From Washington, DC,

• American Hospital News reports
  • “The Centers for Medicare & Medicaid Services April 22 finalized minimum staffing requirements for nursing homes that participate in Medicare and Medicaid. As proposed in September, the final rule will require nursing homes to provide a minimum of 3.48 hours of nursing care per resident day, including 0.55 hours of care from a registered nurse per resident day and at least 2.45 hours of care from a nurse aide per resident day, as well as 24/7 onsite RN services. CMS slightly expanded the opportunity for facilities to seek exemptions from the requirements from its original proposal. AHA had urged CMS not to finalize the proposal but instead develop more patient- and workforce-centered approaches focused on ensuring a continual process of safe staffing in nursing facilities.”

• KFF adds
  • “KFF estimates that 19% of nursing facilities would meet the minimum HPRD staffing standards under full implementation of the final rule with their current staffing levels (Figure 1). Nearly 60% of facilities would meet the interim requirement of an overall requirement of 3.48 HPRD, but fewer facilities would meet the RN and nurse aide provisions that are required when the rule is fully implemented (49% and 30% respectively; data not shown).”

• HHS’s Office for Civil Rights announced a final amendment to the HIPAA Privacy rule concerning reproductive health. The final rule
  • “Prohibits the use or disclosure of PHI when it is sought to investigate or impose liability on individuals, health care providers, or others who seek, obtain, provide, or facilitate reproductive health care that is lawful under the circumstances in which such health care is provided, or to identify persons for such activities.
  • “Requires a regulated health care provider, health plan, clearinghouse, or their business associates, to obtain a signed attestation that certain requests for PHI potentially related to reproductive health care are not for these prohibited purposes.
  • “Requires regulated health care providers, health plans, and clearinghouses to modify their Notice of Privacy Practices to support reproductive health care privacy.
  • “The Final Rule may be viewed here – PDF.
  • “View The Final Rule Fact Sheet here.”

• AHA News adds,
  • “The rule will take effect 60 days after publication in the Federal Register and require covered entities to comply within 240 days. As requested by the AHA, OCR plans to issue a model attestation form before the compliance date.”

• HHS’s Office of the National Coordinator of Health IT announced that
  • “Common Agreement Version 2.0 (CA v2.0) has been released. The Common Agreement establishes the technical infrastructure model and governing approach for different health information networks and their users to securely share clinical information with each other – all under commonly agreed-to rules-of-the-road. The seven designated Qualified Health Information Networks™ (QHINs™) under the Trusted Exchange Framework and Common Agreement℠ (TEFCA℠) can now adopt and begin implementing the new version. Also published today is the Participant and Subparticipant Terms of Participation, which sets forth the requirements that each Participant and Subparticipant must agree to and comply with to participate in TEFCA.”Common Agreement Version 2.0 (CA v2.0) has been released.
  • “The Common Agreement establishes the technical infrastructure model and governing approach for different health information networks and their users to securely share clinical information with each other – all under commonly agreed-to rules-of-the-road. The seven designated Qualified Health Information Networks™ (QHINs™) under the Trusted Exchange Framework and Common Agreement℠ (TEFCA℠) can now adopt and begin implementing the new version. Also published today is the Participant and Subparticipant Terms of Participation, which sets forth the requirements that each Participant and Subparticipant must agree to and comply with to participate in TEFCA.
  • ?Notably, CA v2.0 includes enhancements and updates to require support for Fast Healthcare Interoperability Resources® (FHIR®) Application Programming Interface (API) exchange, which will allow TEFCA Participants and Subparticipants to more easily exchange information directly between themselves and will enable individuals to more easily access their own health care information using apps of their choice via TEFCA. These enhancements and updates mark a huge step forward for TEFCA as it meets the promise of seamless nationwide exchange at scale. Visit HealthIT.gov to view a list of key concepts that have evolved from Common Agreement v1.1 to v2.0.”

• Federal News Network shared the results of survey of federal employee attitudes toward the push to return to office.
  • “Of the 6,300 survey respondents, about 30% said they work entirely remotely, 6% work entirely in-person and 64% were working on a hybrid schedule — a mix of in-person work and telework.
  • “Over half of employees said senior leadership at their agency had not clearly explained the purpose of returning to the office. More than a third were in strong disagreement.”

• From MedTech Dive,
  • “The Food and Drug Administration approved Lumicell’s breast cancer imaging tool, the company said Thursday.
  • “Lumicell developed the Lumisystem imaging technology to enable surgeons to detect residual cancer in the breast cavity after performing a lumpectomy to remove the tumor.
  • “An FDA advisory committee voted in March that the benefits of Lumisystem outweigh the risks, with one expert predicting the system will have the biggest impact on surgeons who have higher re-excision rates.”

