Today's news and Commentary

About health insurance/insurers

FTC urges 21 healthcare marketers to review protocols to avoid misleading claims “The Federal Trade Commission (FTC) has sent warning letters to 21 companies that conduct marketing outreach or generate sales leads for health plans amid a busy window for open enrollment.
The letters do not accuse the recipients of any wrongdoing but warn against practices that could get them into trouble. For example, they cannot misrepresent the benefits included in a plan or misrepresent the costs associated with a certain plan.”

Warren, Hawley introduce bill requiring insurers to offload PBM businesses “Democratic and Republican lawmakers are calling on insurers to divest their pharmacy benefit manager (PBM) businesses in bills introduced to Congress Dec. 11.
While PBM reform has been a widely supported but largely fruitless endeavor so far, mandating insurers sell their PBM businesses is the most sweeping change suggested to date.
The mirrored bills were introduced by Senators Elizabeth Warren, D-Massachusetts, and Josh Hawley, R-Missouri and House representatives Jake Auchincloss, D-Massachusetts, and Diana Harshbarger, R-Tennessee.”

Paying More for Primary Care—A New Approach by Medicare “CMS recently announced a new prospective payment model through the agency’s Innovation Center that supports primary care for ACOs in the MSSP. The ACO Primary Care (ACO PC) Flex model aims to strengthen primary care with one of Medicare’s most substantial increases in payments for primary care services to date. Although a stated goal of ACO PC Flex remains to achieve savings for Medicare, the new model will also direct millions of additional dollars to participating primary care organizations. The model will serve as a time-limited test running from January 2025 through December 2029 and include up to 130 MSSP ACO participants…
ACO PC Flex is open only to ‘low-revenue’ ACOs, or those with patients who generate a small portion of revenue for the ACO compared with their overall costs to Medicare. Low-revenue ACOs, which include less than a third of existing ACOs and involve smaller groups of independent physicians rather than hospitals, are often less resourced. They serve more rural and diverse populations and have demonstrated greater savings for Medicare relative to their high-revenue counterparts.”
Comment: These “less resourced” groups may not only have lack of needed infrastructure, but, more importantly, they will probably not have the expertise to manage this model. Further, if they do not have significant numbers of enrollees in the program, they will not be able to achieve the program’s goals (or if they do, it will be by chance). It would have been better if the plan was rolled out to the larger, more experienced, ACOs.

About hospitals and healthcare systems

Divided court tosses rule boosting rural hospitals’ Medicare payments “The U.S. Department of Health and Human Services overstepped its authority when it boosted Medicare reimbursements to hospitals in low-wage areas to help them recruit and retain staff, a divided federal appeals court ruled on Wednesday.
A 2-1 panel of the San Francisco-based 9th U.S. Circuit Court of Appeals found that HHS's 2020 policy shift ran afoul of the law governing Medicare, the federal health insurance program for seniors and some people with disabilities.”

Hospitals' 'credit split' to widen in 2025: Fitch “Elevated inflation, Medicaid expansion, the reinstatement of Medicare sequestration and significant waves of M&A all have intensified a long-term trend of credit divergence, splitting hospitals into stronger and weaker segments, Fitch Ratings said in a Dec. 9 report.”

About pharma

Unsupported Price Increases Occurring in 2023 From ICER: “We continue to see list price increases that are far above the rate of inflation for many of the costliest drugs. These price hikes resulted in over $800 million in excess costs to the US health care system in just one year alone. This impacts everyone in the country, especially patients and their families… Since launching this report in 2019, we have noticed a decrease in the number of drugs that have significant price hikes without any new clinical evidence. In this report, half of the drugs we assessed had price increases in the setting of new evidence of additional benefits or reduced harm, while the other half lacked such evidence to support their higher price tag.”
 

About the public’s health

Overdose deaths in the U.S. fell 17% in 1-year period, CDC says “Drug overdose deaths in the United States fell 17% between July 2023 and July 2024, the Centers for Disease Control and Prevention said in a new report released Wednesday. 
Since 2021, over 100,000 people have died of overdoses each year in the United States. A record number of overdose deaths — over 108,000 — were recorded in 2022. The numbers dipped in 2023 and have continued to drop monthly throughout 2024.”

Montana Supreme Court upholds lower court ruling that allows gender-affirming care for minors “A Montana law banning gender-affirming medical care for transgender minors will remain temporarily blocked, the state Supreme Court ruled Wednesday, after justices unanimously agreed with a lower court judge who found the law likely violates the state's constitutional right to privacy.
The case against the Montana law now goes to trial before District Court Judge Jason Marks in Missoula.”

Infant RSV vaccine trials on hold: FDA “The FDA has placed a hold on all clinical studies of vaccines for respiratory syncytial virus in infants due to safety concerns following a trial involving two mRNA-based vaccine candidates from Moderna. 
A briefing document released by the FDA ahead of the Vaccine and Related Biological Products Advisory Committee revealed that a phase 1 trial evaluating two RSV vaccines in infants aged 5 to 8 months was paused in July after five severe cases of RSV-related illness were reported among infants receiving the vaccine candidates.”

Today's News and Commentary

About health insurance/insurers

Medicare Advantage: National Carriers Expand Market Share While Regional Carriers Without Affiliation Decline, 2012–23 “National carriers expanded their national market share significantly from 2012 to 2023, whereas the collective market share of regional carriers without affiliation to Blue Cross and Blue Shield organizations declined because of acquisitions. For example, the combined national market share of national carriers increased from 46 percent in 2012 to 66 percent in 2023, while the combined national market share of non-Blue regional carriers decreased from 25 percent to 6 percent. Conversely, concentration in local markets has declined but remains highly concentrated, and evidence suggests that further declines may be unlikely. Specifically, declines in local market concentration have been limited to markets with low MA penetration. Once MA penetration exceeds 20 percent, further MA growth is not associated with further drops in concentration, on average.”

Optum backs out of proposed 'dummy code' settlement  “Optum has backed out of a proposed settlement between Aetna and class members in a lawsuit that accused the companies of improperly charging administrative fees as medical expenses. 
In a Dec. 6 court filing, Optum said it disagreed with the settlement's terms and is prepared to proceed to a bench trial. The company also plans to argue that the plaintiffs lack evidence to support their original claims.
The lawsuit, initially filed in 2015, claimed that Aetna and Optum used misleading billing practices — specifically, employing "dummy codes" to disguise administrative fees for chiropractic services as medical charges — thereby causing plan participants and their employers to pay the fees unknowingly.” 

About pharma

Walgreens Is in Talks to Sell Itself to Private-Equity Firm Sycamore Partners “Walgreens Boots Alliance and Sycamore Partners have been discussing a deal that could be completed early next year, assuming talks don’t fall apart, according to people familiar with the matter.
Walgreens’s market value reached a peak of over $100 billion in 2015 but had since shrunk to around $7.5 billion as of Monday. Mounting pressures on both its pharmacy and retail businesses had helped send its shares down nearly 70% so far this year before The Wall Street Journal reported on the deal talks Tuesday.”

Pharmacies prevail in appeal of $650-million opioid award in Ohio “Ohio's top court ruled on Tuesday that pharmacy chain operators CVS , Walmart and Walgreens could not be held liable for fueling an opioid epidemic in two Ohio counties that won a $650.9-million judgment against them.
The Ohio Supreme Court held on a 5-2 vote, opens new tab that a state law barred Lake and Trumbull counties' claims that pharmacy chains' dispensing of addictive pain medications created a public nuisance that the companies should be forced to remediate.”

About the public’s health

US health panel adds self-testing option for cervical cancer screening “Women should have the option of taking their own test samples for cervical cancer screening, an influential health panel said Tuesday.
Draft recommendations from the U.S. Preventive Services Task Force are aimed at getting more people screened and spreading the word that women can take their own vaginal samples to check for cancer-causing HPV.
Women in their 20s should still get a Pap test every three years. But after that — from age 30 to 65 — women can get an HPV test every five years, the panel said.”

Biden HHS Extends Covid Vaccine Liability Shield Through 2029 “The US Department of Health and Human Services is extending through 2029 liability protections for those producing and administering Covid-19 vaccines, in a move to guard against future potential health emergencies.”

Dietary guidelines may promote plants but punt on ultra-processed foods “Americans should eat more plant and low-fat dairy foods while limiting their intake of red and processed meats, sugary beverages and foods high in sodium and saturated fat, an advisory committee of health and nutrition experts that helps shape the federal government’s Dietary Guidelines for Americans said in a report Tuesday…
The report, however, drew fierce criticism from some nutrition experts because it did not take a hard stance against ultra-processed foods, which many studies and some lawmakers have blamed for the nation’s rising rates of obesity and chronic disease.”

Bird flu in California child related to virus in dairy cows, CDC says “Federal disease trackers reported Tuesday that the first child diagnosed with bird flu in an ongoing U.S. outbreak was infected with a virus strain closely related to one moving rapidly through dairy cattle, even though there is no evidence the youngster was exposed to livestock or any infected animals.”

Today's News and Commentary

Nobel Laureates Urge Senate to Turn Down Kennedy’s NominationAbout health insurance/insurers “More than 75 Nobel Prize winners have signed a letter urging senators not to confirm Robert F. Kennedy Jr., President-elect Donald J. Trump’s pick to lead the Department of Health and Human Services.
The letter, obtained by The New York Times, marks the first time in recent memory that Nobel laureates have banded together against a Cabinet choice, according to Richard Roberts, winner of the 1993 Nobel in Physiology or Medicine, who helped draft the letter. The group tries to stay out of politics whenever possible, he said.”
On the other hand: The pharma industry isn’t lobbying against RFK Jr.’s nomination for a top health role

About health insurance

US Judge Blocks Biden Healthcare Rule for DACA Immigrants in Some States “A [Republican, Trump-appointed] U.S. judge in North Dakota has blocked the Biden administration from requiring 19 Republican-led states to provide health insurance coverage to immigrants brought to the U.S. illegally as children.”

More in U.S. See Health Coverage as Government Responsibility “Sixty-two percent of U.S. adults, the highest percentage in more than a decade, say it is the federal government’s responsibility to ensure all Americans have healthcare coverage. The figure had slipped to as low as 42% in 2013 during the troubled rollout of the Affordable Care Act’s (ACA's) healthcare exchanges. It has been as high as 69% in 2006.”

Trends in Employer Health Insurance Costs, 2014–2023: Coverage Is More Expensive for Workers in Small Businesses “Highlights

• Total premiums (combined employer costs and employee contributions) were generally lower for small firms than large firms in 2023.

• Despite lower total premiums, workers at small businesses faced higher costs on average for their share of premiums. Small-firm employees in most states contributed a larger share of the premium for family coverage than large-firm employees did.

• The average annual family premium contribution for workers nationally in 2023 was $7,529 at small firms and $6,796 at large firms.

• In nearly all states, small-firm employees have larger deductibles than large-firm employees. The average annual family deductible nationally in 2023 was $5,074 at small companies and $3,547 at large ones.

• Within the same state, workers often pay considerably more in premium contributions depending on the size of their employer. For example, in Massachusetts, those at small firms spent an average of $12,604 annually on premiums for family plans in 2023, compared to $6,933 for workers at large firms.”  

View of U.S. Healthcare Quality Declines to 24-Year Low “Americans' positive rating of the quality of healthcare in the U.S. is now at its lowest point in Gallup’s trend dating back to 2001.
The current 44% of U.S. adults who say the quality of healthcare is excellent (11%) or good (33%) is down by a total of 10 percentage points since 2020 after steadily eroding each year. Between 2001 and 2020, majorities ranging from 52% to 62% rated U.S. healthcare quality positively; now, 54% say it is only fair (38%) or poor (16%).
As has been the case throughout the 24-year trend, Americans rate healthcare coverage in the U.S. even more negatively than they rate quality. Just 28% say coverage is excellent or good, four points lower than the average since 2001 and well below the 41% high point in 2012.”

