subjects, including practices and procedures related to utilization review, inpatient admissions and inpatient dialysis at our hospitals,’ according to its Form 10-K, released Wednesday.”

About pharma

 Pharmacies across America are having trouble processing some prescriptions because of a cyberattack “ Pharmacies across the United States are reporting that they are having difficulty getting prescriptions to patients because of a cyberattack on a unit of UnitedHealth.
The company said in a regulatory filing Thursday its Change Healthcare business, which processes prescriptions to insurance for tens of thousands of pharmacies nationwide, was compromised by hackers who gained access to some of its systems. The company became aware of the cyberattack Wednesday, and, in a separate statement, said it expected the attack to last at least throughout the day Thursday.
The cyberattack prevented some pharmacies from processing prescriptions to insurance companies to receive payment.”

Long-term CAR-T data bolsters autoimmune argument “After stealing the show at December’s American Society of Hematology (ASH) meeting with promising early data of lupus patients treated with CAR-T cell therapy, a team of German scientists has now published updated results in the NEJM that suggest the one-time treatment can lead to sustained remission for patients with several autoimmune diseases.
At 29 months of follow-up, all eight patients with systemic lupus erythematosus (SLE) had no signs of disease activity.”

About the public’s health

This article gets the poor wording award: Families of Infertile Men Face Higher Cancer Risks

Variability and patterns in children's media use and links with language development “The current study examines how and why young children are using media and its association with language development. It is clear that media use, especially video watching, is pervasive even by 17–30 months. Children at this age reportedly watch an average of nearly 2 hours of video each day, compared to an hour of reading. This is a 100% increase from prior estimates. Moreover, children with high video watching (but not other media) had lower vocabulary.”

Air pollution tied to signs of Alzheimer’s in brain tissue, study finds “For the study, published this week in the journal Neurology, researchers examined the association between concentrations of ambient air pollution and signs of Alzheimer’s disease in the human brain. They found that people who were exposed to higher concentrations of fine particulate matter air pollution, also known as PM2.5, at least a year before their death were more likely to have higher levels of plaques — abnormal clusters of protein fragments built up between nerve cells, which is a sign of Alzheimer’s in brain tissue. The research also found a strong association between the pollution and signs of the disease for people who were not already genetically predisposed to Alzheimer’s.”

 Deadly opioid detected in wastewater for the first time “University of Queensland researchers and international collaborators have found a deadly synthetic drug in wastewater in the United States – the first such detection globally. 
Dr Richard Bade from UQ’s Queensland Alliance for Environmental Health Sciences led a team which analysed wastewater samples from eight locations in seven US states: Arizona, Georgia, Illinois, New Jersey, New Mexico, Oregon and Washington. 
Dr Bade said wastewater from two of the sites, in Illinois and Washington, recorded a type of opioid called protonitazene.
‘Protonitazene is a novel synthetic opioid around three times more potent than fentanyl, and even very small amounts can produce life-threatening toxic effects,’ Dr Bade said.”

Florida surgeon general defies science amid measles outbreakAs a Florida elementary school tries to contain a growing measles outbreak, the state’s top health official is giving advice that runs counter to science and may leave unvaccinated children at risk of contracting one of the most contagious pathogens on Earth, clinicians and public health experts said.
Florida surgeon general Joseph A. Ladapo failed to urge parents to vaccinate their children or keep unvaccinated students home from school as a precaution in a letter to parents at the Fort Lauderdale-area school this week following six confirmed measles cases.
Instead of following what he acknowledged was the “normal” recommendation that parents keep unvaccinated children home for up to 21 days — the incubation period for measles — Ladapo said the state health department “is deferring to parents or guardians to make decisions about school attendance.” 

