About Covid-19
CDC urges vaccinated people in high-transmission areas to resume wearing masks indoors as delta variant spreads: “The agency advised that vaccinated people who live in high-transmission places wear masks in indoor public spaces, according to three people familiar with the guidance. It also recommended that vaccinated people with vulnerable household members, including young children and those who are immunocompromised, wear masks indoors in public spaces.
The agency also called for universal masking for all teachers, staff members and students in schools, regardless of their vaccination status.”
Moderna says it plans to expand Covid vaccine trial for kids 5 to 11, will seek FDA OK as early as year-end: “The U.S. drugmaker is expanding the trial, which began in late March, to increase the likelihood of detecting potential rare side effects, the company said, declining to say how many children it ultimately hopes to enroll.”
Safety Evaluation of the Second Dose of Messenger RNA COVID-19 Vaccines in Patients With Immediate Reactions to the First Dose: “This multisite US study supports the safety of Pfizer-BioNTech or Moderna vaccine second dose administration in patients who report immediate and potentially allergic reactions after the first dose. Although mild symptoms were reported in 20% of patients with second dose administration, all patients who received a second dose safely completed their vaccination series and could use mRNA COVID-19 vaccines in the future when indicated.”
About healthcare IT
Epic pays hospitals that use its EHR algorithms, report finds: ”Verona, Wis.-based EHR giant Epic gives financial incentives to hospitals and health systems that use its artificial intelligence algorithms, which can provide false predictions, according to a July 26 STAT News investigation.
For its report, STAT interviewed several health systems that use any of Epic's 20 algorithms. Employees of several major systems told the publication they were concerned about Epic's algorithm for predicting sepsis, claiming that the tool routinely fails to identify the condition in advance and frequently triggers false alarms, according to the report. Some hospitals reported benefits for patients after refining the model, but the process took at least a year.”
Anthem and Humana enter into multimillion agreement with SS&C for API cloud platform: “Anthem, Humana and SS&C Technologies have entered into a joint venture named DomaniRx to develop a claims adjudication and pharmacy benefits manager cloud platform, according to documents filed by SS&C Technologies with the Securities and Exchange Commission.
SS&C Technologies holds an 80.2% interest, and Humana and Anthem each hold a minority interest, according to the agreement filed with the SEC on July 15.
The parties have committed up to an aggregate of approximately $925 million in the form of cash, property and/or services to support the development project, according to the filing.
This amount includes $138,300,000 in initial cash contributions, certain assets of the parties, including a nonexclusive license to the claims processing platform known as RxNova, an assignment to a services agreement the company has with Humana, and up to approximately $400 million in cash, other property interests, and/or services.”
Poverty and Access to Internet, by County: This AHRQ interactive page makes the point that internet access should be considered a social determinant of health. See Yesterday’s blog for the case that connectivity should also be a vital sign. Here is an article from today’s JAMA Network that references this AHRQ page: Internet Access as a Social Determinant of Health
About health insurance
The future of accountable care organizations and Medicare’s other payment models: This morning, I listened to an excellent presentation by Harvard Professor Michael Chernew, who is also the chair of MedPAC. I highly recommend it! And in a related article: The Little-Known Agency That’s Trying To Boil The Ocean—A Look At CMMI’s Decade Of Trying To Change Medicare & Medicaid: Former Senate majority leader and cardiac surgeon, Bill Frist, discusses the Center for Medicare and Medicaid Innovation, its initiatives, what works and what does not work.
Millions of Medicare Part D Enrollees Have Had Out-of-Pocket Drug Spending Above the Catastrophic Threshold Over Time: “In 2019, nearly 1.5 million Medicare Part D enrollees had out-of-pocket spending above the catastrophic coverage threshold. Looking over a five-year period (2015-2019), the number of Part D enrollees with out-of-pocket spending above the catastrophic threshold in at least one year increases to 2.7 million, and over a 10-year period (2010-2019), the number of enrollees increases to 3.6 million.” As usual with KFF, the article has helpful graphics.
Florida physician sentenced in $20M healthcare fraud scheme: “Richard Davidson, MD, 42, of Delray Beach, was sentenced about 10 months after entering a guilty plea. He admitted that he and his conspirators established a conglomerate of durable medical equipment companies that they used to submit illegal claims to Medicare. Mr. Davidson said they placed the companies in the names of straw owners, which enabled them to submit high volumes of illegal durable medical equipment claims to Medicare, according to the Justice Department.” Note: As usual, this large fraud was committed against a federal, fee-for-service program.
Centene posts $535M loss in second quarter of 2021: “Centene Corporation posted a $535 million loss in the second quarter of 2021, down from its $1.2 billion haul in the prior-year quarter.
Despite the loss, the company is the black for the first half of the year, according to its earnings report released Tuesday morning, with $164 million in profit through the first two quarters. By comparison, Centene boasted $1.3 billion in profit for the first half of 2020.”