How Trump could roll back Biden-era healthcare regulations “One avenue for quick recissions of federal rules is through the Congressional Review Act (CRA). The lesser-known federal law enacted during President Bill Clinton’s term allows Congress a short window to overturn final rules with the support of the president.”
The article is a great review of how this Act would work after Trump takes office.

Trends to Watch in 2025 [From The Business Group on Health “The following trends represent areas of focus for employers and other industry stakeholders throughout 2025:

• Health care costs are growing at historic rates – sparking an impetus for change.

• Employers must tackle rising pharmacy costs to control overall expenses.

• Employers may need to defend physical well-being programs; more sophisticated approaches are needed.

• Progress has been made in mental health, yet more challenges lie ahead.

• Employers and vendors must better enable employees to find the right support at the right time.

• Employers will hold their vendor partners to higher standards.

• U.S. policy changes and global economic shifts will affect both employers and employees.”

About health insurance/insurers

The Effects of Not Extending the Expanded Premium Tax Credits for the Number of Uninsured People and the Growth in Premiums From the CBO: “CBO estimates that, relative to extending the tax credits, not extending them—either for a year or permanently—will increase the number of people without health insurance. The agency expects some people will exit the marketplaces and become uninsured because of higher out-of-pocket costs for health insurance premiums.
Without an extension through 2026, CBO estimates, the number of people without insurance will rise by 2.2 million in that year. Without a permanent extension, CBO estimates, the number of uninsured people will rise by 2.2 million in 2026, by 3.7 million in 2027, and by 3.8 million, on average, in each year over the 2026-2034 period.

Anthem Blue Cross Blue Shield reverses plan to limit anesthesia coverage “One of the country’s largest health insurers is facing backlash from doctors and government officials over its decision to no longer pay for anesthesia care if a surgery or procedure goes beyond a time limit.
Anthem Blue Cross Blue Shield insurance announced in early November that it planned to change how it evaluates billed time on professional claims for anesthesia services next year and deny any claims for anesthesia services that exceed that time limit.
The change was set to apply to members in Connecticut, New York and Missouri. A spokesperson for the company said in a statement that Anthem had decided not to proceed with the change following what the company claimed was ‘widespread misinformation.’”

Older Adults in U.S. Struggle with Health Care Costs More Than Those in Other Nations “Among the key findings:

•Out-of-pocket costs are high. Nearly one in four older adults in the U.S. spent at least USD 2,000 out of pocket on health care last year. In contrast, less than 5 percent of older adults in France and the Netherlands spent that much. Switzerland was the only survey country where older adults reported spending more.

•Older adults are delaying care because of costs. Delaying medical treatment can worsen health conditions. Although less than 10 percent of older adults across countries reported skipping needed care or forgoing medical treatment because of costs, older Americans did so at the highest rate. One-third of older U.S. adults facing cost-related barriers reported being in fair or poor health.

•People are skipping dental care. One in five older adults in the U.S., Australia, and Canada skipped needed dental care because of costs. By comparison, 5 percent or fewer of older adults in the Netherlands and Germany went without dental care.

Spending was 27% More for People who Disenrolled from Medicare Advantage than for Similar People in Traditional Medicare Key Takeaways

• Medicare spent 27% more, on average, for people who were covered by traditional Medicare after disenrolling from Medicare Advantage than for people who were continuously covered by traditional Medicare, after adjusting for differences in health status and other characteristics. This is a difference of $2,585 in Medicare spending per person, on average, between the two groups in 2022.

• Differences in Medicare spending between people who disenrolled from Medicare Advantage and beneficiaries continuously in traditional Medicare varied by health condition, ranging from 15% for people with pneumonia to 34% for people with diabetes. For example, among people with certain cancers, Medicare spending was 28% ($4,907) higher, on average, among those who disenrolled from Medicare Advantage than among people continuously covered by traditional Medicare.

• Differences in Medicare spending between people who disenrolled from Medicare Advantage and those continuously in traditional Medicare increased with age for Medicare beneficiaries ages 65 and over. For example, among people ages 85 and over the difference was 46% ($7,113) compared to 25% among people ages 65 to 69 ($1,843).

• Differences in Medicare spending between people who disenrolled from Medicare Advantage and beneficiaries continuously in traditional Medicare were larger among Black (55%, $5,203) and Hispanic (54%, $4,434) beneficiaries than White beneficiaries (25%, $2,464).

• People dually-eligible for Medicare and full Medicaid benefits who disenrolled from Medicare Advantage had spending that was 61% ($9,435) higher than their counterparts who were continuously in traditional Medicare, while the difference in spending for Medicare beneficiaries who do not receive Medicaid was 20% ($1,684).

• Skilled nursing facility spending accounted for the largest share of the difference in average Medicare spending per person between people who disenrolled from Medicare Advantage and those continuously in traditional Medicare (34%), followed by outpatient hospital spending (23%), and inpatient hospital spending (20%), with some variation by chronic conditions and other beneficiary characteristics.” 

About hospitals and healthcare systems

Buying across borders: 5 systems acquiring hospitals in a new state FYI

National Hospital Flash Report “Key Takeaways

1. Overall, October data show continued stability. Revenue, average length of stay, and other indicators show stable performance.

2. Outpatient revenue continues to grow. Revenue growth has been steady over the past few years, indicating a shift in how patients seek care.

3. Discharges per calendar day increased compared to the previous month. This has led to a decrease in overall expenses on a volume adjusted basis, though supplies and drug expenses continue to grow. 

About pharma

Novo Holdings wins EU blessing for Catalent buy “Novo Nordisk's controlling shareholder, Novo Holdings, has secured European Commission approval for its $16.5-billion acquisition of Catalent, a move that some say could dramatically reshape the CDMO landscape—and potentially limit manufacturing options for competing pharmaceutical companies.”

The deal involves Novo Holdings acquiring Catalent and subsequently selling three manufacturing sites to Novo Nordisk for $11 billion, positioning the Danish drugmaker to expand production of its popular obesity and diabetes treatments 

About the public’s health

Increases in U.S. life expectancy forecasted to stall by 2050, poorer health expected to cause nation’s global ranking to drop “Key takeaways:

• The U.S. is forecasted to fall in its global rankings below nearly all high-income and some middle-income countries.

• Drug use disorders, high body mass index, high blood sugar, and high blood pressure are driving mortality and disability higher across the U.S.

• Future scenarios for health outcomes identify the states that are forecasted to gain ground, face stagnation, or grow worse.

• Scientific evidence underscores the urgent need to prioritize public health to prevent the economic consequences of sickness, disabilities, and premature mortality in the U.S.” 

About healthcare IT

David O. Sacks, future White House AI Czar, likely to favor startups and 'thoughtful' regulation “Sacks is reportedly a close confidant of Elon Musk, who will also hold a special advisory role to the White House on cutting government spending.
Sacks founded a venture capital firm in 2017 called Craft Ventures. He was also a pivotal player at PayPal in the early 2000s. Sacks is a lawyer by training and hosts the weekly podcast ‘All In’ about the technology industry.”

About healthcare technology From ECRI: “Top 10 Health Technology Hazards for 2025 The List for 2025

1. Risks with AI-Enabled Health Technologies
2. Unmet Technology Support Needs for Home Care Patients
3. Vulnerable Technology Vendors and Cybersecurity Threats
4. Substandard or Fraudulent Medical Devices and Supplies
5. Fire Risk in Areas Where Supplemental Oxygen Is in Use
6. Dangerously Low Default Alarm Limits on Anesthesia Units
7. Mishandled Temporary Holds on Medication Orders
8. Infection Risks and Tripping Hazards from Poorly Managed Infusion Lines
9. Skin Injuries from Medical Adhesive Products
10. Incomplete Investigations of Infusion System Incidents”

About healthcare personnel

Clinician Turnover 2024 “KLAS Arch Collaborative is—for the first time—asking clinicians who report plans to leave their organization where they intend to go. This report examines the cost of clinician turnover, how burnout and the EHR experience affect staff retention, and best practices from organizations who have improved their clinicians’ satisfaction and reversed turnover trends…
[For example]: Since 2019, the risk of clinician turnover has steadily increased. In 2024, nearly half of nurses and physicians are classified as at risk. Of these at-risk clinicians, 21% of nurses and 13% of physicians actually leave…
This turnover results in steep costs for organizations—the average cost of turnover for a nurse and physician respectively is $56,300 and $500,000–$1,000,000.”

The Future of Primary Care: Traditional and Nontraditional Models Continue to Evolve A great overview from Bain. For example: “By 2030, 30% of primary care could be delivered by nontraditional providers, with strong growth from payer-owned providers and enabled primary care providers.”

Aya Healthcare to Acquire Cross Country Healthcare for Approximately $615 Million in Cash “ya Healthcare and Cross Country Healthcare today announced that they have entered into a definitive agreement whereby Aya will acquire Cross Country for $18.61 per share in cash in a transaction valued at approximately $615 million. The all-cash transaction represents a premium of 67 percent to Cross Country’s closing price on December 3, 2024, and a premium of 68 percent to the volume-weighted average trading price for the 30-day trading period ended December 3, 2024.
Aya and Cross Country offer complementary, tech-enabled workforce solutions across the continuum of care.”

Today's News and Commentary

HealthcareInsights.MD will resume on Monday, December 9.

About health insurance/insurers

CMS says ACA open enrollment is on track to set another record for sign-ups “The sign-up period officially kicked off Nov. 1. The Centers for Medicare & Medicaid Services (CMS) said that close to 988,000 people who did not previously have coverage in a marketplace plan have secured it over the past month.
The CMS also said 4.4 million people have returned to a marketplace plan for 2025, putting the exchanges on pace to set another record in enrollment. For the 2024 plan year, the CMS tallied a record 21.4 million sign-ups on HealthCare.gov.”

Enrollment in High-deductible Health Plans Among People Younger Than Age 65 With Private Health Insurance: United States, 2019–2023 “In 2023, among privately insured people younger than age 65, 41.7% were enrolled in an HDHP. Enrollment increased from 40.3% in 2019 to 43.3% in 2021, followed by a decrease to 41.7% in 2023. Among people with employment-based coverage, enrollment in an HDHP increased from 40.2% in 2019 to 43.4% in 2021, followed by a decrease to 41.9% in 2023. For people with directly purchased coverage, enrollment in an HDHP increased from 44.3% in 2019 to 47.0% in 2020, followed by a decrease to 43.1% in 2023.”

Blue Cross Blue Shield will begin limiting anesthesia coverage in some states “Anthem Blue Cross Blue Shield will soon change the way it covers anesthesia for procedures in certain states…
Under the new policy, the Chicago-based company said it would determine a specific amount of time it would cover anesthesia costs for, depending on a procedure.
‘Claims submitted with reported time above the established number of minutes will be denied,’ the company said in its announcement.
Exceptions would be made for anyone under the age of 22 and for maternity-related care.
The policy is slated to begin on Feb. 1, 2025.”
Comment: Sounds like global anesthesia rates by procedure.

About hospitals and healthcare systems

Kaiser's Risant Health to become $35B system in 5 years: 14 things to know FYI 

About pharma

U.S. Patent Office pulls controversial rule to curb pharma patent abuse In an unexpected move, the U.S. Patent & Trademark Office has withdrawn a controversial proposal that was designed to prevent pharmaceutical companies from abusing the patent system.
Specifically, the proposed rule was crafted to stem the use of so-called patent thickets, which are wielded by drug companies to delay the arrival of lower-cost generic medicines in the marketplace. Essentially, thickets are collections of numerous patents that critics contend add only incremental changes to a drug and, therefore, produce little to no additional benefit to patients.”

About the public’s health

Chocolate intake and risk of type 2 diabetes: prospective cohort studies “Increased consumption of dark, but not milk, chocolate was associated with lower risk of T2D. Increased consumption of milk, but not dark, chocolate was associated with long term weight gain. Further randomized controlled trials are needed to replicate these findings and further explore the mechanisms.” 