About healthcare IT

 AHIP, AMA and employer groups team up to accelerate digital health adoption “Fourteen organizations representing providers, payers, consumer technology companies and employers are teaming up to cut through the noise and raise higher standards for finding digital health solutions that work and are worth the investment.
The new Digital Health Collaborative, supported by the Peterson Health Technology Institute, brings together provider groups, purchasers and end users and initial work will focus on pulling together a national purchaser survey, grantmaking and convenings, the organization said.
The Peterson Health Technology Institute formed in July 2023, armed with $50 million in funding, to evaluate digital health technologies and help cut through the hype to identify innovations that actually benefit patients. PHTI focused on providing independent, evidence-based assessments of emerging products, something that is currently lacking in the market.”

About health technology

Study shows a frontline Alzheimer’s blood test could be as accurate as spinal fluid exams “The researchers—some of whom previously worked with the Washington University’s spinout C2N Diagnostics…and developer of the PrecivityAD blood tests for Alzheimer’s—say this new assay is capable of performing on par with PET scans and analyses of cerebrospinal fluid by picking out the tau and amyloid beta proteins in plasma that are associated with the neurodegenerative disease.”

Today's News and Commentary

About Covid-19

 Long COVID linked to persistently high levels of inflammatory protein: a potential biomarker and target for treatments  “SARS-CoV-2 triggers the production of the antiviral protein IFN-γ, which is associated with fatigue, muscle ache and depression. New research shows that in Long COVID patients, IFN-y production persists until symptoms improve, highlighting a potential biomarker and a target for therapies.” 

About health insurance/insurers

 Medicare Advantage’s 33 million club “Roughly 33.4 million people were enrolled in a Medicare Advantage plan at the start of 2024, according to new federal data that we analyzed last week. It’s an increase of 7.1% from the same time last year, although it appears the true annual growth rate is closer to 6% after factoring in some errors within Medicare’s 2023 data…”

About hospitals and healthcare systems

 States ranked by hospital beds per 1,000 population FYI. Not a surprise that more rural states need more hospitals to provide adequate access.

About pharma

 Walgreens' VillageMD to close all Florida primary care clinics “Clinics in the Tampa and Orlando areas will close March 15 as the company exits the Florida market, a company spokesperson confirmed Feb. 21. VillageMD's website lists about 40 clinic locations in Florida, all co-located with Walgreens stores….
 The closures are part of a $1 billion cost-cutting initiative Walgreens implemented late last year that involves closing 60 VillageMD-operated clinics in five markets. As of the company's January earnings call, it had closed nearly half of those, CEO Tim Wentworth told analysts. It shuttered 10 clinics in Jacksonville, Fla., and all 12 of its clinics in Indiana last month.”

FDA approves a drug to treat severe food allergies, including milk, eggs and nuts “Xolair was greenlit by the Food and Drug Administration on Friday to help reduce severe allergic reactions brought on by accidental exposure to certain foods. It is considered the first medication approved by the FDA that can help protect people against multiple food allergies.
The medication is not intended for use during an allergic reaction. Instead, it is designed to be taken repeatedly every few weeks to help reduce the risk of reactions over time. The FDA said people taking the drug should continue to avoid foods they are allergic to…
The cost of the medication ranges from $2,900 a month for children and $5,000 a month for adults, though the cost could be brought down with insurance…”

About the public’s health

Boosting Health for Children: Transition to Electric Vehicles and Clean Power Would Prevent 2.7 Million Asthma Attacks in U.S. Kids From the American Lung Association:
“The new report is based on projected health impacts if all new passenger vehicles sold are zero-emission by 2035 and all new trucks sold are zero-emission by 2040. It also projects that the nation’s electric grid will be powered by clean, non-combustion renewable energy by 2035. According to the report, the transition to zero-emission transportation powered by clean non-combustion energy from 2020 to 2050 would prevent up to:

  • 2.79 million pediatric asthma attacks

  • 147,000 pediatric acute bronchitis cases 

  • 2.67 million pediatric upper respiratory symptoms

  • 1.87 million pediatric lower respiratory symptoms 

  • 508 infant mortality cases”

Historical Redlining, Persistent Mortgage Discrimination, and Race in Breast Cancer Outcomes “In a cohort study of 1764 women with breast cancer, living in a historically redlined area was associated with increased odds of a diagnosis of estrogen receptor–negative breast cancer in non-Hispanic Black women and increased odds of late-stage diagnosis in non-Hispanic White women. Persistent mortgage discrimination was associated with an increase in breast cancer mortality in non-Hispanic White women, and non-Hispanic Black women were more likely to die of breast cancer no matter where they lived.”

