Roll Call notes that the Supreme Court completed its final oral arguments for the current term last week. The Court has dozens of opinions to issue over the next two months.
“U.S. Covid-19 hospitalizations and deaths are hovering near new lows, providing fresh evidence that even as the virus endures it has become less damaging in a population with strengthened immune defenses.
“New subvariants are on the rise, and cutbacks in data reporting have clouded the view of recent trends. But the U.S. has broadly recorded declining numbers this year following a winter of less intense Covid-19 spread.
“This is the first week I have been in the ICU and have not had a Covid-positive patient,” said Dr. Michelle Prickett, a pulmonary and critical-care specialist at Chicago’s Northwestern Memorial Hospital. Federal data show the average number of adults with Covid-19 in intensive care beds hit new lows this month nationally, too.”
An expert writing Medpage Today suggests risk adjusting the start of breast cancer screening:
“The USPSTF recommends age 50 as the start for screening, and adds that women ages 40 to 49 years make an individual decision about screening after discussing the risks and benefits with their primary care practitioners. However, many physicians are not equipped with necessary evidence-based information on how race and ethnicity may influence risk. In other words, guidelines get women to practitioners and practitioners get to the ambiguous guidelines; a vicious cycle that is harmful for Black women at high risk of breast cancer. Studies on race and ethnicity-adapted breast cancer screening provide the precise information that practitioners would need — but many aren’t aware of — for a race and ethnicity-tailored starting age of breast cancer screening.”
An expert writing in Medscape evaluates the utility of the entrenched body mass index measure and considers alternatives.
“BMI is trash. Full stop.” This controversial tweet, which received thousands of likes and retweets, was cited in a recent Medscape perspective by one doctor on when physicians might stop using body mass index (BMI) to diagnose obesity.
“Body mass index (BMI) has for years been the consensus default method for assessing whether a person is overweight or has obesity, and is still widely used as the gatekeeper metric for treatment eligibility for certain weight-loss agents and bariatric surgery.
“But growing appreciation of the limitations of BMI is causing many clinicians to consider alternative measures of obesity that can better assess both the amount of adiposity as well as its body location, an important determinant of the cardiometabolic consequences of fat.”
From the U.S. healthcare front, NPR Shots and Fortune Well look at the growing use of hospital at home services from the patient’s perspective.
“The White House is crafting a roadmap to guide the implementation of the national cybersecurity strategy that it is set to release early this summer, Acting National Cyber Director Kemba Walden said Tuesday during a discussion with journalists at the RSA Conference.
“The strategy, framed around principles, was developed to have a 10-year shelf life. The dynamic and evolving nature of cybersecurity requires flexibility as new threats or technologies emerge, Walden said.
“The devil’s in the implementation planning process,” Walden said. “It’s really going to be who’s accountable for what, who’s responsible for what in the policymaking process, in the sort of sausage factory of the government.”
Cyberscoop informs us that “US cybersecurity officials are stepping up their push for tech companies to adopt secure by-design practices. Efforts at CISA and the Department of Energy are both meant to encourage the practice of building in better security protections.
“Small and medium businesses, local school districts, water utilities, local hospitals, are not going to be successful in managing cybersecurity risk alone if they ever get in the crosshairs of a ransomware gang or an APT actor,” said Eric Goldstein on Wednesday during the annual RSA Conference here that brings together government officials and industry executive. “Those who can bear the burden are held accountable for providing services that are safe and secure by design by default.”
Jack Cable, a senior technical adviser at CISA, told CyberScoop that CISA held two listening sessions recently with industry partners as well as one with the open-source community. He said the agency plans to build on secure by design principles recently outlined in a white paper the agency published. “This is the first chapter of the story here and we want to work closely with industry and governmental partners with this.”
The Cybersecurity and Infrastructure Security Agency (CISA) tells us,
“In line with the theme for this year’s RSA Conference, Stronger Together, Eric Goldstein, Executive Assistant Director for Cybersecurity, Cybersecurity and Infrastructure Security Agency (CISA), and U.S. Army Maj. Gen. William J. Hartman, U.S. Cyber Command’s Cyber National Mission Force commander, delivered a presentation on the importance of partnership in defending America’s critical infrastructure while holding malicious cyber actors accountable.