About healthcare IT

Change Healthcare cyberattack drives 2024 into another record year for health data breaches “As many as 172 million individuals — more than half the population of the United States — may have been impacted by large health data breaches reported to the Department of Health and Human Services in 2024, according to a STAT analysis of records from HHS’ Office for Civil Rights. It’s a new record for the scale of large health care breaches, breaking one set just last year. 
The vast majority of those health data breaches — 532 of the 656 reported as of December 4 — have resulted from hacks and ransomware attacks, continuing a years-long trend. Since 2018, HHS has reported, it has seen a 264% increase in large ransomware breaches, and seven health systems have been fined up to $950,000 for failing to protect patients’ protected health information from ransomware attacks.”

About healthcare personnel

Highest-paid specialties for nurse practitioners, physician assistants FYI

Today's News and Commentary

Trump’s pick to head DEA withdraws after GOP criticism of his covid policies “Chronister, a career law enforcement officer who has spent little time on the national stage, announced his withdrawal from consideration on social media early Tuesday evening, just three days after Trump’s selection. Chronister said he planned to continue serving as the sheriff in Hillsborough County.”

About health insurance/insurers

Police Hunt for Gunman After UnitedHealthcare C.E.O. Is Killed in Midtown Manhattan “he executive, Brian Thompson, was shot in what the police described as a ‘brazen targeted attack’ outside a hotel where the company was holding an investor meeting. The assailant was last spotted in Central Park, investigators said at a news conference.”

 9 States Poised To End Coverage for Millions if Trump Cuts Medicaid Funding “More than 3 million adults in nine states would be at immediate risk of losing their health coverage should the GOP reduce the extra federal Medicaid funding that’s enabled states to widen eligibility, according to KFF, a health information nonprofit that includes KFF Health News, and the Georgetown University Center for Children and Families. That’s because the states have trigger laws that would swiftly end their Medicaid expansions if federal funding falls.
The states are Arizona, Arkansas, Illinois, Indiana, Montana, New Hampshire, North Carolina, Utah, and Virginia.”

The largest commercial insurer in every state | 2024 FYI

Small employers are fleeing from fully insured market, analyst tells regulators “Roughly 40% of employers with three to 99 employees are escaping from the fully insured small-group health insurance market by using level-funded plans, an analyst told state insurance regulators earlier this month in Denver.
In 2018, fewer than 10% of small firms had level-funded health plans, according to Kelly Edmiston, policy research manager at the National Association of Insurance Commissioners' Center for Insurance Policy and Research.”

Insurers Collected Billions From Medicare for Veterans Who Cost Them Almost Nothing “A Wall Street Journal analysis of Medicare and VA data found that Medicare Advantage insurers collected billions of dollars a year in premiums to provide medical coverage for about one million veterans like Kitt, even though they go to the VA for some or all of their healthcare needs.
The analysis found the insurers paid far fewer medical bills for those veterans than for typical members. About one in five members of Medicare Advantage plans that enroll lots of veterans didn’t use a single Medicare service in 2021, the Journal found. That compares with 3.4% of members of other Medicare Advantage plans.
The federal government paid insurers an estimated $44 billion from 2018 through 2021 to cover Medicare Advantage-plan members who were also users of VA services, based on average payments for all members of those plans. The VA spent $46 billion on the same group’s medical care, according to VA data reviewed by the Journal. The figures exclude pharmacy costs, which many Medicare Advantage plans focused on veterans don’t cover.”

About hospitals and healthcare systems

Kaiser's Risant Health acquires 2nd health system “Risant Health, a nonprofit formed by Oakland, Calif.-based Kaiser Permanente, acquired Greensboro, N.C.-based Cone Health, a five-hospital system, effective Dec. 1. 
The transaction cements Risant as the sole corporate member of Cone Health. There was no purchase price or exchange of cash.”

About pharma

Lilly lands first blow against Novo in head-to-head study of weight loss drugs “op-line results from the Phase IIIb SURMOUNT-5 trial showed that on average, Zepbound led to weight loss of 20.2% compared to 13.7% with Wegovy after 72 weeks. Participants on Zepbound lost 50.3 lbs (22.8 kg), while those given Wegovy lost 33.1 lbs (15.0 kg)” 

Nearly 30% of US drugstores closed in one decade, study shows “Nearly three out of 10 U.S. drugstores that were open during the previous decade had closed by 2021, new research shows.
Black and Latino neighborhoods were most vulnerable to the retail pharmacy closures, which can chip away at already-limited care options in those communities, researchers said in a study published Tuesday in Health Affairs.
The trend has potentially gained momentum since the study’s timeframe, because many drugstores are still struggling. In the last three years, the major chains Walgreensand CVS have closed hundreds of additional stores, and Rite Aid shrank as it went through a bankruptcy reorganization.”

About the public’s health

UK junk food ad ban includes porridge and pitta bread snacks “Unhealthy versions of breakfast cereals including muesli, porridge oats and granola will be included in a UK junk food advertising ban from next year. Pitta bread snacks, rice cakes, tea and coffee with added sugar also fall within the regulations that prevent unhealthy food being advertised online or before 9pm on TV. The UK government wants to reduce children’s exposure to foods high in fat, sugar or salt to tackle obesity-related diseases such as diabetes.”
Comment: A laudatory move, but the many special interests in this country would make this move very difficult here.

Acceptability of Guidelines to Stop Colon Cancer Screening by Estimated Life Expectancy “While many older adults found guidelines limiting colon cancer screening after 75 years of age to be somewhat or very acceptable, a sizable minority did not, and this finding is consistent across respondents with different life expectancies.” 

About healthcare IT

Use of Artificial Intelligence in Peer Review Among Top 100 Medical Journals “Overall, 78 medical journals (78%) provided guidance on use of AI in peer review. Of these provided guidance, 46 journals (59%) explicitly prohibit using AI, while 32 allow its use if confidentiality is maintained and authorship rights were respected. Internationally based medical journals are more likely to permit limited use than journals’ editorial located in the US or Europe, and mixed publishers had the highest proportion of prohibition on AI use.”

Secure Messaging Use and Wrong-Patient Ordering Errors Among Inpatient Clinicians “In this cohort study of inpatient clinicians, higher daily secure messaging was associated with increased odds of wrong-patient ordering errors. Although messaging may increase cognitive load and risk for wrong-patient ordering errors, these results do not provide conclusive evidence regarding the direct impact of secure messaging on errors, as increased messaging may also reflect greater care coordination, increased patient complexity, or communication of the presence of a wrong-patient ordering error.”

About healthcare technology

Top health tech hazards of 2025 “The biggest safety concern in health technology for 2025 is artificial intelligence, a new report from nonprofit patient safety organization ECRI found.”
See the ECRI monograph or this article for the list. 

Today's News and Commentary

About health insurance/insurers

UnitedHealth, Centene get Medicare Advantage Star Rating upgrades “UnitedHealthcare and Centene have received higher Medicare Advantage star ratings for the 2025 plan year after the Centers for Medicare and Medicaid Services revised their scores.
On Monday, CMS published updated Medicare Advantage Star Ratings program data that reveal the agency increased the quality ratings for 12 UnitedHealthcare contracts and seven Centene contracts, each of which comprise multiple Medicare Advantage plans…
Centene gained its sole four-star contract under the recalculations CMS disclosed Monday. Two UnitedHealthcare contracts were upgraded to five stars and three to four stars, giving the UnitedHealth Group subsidiary 37 contracts rated at least four stars.
The U.S. District Court for the Eastern District of Texas ordered CMS to redo UnitedHealthcare’s scores last month in a case involving how the agency evaluated the company’s call center services. Centene initiated a similar lawsuit in October, which is still on the docket, as is a complaint from Humana. Elevance Health and Blue Cross and Blue Shield of Louisiana sued over their scores on different grounds.” 

About hospitals and healthcare systems

Inova first to earn Joint Commission's health data certification “Falls Church, Va.-based Inova has become the first health system in the U.S. to achieve The Joint Commission's Responsible Use of Health Data certification. 
Launched Jan. 1, the voluntary certification program recognizes hospitals and health systems for ethical practices in using data beyond clinical care, such as for safety and quality work or operational improvements. The certification provides a framework for healthcare organizations to safely use and transfer patient data, ensuring transparency and responsible use.”
And in a related article:Biggest hospital cyberattacks of '24 

About the public’s health

House COVID-19 panel releases final report: 3 key takeaways From the Republican controlled House: “The report starts with the finding that the SARS-CoV-2 virus ‘likely emerged because of a laboratory or research related accident…’  
The report is critical of many of the mitigation measures that were employed early on in the pandemic. 
It found masks and mask mandates were ‘ineffective at controlling the spread of COVID-19.’ Several studies, including one published this August, have found masking in public has an effect on lowering respiratory viral transmission, though this should not be the sole measure used to mitigate spread.
Further, the report concluded lockdowns caused ‘more harm than good’ to the economy, overall health of Americans and development of children…
The subcommittee’s report paid particular attention to the actions of EcoHealth Alliance, the nongovernmental organization that subawarded NIH grants to global labs including the Wuhan Institute of Virology. 
Echoing criticism from members of the subcommittee, the report found EcoHealth failed to carry out proper oversight of the experiments it provided funding for, facilitated gain-of-function research and misled the NIH on the details of its research projects. 
The NIH in turn was found to have failed in its oversight of EcoHealth.”

Treatment patterns in patients with newly diagnosed COPD in the USA “Overall, during the 4-year follow-up period, 32.9% of the patients had at least one moderate or severe exacerbation, and 25.8% and 13.8% experienced moderate and severe exacerbations, respectively. At diagnosis, 86.2% of the patients were untreated and most remained untreated by the end of the follow-up (63.8%).”

About healthcare IT

The invisible wasteland of health care data According to a 2019 report from the World Economic Forum, the average hospital produces approximately 50 petabytes of data per year, with 97% of the data going unused. To put that enormous number in perspective, this is the equivalent of streaming a two-hour movie about 25 million times annually. Multiply that number by the over 6,000 hospitals in the United States, and the amount of data becomes incomprehensibly large. And that report was from five years ago — the numbers are likely even higher now!…
Based on carbon dioxide production per unit of electricity estimates from the Environmental Protection Agency, some experts have stated that storing 100 gigabytes of data — about the size of many modern hard drives — in the cloud over a year would produce 0.2 tons of carbon dioxide. By this logic, a typical hospital in the United States employing a similar storage strategy would have a carbon footprint of 100,000 tons from its digital data storage alone. Furthermore, this would mean that digital waste would be responsible for 97,000 tons of the carbon dioxide produced. The U.S. health care sector is responsible for over 8% of the country’s carbon emissions annually, yet many estimates don’t factor the toll of digital waste into the carbon footprint.”

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About health insurance/insurers

HIV prevention pills should be free, but insurers are still charging “Nearly a third of a national sample of 325 health coverage plans on government insurance marketplaces did not include PrEP on their lists of covered preventive services, according to the AIDS Institute, a New York-based nonprofit.|
Between 20 and 30 percent of PrEP users with commercial insurance still had to pay for it despite the coverage mandate, with an average cost of $227 for 2022, according to the Centers for Disease Control and Prevention.”

About hospitals and healthcare systems

25 largest health systems by hospital beds FYI

Update from StatNews:
“Ascension: The Catholic system, still reeling from a massive cyberattack earlier this year, has been busy offloading hospitals in Alabama and Michigan. Its operating margin stood at -3% in the most recent quarter.

Bon Secours Mercy Health: BSMH narrowed its operating losses in the latest quarter as demand for care grows. Bon Secours Mercy also received $331 million in July from its investment in the revenue cycle company Ensemble Health Partners.

Cleveland Clinic: The 21-hospital academic health system posted a 1.1% operating margin in the quarter on almost $4 billion of revenue, and big investment gains pushed Cleveland Clinic’s total margin above 9%. Higher drug costs continued to gnaw at its expenses.

Northwell Health: Northwell, which operates 21 hospitals throughout New York, remained in the black with a 1.7% operating margin in the quarter. The system noted higher demand for medical care and pharmacy services.

