“Simplicity is a great virtue but it requires hard work to achieve it and education to appreciate it. And to make matters worse: complexity sells better.”
– Edsger W. Dijkstra

From Washington, DC

• The House of Representatives and the Senate return to Capitol Hill on Monday for a lame duck session of Committee hearings and legislative business.

• Roll Call discusses what is likely to happen on Capitol Hill this week.

• The Federal Benefits Open Season begins at noon (ET) tomorrow. OPM adds,
  • “The Federal Benefits Open Season ends at 11:59 pm Eastern Time on Monday December 14, 2026 for the Federal Employees Dental and Vision Insurance Program (FEDVIP) and the Federal Flexible Spending Account Program (FSAFEDS). Open Season for the Federal Employees Health Benefits Program (FEHB) and Postal Service Health Benefits Program (PSHB) ends at 11:59 pm, per the location of your electronic enrollment system, on Monday December 14, 2026.”

• Beckers ASC Review reports,
  • “Physician leaders warn that CMS’ 2027 Medicare physician fee schedule final rule will put more strain on independent practices and make it harder for patients to get care.
  • “The final rule, released Nov. 4, cuts the conversion factor 2.31% to $32.63 for physicians who aren’t qualifying participants in an advanced alternative payment model. CMS had proposed a 1.68% cut in July. Much of the drop comes from the expiration of a temporary 2.5% payment increase for 2026. The rule also finalizes a 20% payment reduction for certain evaluation and management services billed with modifier 25 on the same day as a zero-day global procedure.”

• Contemporary OB/GYN tells us,
  • “The Centers for Medicare & Medicaid Services (CMS) has included the American Medical Association’s (AMA) new obstetric billing codes in the final 2027 Medicare Physician Fee Schedule, according to a statement from Camille A. Clare, MD, MPH, CPE, FACOG, president, American College of Obstetricians and Gynecologists.¹ 
  • “ACOG is deeply grateful to CMS for including AMA’s new obstetric codes in the final 2027 Medicare Physician Fee Schedule, and we look forward to ushering in a new system that will contribute to improved maternal health outcomes,” Clare said in part. “This change follows years of ACOG advocacy and will address several challenges related to the current method of billing for prenatal care services.” 

• The FEHBlog guessed last Sunday that CMS would announce the Medicare Part B and D premiums after the national election day on November 3. We are now three business days past election pay with no announcement. Perhaps the announcement will be made this week.

From the public health and medical / Rx research front,

• The New York Times reports,
  • Nutrient deficiencies are rare in the United States, thanks in part to advances in food fortification in the 1900s. But many people, especially those in certain high-risk groups, are still not meeting daily recommendations for some nutrients, said Teresa Fung, a nutrition professor at Simmons University in Boston.
  • Nutrient inadequacies typically don’t cause the obvious symptoms that severe nutrient deficiencies do, Dr. Fung said. But they sometimes cause more vague symptoms that can affect quality of life and increase the risk of certain health conditions.
  • [The article identifies] “five, commonly under-consumed nutrients in the United States, according to experts — and the signs you may be falling short.”
• and
  • “Cardiologists have been on edge for months, waiting for the details surrounding recent reports of the stunning failures of two new heart drugs.
  • The drugs — pelacarsen and ziltivekimab — were widely expected to usher in a new era in preventing heart disease. Companies, betting on the drugs’ promise, made huge investments in developing them.
  • So when doctors saw preliminary announcements that the drugs were not helping patients in large clinical trials, many felt blindsided, although still hopeful that there was more to the story than they knew.
  • “The whole cardiovascular community was gobsmacked,” said Dr. Karol Watson, a director of UCLA’s preventive cardiology program.”
  • Were the drugs close to succeeding, just barely missing a statistically significant benefit? Or were there at least subgroups of patients who were helped?
  • “Now the answers are in. There was not a shred of evidence that the drugs helped anyone. By every measure, they were no better than placebos.
  • “The results, Dr. Watson noted, “are about as neutral as they can be.” The full data were presented on Saturday morning at the annual meeting of the American Heart Association and in simultaneous publications in The New England Journal of Medicine.”