“Goldstein and Hartman shared newly-declassified details of interagency responses to cyber attacks from nation-state actors and cybercriminals, including how CNMF shares information from foreign operations to enable CISA’s domestic defensive mission. They also discussed how CISA shares information from domestic cyber incidents to enable CNMF’s operations to impose costs on foreign malicious cyber actors. Goldstein and Hartman discussed case studies, including the “SolarWinds” campaign, the mitigation of Chinese hacking of Microsoft Exchange, the disruption of Iranian targeting of an election reporting website, and ongoing data-sharing from cyber criminal targeting of federal agencies and educational institutions to enable CNMF operations.
“As our nation’s cyber defense agency, CISA recognizes that we must leverage all tools and capabilities to increase costs against our adversaries. Our work with CNMF enables us to not only more effectively defend our nation’s critical infrastructure from cyberattacks but also clearly demonstrate to our adversaries that there is a price to pay if you decide to attack American infrastructure,” said CISA EAD Goldstein. “Our presentation demonstrated for the first time how this partnership yields real-world operational benefits and how we rely upon collaboration with, and incident reporting from, the private sector to catalyze this work.”
NIST’s Computer Security Resource Center announced
“For the past 18+ months NIST, in collaboration with the Department of Health and Human Services (HHS) Office for Civil Rights (OCR), has been working to update NIST Special Publication (SP) 800-66, Implementing the Health Insurance Portability and Accountability Act (HIPAA) Security Rule: A Cybersecurity Resource Guide, from Revision 1 to Revision 2.
“Thank you to all who provided feedback during the open comment period; in total, over 250 unique comments were received from dozens of individuals and organizations. Many commenters suggested that more resources be developed for small, regulated entities. NIST agrees… and anticipates follow-on work in this area—but NIST can’t do it alone and plans to work collaboratively with other agencies, entities, and colleagues to produce useful resources. Stay tuned for more information about this in the coming months.
“NIST and OCR are still in the process of adjudicating the received comments carefully. Once all comments are adjudicated, NIST plans to publish a blog or whitepaper detailing the proposed changes to SP 800-66 r2 (with the goal being to publish a final version of SP 800-66 r2 later this year).Thank you for the opportunity to share this update. Feel free to reach out with any questions or comments to sp800-66-comments@nist.gov (and follow us on @NISTcyber and subscribe to our Cybersecurity Insights blog to stay updated in the future).”
“As hacking has gotten more destructive and pervasive, a powerful type of tool from companies including CrowdStrike Holdings Inc. and Microsoft Corp. has become a boon for the cybersecurity industry.
“Called endpoint detection and response software, it’s designed to spot early signs of malicious activity on laptops, servers and other devices – “endpoints” on a computer network — and block them before intruders can steal data or lock the machines.
“But experts say that hackers have developed workarounds for some forms of the technology, allowing them to slip past products that have become the gold standard for protecting critical systems.
“Investigators from multiple cybersecurity firms said the number of attacks where EDR is disabled or bypassed is small but growing, and that hackers are getting more resourceful in finding ways to circumvent the stronger protections it provides. * * *
“Security software cannot stand alone — you need eyes on-screen combined with technology,” [an investigator] said. EDR “is much better than antivirus software. So for sure you need it. It’s just not the silver bullet that some think it is.”
“The Service Location Protocol (SLP, RFC 2608) allows an unauthenticated remote attacker to register arbitrary services. This could allow an attacker to use spoofed UDP traffic to conduct a denial-of-service (DoS) attack with a significant amplification factor.
HHS’s Healthcare Sector Cybersecurity Coordination Center issued a sector alert yesterday
“Ransomware-as-a-service (RaaS) groups Cl0p and Lockbit recently conducted several distinct attacks, exploiting three known vulnerabilities (CVE-2023-27351, CVE-2023-27350, and CVE-2023-0669). The Cybersecurity and Infrastructure Security Agency (CISA) added the latter two vulnerabilities to its Known Exploited Vulnerabilities Catalog but has not yet added the first. This Sector Alert follows previous HC3 products on Cl0p (Cl0p Allegedly Targeting Healthcare Industry and Cl0p Ransomware) and Lockbit (Lockbit Ransomware, LockBit 3.0, and LockBit 2.0 IOCs), and provides an update on the recent attacks, and recommendations to detect and protect against future ransomware attacks.”