Providence: The 51-hospital system that’s mostly in the Pacific Northwest has been losing money from patient operations for years, the latest quarter being no exception. But Providence narrowed its operating losses in the most recent quarter thanks to seeing more patients, negotiating higher prices from commercial insurers, and reducing contract labor costs by 39%. Providence registered a 1.3% net margin in the first nine months of this year after factoring in investment profits.

UPMC: UPMC registered a -0.7% operating loss in the last three months, but not because of its hospital and physician businesses, which were booming. It was due to higher costs in its insurance business. Pennsylvania is one of 13 states where Medicaid programs and their insurers cover the pricey GLP-1 drugs for obesity.”

8 health systems ditching their health plans FYI

Novartis pays PTC $1B upfront for midphase Huntington's program, reestablishing itself in R&D race “Novartis is paying $1 billion upfront for global rights to PTC Therapeutics’ midphase Huntington's disease program, helping the biotech bounce quickly back from disappointing data on another program.
PTC went into the Thanksgiving break reeling from the failure of an amyotrophic lateral sclerosis trial and its subsequent decision to stop further development of the candidate. Monday, PTC revealed a deal with Novartis for its Huntington's drug candidate PTC518, sending its share price up 17% to above $51 in premarket trading.”

About pharma

Trump taps Florida sheriff as DEA administrator “President-elect Donald Trump on Saturday tapped Hillsborough County Sheriff Chad Chronister to lead the Drug Enforcement Administration, replacing Anne Milgram.
In picking the Florida sheriff to lead the DEA, Trump has selected a law enforcement professional with three decades of experience working for the Hillsborough County Sheriff’s Office but seemingly little time in the national spotlight.”

A twice-yearly shot could help end AIDS. But will it get to everyone who needs it? “The twice-yearly shot was 100% effective in preventing HIV infections in a study of women, and results published Wednesday show it worked nearly as well in men.
Drugmaker Gilead said it will allow cheap, generic versions to be sold in 120 poor countries with high HIV rates — mostly in Africa, Southeast Asia and the Caribbean. But it has excluded nearly all of Latin America, where rates are far lower but increasing, sparking concern the world is missing a critical opportunity to stop the disease.”

Drug Prices Negotiated by Medicare vs US Net Prices and Prices in Other Countries “Apart from insulin, which had a voluntary price reduction in 2024, all products remained more expensive in the US than in other countries (Table). For example, the price negotiated by Medicare for ustekinumab ($4695.00 per 30-day supply) was higher than prices in other countries, which ranged from $1219.92 in France to $2503.99 in Germany. However, the gap between US and non-US prices narrowed for all drugs.”

About the public’s health

Reusing plastic water bottles, to-go containers? Scientists say that’s a bad idea. “That means a single-use plastic water bottle sheds micro- and nanoplastics into your water when you refill it, and a takeout container or frozen meal tray sheds these particles into your food.”

Characteristics of Older Adults Who Met Federal Physical Activity Guidelines for Americans: United States, 2022 From the CDC: “Overall, 13.9% (age adjusted) of adults age 65 and older met federal physical activity guidelines for both aerobic and muscle-strengthening activities in 2022. Differences were seen by several sociodemographic characteristics. Men (16.9%), White non-Hispanic adults (15.2%), and those living in metropolitan areas (14.7%) were more likely to meet the guidelines. The percentage meeting the federal physical activity guidelines increased with increasing education level and family income and decreased with number of chronic conditions.”

How Much Water Should We Drink in a Day? The “8 glasses a day” you may be used to hearing does not tell the whole story. This article provides a really good, evidenced-based reply to the title’s question.

About healthcare technology

Baxter moves closer to 100% allocation levels for IV products “Baxter… outlined plans to gradually increase allocations over the next several weeks, with the goal of reaching 100% allocation for several IV product codes by the end of 2024. The company has also said it will provide updates on its allocation plans in mid-December and again at year's end.” 

About healthcare personnel

The Past, Present, and Future of Restrictive Covenants in Medicine in the United States: A Narrative Review An excellent review of the topic from The Annals of Internal Medicine. If you are interested in this topic, it is well-worth seeking out this article, which is from a subscriber-only publication.

Today's News and Commentary

HealthcareInsights will resume Monday, December 2.
Happy Thanksgiving!

About health insurance/insurers

CMS pitches major Medicare Advantage changes: 10 notes A great summery of recent activity

Highmark posts $22.1B in revenue through first 3 quarters of 2024 “Pittsburgh-based health insurer and provider Highmark Health has brought in $529 million in net income through the first three quarters of the year, according to its latest financial details released Tuesday.
That's on $22.1 billion in revenue through the first nine months of 2024 along with $273 million in operating gain.
Highmark said its financial performance is driven by its health plans along with increased volumes at its Allegheny Health Network (AHN). As of Sept. 30, the AHN saw a 3% increase in inpatient discharges and observations as well as 7% more outpatient registrations compared to the same time last year.”

About hospitals and healthcare systems

40 largest health systems in the US | 2024 FYI

Seventh Semi-Annual Hospital Price Transparency Report November 2024 “Our latest review, conducted nearly four years after the rule took effect, analyzed the websites of 2,000 U.S. hospitals and found only 21.1% of them (421) to be fully compliant with all requirements of the rule, a significant decrease from our last report’s compliance finding of 34.5% and from the highest observed rate in July 2023 of 36.0%. The widespread noncompliance of 78.9% of hospitals is due to files not having prices clearly associated with payer and plan names and not following required formats. All of the hospitals reviewed for this report posted a machine-readable file, though 532 hospitals’ files failed the Centers for Medicare & Medicaid Services (CMS) Validator Tool.”

About pharma

Same Drug, 2,200 Different Prices “The reason for the huge price differences: America’s complicated drug-reimbursement system, which uses middlemen to negotiate prices. 
To control drug spending, these firms have created a pricing patchwork, negotiating different prices for different plans.”
The interstate and intrastate differences are astounding. 

About the public’s health

HHS invests $44M in medical supply chain “The Administration for Strategic Preparedness and Response, an HHS agency, is providing $44 million to bolster the U.S. public health supply chain. 
Under the Defence Product Act, the agency greenlit $32.4 million for Manus Bio, a biomanufacturing company in Waltham, Mass., and up to $12 million for Antheia, an active pharmaceutical ingredient manufacturer in Menlo Park, Calif. 
With these funds, Manus and Antheia will focus on expanding capabilities to produce key starting materials and APIs for essential medicines…”

Pertussis Surveillance and Trends “In 2024, reported cases of pertussis increased across the United States, indicating a return to more typical trends. Preliminary data show that nearly six times as many cases have been reported as of week 46 reported on November 16, 2024, compared to the same time in 2023.”

I Ran Operation Warp Speed. I’m Concerned About Bird Flu A thoughtful and compelling article by former FDA Commissioner and public health expert Dr. David Kessler.

Americans are not getting seasonal vaccines ahead of the holidays As of this month, about 37 percent of adults 18 and older had received a seasonal flu shot, while 19 percent had received updated coronavirus vaccines and 40 percent of adults 75 and older — the group at greatest risk — got an RSV vaccine.
The vaccination rates are similar to last year’s figures, and the numbers reflect a persistent public health challenge achieving broader vaccine uptake for these illnesses.”

Trump picks Jay Bhattacharya to lead NIH, overseeing scientific research “President-elect Donald Trump selected Jay Bhattacharya, a Stanford-trained physician and economist, on Tuesday to lead the National Institutes of Health, the nearly $50 billion agency that oversees the nation’s biomedical research…
Trump also announced Jim O’Neill, a Silicon Valley investor and former federal health official, as his selection to be HHS deputy secretary. That role would position O’Neill to help run day-to-day operations and shape policy at the nearly $2 trillion agency.”

Cervical Cancer Mortality Among US Women Younger Than 25 Years, 1992-2021 “This study found a steep decline in cervical cancer mortality among US women younger than 25 years between 2016 and 2021. This cohort of women is the first to be widely protected against cervical cancer by HPV vaccines. The findings from this study in the context of other published research suggest that HPV vaccination affected the sequential decline in HPV infection prevalence, cervical cancer incidence, and cervical cancer mortality. Since its introduction, HPV vaccination coverage (≥1 doses) has increased steadily, reaching 78.5% in 2021. The gradual decline in mortality observed from 1992 to 2015 was likely due to improved screening coverage and approaches.”

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About Health Policy

Impact of Trump tariffs on US medical device market “President Trump’s plan to impose tariffs on imported goods will affect the prices of the approximately 75% of available US-marketed medical devices that are manufactured out of the country, and more specifically the 69% of available US-marketed devices that are manufactured solely outside of the US, according to GlobalData’s Medsource Database, which collates data on the medical device supply chain…
As a result of these policy changes, companies will be forced to increase prices to make up for losses incurred by the proposed tariffs. Additionally, this may cause supply chain disruptions, reducing accessibility to medical devices and inflating the cost of these products due to the higher demand in comparison to the supply.”

Trump's tariffs could raise the cost of generic drugs in the U.S. “Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, said that about half of all generic drugs are manufactured overseas and that about 80% of all active pharmaceutical ingredients, or APIs, are produced abroad, in China, India and other places.
Generic drugs are the backbone of medicines prescribed in the U.S.: They account for about 90% of all prescriptions filled…”
Comment: Not only will prices go up, but the tariff will disrupt the supply chain and exacerbate shortages.

About health insurance/insurers/costs

Double-digit medical cost increases expected globally in 2025 “Insurers expect global medical costs to increase by 10.4% in 2025, which mirrors this year’s rate. The projected growth in medical costs varies by region:

• In North America, costs are projected to rise from 8.1% in 2024 to 8.7% in 2025.

• In the United States, insurers project a 10.2% increase in 2025, up from 9.3% this year.

• Costs also are projected to accelerate in Asia Pacific, the Middle East and Africa, while Europe and Latin America will see slower increases”

About pharma

Thousands turn to Wegovy copies each month as FDA considers shortage status “Summary:
—More than 200,000 prescriptions for Wegovy alternatives are filled in the U.S. each month
—FDA is weighing whether to remove Wegovy from its shortage list
—Pharmacy compounding group has asked FDA to consider its data when making a decision”

Obesity Drugs Would Be Covered by Medicare and Medicaid Under Biden Proposal “The Biden administration, in one of its last major policy directives, proposed on Tuesday that Medicare and Medicaid cover obesity medications, a costly and probably popular move that the Trump administration would need to endorse to become official.
The proposal would extend access of the drugs to millions of Americans who aren’t covered now.
C.M.S. estimates that around 3.4 million more patients in Medicare would become eligible for obesity drugs, and around four million patients in Medicaid would gain coverage…
C.M.S. estimates that coverage will cost the federal government about $25 billion for Medicare and $11 billion for Medicaid over a decade; states would pay around $4 billion for their share of the Medicaid bill…”

Roche inks $1.5B Poseida buyout, betting off-the-shelf CAR-Ts will democratize access to cell therapies “Roche has struck a $1.5 billion deal to buy Poseida Therapeutics. The takeover will establish off-the-shelf cell therapies, which Roche has said can democratize CAR-Ts, as a new core capability at the drugmaker.”

About the public’s health

Ten Americas: a systematic analysis of life expectancy disparities in the USA “Our analysis confirms the continued existence of different Americas within the USA. One's life expectancy varies dramatically depending on where one lives, the economic conditions in that location, and one's racial and ethnic identity. This gulf was large at the beginning of the century, only grew larger over the first two decades, and was dramatically exacerbated by the COVID-19 pandemic. These results underscore the vital need to reduce the massive inequity in longevity in the USA, as well as the benefits of detailed analyses of the interacting drivers of health disparities to fully understand the nature of the problem. Such analyses make targeted action possible—local planning and national prioritisation and resource allocation—to address the root causes of poor health for those most disadvantaged so that all Americans can live long, healthy lives, regardless of where they live and their race, ethnicity, or income.”
Look at Table 1 for an explanation of the “10 different Americas.”

