Today's News and Commentary

About pharma

CMS: Medicare will begin to cover CAR T-cell therapies in some facilities: “Medicare will cover the therapies when they are provided in healthcare facilities enrolled in the FDA risk evaluation and mitigation strategies (REMS) for FDA-approved indications, officials said. In addition, Medicare will cover the FDA-approved therapies for off-label uses that are recommended by CMS'-approved compendia.”

CEO confirms Novartis knew about data issues before FDA approval of Zolgensma:  Continuing the Novartis Zolgensma story, CEO Vas Narasimhan said that the company first received the allegations of data manipulation in mid-March. The FDA approved the drug May 24. He explained: "We made the decision to progress our quality investigation prior to informing FDA and other regulatory authorities so that we could provide the best information and technical analysis, which we did promptly on completion on June 28." Undoubtedly more will come out in the near future.

What's behind the surge of prescriptions for risky, expensive medications? Millions from drugmakers: This article is a really good in-depth explanation of the biologic medication sector and the questionable marketing techniques that have contributed to its growth. Check here for a closely related story.

About health insurance

The Potential Impact of a Medicare Public Option on U.S. Rural Hospitals and Communities: Many hospitals rely on relatively higher private insurance payments to stay solvent. If a “Medicare for All” option is implemented, all providers would receive payments according to a (lower) Medicare fee schedule. What would the impact be of that payment change? According to this Navigant analysis: “offering a government insurance program reimbursing at Medicare rates as a public option on the health insurance exchanges created by the Affordable Care Act (ACA) could place as many as 55% of rural hospitals, or 1,037 hospitals across 46 states, at high risk of closure. The rural hospitals at high risk represent more than 63,000 staffed beds and 420,000 employees…”

Doctors Argue Plans To Remedy Surprise Medical Bills Will ‘Shred’ The Safety Net: On the other handPhysicians for Fair Coverage is a “coalition formed by large companies — firms such as US Acute Care Solutions, U.S. Anesthesia Partners and US Radiology Specialists — that serve as corporate umbrellas for medical practices.” This organization is running a $1.2 million ad campaign that claims Congress’ solution to end surprise billing will reduce payments and result in shredding the safety net for vulnerable patients. The Kaiser Family Foundation thoroughly investigated this claim and found it to be “False.” It reminds me of the Upton Sinclair quotation: It is difficult to get a man to understand something, when his salary depends upon his not understanding it!

Wisconsin Governor Credits Health Reinsurance Plan for Drop in Premium Rates: This is the most recent report of the effect on premiums of state reinsurance plans. (Previously reported was Colorado’s experience.) Wisconsin Governor Tony Evers said the program will lower rates by an average of 3.2%, rather than face a projected 9% increase.

About the public’s health

Three hospitals team up on $3m plan to help low-income families pay the rent: This type of program is not new, just the latest example of hospitals providing low-income housing to local residents.

Aligning Payment And Prevention To Drive Antibiotic Innovation For Medicare Beneficiaries: This article, by CMS Administrator Verma, discusses the health policy/payment changes that need to be enacted in order to address the problem of antibiotic resistance (AMR).
“Specifically, the agency has finalized the following changes to foster antibiotic innovation and secure beneficiaries’ access to these medications:

  1. Develop an alternative pathway for New Technology Add-On Payments (NTAPs) without the “substantial clinical improvement” (SCI) criterion and increase the value of these payments from 50 percent to 75 percent for Qualified Infectious Disease Products (QIDPs)

  2. Adjust severity levels for AMR within clinically-relevant DRGs

  3. Explore policy changes in rulemaking beyond IPPS [Inpatient Prospective Payment System] to scale hospital stewardship programs to enhance patient safety”

The Best Probiotics: Vitamins and other nutrients are best obtained through diet rather than supplements. For example, the best probiotic may be the apple, which has an average of about 100 million bacteria. These bacteria are of many different species—far more diverse than store-bought supplements. The one problem is that 90% are in the core, which we most often do not eat.

Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults: Speaking of diets…the headline tells the research’s results.

About healthcare IT

Predictive analytics in health care: how can we know it works?: The main message of this article is that algorithms should be open to scrutiny to make sure they are valid. Too often private companies, like health plans, employ “black boxes” for uses like utilization review. Such lack of transparency can hurt not only patients but the companies using these potentially flawed tools. Here is a related article on this subject.