Cybersecurity Dive calls attention to “Mandiant CEO Jack Mandia’s seven tips for cyber defense; Organizations’ institutional knowledge is an advantage that no adversary can match, Kevin Mandia told RSA Conference attendees.” The FEHBlog’s favorites are
Lean on multifactor authentication
“The biggest bang for the buck against any impactful attack is multifactor authentication period,” Mandia said. “Figuring out a way to get it everywhere and know that you have it everywhere with some sort of validation is critical.”
Build honeypots
Honeypots, or fake accounts deliberately left untouched by authorized users, are effective at helping organizations detect intrusions or malicious activities that security products can’t stop, Mandia said.
The FEHBlog uses multifactor authentication but had not heard of honeypots.
“A new prototype technology has the potential to revolutionize cybersecurity, making it possible for businesses to prevent the majority of cyberattacks with ease.
“In a joint project developed by ARM and the University of Cambridge, world-renowned for its computer science pedigree, the prototype processor was used in experiments by various companies for six months as part of the Technology Access Programme, courtesy of Digital Catapult with support from the University of Cambridge and Arm.
“As a result of this programme, 27 of the participating companies gathered Digital Catapult’s London HQ to demonstrate their findings, and many were impressed it seems with the prototype’s ability to defend against memory-related cyberattacks. * * *
“Although it is still in the research phase, the prototype is claimed to have the potential to help protect industries and firms. already, the programme has racked up over a thousand days in development work wot other 13 million lines of code being experimented with.”
Here are links to the CDC’s Covid Daily Tracker and its Fluview. It turns out that the CDC is planning one more issue of its Covid statistics review on May 12. All signs continue to support ending the PHE on May 11.
ABC News reports on the latest results of the Youth Risk Behavior Survey, published Thursday by the Centers for Disease Control and Prevention.
The GAO issued a report on government efforts to curb antibiotic resistance. The Wall Street Journal adds
A bipartisan group of U.S. senators and representatives introduced legislation aimed at encouraging drugmakers to develop antibiotics and antifungal drugs to address a growing public health threat.
Bills that lawmakers proposed in the House and Senate on Thursday would commit $6 billion to purchasing new drugs to treat drug-resistant bacteria and fungi that federal officials designate as critically important targets.
Nearly three million people in the U.S. are infected each year with bacteria immune to many antibiotics, the Centers for Disease Control and Prevention said. Some 35,000 of them die. The manufacturers of some promising antibiotics have gone bankruptbecause sales of drugs needed only in emergencies are small, public-health experts said. Many big pharmaceutical companies got out of the antibiotic business years ago.
A record-low number of adults reported cigarette use in 2022, while reported usage of electronic cigarettes rose among adults.
Preliminary survey results from the Centers for Disease Control and Prevention (CDC) found just 11 percent of American adults — or about 1 in 9 — reported they are smokers, which is a drop from 12.5 percent reported in 2020 and 2021.
The new data, which is based on responses from 27,000 adults, captured an uptick in e-cigarette use among adults, from 4.5 percent who reported use in 2021 to 6 percent in 2022.
With its next-generation pneumococcal vaccine, Pfizer has been playing catch-up with Merck in the indication’s key age group—infants. Thursday, Pfizer got to the finish line 10 months after its rival, but with a shot that offers more protection.
The FDA approval of Prevnar 20 covers children ages 6 weeks to 17 years and gives Pfizer a chance to continue to control a market it has dominated for two decades.
Prevnar 20 is Pfizer’s follow-on to Prevnar 13, offering protection against seven additional serotypes. Merck’s next-gen shot, Vaxneuvance, is a 15-valent vaccine.
In the U.S., the seven additional serotypes covered by Prevnar 20 have shown to be associated with antibiotic resistance and heightened disease severity, according to Pfizer. In children five and younger, the seven serotypes account for 37% of the incidence of pneumococcal disease.
“To equip both clinicians and patients with the tools to prevent these [maternal health] tragedies, a group of experts * * * have developed a new, evidence-based preventive care plan for those who are at moderate to high risk of preeclampsia, a pregnancy complication that can drive blood pressure dangerously high and is a leading cause of maternal and infant deaths. The care plan, published Friday in the American Journal of Obstetrics and Gynecology, recommends a range of interventions to lower a patient’s risk, including at-home blood pressure checks, treatments like low-dose aspirin, and continuing to take any other needed heart medication, which people are often wary to do when pregnant. The plan also includes lifestyle recommendations for patients like eating a Mediterranean diet, exercising, and getting at least 7 hours of sleep per night.”