Global rates of HIV infections and deaths fall sharply “Global rates of HIV infections and deaths related to the virus have dropped sharply but must fall faster to meet a UN target to end Aids as a public health threat by 2030, research has found. New HIV infection rates in sub-Saharan African countries have plunged more than half since their 1995 peak, but risen steeply in central Europe, eastern Europe and central Asia, the international survey said.

Supreme Court rejects tobacco industry challenge to graphic anti-smoking images on cigarette packs “The Supreme Court declined Monday to hear a challenge from major tobacco companies to the Food and Drug Administration’s requirement that they place graphic health warnings on cigarette packages and in advertisements.
The FDA issued a rule in 2020 that requires health warnings on cigarette packages and in advertisements, occupying the top 50% of the area on the front and back panels of packages and at least 20% of the area at the top of cigarette ads, according to the FDA.”

About healthcare IT

Yale study shows how AI bias worsens healthcare disparities “A new research report from Yale School of Medicine offers an up-close look at how biased artificial intelligence can affect clinical outcomes. The study focuses specifically on the different stages of AI model development, and shows how data integrity issues can impact health equity and care quality.” 

Artificial Intelligence and Machine Learning (AI/ML)-Enabled Medical Devices “The FDA is providing this list of AI/ML-enabled medical devices marketed in the United States as a resource to the public about these devices and the FDA’s work in this area. The devices in this list have met the FDA’s applicable premarket requirements, including a focused review of the devices’ overall safety and effectiveness, which includes an evaluation of appropriate study diversity based on the device’s intended use and technological characteristics.”

Teladoc Health launches AI motion detection solution to improve patient safety in hospital beds “Teladoc Health launched an artificial-intelligence-enabled technology that allows hospital staff to virtually detect when a patient is at risk of falling from a hospital bed. The solution, unveiled Monday and called Virtual Sitter, is now commercially available.”

The Office for Civil Rights Should Enhance Its HIPAA Audit Program to Enforce HIPAA Requirements and Improve the Protection of Electronic Protected Health Information From the OIG: “OCR fulfilled its requirement under the HITECH Act to perform periodic HIPAA audits. However:

• OCR’s HIPAA audit implementation was too narrowly scoped to effectively assess ePHI protections and demonstrate a reduction of risks within the health care sector. Specifically:

  • OCR’s audits consisted of assessing only 8 of 180 HIPAA Rules requirements; and

  • only 2 of those 8 requirements were related to Security Rule administrative safeguards and none were related to physical and technical security safeguards.

• OCR oversight of its HIPAA audit program was not effective at improving cybersecurity protections at covered entities and business associates.

We made a series of recommendations to OCR to enhance its HIPAA audit program, including that it expand the scope of its HIPAA audits to assess compliance with physical and technical safeguards from the HIPAA Security Rule, document and implement standards and guidance for ensuring that deficiencies identified during the HIPAA audits are corrected in a timely manner, and define metrics for monitoring the effectiveness of OCR’s HIPAA audits at improving audited covered entities and business associates’ protections over ePHI and periodically review whether these metrics should be refined.”
Comment: According to StatNews analysis: “OCR has not conducted any HIPAA audits since 2017, leaving the nation’s health care organizations to either police themselves or wait until a cyberattack exposes their systems’ inadequacy.”

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President-elect Trump's picks for CDC, FDA, surgeon general: 31 notes FYI- a really good summary.

About health insurance/insurers  

Most American workers satisfied with employer-provided health coverage “A new nationwide poll finds that a strong majority of Americans receiving health care coverage through work — about 180 million people — are satisfied with their current employer-provided plans (75%) and prefer to get their coverage through an employer rather than through the federal or state government (74%).”

UnitedHealthcare beats CMS in Medicare Advantage star ratings lawsuit “UnitedHealthcare has prevailed in its lawsuit against CMS regarding the methodology used to calculate its 2025 Medicare Advantage star ratings. 
The lawsuit, filed Sept. 30 in the U.S. District Court for the Eastern District of Texas, revolved around the inclusion of a single disputed customer service phone call in the agency's calculations.
Judge Jeremy Kernodle ruled that CMS must "recalculate Plaintiffs' 2025 star ratings without consideration of the disputed call and shall immediately publish the recalculated star ratings." The court found that CMS had acted "contrary to its own guidelines" when evaluating the phone call, which was marked as "unsuccessful" despite evidence showing it lasted over eight minutes and connected to a call center representative.”

12 payers recently fined by states FYI

How much each state has spent to expand Medicaid “States spend nearly $40 billion annually on expanded Medicaid coverage under the ACA, according to KFF.
Medicaid is financed by the federal government and the states based on per capita income. The federal funding share varies from 50% to 74%, depending on the state. The ACA expanded Medicaid eligibility in 2014, and the federal government has paid for 90% of expansion costs since 2020.”
Expansion costs range from $3.23B (California) to $960K (Sound Dakota).

Attributing Racial Differences in Care to Health Plan Performance or Selection “In this cross-sectional study, we found substantial variation across MMC [Medicaid managed care] plans in racial differences in health care that was largely an artifact of selection bias. These findings highlight the difficulty of measuring a plan’s impact on health equity while underscoring that health care disparities remain large in Medicaid. Although these findings suggest that initiatives to adjust payments to MMC plans based on health equity measures may have unintended consequences, they also demonstrate a pressing need for well-designed policies to measure and address inequities in Medicaid.”

About hospitals and healthcare systems

Geisinger performs 1st shoulder surgery with 'lifetime guarantee' “Wilkes-Barre, Pa.-based Geisinger performed the first reverse shoulder replacement surgery in the world with a guarantee for the full cost of care throughout the patient's lifetime.
The surgery and lifetime guarantee are in partnership with Medacta Group SA, a Swiss company specializing in innovative and sustainable solutions for joint replacement, sports medicine and spine surgeries…”

About the public’s health

Study provides more positive data for Paxlovid use in high-risk patients with COVID-19 “Overall, the analysis showed that Paxlovid “significantly reduced” times to sustained alleviation (13 vs. 15 days; HR = 1.27; P < 0.0001) and resolution through day 28 (16 vs. 19 days; HR = 1.2; P = 0.0022). Treatment with Paxlovid also reduced the number of COVID-19related medical visits by 64.3% and reduced the number of patients needing these visits (2.3% vs. 8.4%).”

New Clinical and Public Health Challenges: Increasing Trends in United States Alcohol Related Mortality “During the last 20 years there have significant increases of about 2-fold in US alcohol-related mortality. Clinical challenges are increased by interrelationships of risk factors, especially overweight and obesity and diabetes.” 

State Reported Efforts to Address Health Disparities: A 50 State Review “This analysis focuses on current state efforts, many of which were implemented during or after 2020, to address health disparities and advance health equity based on a review of publicly available materials from all 50 states and DC. In addition, case study interviews were conducted with 14 stakeholders in three states (California, North Dakota, and Michigan) to increase understanding of the factors contributing to success of these state initiatives, lessons learned, and potential implications for other states.” 

About healthcare personnel

MD-Granting Medical Schools in the US, 2023-2024 FYI. Annual report from the AMA

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About healthcare policy

Sweeping nonprofit House bill passes, healthcare groups turn attention to Senate “Legislation that gives a president wide-reaching power to financially harm any nonprofit an administration deems as terrorist supporting passed out of the House of Representatives Nov. 21.
By a vote of 219 to 184, 15 Democrats joined with an overwhelming majority of Republicans allowing a president to abolish the tax-exempt status of nonprofits. Just one Republican voted against H.R. 9495, and 30 representatives did not vote…
’To those who say this bill only applies to groups who are supporting terrorism, consider how expansive that term can be,’Rep. Lloyd Doggett, D-Texas, said on the House floor Tuesday.”

About health insurance/insurers

RFK Jr. weighs major changes to how Medicare pays physicians The proposals (still preliminary) are to take the relative rate payment determinations away from the AMA.

Medicare’s New Pathway for Transitional Coverage for Emerging Technologies A good review of this topic.

Mercer: As costs rise, employers are pursuing benefit enhancements. Here's how “Earlier this fall, Mercer released the first look at initial results from its annual survey of employer-sponsored health plans. That showed employers are bracing for medical costs to rise by more than 5% in 2025 for the third straight year…
To address affordability more broadly, employers are taking steps to offer more plan options for workers with the goal of accommodating a broader range of financial and health needs. Mercer found that 65% of large employers provided at least three plan options to employees…
Employers are also focusing on benefits in key areas. For example, the study found that 47% of large employers cover in vitro fertilization, growing from 45% in 2023.”

About the public’s health

Influenza, COVID-19, and Respiratory Syncytial Virus Vaccination Coverage Among Adults — United States, Fall 2024 “By November 9, 2024, an estimated 34.7% and 17.9% of adults aged ≥18 years had received influenza and COVID-19 vaccines, respectively, for the 2024–25 season; 39.7% of adults aged ≥75 years and 31.6% of adults aged 60–74 years at increased risk for severe RSV disease had ever received RSV vaccine. Many unvaccinated adults reported intent to get vaccinated.” 

Chloronitramide anion is a decomposition product of inorganic chloramines “Municipal drinking water in the US is often treated with chloramines to prevent the growth of harmful microorganisms, but these molecules can also react with organic and inorganic dissolved compounds to form disinfection by-products that are potentially toxic. Fairey et al. studied a previously known but uncharacterized product of mono- and dichloramine decomposition and identified it as the chloronitroamide anion... This anion was detected in 40 drinking water samples from 10 US drinking water systems using chloramines, but not from ultrapure water or drinking water treated without chlorine-based disinfectants. Although toxicity is not currently known, the prevalence of this by-product and its similarity to other toxic molecules is concerning.”

About healthcare technology

Baxter International releases first IV solutions manufactured at hurricane-hit NC facility “Baxter International this week released the first product – 1-liter IV solutions – manufactured post-hurricane at its North Cove, North Carolina facility. 
The product release is ahead of the company's original expectations and made possible by the dedication and resilience of the North Cove and broader Baxter teams, working in coordination with FDA, the company said in an update posted to its website.”

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About health insurance/insurers

Four Million People Will Lose Health Insurance If Premium Tax Credit [PTC] Enhancements Expire in 2025 From The Urban Institute: “By our analysis, if PTC enhancements expire after 2025, subsidized Marketplace enrollment would decline by 7.2 million people, and 4.0 million people would become uninsured. However, these effects aren’t felt equally across states or by race, income, and age, which means some communities may experience greater coverage losses, making health care unaffordable and inaccessible. To explore these effects by state, we produced an interactive tool displaying effects on health insurance coverage in each state by age, income, race, and ethnicity.” 

The State of Health Insurance Coverage in the U.S.: Findings from the Commonwealth Fund 2024 Biennial Health Insurance Survey “Survey Highlights

• More than half (56%) of U.S. working-age adults were insured all year with coverage adequate to ensure affordable access to care. But there are soft spots requiring policy attention: 9 percent of adults were uninsured, 12 percent had a gap in coverage over the past year, and 23 percent were underinsured, meaning they had coverage for a full year that didn’t provide them with affordable access to heath care.

• Among adults who were insured all year but underinsured, 66 percent had coverage through an employer, 16 percent were enrolled in Medicaid or Medicare, and 14 percent had a plan purchased in the marketplaces or the individual market.

• Nearly three of five (57%) underinsured adults said they avoided getting needed health care because of its cost; 44 percent said they had medical or dental debt they were paying off over time.

• Delaying care has health consequences: two of five (41%) working-age adults who reported a cost-related delay in their care said a health problem had worsened because of it.

• Nearly half of adults (48%) with medical debt are paying off $2,000 or more; half of those with debt said it stemmed from a hospital stay.”

About pharma

CVS Health 1st to earn new health equity accreditation “CVS Health has become the first organization to receive the Health Equity Accreditation from URAC, an independent accrediting body, for its efforts to address health disparities, according to a Nov. 19 news release from the company.” 