About healthcare personnel

Almost All U.S. Physicians Surveyed Feel Burned Out on a Regular Basis, with Many Having Considered Career Change, according to Recent athenahealth Physician Sentiment Survey “Excessive administrative workloads, reduced staffing, concerns over financial viability, and rising patient expectations around communications are all contributing to major challenges for America’s healthcare industry, athenahealth’s third Physician Sentiment Survey (PSS), conducted by The Harris Poll, has revealed. The survey polled 1,003 primary care and specialist physicians nationwide, with just five percent of respondents identifying as athenahealth customers.
Most physicians (93%) surveyed for the PSS said that they feel burned out on a regular basis, with doctors reporting that they spend an average of 15 hours per week working in ‘pajama time,’ outside their normal work hours. When asked about their current employment situation, a majority (56%) said they have considered leaving the field or remaining in the field but no longer seeing patients.”
 

About health technology

Do Not Use Smartwatches or Smart Rings to Measure Blood Glucose Levels: FDA Safety Communication “The U.S. Food and Drug Administration (FDA) is warning consumers, patients, caregivers, and health care providers of risks related to using smartwatches or smart rings that claim to measure blood glucose levels (blood sugar) without piercing the skin. These devices are different than smartwatch applications that display data from FDA-authorized blood glucose measuring devices that pierce the skin, like continuous glucose monitoring devices (CGMs). The FDA has not authorized, cleared, or approved any smartwatch or smart ring that is intended to measure or estimate blood glucose values on its own.”

About healthcare finance

 AbbVie eyes selling at least $13 billion of bonds to fund M&A “Pharmaceutical giant AbbVie Inc. is looking to sell at least $13 billion of corporate bonds to help fund its acquisitions of ImmunoGen Inc. and Cerevel Therapeutics Holdings Inc., according to people with knowledge of the matter.
The sale is expected to be announced as soon as Thursday, following fixed-income investor calls on Wednesday, said the people, who asked not to be identified because the discussions are private. The size of the offering is subject to change, and will be determined on the day of the sale. A spokesperson for AbbVie didn’t immediately respond to requests for comment.”

Today's News and Commentary

About Covid-19

 Tax records reveal the lucrative world of covid misinformation “Four major nonprofits that rose to prominence during the coronavirus pandemic by capitalizing on the spread of medical misinformation collectively gained more than $118 million between 2020 and 2022, enabling the organizations to deepen their influence in statehouses, courtrooms and communities across the country, a Washington Post analysis of tax records shows.”

About health insurance/insurers

 Who is winning surprise billing disputes? Providers, facilities and air ambulance companies prevailed in 77% of No Surprises Act payment determinations in the first half of 2023. 
Certified independent dispute resolution entities made payment determinations in 83,868 disputes during the first six months of 2023, according to a Feb. 15 report from CMS. 
Health plans and issuers were the prevailing party in 23% of payment determinations over that span, according to the report. 
The prevailing offer was higher than the qualifying payment amount in 82% of cases. Both parties submitted an offer and paid fees in 79% of cases, while only one party submitted an offer and paid fees in 21% of disputes.   |
A smaller percentage of disputes were determined to be ineligible in the first half of 2023 (22%) compared to 2022 (46%), the report said. CMS attributed this to process improvement and disputing parties' greater familiarity with eligibility requirements.”

