Read today’s Kaiser Health News
In other news:
About health insurance/insurers
U.S. Supreme Court rules against Advocate Christ in fight over billions in Medicare payments: In the 7-2 decision on Advocate Christ Medical Center v. Kennedy announced Tuesday, the high court determined the Centers for Medicare and Medicaid Services does not need to count all beneficiaries enrolled in both Medicare and Supplemental Security Income, or SSI, when tallying how many low-income patients a hospital treats. As a result, health systems will get paid less than they sought.
CMS only counts Medicare enrollees who got SSI cash payments during the same month they received hospital care — not anyone merely eligible for or enrolled in SSI — when calculating disproportionate share hospital payments for facilities that treat large shares of low-income patients.
Advocate Christ Medical Center in southwest suburban Oak Lawn and more than 200 other hospitals filed the lawsuit in 2017.
Mental health network misled policyholders about provider options, lawsuit claims: Elevance Health is facing a second lawsuit alleging it misrepresented providers as in-network, creating what are known as "ghost networks." The plaintiffs in this lawsuit, who are state employees covered under New York state health benefits, claim that Elevance Health's subsidiary, Carelon Behavioral Health, misled them, causing financial harm. The lawsuit seeks class-action status.
About hospitals and healthcare systems
The cost of hospital closures in 21 numbers: See the article for the numbers. For example: An NIH National Center for Advancing Translational Sciences report from March 2023 found of the 53 rural hospitals that closed, 66% were located in the South and 21% were in Appalachia. The spillover from these closures resulted in a $1.4 million average annual cost increase at for-profit hospitals, $2.1 million at government hospitals and $7.3 million for nonprofit hospitals.
About pharma
Novo Nordisk strikes telehealth deals for obesity drug, following Eli Lilly: Novo Nordisk is expanding its efforts to sell its obesity drug Wegovy directly to patients, striking agreements with telehealth companies including Hims & Hers, Ro, and LifeMD.
Novo last month launched a new direct-to-consumer website called NovoCare Pharmacy that sells Wegovy, which normally carries a list price of about $1,350 a month, at $499 a month to patients who are paying on their own without insurance. With the new deals, patients can order this lower-priced Wegovy directly on the telehealth companies’ sites and get the treatment delivered to their homes.
1st pediatric patient receives FDA-approved gene therapy: At Children’s Hospital of Philadelphia, an 11-year-old girl with severe beta thalassamia, became the first pediatric patient to receive Zyntelgo, the first FDA-approved gene therapy for transfusion-dependent beta thalassamia.
Since receiving the therapy, the patient, Rahameen Nabeel, no longer requires blood transfusions and has seen dramatic improvements in her health and daily life, according to an April 28 news release from the hospital.
Germany’s Merck to buy US biotech SpringWorks for $3.9bn: German pharmaceutical group Merck has agreed to buy US biotech SpringWorks Therapeutics for an equity value of $3.9bn, expanding its portfolio of cancer treatments and investing in the US despite policy uncertainties.
About the public’s health
Phthalate exposure from plastics and cardiovascular disease: global estimates of attributable mortality and years life lost: New evidence has emerged that plastic polymers and their chemical additives, particularly di-2-ethylhexylphthalate (DEHP), contribute to cardiovascular disease (CVD). Phthalates are commonly used in the production of plastic materials and have been linked to increased oxidative stress, metabolic dysfunction, and cardiovascular disease…
In 2018, an estimated 356,238 deaths globally were attributed to DEHP exposure, representing 13.497% of all cardiovascular deaths among individuals aged 55–64. Of these, 349,113 were attributed to the use of plastics. Geographic disparities were evident, with South Asia and the Middle East suffering the greatest percentage of cardiovascular deaths attributable to DEHP exposure (16.807%). The Middle East, South Asia, East Asia, and the Pacific accounted for the largest shares of DEHP-attributable CVD deaths (73.163%). Globally, DEHP resulted in 10.473 million YLL.