Trump leans toward selecting surgeon and COVID mandate critic Martin Makary for top FDA job: reports “England-born Makary, current chief of Inlet Transplant Surgery at Johns Hopkins, has received worldwide recognition for his achievements in novel surgeries and widely-used research, including a World Health Organization-sponsored checklist on surgical safety.
On the drug policy front, Makary has previously raised concerns about pharmaceutical companies “gaming the system” of the Orphan Drug Act, a pathway used to usher in treatments for rare diseases.
More recently, Makary has been an outspoken critic of vaccine mandates during the pandemic, which ‘ignored natural immunity, he argued in 2023 remarks to the Senate’s COVID subcommittee. During the pandemic, natural immunity and herd immunity were topics often addressed by Makary, who expected the concepts to help COVID be ‘mostly gone’ by April 2021.
The possible FDA commissioner pick has also argued against the use of masks for children to reduce the spread of COVID and has been accused of using misleading claims to make criticisms of the U.S. government.”

About the public’s health

A quarter of Americans suffer from chronic pain “Researchers asked more than 87,000 people how often they experienced pain in the last three months and found 24.3% reported "most days" or "every day."

• To get at how many people were experiencing what they called "high-impact chronic pain" the researchers asked how often people experienced pain that limited their life or work activities. A total of 8.5% said most or all days.

• The risk for chronic pain rose as people aged and was highest in rural areas.

• American Indian and Alaska Native adults were more likely to have chronic pain in the past three months (30.7%) compared with white (28%), Black (21.7%), Hispanic (17.1%) and Asian (11.8%) adults.”

Total and High-density Lipoprotein Cholesterol in Adults: United States, August 2021–August 2023 From the CDC: “Key findings

• During August 2021–August 2023, the prevalence of high total cholesterol was 11.3% in adults, with no significant difference between men (10.6%) and women (11.9%).

• The prevalence of low high-density lipoprotein cholesterol (HDL-C) for adults was 13.8%, was higher in men (21.5%) than women (6.6%), and declined with increasing age.

• High total cholesterol prevalence declined from 1999–2000 to 2013–2014 and then did not change significantly. Low HDL-C prevalence declined from 2007–2008 to August 2021–August 2023.” 

About healthcare technology

Scientists map out the human body one cell at a time “Researchers have created an early map of some of the human body’s estimated 37.2 trillion cells…
Scientists focused on certain organs — plotting the jobs of cells in the mouth, stomach and intestines, as well as cells that guide how bones and joints develop. They also explored which cells group into tissues, where they’re located in the body and how they change over time.
They hope the high-resolution, open-access atlas — considered a first draft — will help researchers fight diseases that damage or corrupt human cells.”
See: Human Cell Atlas 

Today's News and Commentary

About healthcare quality

The Joint Commission and the National Association for Healthcare Quality Form Strategic Alliance to Advance Global Patient Safety and Healthcare Quality “The Joint Commission and the National Association for Healthcare Quality (NAHQ) announce a strategic alliance to advance global healthcare Quality and safety for all…
With the alliance, The Joint Commission and NAHQ will transform healthcare by:

• Uniting to a universal set of Quality competencies: The Joint Commission endorses and encourages healthcare organizations to adopt NAHQ’s Healthcare Quality Competency Framework™, which defines the full spectrum of work required for a high-functioning Quality program. This framework will not be a requirement for Joint Commission accreditation or certification. It will not be scored or determinative of survey or review outcome.

• Skilling healthcare professionals: NAHQ offers the only accredited certification in healthcare Quality through its Certified Professional in Healthcare Quality (CPHQ)® To support the importance of competency development, Joint Commission and Joint Commission International (JCI) surveyors and reviewers will obtain and maintain this certification. Furthermore, The Joint Commission and NAHQ will jointly offer 25 annual scholarships to fund CPHQ attainment in underfunded organizations.

• Co-developing best-in-class training and education: The alliance will create training and education on the most critical topics in healthcare, along with other global products and services. NAHQ will develop a series of micro-credentials aligned with each of the eight domains of its Healthcare Quality Competency Framework, including a micro-credential in Regulatory & Accreditation in collaboration with The Joint Commission.

• Aligning critical missions and approaches: NAHQ recognizes and endorses Joint Commission and JCI accreditation and certification approaches and products as best practices for assessing Quality and safety within healthcare organizations around the world.”

About health insurance/insurers

IRS loosens rules on health plan coverage for preventive care “The IRS has expanded its list of preventive care benefits for high-deductible health plans. Services that must be covered at no cost to policyholders now include condoms and breast cancer screenings other than mammograms, among other items.”

COMPETITION in HEALTH INSURANCE From an annual AMA report: “A comprehensive study of U.S. markets“We find that the vast majority of U.S. health insurance markets are highly concentrated. In fact, health insurance markets have remained stubbornly highly concentrated over time, with the vast majority of them being so in the last 10 years. The share of commercial markets that are highly concentrated was 95% in both 2014 and 2023 and hovered between 95% and 96% over that 10-year period.” 

About pharma

CVS, UnitedHealth, Cigna sue to block FTC case over insulin prices “KEY POINTS

• CVS Health, UnitedHealth Group and Cigna sued the Federal Trade Commission, claiming the agency’s case against drug middlemen over high insulin prices in the U.S. is unconstitutional. 

• The complaint is the latest move in a bitter legal fight between the three largest pharmacy benefit managers, or PBMs, in the U.S. and the FTC.

• The FTC in September sued CVS’s Caremark, Cigna’s Express Scripts and UnitedHealth’s Optum Rx in the agency’s administrative court.”

About the public’s health

What to know about microplastics, phthalates, BPA and PFAS An excellent review of this topic.

Today's News and Commentary

About healthcare quality

Safety of inpatient care in surgical settings: cohort study “Adverse events were identified in more than one third of patients admitted to hospital for surgery, with nearly half of the events classified as major and most potentially preventable. These findings emphasize the critical need for ongoing improvement in patient safety, involving all health professionals, throughout perioperative care.”
At least 1 in 5 of these complications is the result of medical errors.

About health insurance/insurers

TV personality and surgeon Dr. Oz nominated to run Medicare, Medicaid Another payback: “In 2022, he ran for the Senate in Pennsylvania as a [Trump-endorsed] Republican against then-Lieutenant Governor John Fetterman. Though he beat now-Senator-elect Dave McCormick in the primary, he lost to Fetterman in the general election.” 

Change Healthcare restores claims clearinghouse: 5 things to know A good update.

States rush Medicaid requests before Trump return “States are racing to have their Medicaid requests approved before the Trump administration takes power.
The new administration is expected to have a very different view of Medicaid than the Biden administration, and GOP lawmakers in Congress are eyeing major changes. Some states want waivers that will impact their states’ budgets, but others seek to allow Medicaid to pay for social services, a Biden administration innovation that links health to social well-being…”

Medicare Improperly Paid Acute-Care Hospitals an Estimated $190 Million Over 5 Years for Outpatient Services Provided to Hospice Enrollees From HHS OIG: “For 30 of 100 sample items, payments to acute-care hospitals for outpatient services provided to hospice enrollees complied with Medicare requirements. For the remaining 70 sample items, however, payments did not comply with the requirements. Specifically, our medical reviewer found that Medicare paid acute-care hospitals for outpatient services that palliated or managed hospice enrollees’ terminal illnesses and related conditions. These services were already covered as part of the hospices’ per diem payments and should have been provided directly by the hospices or under arrangements between the hospices and acute-care hospitals.”

About pharma

Antidiabetic Medication and Asthma Attacks “In this self-controlled case series and population-based cohort study of 12 702 patients with asthma, metformin was associated with a lowered risk of asthma attacks by approximately 30%, and adding glucagon-like peptide-1 receptor agonists were associated with an additional lowered risk of approximately 40%. Associations were found regardless of glycemic control, weight, or asthma phenotype.”

Semaglutide Eligibility Across All Current Indications for US Adults “A total of nearly 137 million adults, representing more than half of all US adults, are eligible for semaglutide therapy. This exceeds the number of adults eligible for statins (approximately 82 million), currently the most prescribed pharmaceuticals among US adults.6 Although most of these individuals are eligible for semaglutide based on the weight-management indication that is not universally covered by payers, we estimate that more than 39 million adults qualify for indications other than weight management alone, a substantial increase over the estimated 15 million currently taking a glucagon-like peptide-1 (GLP-1) receptor agonist.”

About the public’s health

The many legal fronts of RFK Jr.’s fight against vaccines “Robert F. Kennedy Jr. took leave as chairman of Children’s Health Defense, a nonprofit known for spreading doubt about vaccines, to run for president last year. But he is still fighting in court alongside the group, putting him in an unusual position for someone nominated as Secretary of Health and Human Services.  
If confirmed by the Senate, Kennedy will have power to guide the agencies he oversees toward his priorities. The legal fights he and his group pursue offer a glimpse of his policy interests and the tools he’s used to further them — as well as the scrutiny they could face in court.”

The US Preventive Services Task Force in Legal Jeopardy An excellent summary of recent court decisions on the legal ability of the USPTF to set policies (especially preventive care coverage for the ACA).

Childhood Vaccination Rates Continue to Decline as Trump Heads for a Second Term For example: “The share of kindergarten children up to date on their vaccinations continues to decline.
Over three-quarters (39) of states had MMR vaccination rates below the “target” rate of 95% for the 2023-2024 school year, an increase from 28 states during the 2019-2020 (pre-pandemic) school year.”

About healthcare IT  

A strategy for cost-effective large language model use at health system-scale “Large language models (LLMs) can optimize clinical workflows; however, the economic and computational challenges of their utilization at the health system scale are underexplored. We evaluated how concatenating queries with multiple clinical notes and tasks simultaneously affects model performance under increasing computational loads…Performance deteriorated as the number of questions and notes increased. High-capacity models, like Llama-3–70b, had low failure rates and high accuracies. GPT-4-turbo-128k was similarly resilient across task burdens, but performance deteriorated after 50 tasks at large prompt sizes. [Emphasis aded]After addressing mitigable failures, these two models can concatenate up to 50 simultaneous tasks effectively, with validation on a public medical question-answering dataset. An economic analysis demonstrated up to a 17-fold cost reduction at 50 tasks using concatenation. [Emphasis added] These results identify the limits of LLMs for effective utilization and highlight avenues for cost-efficiency at the enterprise scale.”

Consolidation Looms in Ambient Voice A good graphic summary of the consolidation in the voice transcription space.

Today's News and Commentary

“…it is however a bad day for science when truth is dominated by passions and expediency."
 Sir William John Ritchie Simpson [1855-1931]
Public Health Expert and contributing founder of the London School of Tropical Medicine and Hygiene

About healthcare policy

Jay Bhattacharya, an NIH critic, emerges as a top candidate to lead the agency “When three academics in October 2020 insisted it was time to roll back coronavirus lockdowns — writing an open letter known as the Great Barrington Declaration that attracted hundreds of thousands of signatures — public health leaders rebuked their proposal as premature. Francis S. Collins, then director of the National Institutes of Health, privately dismissed the authors as “fringe” experts and called for a “take down” of their suggestions to reopen schools and businesses, according to emails subsequently released under the Freedom of Information Act.
Now, one of the authors of that declaration — Jay Bhattacharya, a Stanford University physician and economist — appears poised for a top government health role, perhaps as head of NIH itself…
The rise of Bhattacharya — from being scorned by the nation’s NIH director to possibly occupying his office four years later — reflects how the backlash to coronavirus policies has helped reshape conservative politics and elevate new voices. While Collins and other public health experts maintain that the Great Barrington Declaration’s ideas were rash and would have put vulnerable people at risk, many Americans have come to believe that school shutdowns and other pandemic-related policies lasted too long.”

Planned Parenthood, nonprofits condemn executive power granted in looming House bill “National healthcare groups have signed on in opposition to a House bill that would soon grant President Donald Trump the ability to undermine nonprofits and remove their tax-exempt status, civil liberty organizations claim.
These groups, led by the American Civil Liberties Union (ACLU), say the Stop Terror-Financing and Tax Penalties on American Hostages Act introduces “broad and easily abused new powers for the executive branch” in a letter sent to congressional leaders in September.”