KFF Health Tracking Poll February 2024: Voters on Two Key Health Care Issues: Affordability and ACA Worth reading the entire article, but below are some excerpts:
“Inflation and health care affordability continue to be the top issues voters want the 2024 presidential candidates to talk about on the campaign trail, and while national news has recently emphasized an improving national economy alongside expanded consumer spending, most voters (67%) rate the national economy as ‘not so good’ or ‘poor.’…
—Unexpected medical bills and health care costs top the list of expenses that adults, regardless of partisanship, say they worry about affording, with three in four adults saying they are ‘very’ or ‘somewhat worried’ about being able to afford unexpected medical bills (74%) or the cost of health care services (73%) for themselves and their family. Just over half (55%) report worrying about being able to afford prescription drug costs, and about half of insured adults (48%) say they are worried about being able to afford their monthly health insurance premium…
—Voters are divided along party lines over which candidate they think has the better approach to the future of the Affordable Care Act, with partisans overwhelmingly choosing their party’s candidate. Nine in ten Democratic voters (90%) say Biden has the better approach and nine in ten Republican voters (91%) say Trump does. Although the vast majority of Republicans say Trump has a better approach to the ACA, few (30%) Republican voters think Trump has a health care plan to replace it…”

About hospitals and healthcare systems

 Rule cuts Medicaid DSH pay for some safety-net hospitals “…some safety-net hospitals will receive lower Medicaid disproportionate share hospital [DSH] payments under a final rule…” The rule '“sets new restrictions on how Medicaid DSH payments are calculated and distributed, carrying out a congressional directive from the Consolidated Appropriations Act of 2021. ”Previously, “hospitals determined their Medicaid shortfalls – the gaps between reimbursements and costs – by estimating annual treatment costs for patients with Medicaid alone and those with other additional forms of coverage, such as Medicare or private health insurance.” Under the new rule, “hospitals will only be able to account for patients with Medicaid as their primary payer.” 

About the public’s health

Outcomes of Breast Cancer Screening Strategies Based on Cancer Intervention and Surveillance Modeling Network Estimates [CISNET] “Estimates from CISNET 2023 showed that annual screening ages 40–79 years improved breast cancer mortality reduction compared with biennial screening ages 50–74 years and biennial screening ages 40–74 years (41.7%, 25.4%, and 30%, respectively). Annual screening ages 40–79 years averted the most breast cancer deaths (11.5 per 1000) and gained the most life-years (230 per 1000) compared with other screening scenarios (range, 6.7–11.5 per 1000 and 121–230 per 1000, respectively). False-positive screening results per examination were less than 10% for all screening scenarios (range, 6.5%–9.6%) and lowest for annual screening ages 40–79 years (6.5%). Benign biopsies per examination were less than 1.33% for all screening scenarios (range, 0.88%–1.32%) and lowest for annual screening ages 40–79 years (0.88%).
Conclusion CISNET 2023 modeling estimates indicate that annual breast cancer screening starting at 40 years of age provides the greatest benefit to women and the least risk per examination.”

Ambitious survey of human diversity yields millions of undiscovered genetic variants “Analyses of up to 245,000 genomes gathered by the All of Us programme, run by the US National Institutes of Health in Bethesda, Maryland, have uncovered more than 275 million new genetic markers, nearly 150 of which might contribute to type 2 diabetes. The work has also identified gaps in genetics research on non-white populations. The findings were published on 19 February in a package of papers in Nature1,2, Communications Biology3 and Nature Medicine4.”

CARDIOVASCULAR CONDITIONS IN 2024 A really good monograph on cardiovascular epidemiology.

About healthcare IT

 Teladoc forecasts slower growth in saturated telehealth market, focuses on boosting bottom line “Teladoc offered a weaker-than-expected forecast for 2024, projecting slower revenue growth as the telehealth market has become crowded with digital health players.
The virtual care giant pulled in $661 million in revenue in the fourth quarter of 2024, up 4% from $638 million in the same period a year ago. Access fees revenue grew 4% to $574 million, and other revenue grew 3% to $87 million. U.S. revenue grew 2% to $565 million, and international revenue grew 15% to $96 million.”