From the public health and medical research front,

• The New York Times asks and considers,
  • Bird Flu Is Infecting More Mammals. What Does That Mean for Us?
  • H5N1, an avian flu virus, has killed tens of thousands of marine mammals, and infiltrated American livestock for the first time. Scientists are working quickly to assess how it is evolving and how much of a risk it poses to humans. * * *
  • “I never let my kids go to a state fair or animal farm, I’m one of those parents,” Dr. Lakdawala said. “And it’s mostly because I know that the number of interactions that we increase with animals, the more opportunities there are.”
  • “Should H5N1 adapt to people, federal officials will need to work together and with their international counterparts. Nationalism, competition and bureaucracy can all slow down the exchange of information that is crucial in a developing outbreak.
  • “In some ways, the current spread among dairy cows is an opportunity to practice the drill, said Rick Bright, the chief executive of Bright Global Health, a consulting company that focuses on improving responses to public health emergencies. But the U.S. Agriculture Department is requiring only voluntary testing of cows, and is not as timely and transparent with its findings as it should be, he said.
  • “Dr. Rosemary Sifford, the department’s chief veterinarian, said the staff there were working hard to share information as quickly as they can. “This is considered an emerging disease,” she said.
  • “Government leaders are typically cautious, wanting to see more data. But “given the rapid speed at which this can spread and the devastating illness that it can cause if our leaders are hesitant and don’t pull the right triggers at the right time, we will be caught flat-footed once again,” Dr. Bright said.
  • “If we don’t give it the panic but we give it the respect and due diligence,” he added, alluding to the virus, “I believe we can manage it.”

• MedPage Today discusses the ready availability of human vaccines for the H5H1 avian flu virus should the need arise.

• Precision Vaccinations reminds us,
  • “In April 2024, the United States observes the 15th Annual Oral Cancer Awareness Month, which emphasizes the significance of preventing human papillomavirus (HPV)- related oral cancers [with HPV vaccines].

• HealthDay tells us,
  • “The right diet may be the best medicine for easing the painful symptoms of irritable bowel syndrome (IBS), new research shows. 
  • “In the study, two different eating plans beat standard medications in treating the debilitating symptoms of the gastrointestinal disease. One diet was low in “FODMAPs,” a group of sugars and carbohydrates found in dairy, wheat and certain fruits and vegetables, while the second was a low-carb regimen high in fiber but low in all other carbohydrates.
  • “Published April 19 in the journal Lancet Gastroenterology and Hepatology, the findings suggest that patients should first try dietary changes before moving to drugs for relief.”

• MedScape informs us,
  • “A new three-phase screening protocol that incorporates a PSA test, a four-kallikrein panel, and an MRI scan appears to improve the prostate cancer detection rate among men invited to participate in a single screening compared with those not invited, according to preliminary findings from the Finnish ProScreen randomized clinical trial.”

From the U.S. healthcare business front,

• The Wall Street Journal reports,
  • “UnitedHealth’s results beat Wall Street expectations on an adjusted basis, with the company noting that overall care patterns in the first quarter were“consistent with the company’s expectations.” Nothing to worry about here, executives repeatedly told investors, who promptly sent UnitedHealth’s stock soaring and hospital shares tanking. Then on Thursday, Elevance offered more relief, saying that costs were running as expected while raising its full-year earnings guidance.
  • “Various monthly surveys are also showing a moderation in hospital volumes. TD Cowen’s survey, for instance, found that 305 hospitals reported only 1% year-over-year revenue growth in March, which was far weaker than 11% growth in February. Analysts led by TD Cowen’s Gary Taylor suggested that we could be at the start of a reversal of hospitals’ outperformance over managed care companies. 
  • “Investors will find out more this week as providers including Universal Health and HCA Healthcare, two large hospital chains, report earnings. HCA might still deliver solid results, as improvements in labor cost pressures and pricing should still positively influence earnings, notes UBS analyst A.J. Rice. 
  • And in any case, stabilization of healthcare utilization isn’t the same as a sharp drop-off. UnitedHealth and Elevance earnings may have signaled to investors that their views on providers were perhaps a bit too rosy, but they didn’t exactly demonstrate that cost pressures have eased. UnitedHealth noted that while it was no longer seeing the “aggressive acceleration” in medical utilization the industry saw in 2023, it hasn’t yet seen a major “step down.”

• Per Fierce Healthcare,
  • “UnitedHealth Group provided an update late Monday on its analysis of the data accessed in the cyberattack on Change Healthcare, and said it identified files that contain personal and health information.
  • “The company said that the personal health information (PHI) and personally identifiable information (PII) found in the files “could cover a substantial proportion of people in America.” However, UHG said it has not yet uncovered evidence that full medical histories or doctors’ charts were among what was stolen.
  • “UnitedHealth added that with the complexity of the review, it will likely take months of further analysis to identify and notify impacted customers. In the meantime, it’s offering two years of credit monitoring and identity theft protection to anyone who has been effected by the breach.
  • “In addition, the company has also offered to make notifications and conduct required administrative steps on behalf of providers and customers.”

• Per BioPharma Dive,
  • “Bristol Myers Squibb is turning to a manufacturing startup to help produce cancer cell therapies faster, announcing Monday a partnership with the South San Francisco, California-based Cellares.
  • “The deal, which reserves Cellares’ production capacity for Bristol Myers’ use, is worth up to $380 million in upfront and milestone payments. Cellares will handle technology transfer of certain Bristol Myers cell therapies to its automated manufacturing platform, dubbed the Cell Shuttle.
  • :Bristol Myers currently sells two so-called CAR-T cell therapies, Breyanzi for lymphoma and Abecma for multiple myeloma, and has several others in development. In a statement, Lynelle Hoch, head of the pharmaceutical company’s cell therapy unit, said the Cellares deal would help it meet demand for CAR-T therapies “now and in the future.”