Happy Columbus Day!

From Washington, DC

• Congress remains on the campaign trail this week.

• The Social Security Cost of Living Adjustment will be announced on Wednesday, October 14,

• Medicare Open Enrollment Period for Medicare Advantage and standalone Part D prescription drug plans begins on Thursday, October 15.

• Beckers Hospital Review reports,
  • “Health systems told CMS in public comment letters how much its proposed cut to 340B drug payments would cost them, with estimates ranging from about $7 million to $109 million a year [as detailed on the article].
  • “The 2027 outpatient payment rule, proposed July 2, would pay hospitals for drugs bought through the 340B program at average sales price minus 33.4%, down from average sales price plus 6%. CMS estimates the change would cut Original Medicare drug payments by $4.55 billion in the first year. Because the rule must be budget neutral, CMS would raise payments for nondrug outpatient services by 8.44% for all hospitals, including those that do not participate in 340B.

From the U.S. Office of Personnel Management front,

• David Setia, writing in Federal News Network, breaks down why federal employees “should consider retiring after 62, why it just got even more compelling, and how you can make this decision slightly less painful.”
  
• FedSmith explains ‘how federal employees can build a financial cushion before the next shutdown.
  • “Federal shutdowns are unpredictable, but financial preparedness isn’t. Here’s how to build a savings cushion before the next funding lapse.”

From the judicial front,

• Fierce Healthcare reports,
  • “Alignment Healthcare sued federal regulators, alleging that its 2027 Medicare Advantage star ratings were determined “in flagrant violation” of statute.
  • “In the lawsuit filed Friday in District of Columbia federal court, the insurer says that the Centers for Medicare & Medicaid Services “has completely departed from Congress’s vision of leveraging predictable, valid measures developed with input from providers, plans, and the public” in establishing the methodology for the star ratings.
  • “The company argues that rather than establish “consistent, stable specifications” for metrics through the traditional rulemaking process, the agency instead detailed key measures through a series of “technical notes.” This violates the Administrative Procedure Act, per the lawsuit.”

• Modern Healthcare adds,
  • “The Centers for Medicare and Medicaid Services excluded 20 measures from its 2027 Medicare Advantage star ratings methodology for Clover Health PPOs.
  • “Clover Health successfully sued CMS to get those metrics excluded from its 2026 scores.
  • “Other Medicare Advantage insurers were evaluated on different metrics than Clover Health.”

From the public health and medical / Rx research front,

• The Washington Post reports,
  • “A 39-year-old unvaccinated woman from Franklin County, Pennsylvania, who had been diagnosed with measles has died, according to the local coroner’s office, marking the sixth such death reported since the state’s outbreak began this year.
  • “The woman’s primary cause of death was a “probable acute cardiac event due to possible complications of the measles,” the coroner’s office said in an emailed statement.
  • “The patient had “a recent history” of having contracted the highly contagious disease, the coroner’s office wrote in a Facebook post, adding that it meets the state health department’s definition of a measles-associated death. The woman had several underlying health conditions and had a “past diagnosis of measles with treatment.”

• Beckers Clinical Leadership relates,
  • Flu season is off to an early start, with weekly lab-confirmed flu hospitalizations nearly tripling between early September and early October, according to CDC data. 
  • Hospitals reported 3,334 flu admissions in the week ending Oct. 3. That’s up from 2,572 the week before and 1,133 in the week ending Sept. 5. The national admission rate rose to 1.0 per 100,000 people, up from 0.3 in early September.
  • The West is furthest ahead. “California has a full-on flu epidemic right now,” Scott Gottlieb, MD, a former FDA commissioner, said in an interview with CNBC.
• and
  • “Hospital and health system leaders are grappling with the balance between keeping patients safe and what to do when aging physicians continue to practice amid declining abilities, The Washington Post reported Oct. 12. 
  • “Nearly 47% of the active physician workforce is 55 or older, up from 38% in 2007, and in 2025, 22.4% of physicians are over 65. At older ages, reaction times slow, knowledge can become outdated and some can experience cognitive decline. Mild cognitive impairment increases with age, going from 8.4% in adults 65 to 69, up to 25.3% in adults 80 to 84, according to the American Academy of Neurology.
  • “Studies from Yale New Haven Hospital and Hartford (Conn.) Healthcare found 12.7% to 14.4% of physicians over 70 who were screened showed some degree of cognitive impairment.  
  • “It’s becoming a bigger issue with each passing year,” clinical neuropsychologist Victor Del Bene,PhD, of the University of Alabama at Birmingham, told the Post.”

• The American Medical Association lets us know “what doctors want patients to know about the common cold.”
  • “Nearly everyone will experience a cold, most often caused by rhinovirus. While there is no cure, there are several ways to manage your symptoms.”