Lawmakers introduce patient-matching bill for EHRs “U.S. lawmakers introduced bipartisan legislation Feb. 16 to better match patients with their EHRs…
The legislation aims to improve the standardization of patients' demographics inputted into certified health IT products and form an anonymous, voluntary system to analyze patient match rates. The College of Healthcare Information Management Executives, HIMSS, and the American Health Information Management Association all expressed their support for the bill.”
Comment: The easiest way to accomplish this goal is assigning unique patient identifiers they can use across systems. However, our fear of security has prevented doing so. Recall all entities in the healthcare system have unique identifiers—except patients.

About health technology

 Elon Musk says Neuralink patient can control computer mouse with mind “‘"[The] patient seems to have made a full recovery with no ill effects that we are aware of and is able to control the mouse, move the mouse around the screen just by thinking,’ Mr. Musk said during a live audio Spaces session on social media platform X.”

About healthcare finance

 Amazon to replace Walgreens in Dow Jones Industrial Average “The index change, which was announced after the market close on Tuesday, was prompted by Walmart Inc.’s decision to split its stock 3-to-1, the index provider said in the release. The latter move will reduce Walmart’s index weight due to the price weighted construction of the Dow. Walmart will remain in the index. The change will go into effect prior to the open of trading on Monday, Feb. 26.”

Today's News and Commentary

About Covid-19

Covid Vaccines Linked To Small Increase In Heart And Brain Disorders, Study Finds—But Risk From Infection Is Far Higher “Covid vaccines from companies like Pfizer, Moderna and AstraZeneca were linked to rare occurrences of heart, brain and blood disorders, a recent peer-reviewed study found, though experts say the risks of developing Covid-19 greatly outweigh the risks of getting vaccinated.”

About health insurance/insurers

 Point32Health Signs Definitive Agreement With Baystate Health to Acquire Health New England “The acquisition is expected to improve product offerings and expand access to a broader network with wider geographic reach.  Among both organizations’ shared priorities is expanding high-quality programs and services, particularly those that cover underserved populations and seniors, as well as maximizing the benefits that not-for-profit health plans provide to communities.”

No Surprises Act dispute volume 13 times higher than estimated “There were 288,810 No Surprises Act disputes initiated during the first six months of 2023, which was 13 times greater than federal agencies initially anticipated, according to a Feb. 15 report from CMS.”

New CMS rules will throttle access researchers need to Medicare, Medicaid data Another explanation of why these new data charges will hurt research.

About hospitals and healthcare systems

 From STAT, an update on some health systems’ performances:
Allina Health
: The $5 billion system is struggling a lot more than most, posting a -6.8% operating margin in 2023. Allina laid off employees and outsourced its billing operations to Optum.

Ballad Health: The last quarter of 2023 was good for Ballad, but the system said it has been having problems with Medicare Advantage plans using proprietary criteria to push patients to lower-paying codes or outpatient observation status, “even if the admission was prior-authorized by the payer.”

Baylor Scott & White Health: Everything’s bigger in Texas, including the hospital profits.

CommonSpirit Health: Patient volumes are up so much across the country that even CommonSpirit is in the black. The hospital giant also disclosed it received $234 million last year from the extra 340B drug payments.

Johns Hopkins Health System: A 12% net margin was fueled by massive investment gains. If patient care doesn’t work out, Johns Hopkins has a future as a hedge fund.

Mass General Brigham: Holy investment income, Batman. It also banked an extra $98 million from 340B drug underpayments.

RWJBarnabas Health: Nurses went on strike for roughly four months at one of the New Jersey system’s main hospitals, and it cost RWJBarnabas $184 million, pushing it into the red. However, if the hospital would have paid its own nurses and avoided a strike, instead of having to hire expensive temporary nurses, it would have turned a profit.