“AbbVie withstood the first months of U.S. copycat competition to its lucrative arthritis drug Humira about as Wall Street had expected, conceding on price to maintain insurance coverage in response to Amgen launching the country’s first biosimilar rival in January.
“Amgen, which recorded $51 million in U.S. revenue for its biosimilar Amjevita, is selling its Humira rival at two different prices: a 5% discount to Humira’s nearly $90,000 annual list price, and a 55% discount. The approach is meant to address the unique demands of the U.S. healthcare system, in which insurers rely on manufacturers providing rebates off of a drug’s sticker price.”
Becker’s Health IT provides more details about this week’s Kaiser Permanente deal with Geisinger, while Beckers ASC Review explores Optum’s physician acquisition strategy.
“On Wednesday, lawmakers hammered CMS Administrator Chiquita Brooks-LaSure on a variety of healthcare issues in her first appearance before a congressional panel since being confirmed to her post.
“One of the hearing’s biggest themes was site neutrality, as members of the House Energy and Commerce health subcommittee queried the administrator on why the government pays hospital-owned outpatient sites more than other physician offices for the same services.
“Lawmakers on both sides of the aisle expressed support for enacting site-neutral payments, policies fiercely opposed by hospitals because they would lower revenue. * * *
“Members of the health subcommittee on both sides of the aisle suggested site-neutral payment reforms would save the government money and tamp down on provider consolidation.”
“Medicare will cover the new Alzheimer’s treatment Leqembi for all patients eligible under the medication’s label if the Food and Drug Administration fully approves the drug in July, a federal official told members of Congress on Wednesday.
“The official, Chiquita Brooks-LaSure, testified before Congress Wednesday for the first time since her confirmation as administrator of the Centers for Medicare and Medicaid Services.”
“The drug giant Eli Lilly said Thursday that its diabetes drug Mounjaro helped patients with the condition lose 15.7% of their body weight in a clinical trial, a result that Wall Street analysts expect to pave the way for the therapy’s approval as a weight loss treatment.
“Mounjaro is the latest drug in a class known as GLP-1s or incretins — the same class as Novo Nordisk’s Ozempic, which has become a sensation because of its ability to help patients lose weight. Mounjaro has shown the potential to lead to even greater weight loss than Ozempic, and industry experts expect that it will eventually generate many billions of dollars in annual sales. Analysts at SVB Securities projected in December that Mounjaro sales could reach $26.4 billion by 2030.
“Eli Lilly on Thursday also announced quarterly earnings of $1.64 per share, adjusted for one-time items, slightly below analyst expectations, on sales of $6.96 billion. Sales were hurt because of a comparison to a year ago when the company’s Covid-19 monoclonal antibodies were still on the market. Mounjaro sales for the first quarter were $586 million, largely for people with diabetes, compared to an analyst consensus of $433.2 million.”
According to the American Hospital Association,
“The Food and Drug Administration yesterday approved the first fecal microbiota product taken orally to prevent recurrent C. difficile infection.
“Today’s approval provides patients and healthcare providers a new way to help prevent recurrent C. difficile infection,” said Peter Marks, M.D., director of the FDA’s Center for Biologics Evaluation and Research. “The availability of a fecal microbiota product that can be taken orally is a significant step forward in advancing patient care and accessibility for individuals who have experienced this disease that can be potentially life-threatening.”
Clostridioides difficile (klos-TRID-e-oi-deez dif-uh-SEEL) is a bacterium that causes an infection of the large intestine (colon). Symptoms can range from diarrhea to life-threatening damage to the colon. The bacterium is often referred to as C. difficile or C. diff.
Illness from C. difficile typically occurs after use of antibiotic medications. It most commonly affects older adults in hospitals or in long-term care facilities. In the United States, about 200,000 people are infected annually with C. difficile in a hospital or care setting. These numbers are lower than in previous years because of improved prevention measures.