• Health Day tells us,
  • “Late-night snack may be doing more than affecting your waistline — it could be hurting your liver health.
  • “A few studies have hinted at this idea but this is among the first long-term analyses to explicitly draw the connection to fatty liver disease,” lead author Dr. Robert Wilechansky said in a news release. He’s a hepatologist at Oregon Health & Science University in Portland who specializes in liver transplantation.
  • “Researchers analyzed diet and lifestyle data from nearly 200,000 healthy people who were monitored for about 16 years.
  • “Those who reported eating after dinner or after bedtime had a 36% higher risk of developing non-alcoholic fatty liver disease and a 28% higher risk of cirrhosis.
  • “The results were consistent even after adjusting for factors like age, diabetes status, physical activity and body mass index (BMI), an estimate of body fat based on height and weight.”

• The Washington Post offers an interview with an oncologist who tells us what to know about DCIS or Stage 0 breast cancer.
  • Experts are starting to question whether identifying ductal carcinoma in situ as cancer leads to unnecessary interventions such as radiation and surgery.

• The New York Times explains “why ketamine immobilizes some users.”
  • “Potent powders can produce a nearly catatonic state, particularly in those who have not tried the drug before.”
• and
  • considers whether we ever will understand dementia.
    • “Today dementia is estimated to affect more than 55 million people worldwide, and nearly 10 million cases are added every year. By 2050 — as populations age and the power of diagnosis improves — that number is projected to rise as high as 139 million. We’re already on our way to becoming a society of caregivers, looking after an aging population unable to support itself.
    • “And yet, in a sense, we understand little more about the plaques and tangles of Alzheimer’s disease than we did 120 years ago, when Alois Alzheimer first noticed them. In recent years, we may have even lost ground. A decades-long consensus about the meaning of those plaques and tangles has collapsed as treatments built on those theories have failed, reopening what now must be understood as one of the most urgent unsolved problems in medical science: What is dementia, and how can we possibly slow its advance and reduce its terrible toll?” * * *
    • “A recent overview of the Alzheimer’s literature in the journal Cell offers “hope for a future where AD is not only treatable but also preventable,” while still acknowledging the condition’s “complex pathologic underpinnings.”
    • “This, after all, was Arnold Pick’s insight: that dementia is many things. What if we could nip these complex problems in the bud genetically, before the crippling health care costs and heartbreaking losses — before the ones we love lose much of what makes them who they are?
    • “With the gene carriers, you can get in very early, maybe even before any age-related change is happening, any pathology is present at all,” Dr. Miller said. “I think it’s going to be a really huge decade. We’re just beginning.”

• Per Genetic Engineering and Biotechnology News,
  • “Domestic dogs offer a useful model for understanding the biology of aging because their lifespans vary dramatically with body size. Large dogs tend to be shorter lived than their smaller counterparts, but why? Headed by a team at Arizona State University, a study of nearly 900 dogs now suggests that the answer may be written into the animals’ epigenomes.
  • “Research professor Noah Snyder-Mackler, PhD, at Arizona State University School of Life Sciences, and colleagues developed an epigenetic clock that predicted mortality in dogs and showed that epigenetic aging is fastest early in life. The study results indicated that male dogs and larger dogs undergo accelerated molecular aging, with male dogs exhibiting pronounced DNA methylation (DNAm) changes on the X chromosome, and larger animals exhibiting methylation changes at transposable elements (TEs), stretches of DNA that can influence genome stability and gene regulation.”
  • “Snyder-Mackler is senior and corresponding author of the researchers’ published paper in Science (“Epigenetic aging and transposon dysregulation reflect size-related lifespan compression in dogs,”) in which they concluded, “Our findings broadly establish companion dogs as a translational model for uncovering molecular mechanisms of lifespan variation, epigenomic instability, and age-related disease.”
    
• Per Fierce Pharma,
  • “Mirum pharmaceutical is on a hot streak. On the heels of an FDA approval and a phase 3 win in hepatitis delta, the rare disease company just announced another phase 3 victory for Livmarli, its ileal bile acid transporter (IBAT) inhibitor.
  • “Mirum’s Expand trial tested Livmarli in patients aged 6 months or older with cholestatic pruritus, an intense itch caused by an ultra-rare cholestatic liver disease. The topline readout showed the trial met its primary endpoint achieved significance across all five secondary endpoints.

