Patient Zero This article is an in-depth interview with Tom Scully, former CMS director (among other titles) as well as a good summary of healthcare policy/laws over the past few decades. Worth a read.
About Covid-19
COVID-19 Provider Relief Fund Payments Were Appropriately Targeted And Did Not Boost Selected Hospitals’ Profits “To help mitigate the COVID-19 pandemic’s financial effects on health care providers, Congress allocated $178 billion to the Provider Relief Fund (PRF) beginning in 2020…
Our findings indicate that PRF distributions to hospitals were appropriately targeted and did not make some hospitals significantly more profitable than others; rather, PRF payments helped offset financial losses associated with the pandemic. The effects of PRF support intensity were concentrated among hospitals that were financially vulnerable before the pandemic and thus in need of support to remain financially viable during the crisis.”
About health insurance/insurers
How much and why 2024 premiums are expected to grow in Affordable Care Act Marketplaces “The median proposed rate increase is 6% nationally, with most proposed increases falling between 2% and 10%. Most enrollees in this market are subsidized and do not pay the full premium. However, premium increases can affect federal spending and the driving factors behind these increases illustrate broader trends driving health costs in 2024.
A key driver of the increase in premiums in 2024 appears to be rising health prices. While prices for health services tend to grow every year, it also appears that inflation in the rest of the economy may now be starting to flow into the health sector. Rising prices and utilization are not necessarily specific to the ACA individual market. Similar levels of medical trend were observed in small group market filings as well.”
CMS again pauses out-of-network billing arbitration after judge sides with providers “The Centers for Medicare & Medicaid Services (CMS) has again suspended arbitration of out-of-network payment disputes between providers and payers due to a court order that the agency’s implementation of the No Surprises Act had run afoul of proper notice-and-comment procedure.
The decision stems from a Texas Medical Association (TMA) complaint filed in the U.S. District Court for the Eastern District of Texas back in January. The provider group argued that an increase in administrative fees from $50 to $350 that was implemented earlier that month was “arbitrary and capricious” and would curtail certain physician organizations’ ability to contest a health plan’s reimbursement offer.”
About hospitals and healthcare systems
Hospital Prices For Commercial Plans Are Twice Those For Medicare Advantage Plans When Negotiated By The Same Insurer “The median commercial-to-MA price ratio in the same hospital varied, from 1.8 for surgery and medicine services to 2.2 for laboratory tests and emergency department visits and 2.4 for imaging services. In multivariable Poisson regression analysis, higher ratios were associated with system-affiliated, nonprofit, and teaching hospitals, as well as with large national insurers.”
Kaiser Permanente reports $2.1B profit, 2.9% operating margin in Q2 2023 “Kaiser Permanente built on 2023’s strong start with $2.08 billion of net income during the quarter ended June 30, bringing its midyear total to about $3.29 billion, the integrated system announced late Friday.
Operating income was also strong at $741 million (2.9% margin) and raised the organization’s six-month performance to $974 million (1.9% margin).”
About pharma
Changes In Net Prices And Spending For Pharmaceuticals After The Introduction Of New Therapeutic Competition, 2011–19 “Across twelve therapeutic classes with new drug entrants in 2013–17, the introduction of new therapeutic competition was associated with a 4.2 percent decrease in annual net price growth. The introduction of new brand-name therapies in twelve therapeutic classes reduced net commercial spending on existing therapies by $10.4 billion—an 18.5 percent reduction in projected spending absent therapeutic competition. Our findings demonstrate that new therapeutic competition allows pharmacy benefit managers to use formulary management to decrease net prices and reduce drug spending, contrary to observed trends in list price increases.”
Authorized Generics In The US: Prevalence, Characteristics, And Timing, 2010–19 A really good analysis of the topic.
Novo’s obesity drug Wegovy lowers cardiovascular risk by 20%, landmark trial finds “Novo Nordisk’s obesity drug Wegovy cut the risk of major heart complications by 20% in a closely watched trial, results that could streamline insurance coverage and spur even greater demand for the highly popular therapy.
The milestone Select trial of about 17,500 patients with obesity and heart disease is the first to show that a weight loss medication leads to long-term cardiovascular benefits.”
About the public’s health
Use of Medication for Opioid Use Disorder [MOUD] Among Adults With Past-Year Opioid Use Disorder in the US, 2021 “Despite guidelines recommending MOUD, approximately 1 in 5 adults with past-year OUD received any MOUD. Furthermore, some groups were substantially less likely to receive MOUD, in particular Black adults, women, those unemployed, and those in nonmetropolitan areas. Addressing disparities in MOUD uptake should be prioritized in program, policy, and clinical initiatives.”
Effects of Cuff Size on the Accuracy of Blood Pressure Readings “Using a regular BP cuff size for all individuals regardless of arm size resulted in strikingly inaccurate BP readings with an automated device; a renewed emphasis on individualized BP cuff selection is warranted, particularly in individuals with larger arm sizes.”
Comment: These finding have been known for many years, yet right-sized cuffs are still not being used.
Probability of 5% or Greater Weight Loss or BMI Reduction to Healthy Weight Among Adults With Overweight or Obesity “In this cohort study of 18 461 623 US patients with overweight and obesity, the annual probability of 5% or greater weight loss was low (1 in 10) but increased with higher initial BMI. The annual probability of reducing BMI to the healthy weight category was less likely, especially for individuals with initial BMI of 45 or higher.”
About healthcare IT
Zoom addresses privacy concerns raised by AI data collection language in terms of service “The videoconferencing app Zoom said Monday it won’t use customers’ data without their consent to train artificial intelligence, addressing privacy concerns of a growing number of customers over new language in the app’s terms of service.”
About healthcare personnel
The average doctor in the U.S. makes $350,000 a year. Why? Well-worth treading if you can access this article from The Washington Post. It has explanations of earnings differentials by specialties, number of residency positions, and international comparisons. One fact worth noting, the US has far fewer primary care physicians per total physicians than most countries.
About healthcare finance
Nautic Partners to take PBM Tabula Rasa private in $570M cash deal “The private equity firm plans to merge Tabula Rasa with ExactCare Pharmacy, a Nautic Partners portfolio company that provides medication management and pharmacy services. The all-cash deal values Tabula Rasa at $570 million, including debt of approximately $262 million.”