• The Washington Post relates,
  • “The humble flu shot may have a hidden talent: fighting cancer.
  • “In a small clinical trial in Ohio, doctors injected an ordinary flu vaccine straight into patients’ skin tumors, hoping to fool the immune system into mistaking the cancer for an infection.
  • The ruse seemed to take. Immune cells flooded into most of the injected tumors. By the time surgeons cut the cancers out, more than a third of patients showed signs that their tumors were in retreat. In a few, no trace of cancer remained.
  • “The trial involved just 18 patients and lacked a comparison group, so the findings are far from proof that the approach works. But they hint at a possibly inexpensive, off-the-shelf way to help cancer patients and offer an alternative to cancer vaccines, a field that has lately centered on bespoke, highly expensive shots built to match the mutations in each patient’s tumor. The findings were presented last week at the Society for Immunotherapy of Cancer’s annual meeting in Phoenix.”

• Cardiovascular Business tells us,
  • “The Society for Cardiovascular Angiography and Interventions (SCAI) released updated cardiogenic shock classifications to help clinicians better identify patients at risk, assess disease severity, and determine whether treatments are restoring adequate organ perfusion.
  • “The 2026 SCAI SHOCK Classification Expert Consensus Update, published in the Journal of the SCAI (JSCAI) in conjunction with the 2026 American Heart Association (AHA) Scientific Sessions, represents the third iteration of the classification system first introduced in 2019.[1] The framework has become widely adopted in clinical care, research and regulatory settings as a common language for communicating cardiogenic shock severity.
  • “Srihari Naidu, MD, FACC, FAHA, MSCAI, immediate-past SCAI president and director of the catheterization laboratories at Westchester Medical Center, was a co-chair of the consensus writing group. He said the update retains the familiar five-stage classification, A through E, while refining how clinicians identify patients at risk of deterioration and evaluate their response to treatment. Originally issued in 2019 and revised in 2022, this new iteration incorporates additional data from the past few years.
  • “We were happy that most of the data that had supported the shock classification and showed that really it was instrumental in improving shock care and really tracking with mortality. This is the third iteration of the shock classification, and I think people will agree that this has been a major step forward,” he said.
  • “One of the most important clarifications is the emphasis on tissue hypoperfusion rather than blood pressure alone when determining shock severity.”

• Genetic Engineering and Biotechnology News informs us,
  • “Right now, there is no pharmaceutical treatment for obstructive sleep apnea, a condition that is estimated to affect more than one billion people globally and approximately 30 million Americans. Multiple studies (notably in 2010¹ and 2017²) report that as many of half those prescribed continuous positive airway pressure (CPAP)—the gold standard apnea therapy—reject it outright, and between 12% and 25% of those who begin those treatments abandon CPAP within three years.
  • “The reason for such high non-compliance is that CPAP is uncomfortable and socially awkward, Joel Latham, president and CEO, Incannex Healthcare, says. His company aims to be the first to potentially market an oral pharmaceutical therapy for obstructive sleep apnea.
  • “Latham says Incannex Healthcare’s mission is “targeting indications that have limited or no treatment options available.” So, while a therapy for obstructive sleep apnea, known as IHL-42X, is its lead therapeutic, the company’s pipeline also includes therapeutics based on distinctly different therapeutic platform to treat generalized anxiety disorder and rheumatoid arthritis.”

From the U.S. healthcare business and artificial intelligence front,

• Beckers Hospital Review reports,
  • “Hospital sales are picking up steam as various health systems under financial pressure look to trim underperforming assets, exit noncore markets and redirect capital toward strategic priorities. 
  • “Recent hospital divestitures have come from nonprofit giants carrying hundreds of millions of dollars in operating losses, for-profit operators completing full-state exits and other systems shedding community hospital portfolios they no longer consider core to their portfolios. 
  • [The article identifies] “10 large health systems that have sold or announced plans to sell hospitals this year.”

