Read today’s Kaiser Health News
In other news:
RFK Jr. fires all 17 members of CDC's vaccine committee: Health and Human Services Secretary Robert F. Kennedy Jr. on Monday fired the 17 sitting members of the Centers for Disease Control and Prevention's Advisory Committee for Immunization Practices (ACIP), claiming that removing all doctors and public health experts on the panel will restore public trust.
According to Kennedy, each member was appointed by the Biden administration as part of a "concerted effort to lock in public health ideology" and to limit the Trump administration from taking "the proper actions to restore public trust in vaccines."
ACIP members usually serve four-year terms. Because 13 appointees took their seats in 2024, without the complete ouster, the committee would not have had a Kennedy-selected majority until 2028.
"A clean sweep is necessary to reestablish public confidence in vaccine science," Kennedy said in the HHS release.
RFK Jr.’s chronic disease agency would eliminate or reduce funding for some prevention programs: Budget documents released by the Trump administration Friday provide the first clear indication of the priorities of a proposed new agency focused on preventing chronic disease.
The Administration for a Healthy America would absorb multiple federal agencies and existing programs, but the documents indicate that numerous initiatives axed from the Centers for Disease Control and Prevention through a reduction in force (RIF) in April will be resurrected with reduced funding — or not at all.
NIH walks back ban on new grants for universities with DEI programs or Israel boycotts: The National Institutes of Health has, for now, walked back a policy requiring universities and other research institutes to certify that they do not have unlawful diversity, equity, and inclusion programs or boycotts of Israel in order to receive research dollars.
The rule, which was initially posted in April, was seen as the next stage of using research funds as leverage against private universities and efforts to increase diversity in the sciences. It is unclear what prompted the rescission of the policy, which is effective immediately. But the notice published on Monday says, “NIH is awaiting further Federal-wide guidance and will provide a future update to the extramural community.”
About health insurance/insurers
Medicare Advantage Plan Disenrollment: Beneficiaries Cite Access, Cost, And Quality Among Reasons For Leaving: Enrollees’ self-reported inability to access and receive high-quality care, more than perceived burdens of out-of-pocket costs, was associated with MA plan disenrollment, as was an objective measure of plan generosity. Difficulty accessing needed medical care was more strongly associated with MA-to–traditional Medicare exits than MA-to-MA plan switching. Dissatisfaction with access, cost, and quality was much more common for enrollees in poor health. These findings renew concerns about access to high-quality care for high-risk and other MA enrollees.
Medicare Advantage Denies 17 Percent Of Initial Claims; Most Denials Are Reversed, But Provider Payouts Dip 7 Percent:Employing medical claims data from multiple MA plans, covering 30 percent of the entire MA market in 2019, our study found claim denial rates of 17 percent as a share of initial claim submissions. We also found that 57 percent of all claim denials were ultimately overturned. We calculated that denials resulted in a 7 percent net reduction in provider MA revenue, based on the dollar-weighted share of claim denials that were not overturned. However, the indirect impact of denials could be even greater than this direct effect that we measured.
Medicare Advantage Compliance Audit of Specific Diagnosis Codes That Coventry Health and Life Insurance Company [from the HHS OIG]:
-For the 10 high-risk groups covered by our audit, most of Coventry’s submissions of the selected diagnosis codes to CMS for use in CMS’s risk adjustment program did not comply with Federal requirements.
- For 249 of 300 sampled enrollee-years, the diagnosis codes that Coventry submitted to CMS were not supported by medical records and resulted in $752,587 in net overpayments. On the basis of our sample results, we estimated that Coventry received at least $6.9 million in net overpayments for 2018 and 2019.
-As demonstrated by the errors we identified, Coventry’s policies and procedures to prevent, detect, and correct noncompliance with CMS’s program requirements, as mandated by Federal regulations, could be improved.
Recommendations are in the report.
About hospitals and healthcare systems
National Hospital Flash Report: April 2025 Data Key Takeaways
1. Hospital financial performance improved between January and April. On a year-to-date basis, hospital performance in the first four months of 2025 compared favorably to the same time period in 2024.
2. Average length of stay decreased and adjusted discharges per calendar day increased compared to the prior year period. This reflects improved patient throughput and a higher demand for hospital services.
3. Measures of patient volume showed improvement. Inpatient revenue, discharges, ED visits and operating room minutes all increased compared to the prior year period.
About pharma
FDA Approved — And Ineffective: This investigation found that from 2013 through 2022:
Seventy-three percent of drugs approved by the FDA did not meet the agency’s four foundational standards required to show they work as expected.
More than half of drug approvals were based on preliminary data rather than sound evidence that patients had fewer symptoms, improved function, or lived longer.
Fifty-five of the 429 drugs approved met only one of the four standards needed to show that a drug is safe and effective; 39 drugs met none of them.
Merck & Co.'s oral PCSK9 inhibitor succeeds in dual Phase III trials:Merck & Co. is a step closer to bringing the first oral PCSK9 inhibitor to market. On Monday, the company announced that its experimental pill, enlicitide decanoate (formerly MK-0616), hit its main goals in two Phase III trials, significantly lowering LDL cholesterol with a safety profile comparable to placebo and existing oral treatments.
Comment: This oral form could significantly lower ther price for patients who need this drug. Among other cost-lowering factors is saving a physician visit with a facility fee.