Assistant Attorney General Jonathan Kanter Delivers Remarks on the Platformization of Health care A good summary about why the government has pressed antitrust actions in healthcare, The discussion may be moot as the Trump administration will probably cut back on antitrust actions.
See, also: A conversation with Assistant Attorney General Jonathan Kanter on U.S. HealthCare

About health insurance/insurers

5 big changes to Medicare 2025 plans you should know during open enrollment Good review of the 2025 changes.

Survey Shows Health Plans Are Expanding Value-Based Arrangements to Deliver Higher-Quality, More Affordable Health Care  [An AHIP survey] “Key findings from the survey include:

• Continued growth in the adoption of VBC arrangements and shared risk arrangements. Across all lines of business, value-based arrangements grew by nearly 4 percentage points from 41.3% in 2022 to 45.2% in 2023. Shared risk arrangements also saw an increase, growing by 4 percentage points, from 24.5% in 2022 to 28.5% in 2023.

• Medicare Advantage continues to lead the way. Medicare Advantage (MA) continues to lead innovation in this space with 64.3% of payments in 2023 flowing through value-based arrangements, compared to 42% for fee-for-service (FFS) Medicare. This is a 7.1 percentage point year-over-year increase for MA plans from 57.2% in 2022, compared with a 0.6 percentage point increase for FFS over 2022.

• Commercial health plans continue making progress toward value-based adoption.Participation in commercial VBC arrangements grew from 34.6% in 2022 to 39.2% in 2023, a 5.1 percentage point increase. Adoption of downside risk arrangements in the commercial market also saw an increase of 5.1%.”

About hospitals and healthcare systems

Hospital financial stability in 2025: 8 predictions Good summary from Moody's Investor Services.

Caregiver-Reported Quality in Hospices Owned by Private Equity Firms and Publicly Traded Companies “Hospices owned by PEFs or PTCs performed significantly worse across CAHPS measures relative to not-for-profit and non-PEF/PTC for-profit agencies. Although prior research has highlighted poorer user experiences in for-profit vs not-for-profit hospices,1 this study found that PEF/PTC ownership was an especially problematic category of for-profit hospice.”

About the public’s health

Is it the flu or is it COVID? One at-home test can tell you “For the first time, new home tests — available at pharmacies without a prescription — can test for both the flu and COVID simultaneously.” 

About healthcare IT

DEA extends telehealth prescribing flexibilities “The Drug Enforcement Administration extended the flexibilities enacted during the COVID-19 pandemic that allows healthcare providers to prescribe specific controlled substances via telehealth.”

Today's News and Commentary

RFK Jr. conspiracy theories and false claims, in his own words
[Edited and quoted from the original, but read the entire article]
1.Kennedy has falsely linked vaccines to autism
“I do believe that autism does come from vaccines,” he said last summer in an interview with Fox News host Jesse Watters.
2.Kennedy falsely called the coronavirus vaccine the ‘deadliest vaccine ever made’
3.Kennedy promotes raw milk, stem cells and other controversial or debunked medical treatments
4.Kennedy argues government employees have an interest in ‘mass poisoning’ the American public
“The agency, the USDA, the FDA have been captured by the industries they’re supposed to regulate, and they all have an interest in subsidies and mass poisoning the American public,” Kennedy told Fox News in August.
5.Kennedy has suggested mass shootings committed by young people are spurred by antidepressants and video games.
6.Kennedy incorrectly suggests AIDS may not be caused by HIV
“They were doing phony, crooked studies to develop a cure that killed people without really being able to understand what HIV was, and pumping up fear about it constantly, not really understanding whether it was causing AIDS,” Kennedy said in an interview last summer with New York Magazine.
7.Kennedy falsely argues children’s gender identity can be impacted by water
8.Kennedy has falsely touted ivermectin and hydroxychloroquine as effective covid treatments
9. Kennedy argued that covid-19 was ‘ethnically targeted’ to spare Ashkenazi Jews and Chinese people
Kennedy said in a video recorded by the New York Post last July: “Covid-19 is targeted to attack Caucasians and Black people. The people who are most immune are Ashkenazi Jews and Chinese.”
10.Kennedy claims 5G high-speed wireless network is used to ‘control our behavior’
Kennedy has claimed that 5G high-speed wireless network service is being used to “harvest our data and control our behavior.”

Public Trust in Scientists and Views on Their Role in Policymaking “Key findings
-76% of Americans express a great deal or fair amount of confidence in scientists to act in the public’s best interests.
-Majorities view research scientists as intelligent (89%) and focused on solving real-world problems (65%).
-Communication is seen as an area of relative weakness for scientists.
-Americans are split over scientists’ role in policymaking.
-Democrats continue to express more confidence than Republicans in scientists, but ratings within the GOP have edged higher in the last year.”
Read the entire article. Many difference exist among population subgroups.

About health insurance/insurers

CMS to lower importance of ‘call center’ metric in Medicare Advantage star ratings “UnitedHealthcare, Centene and Humana have all sued the government this fall for downgrading their quality scores based on assessments of their customer support centers. Payers argued the measure had an outsized impact on final star ratings, and it seems that regulators agree.
’We have already put in place that [the call center metric] is going to have a smaller weighting on star ratings moving forward,’ CMS Medicare Director Meena Seshamani said Wednesday at the Milken Institute’s Future of Health Summit in Washington, D.C.”

About hospitals and healthcare systems

A couple performance reports:
Advocate Health posts $885M operating gain through Q3 
Henry Ford Health's operating income up $242M through Q3 

About pharma

Vaccine maker stocks fall as Trump chooses RFK Jr. to lead HHS “The stocks fell in the final hour of trading as reports emerged about Trump’s expected pick. Moderna’s stock closed more than 5% lower on Thursday, shares of Novavax fell more than 7% and Pfizer’s stock ended more than 2% lower.
Shares of BioNTech, the German drugmaker that helped develop a Covid vaccine with Pfizer, closed more than 6% lower. British drugmaker GSK, which makes flu shots and several other vaccines, closed roughly 2% lower.”

New FDA rules for TV drug ads: Simpler language and no distractions “The new rules, which cover both TV and radio, instruct drugmakers to use simple, consumer-friendly language when describing their drugs, without medical jargon, distracting visuals or audio effects. A 2007 law directed the FDA to ensure that drug risk information appears ‘in a clear, conspicuous and neutral manner.’” 
Read the whole article for explanations about what why the FDA is taking these steps.

About the public’s health

A Big Climate Goal Is Getting Farther Out of Reach “The report by the Climate Action Tracker, a research group, estimates that the climate and energy policies currently pursued by governments around the world would cause global temperatures to rise roughly 2.7 degrees Celsius, or 4.9 degrees Fahrenheit, above preindustrial levels by 2100.
That estimate of future warming has barely budged for three years now, the group said.”

Recent Decade Saw Drop in Marijuana Use in U.S. Adolescents “The researchers found that the percentage of adolescents who reported current marijuana use dropped significantly from 23.1 percent in 2011 to 15.8 percent in 2021. There were also significant decreases in self-reports of trying marijuana for the first time before age 13 years (8.1 percent in 2011 to 4.9 percent in 2021). Similar significant decreases were seen for current use by race/ethnicity, with Asian, Hispanic, and White adolescents experiencing the steepest declines. The percentage of Black adolescents self-reporting marijuana use was significantly higher (20.5 percent) in 2021 compared with White (14.8 percent), Hispanic (16.7 percent), and Asian (5.1 percent) adolescents. While there were significant declines in current marijuana use for both girls and boys over time, in 2021, girls were more likely (17.8 percent) to currently use marijuana than boys (13.6 percent), but the opposite was true in 2011 (25.9 percent for boys versus 20.1 percent for girls).”

National-level and state-level prevalence of overweight and obesity among children, adolescents, and adults in the USA, 1990–2021, and forecasts up to 2050 “In 2050, in most states, a projected one in three adolescents (aged 15–24 years) and two in three adults (≥25 years) will have obesity.”

 March of Dimes Report Card “In 2023, over 370,000 babies were born preterm—10.4% of all births—earning our nation a D+ for the third year in a row. In addition to the preterm birth rate, the report also includes indicators to better reflect the state of maternal and infant health in the US.”
You can also see stat-by-state comparisons. The only “A’ grade is Vermont.

About healthcare IT

Amazon One Medical rolls out telehealth treatment services in competition with Ro, Hims & Hers “Amazon One Medical is rolling out a new service to provide Prime members access to clinical treatments for common health and lifestyle conditions like men's hair loss and anti-aging skin care.
The new service builds on Amazon One Medical's existing Pay-per-visit telehealth service that offers healthcare for more than 30 common conditions.
The new service offers a subscription plan with low, upfront monthly pricing for a clinical visit, treatment plan, and free medication delivery. The service initially focuses on five conditions: anti-aging skin care treatment, men’s hair loss, erectile dysfunction, eyelash growth, and motion sickness.”

About healthcare quality

Fall 2024 Leapfrog Hospital Safety Grade Shows Significant Progress in Patient Safety Nationwide Go to this link for national figures for specific practices. Go here to find the ratings of hospitals near you.

Unnecessary Back Surgery From the Lown Institute:
”KEY TAKEAWAYS

• Over three years, U.S. hospitals performed more than 200,000 unnecessary back surgeries on Medicare beneficiaries. That’s one low-value back procedure every eight minutes.

• These low-value back procedures cost Medicare about $2 billion in total over three years.

• On average, 14% of spinal fusions/laminectomies met criteria for overuse, with individual hospital overuse rates ranging from less than 1% to more than 50%.

• On average, 11% of patient visits for osteoporotic fracture resulted in an unnecessary vertebroplasty, with individual hospital rates of overuse ranging from zero to 50%.

• New Hampshire, Iowa, Massachusetts, and Pennsylvania had the highest overuse rates of spinal fusion/laminectomy with rates over 18%. Arkansas, Kansas, Oklahoma, and Nevada had the highest overuse rates of vertebroplasty, with rates over 16%.

• U.S. News Honor Roll hospitals had varied performance. At Cleveland Clinic fewer than 1% of patient visits with osteoporotic fracture resulted in an unnecessary vertebroplasty, compared to nearly 20% at Mayo Clinic Phoenix.

• A total of 3,454 physicians performed a measurable number of low-value back surgeries. Over three years, these physicians received a total of $64 million from device and drug companies for consulting, speaking fees, meals, and travel, according to Open Payments data analyzed by Conflixis.”

Today's News and Commentary

Trump taps Robert F. Kennedy Jr., vaccine skeptic, to lead health department “Kennedy, founder of one of the country’s most prominent anti-vaccine groups, has long criticized the Centers for Disease Control and Prevention’s recommended list of childhood immunizations, promoting debunked claims about vaccines’ link to autism. He has argued that federal agencies have not done enough research on the shots that hundreds of millions of Americans have received to protect them from measles, flu and other infectious diseases. His claims are rejected by health officials who say that vaccines have been thoroughly studied and are responsible for ending threats such as polio in the United States”
In a related story:RFK Jr.’s anti-vaccine group lost $3 million last year “After years of financial growth, Children’s Health Defense, the anti-vaccine nonprofit group founded by Robert F. Kennedy Jr., recorded a more than 30% drop in revenue last year, to $16 million, according to recent tax filings.”

About health insurance/insurers

Medicare Part D in 2025: Preferred Pharmacy Networks Fade in a Collapsing PDP Market “For 2025, DCI’s exclusive analysis of Center for Medicare & Medicaid Services’ (CMS) data reveals that the number of PDPs will drop to a historic low. What’s more, the share of plans with a preferred cost sharing pharmacy network will fall to its lowest rate in more than 10 years…
The destruction of the Part D market marks yet another unintended consequence of the Inflation Reduction Act of 2022 (IRA). The IRA makes PDPs less economically viable and will drive even more seniors into Medicare Advantage Prescription Drug (MA-PD) plans—despite the challenges facing those plans. The 2025 decline will occur even after CMS gifted $7 billion to PDPs to prevent a complete collapse of the 2025 market.”