• Healthcare Dive adds,
  • “It was a busy Thursday morning at the strip mall in White Hall, West Virginia. Once the sprawling grounds of Middletown Mall, the state’s first shopping mall before it shuttered in 2017, customers shuffled under a searing August sun between stores like Michaels, Five Below, Ace Hardware and Tractor Supply.
  • “You’d be forgiven for overlooking the catty-cornered building sandwiched between the Department of Motor Vehicles and across the two-lane road from the Italian pizzeria. 
  • “The bright red “Emergency” sign over the front entrance might get your attention though. Or the Marion County ambulances with their engines idling around back.
  • The building, containing just two hallways, is Mon Marion Neighborhood Hospital, part of a burgeoning trend of small acute care hospitals dubbed “micro-hospitals” or “neighborhood hospitals” that can hold anywhere from eight to 25 inpatient beds.
  • The micro-hospitals are popping up nationwide — from Pennsylvania to Arizona, Colorado to Texas — as lower-cost alternatives to traditional hospitals, including in semi-urban and rural areas where care access is strained.
  • “It’s been well received by the community,” said David Goldberg, the former CEO of Mon Health System, owner of Mon Marion. “Very busy, very widely accepted.”
  • “Micro-hospitals differ from freestanding emergency rooms or urgent care, two types of care sites that are offered as solutions to the rural care crisis because they have inpatient care capabilities. Though diminutive, the facilities are certified as hospitals according to federal standards set by the CMS.”

• Fierce Healthcare relates,
  • “Omada Health saw its “strongest quarter ever” in the third quarter of 2026, CEO and co-founder Sean Duffy told investors and analysts during a Thursday evening earnings call.
  • “We delivered our highest quarterly revenue, gross margin progression, and our most profitable quarter to date,” Duffy said.
  • “The virtual chronic care provider, which went public last June, brought in $91 million in revenue—up 34% year-over-year—and reported gross margin of 76% on a GAAP basis and 78% on a non-GAAP basis, according to Duffy. Omada reported net income of $7 million in the third quarter, compared with a net loss of $3 million in Q3 2025.
  • “The company also reported adjusted EBITDA of $12 million, compared to $2 million the year prior. 
  • “It beat Wall Street analysts’ estimates for revenue, though slightly trailed behind projections for total membership.
  • “Total members reached 1.1 million, up 36% year-over-year, with trailing 12-month revenue per total member increasing 5% year-over-year to $294, according to financial results publishedThursday. Average member tenure also grew 10% compared to the year prior, to approximately two years and four months. Member retention has improved to 58%, up from 43% in Q4 of 2024, executives said.”

• Beckers Payer Issues tells us,
  • “Aetna left the ACA market at the beginning of 2026, citing underperformance. Other insurers have also been navigating a rocky ACA landscape, marked by the expiration of enhanced premium subsidies and shifting risk-pool dynamics.
  • “CVS Health previously recorded a $448 million premium deficiency reserve in the first quarter of 2025 for its individual exchange business related to expected losses that year. During that quarter’s earnings call, former CFO Tom Cowhey had projected losses for the individual exchange business between $350 million and $400 million for full-year 2025.
  • “Aetna CFO Andreana Santangelo recently joined the Becker’s 5th Annual Fall Payer Issues Roundtable and shared more about the decision. 
  • “Very early on, you could see that we just didn’t have the right cost structure for our ACA business,” she said. 
  • “Citing her experience at a Blues plan and at Cigna, Ms. Santangelo said considerations around scale and cost structure are especially important for that business line. 
  • “While addressing how scale can be about more than sheer numbers, Ms. Santangelo said that “scale is also about having the right kind of risk pool” and attracting the right people who will find value in the product.”

• Fierce Healthcare informs us,
  • “Equiti is acquiring Lexi AI to build a hybrid language-access model that combines AI language support with human medical interpreters. 
  • “Equiti, which sells medical interpretation services to hospitals and health systems through its Martti business, provides 24/7 access to qualified medical interpreters across more than 250 languages and dialects. Lexi provides multilingual, AI-powered medical interpretation. The acquisition deal merges Lexi’s immediate AI language support, covering over 35 languages and dialects, with Martti and its network of qualified medical interpreters to help healthcare organizations expand language access.
  • “The acquisition was announced October 28. Financial details of the deal were not disclosed.”