From the U.S. healthcare business front,

• Medical Economics reports,
  • “More GLP-1 prescriptions are being filled without ever touching a patient’s insurance, and pharmacists say the shift is accelerating.
  • “Nearly seven in 10 pharmacists (68%) have seen cash-pay GLP-1 transactions increase over the past year, according to a Buzz Health survey of 256 U.S. pharmacists conducted in July 2026. The trend shows up weekly at the pharmacy counter, where patients often pay cash for a GLP-1 while still running their other prescriptions through insurance.
  • “Price isn’t the only factor. More than half of pharmacists say patients have paid cash even when a cheaper or equivalent option was covered by their plan, which suggests convenience and product preference play a role. Pharmacists credit manufacturer direct-to-consumer programs, telehealth pricing and new oral GLP-1s with pulling patients away from their benefits. That is the same growing mix of channels physicians already navigate when patients can’t access the GLP-1 they prescribe.
  • “The shift also creates a data problem. Cash purchases don’t always appear in the claims records that health plans and PBMs use to track utilization and adherence, and most patients don’t realize their insurer can’t see those fills. As online GLP-1 options continue to multiply, that blind spot could make it harder to know what patients are actually taking.”

• Beckers Hospital Review relates,
  • “Durham, N.C.-based Duke University Health System recorded operating income of $453.1 million (5.4% margin) for fiscal year 2026, compared with operating income of $179 million (2.5% margin) in fiscal 2025, according to its Oct. 5 financial report.”
• and 
  • “Many large health system layoffs in 2026 feature a common theme: Leadership is cutting corporate and administrative support roles while protecting positions that focus on patient care. It’s a pattern that shows how organizations are deciding what to cut as costs rise and federal policy changes reshape the industry.” * * *
  • “Even while administrative ranks thin, systems are still spending to retain workers. Becker’s has reported that 49 hospitals and health systems have announced plans to raise workers’ pay since December 2025. For example, Hartford (Conn.) HealthCare shared in late September that it will raise its minimum wage to $20 an hour Dec. 27, affecting about 4,000 employees. An additional 4,000 employees will receive pay adjustments to address wage compression resulting from the increase.”

• Radiology Business tells us,
  • “Siemens Healthineers has officially ceased all sales of its general imaging ultrasound systems. The healthcare giant announced the shift in strategy on Monday, Oct. 12, saying it will now increase its focus on procedural imaging and image-guided therapies. The goal is to build on its strength in cardiovascular imaging, specifically in the areas of intracardiac echocardiography (ICE) and AI, and help care teams perform more complex procedures than ever as technologies continue to evolve. 
  • “Going forward, Siemens Healthineers remains focused on technologies used by electrophysiologists and interventional cardiologists for the detection and management of cardiovascular disease. The company’s Acuson Origin, for example, is a cardiovascular ultrasound system with advanced artificial intelligence (AI) capabilities that first gained U.S. Food and Drug Administration clearance in 2024. The Acuson P500 and Acuson Freestyle systems are also still part of the Siemens Healthineers portfolio.
  • “On the other hand, the company will no longer be selling its Acuson Sequoia, Acuson Redwood, Acuson Juniper or Acuson Maple systems.”

• Beckers Payer Issues explains why payers have invested in ambulatory surgical centers and lets us know that
  • “Former UnitedHealth Group CEO Sir Andrew Witty has been named chairman of Hatteras Venture Partners, a venture capital firm focused on healthcare innovation, investing across biopharmaceuticals, medical devices and health technology.
  • “Mr. Witty is returning to Hatteras, where he served as a venture partner from 2017 to 2019, according to a Sept. 30 news release from the company.” 

• Beckers Physician Leadership considers whether any physician can be truly independent.
  • “Independent” has become one of the most loaded words in physician practice. As hospitals, health systems and private equity firms have absorbed practices over the past two decades, the label has come to signal a practice that has stayed outside all three.
  • “Siddharth Tambar, MD, a rheumatologist and physician owner of Chicago Arthritis and Regenerative Medicine, questions how much that label actually describes.
  • “I understand what people mean when they say independent practice, right? That you’re not part of a large either group system, hospital system, PE-owned system,” Dr. Tambar told Becker’s. “So I get that, but realistically, if you are part of the American healthcare system, if you accept insurance, you’re part of these large networks. You’re part of these flows of how patients get to you, and so I don’t think any of us are truly independent in that regard.”
  • “Physicians have little leverage inside those networks. Only 5% of physicians report significant negotiating leverage in private-payer contract talks, and more than 40% report none, according to a Medscape‘s report, “Private-Payer and Government Insurance Report 2026: Medicare, Medicaid, and More,” published Oct. 2.” * * *
  • “Despite continuous shifts in the structures and regulations shaping the physician practice space, Dr. Tambar maintains that strong patient relationships and a desire to stay connected to them is what will keep practices growing in the future — regardless of their independence. 
  • “Long term, obviously, if you’re offering good care to patients, ethical care, that’s how you maintain, right?” he said. “As a physician or as an owner, you have to keep on finding ways to offer value to patients, and whatever treatments are new that can be helpful for the patients, you have to find a way to somehow introduce them and stay relevant and stay present in their minds.”