Healthcare billing fraud: 10 recent cases FYI

How Lincare Became a Multibillion-Dollar Medicare Scofflaw A great investigative piece from ProPublica.

About hospitals and healthcare systems

Medicare Faces Barrage of Hospital Pay Cases After Chevron's End A thoughtful analysis of the impact of this Supreme Court decision vis-a-vis hospitals.

About pharma

Drug Safety:FDA Should Implement Strategies to Retain Its Inspection Workforce From the GAO: “The Food and Drug Administration paused many drug manufacturer inspections during the COVID-19 pandemic. Inspections help ensure that the drugs Americans rely on are safe.
Since resuming inspections, FDA has struggled to retain staff. From Nov. 2021 to June 2024, the vacancy rate among investigators who inspect foreign and domestic manufacturers jumped from 9% to 16%—leading to fewer inspections.
FDA said concerns with travel, pay, training, workload, and work-life balance contribute to turnover. For example, investigators can travel up to 75% of the time.
We recommended developing a plan that balances inspection needs with addressing turnover.”

About the public’s health

US overdose deaths are down, giving experts hope for an enduring decline “The decline in U.S. drug overdose deaths appears to have continued this year, giving experts hope the nation is seeing sustained improvement in the persistent epidemic.
There were about 97,000 overdose deaths in the 12-month period that ended June 30, according to provisional Centers for Disease Control and Prevention data released Wednesday. That’s down 14% from the estimated 113,000 for the previous 12-month period.”‘

Tide is turning’: STI epidemic shows signs of slowing, CDC says “Key takeaways:
More than 2.4 million STIs were reported in the U.S. in 2023 — a 1.8% decrease from 2022.
Data showed rates of gonorrhea and chlamydia decreased, whereas overall syphilis rates increased by 1%.”

Measles cases rose 20% worldwide in 2023, per new report “Measles vaccination coverage globally has still not recovered to pre-Covid levels, a fact that contributed to a 20% increase in measles cases in 2023 over the previous year, according to a new report from the World Health Organization and the Centers for Disease Control and Prevention that was released Thursday.
The pandemic backsliding is hindering efforts to eliminate measles globally, and subjecting children — generally children under the age of 5 — to a health threat that can be fatal in some cases or trigger lifelong consequences such as deafness in others.”

About healthcare IT

Healthcare Cybersecurity: HHS Continues to Have Challenges From the GAO: “HHS has several initiatives intended to mitigate ransomware risks for healthcare and public health. Nevertheless, our prior work has found that the department had not adequately monitored the sector’s implementation of ransomware mitigation practices.”
This statement outlines a set of recommendations to address this problem.

About healthcare technology

PTC wins FDA approval for first brain-delivered gene therapy Kebilidi “The FDA issued its first stamp of approval for a cell or gene therapy back in 2017 to Novartis' Kymriah. Now, seven years and many approvals later, innovation in the space has hit new heights with PTC Therapeutics’ Kebilidi, the first U.S. gene therapy that’s administered directly in the brain.
The one-time therapy picked up an FDA nod to treat the ultra-rare disease aromatic L-amino acid decarboxylase (AADC) deficiency, a fatal genetic disorder that manifests in severe disability from the first months of life across the physical, mental and behavioral spectrums, according to PTC.”

Gene screening can cut early disease deaths by 25%, study shows “The scientists used Genomics’ analytical tool, known as a polygenic risk score (PRS), to identify those at high risk from birth of nine diseases. The conditions, which all have existing screening programmes globally, are breast cancer, prostate cancer, colorectal cancer, abdominal aortic aneurysm, melanoma, type 2 diabetes, hypertension, cardiovascular disease and atrial fibrillation. The researchers found very high risk individuals reached the average risk levels on which screening programmes are based 12.4 years early. In other words, if a screening programme were devised on the basis of the average risk facing a 50-year-old, this high-risk group would face the same predicted risk at age 37.6. By contrast, a group of reduced genetic risk individuals did not reach normal initial screening-age risk levels until about 17.7 years later — or 67.7 years old in the example given. Overall, the use of the genetic prediction tools and consequent early medical intervention could prevent 24.5 per cent of premature, preventable deaths that occur before screening programmes start, the researchers said.”

Today's News and Commentary

About hospitals and healthcare systems

National Hospital Flash Report “Key Takeaways

1. September data show relative stability. Though most indicators are down this month, performance remained relatively stable overall.
2. Inpatient revenue and average length of stay increased. This indicates that hospitals are treating more high-acuity patients, which results in a decline in volume and an increase in expenses.
3. Expenses, with the exception of labor, are still high compared to 2021-2023. Contract labor rates and utilization have decreased, but the overall labor market is still tight. 

About pharma

Cardinal Health inks two deals worth $3.9B to expand diabetes, gastroenterology businesses “The pharmaceuticals and specialty products distributor announced Tuesday it entered into definitive agreements to acquire a majority stake in GI Alliance (GIA), a gastroenterology management services organization from a combination of GIA physician owners and funds managed by affiliates of Apollo. Cardinal Health said it will purchase its majority stake for approximately $2.8 billion in cash, which will represent 71% ownership. 
Also on Tuesday, the company, which also offers data analytics services, said it plans to buy the Advanced Diabetes Supply Group (ADSG), a leading diabetic medical supplies provider, for approximately $1.1 billion in cash. “

BioNTech pays $800M to take control of potential Keytruda killer “BioNTech is upping its bet on a PD-L1xVEGF-A bispecific, paying $800 million upfront to buy its Chinese partner Biotheus and secure full rights to a leading prospect in the white-hot immuno-oncology space.
Germany-based BioNTech got into the space before the gold rush that was unleashed in September by the news that Akeso and Summit Therapeutics’ PD-1xVEGF-A prospect ivonescimab had beaten Merck & Co.’s Keytruda.”

Many Americans Unable to Afford Medications, Navitus Survey Finds “In the survey, 48% reported that the price of medication had affected their ability to get a medicine they needed at least once, and few understand the role of pharmacy benefit managers…
The survey, which was conducted online via Pollfish on Oct. 2, 2024 of those aged 18 and older, also found that 75% of respondents don’t know what a PBM is, and 84% couldn’t name one.
Other key findings include:

• 89% of Americans think healthcare consumers in the United States pay more than other countries.

• 45% haven’t filled a prescription due to cost.

• 43% have had to change medications because it wasn’t covered by insurance

• 50% have used a cost savings options such as discount cards”

About the public’s health

CDC estimates a national diabetes prevalence of nearly 16% “A data brief from the CDC focused on the national diabetes prevalence across the U.S. estimates that 16% of adults in the U.S. have diabetes, with approximately 4.5% being undiagnosed.” 

About healthcare personnel

Physician employment models 'are not sustainable' as labor expenses rise “Medical groups are also experiencing high labor costs, with 84% of the group's total expenses attributed to labor, according to Kaufman Hall's Physician Flash Report based on data from more than 200,000 providers. The average subsidy per employed physician was $304,312. This is the first time it's exceeded $300,000. ‘Investment/subsidy per physician rose above $300,000 for the first time — a sign that current models of physician employment are not sustainable,’ said Matthew Bates, managing director and Physician Enterprise service line leader with Kaufman Hall. ‘Revenue is increasing but physicians and providers are working more while generating less revenue. Health systems need to rethink operations to align the costs of provider employment with the current healthcare environment.’”

Healthcare's most dangerous workplaces”In 2023, private industry employers reported 2.6 million nonfatal workplace injuries and illnesses, down 8.4% from 2022, the U.S. Bureau of Labor Statistics reported
Nov. 8…
ome of the healthcare subsectors with the highest rates of nonfatal injury or illness per 100 full-time workers are: 
Ambulance services — 7.4
Nursing care facilities (skilled nursing facilities) — 6.9
Continuing care retirement communities and assisted living facilities for the elderly — 6.5 
Psychiatric and substance abuse hospitals — 6.3
General medical and surgical hospitals — 5.1”

Primary care player Forward shutters after raising $400M, rolling out CarePods Primary care player Forward is abruptly shutting down its operations, closing its locations and canceling scheduled visits, the company publicly announced Wednesday.
The company also is shutting down its mobile application effectively immediately, the company said in a post on its website. There was no other information available on the website.”
Comment: It is worthwhile reading the whole article to get an understanding of what Forward did and speculate why it didn’t work.

Medical Board Discipline of Physicians for Spreading Medical Misinformation “Extremely low rates of disciplinary activity for misinformation conduct were observed in this study despite increased salience and medical board warnings since the start of the COVID-19 pandemic about the dangers of physicians spreading falsehoods; these findings suggest a serious disconnect between regulatory guidance and enforcement and call into question the suitability of licensure regulation for combatting physician-spread misinformation.”
See also: State Medical Board Sanctions for Misinformation Should Be Rare

Today's News and Commentary

About health insurance/insurers

Where does each health care dollar go? “Total hospital costs account for 40.7 cents of each dollar, according to AHIP.”
Read the rest of the article for the breakdown of payments.

Justice Department sues UnitedHealth over Amedisys deal The U.S. Justice Department has sued UnitedHealth Group over its planned purchase of home health company Amedisys for $3.3 billion, Bloomberg reported Nov. 12.
According to the report, the lawsuit was filed in a Maryland federal court Nov. 12 and comes over concerns of lessened competition in the home health market. UnitedHealth representatives have met with DOJ officials in recent weeks to make the case for the acquisition.
The lawsuit claims the purchase could increase home healthcare prices across 23 states and in Washington, DC. Maryland, Illinois, New Jersey, and New York attorney generals have also joined the complaint.”

31 health systems dropping Medicare Advantage plans | 2024 FYI

Major payers saw mixed results in Q3. Here's a look at how each fared “Profits in the third quarter shrunk year over year for all but two of the payers included in Fierce Healthcare's review of quarterly earnings reports. Industry juggernaut UnitedHealth Group came out on top yet again with nearly $6.1 billion in profit, up from $5.8 billion.” 

About hospitals and healthcare systems “CHS' $1B divestiture plan  Franklin, Tenn.-based Community Health Systems has completed or lined up multiple hospital sales this year as part of its divestiture plan, which aims to take in about $1 billion this year after offloading hospitals across various markets. 
CHS has sold 29 hospitals since 2020, but its long-term debt still stands at about $11.5 billion, with its debt exposure driving its M&A strategy. Despite recent reductions, CHS still has one of the highest debts among health systems, and remains focused on deleveraging its balance sheet.”

CDC Data: Uninsured Rate In US Steadies At 7.6% “The latest numbers collected from April to June show that about 25.3 million Americans don't have health insurance — numbers consistent with the 2023 all-time low uninsured rate. Nearly 40% of people are insured under public programs like Medicare, Medicaid, CHIP, or military plans.”

About the public’s health

Online Retailer Nonadherence to Age Verification, Shipping, and Flavor Restrictions on E-Cigarettes “These results demonstrated pervasive nonadherence to age verification, shipping, and flavored tobacco restrictions among online tobacco retailers.” 

Obesity-Linked Heart Deaths Nearly Tripled in U.S. Over Past Two Decades “Key Takeaways

• Obesity-related heart disease deaths have nearly tripled over the past two decades

• These deaths increased 2.8-fold between 1999 and 2020

• Middle-aged men, Black adults, Midwesterners and rural residents are most at risk

About healthcare technology

23andMe shutters cancer drug research programs, lays off 40% of staff “23andMe is shutting down its therapeutics development division and plans to seek out buyers to find a new home for its in-house pipeline of DNA-informed immuno-oncology antibody drugs.
The consumer genetics company said it would lay off more than 200 employees, or about 40% of its workforce, to instead focus on the personalized DNA and ancestry tests that first made it famous as well as its telehealth platforms and the research services it provides for other drugmakers.”