About pharma
FDA generic drug approvals falling, analysis finds: “In the first half of 2021, the FDA gave full approval to 343 generic drugs and gave 72 tentative approvals. In the first half of 2020, it gave full approval to 361 generic drugs and gave 92 tentative approvals.
The agency has seen a steady decline in new generic drug sumbisisons from drugmakers, Politico reported. In the first half of this year, the FDA received an average of 66 generic drug submissions per month, down from a high of 94 per month in 2017.”
Jury Orders Novartis to Pay $178 Million for Patent Violation: “A jury in the U.S. District Court for the Northern District of California has ordered Novartis to pay $177.8 million to Plexxikon, a subsidiary of Daiichi Sankyo, for infringing on two of the Japanese company’s patents.
Novartis’s Tafinlar (dabrafenib) is a kinase inhibitor indicated for treating patients with unresectable or metastatic melanoma with the BRAF V600E gene mutation. It competes with Zelboraf (vemurafenib), another BRAF inhibitor that was discovered by Plexxikon and licensed to Roche.”
About the public’s health
Many articles in the news the past week about health disparities and racism:
What US News' equity analysis reveals about racial gaps in hospital care: 5 takeaways: For example: “Only 29 percent of hospitals treated a proportion of Black patients comparable to or higher than their community's Black population. This figure sat at 18 percent for Hispanic patients and 5 percent for Asian/Pacific Islander patients.”
Changes in Racial and Ethnic Disparities in Access to Care and Health Among US Adults at Age 65 Years: “In this cross-sectional study that uses a regression discontinuity design, eligibility for Medicare at age 65 years was associated with marked reductions in racial and ethnic disparities in insurance coverage, access to care, and self-reported health.”
From the AMA: Defining racism is key to helping doctors advance health equity: The article, along with a video and reference to an action plan, has a useful glossary of terms.
Racial and Ethnic Disparities in Outpatient Visit Rates Across 29 Specialties: “Racial and ethnic minority groups are markedly underrepresented in the outpatient practices of most medical and surgical specialties. Disparities persisted after accounting for several social determinants of access to care.
Several factors may underlie these findings. Racial/ethnic minority groups are more likely to reside in areas with a shortage of physicians and less likely to receive specialty referrals from primary care physicians. The history of racism in health care may lead non-White patients to distrust the health care system, suppressing utilization. Physicians are less likely to grant appointments for patients with Medicaid or without insurance, who are disproportionately members of racial/ethnic minority groups. A higher burden of end-stage kidney disease and nearly universal Medicare coverage for patients with this disease may explain the high nephrology visit rates for individuals of racial/ethnic minority groups.”
I copy most of the Discussion section since the article is available by subscription-only. If you can get the original, the differences by specialty and race displayed in the chart are interesting.
Fauci Wants to Make Vaccines for the Next Pandemic Before It Hits: “The idea is to make ‘prototype’ vaccines to protect against viruses from about 20 families that might spark a new pandemic. Using research tools that proved successful for Covid-19, researchers would uncover the molecular structure of each virus, learn where antibodies must strike it, and how to prod the body into making exactly those antibodies.”
BioNTech says it will create an mRNA-based vaccine to prevent malaria: The headline is the story.
WHO reports progress in the fight against tobacco epidemic: “More than four times as many people are now covered by at least one WHO-recommended tobacco control measure as compared with 2007. The six MPOWER measures are monitoring tobacco use and preventive measures; protecting people from tobacco smoke; offering help to quit; warning about the dangers of tobacco; enforcing bans on advertising, promotion and sponsorship; and raising taxes on tobacco.
Some 5.3 billion people are now covered by at least one of these measures - more than four times the 1 billion who were covered in 2007.”
About hospitals and health systems
Best Hospitals by Specialty: The annual US News report. “Of the nearly 5,000 hospitals analyzed and 30,000 physicians surveyed, only 175 hospitals ranked in at least one of the specialties.” Here are the top 10 overall:
1. Mayo Clinic, Rochester, Minnesota.
3. UCLA Medical Center, Los Angeles.
4. Johns Hopkins Hospital, Baltimore.
5. Massachusetts General Hospital, Boston.
6. Cedars-Sinai Medical Center, Los Angeles.
7. New York-Presbyterian Hospital-Columbia and Cornell, New York.
8. NYU Langone Hospitals, New York.
9. UCSF Medical Center, San Francisco.
10. Northwestern Memorial Hospital, Chicago.
Despite raising guidance for 2021, UHS still has concerns about COVID's strain on labor markets: “Universal Health Services has followed in the wake of other outperforming for-profit health systems during the second quarter of 2021, reporting $325 million in profits and a 17.1% year-over-year increase in net revenues as patients returned to its hospitals and behavioral health services.
But while the strong performance allowed UHS to increase its forecast for the remainder of 2021—it now predicts net revenues for the year will fall between $12.12 billion and $12.36 billion—executives warned investors that continued acceleration of recent COVID-19 case trends could take a bite out of its sunny forecast.”