Sanford Health: It turns out that not all rural hospitals are dying! Sanford is one of the largest rural health systems in the country, and yet it was profitable across the board in 2023, surpassing several years of pre-pandemic operations.”

About pharma

 Obamacare plans don’t have to cover weight loss drugs. The government is considering changing that “Drugmakers are doing everything to tap the bottomless well of demand for new obesity drugs, and they might get some government help. The agency that regulates Obamacare insurance is considering a technical change that would require insurers to cover obesity drugs in a market of more than 20 million Americans.  There is a lot of demand for the drugs, but there are barriers to coverage. Medicare by law is prohibited from paying for obesity drugs. State Medicaid programs don’t have to cover them, so most don’t.”

About health technology

Alabama Supreme Court rules frozen embryos are children, imperiling IVF “The Alabama Supreme Court ruled Friday that frozen embryos are people and someone can be held liable for destroying them, a decision that reproductive rights advocates say could imperil in vitro fertilization(IVF) and affect the hundreds of thousands of patients who depend on treatments like it each year.”

Today's News and Commentary

About health insurance/insurers

 Cigna to buy back $3.2B in stock “The Cigna Group is buying back $3.2 billion in common stock through accelerated repurchase agreements with Deutsche Bank and Bank of America, the company announced Feb. 15. 
Cigna is expecting an initial delivery of 7.6 million shares, with a final settlement expected in the second quarter of 2024.”

The burden of medical debt in the United States “This analysis shows that 20 million people (nearly 1 in 12 adults) owe medical debt. The SIPP [2021 Survey of Income and Program Participation] survey suggests people in the United States owe at least $220 billion in medical debt. Approximately 14 million people (6% of adults) in the U.S. owe over $1,000 in medical debt and about 3 million people (1% of adults) owe medical debt of more than $10,000. While medical debt occurs across demographic groups, people with disabilities or in worse health, lower-income people, and uninsured people are more likely to have medical debt.”

Postacute Care for Medicare Advantage Enrollees Who Switched to Traditional Medicare Compared With Those Who Remained in Medicare Advantage “Findings  This cohort study using Medicare data including 4613 hospitalizations of retired Ohio state employees found that after a mandatory MA plan was discontinued, enrollees who switched to traditional Medicare received more intensive postacute care. No changes in 30-day hospital readmissions or mortality were observed.
Meaning  This finding suggests that MA plans provided less intensive postacute care than traditional Medicare, with no significant difference in measured short-term outcomes; measures of postacute functional status over a longer follow-up period are needed.”

Medicare Advantage enrollment races past 33 million “Roughly 33.4 million adults older than 65 and people with disabilities were enrolled in a Medicare Advantage plan as the calendar flipped to 2024 — another year of steady, albeit slower, growth for the taxpayer-funded program.
Enrollment increased 7.1% year over year, which would make this year’s annual growth rate identical to last year’s, according to new federal Medicare Advantage enrollment data analyzed by STAT.”

About hospitals and healthcare systems

 $1.48B Kaiser Sacramento hospital could break ground in 2024 “Oakland, Calif.-based Kaiser Permanente might be breaking ground on a hospital in the Sacramento rail yards this year, the Sacramento Business Journal reported Feb. 15.
The project, which will replace the current 287-bed Arden-Arcade, Calif.-based Kaiser Permanente Sacramento Medical Center, is expected to cost $1.48 billion, according to a free estimate request the city received in December, the publication reported.” 

CommonSpirit Health's finances trend upward thanks to higher volumes, efficiency pushCommonSpirit Health reported Thursday a $356 million operating gain (3.5% operating margin) for the three months ended Dec. 31—its first quarter on the right side of zero since tthe summer of 2022—thanks to substantially higher volumes, shorter stays and other efficiency programs launched by the Catholic giant.”
Comment: The above two articles highlight the turnaround in hospital finances.