People not in care settings or hospitals also can develop C. difficile infection. Some strains of the bacterium in the general population may cause serious infections or are more likely to affect younger people. In the United States, about 170,000 infections occur annually outside of health care settings, and these numbers are increasing.
“Mark Cuban Cost Plus Drug Co. decreased 35 drug prices April 26, according to a news release shared with Becker’s.
“The company began selling a few dozen generics in January 2022, and since then, Cost Plus Drugs has added about 1,000 more drugs, including four brand-name drugs, partnered with three pharmacy benefit managers and teamed up with independent pharmacists to complement its mail-order pharmacy business.
From the public health front, Mercer Consulting explains that
“Ending the HIV epidemic in the United States is finally within our reach, but it will require all sectors of society, including employers, working together to ensure that the most powerful HIV prevention and treatment tools in history reach those who need them the most. – Health Action Alliance
“Mercer has joined a coalition of companies to help achieve what was once thought impossible – the end of the HIV epidemic in the US by 2030. Scientific advancements over the past four decades have made it possible to dramatically reduce new cases of HIV, which currently number nearly 35,000 per year in the United States. A key obstacle is misinformation, discrimination, and stigma around HIV. When we support people affected by HIV, we make it easier for everyone to lead healthy lives.
“Current HIV prevention and treatment tools mean it’s easier than ever for people to stay healthy and prevent the spread of the virus:
“Rapid, non-intrusive HIV tests can be done without needles, and results are available within 20 minutes or less.
“The use of PrEP (pre-exposure prophylaxis) can prevent people without HIV from contracting the disease. It’s available as a daily pill or a shot taken every eight weeks.
“A range of new antiretroviral treatments (ARTs) make it possible for people with HIV to live long, healthy lives. In addition to maintaining health, people who take their ARTs as prescribed and who achieve and then maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.”
Mercer’s article also identifies five ways to address HIV in the workplace.
“Teladoc beat Wall Street expectations in the first quarter and raised its 2023 guidance as a result, with management citing growing demand for chronic care offerings among employers and health plans.
“Teladoc’s revenue grew 11% year over year to $629 million in the first quarter, the company reported aftermarket Wednesday. Despite inflationary headwinds, direct-to-consumer mental health business BetterHelp’s revenue grew 21% year over year to $279 million. BetterHelp had almost half a million users in the quarter.”
“Quest Diagnostics on Thursday said it agreed to pay up to $450 million to acquire Haystack Oncology, an early-stage company focused on liquid biopsy testing to detect residual or recurring cancer.
“The announcement came as Secaucus, N.J.-based Quest reported a 10.7% drop in first-quarter revenue to $2.33 billion, compared to a year ago, on a faster-than-expected decline in COVID-19 testing as the public health emergency approaches an end.
“Revenue in Quest’s base business, excluding COVID testing, rose 10% to $2.21 billion, bolstered by strong volume growth across customer types, CEO James Davis said on the company’s earnings call.
Finally, Tammy Flanagan writing in Govexec discusses what is the best age for a federal employee to retire.
Thanks to Alexandr Hovhannisyan for sharing their work on Unsplash.
From Capitol Hill, Roll Call reports, “House Republicans narrowly passed legislation Wednesday pairing nearly $4.8 trillion in deficit reduction measures with a debt limit increase into next year — a move they argue should force Democrats to finally negotiate conditions for raising the nation’s borrowing limit.” Time will tell.
Politico explains why and how prescription benefit managers are playing defense on Capitol Hill.
From the U.S. healthcare business front, Healthcare Dive informs us
“Kaiser Permanente is acquiring Geisinger Health and forming a new nonprofit to buy and operate other value-oriented nonprofit systems, the organizations announced Wednesday.
“The new nonprofit, Risant Health, will operate separately from Kaiser Permanente. Geisinger will become part of Risant but maintain its own name and mission, according to a press release.
“Geisinger president and CEO Jaewon Ryu will be CEO of Risant as the transaction closes, subject to regulatory review. Risant will have its headquarters in Washington, D.C.
Both Kaiser and Geisinger are FEHB plan carriers. Kaiser is the third largest carrier in the FEHB Program. Healthcare Dive adds
“Kaiser, which reported $95 billion in revenue in 2022, plans to spend $5 billion on Risant over the next five years and add five or six health systems to Risant over that period, according to reports.
“Kaufman Hall said recently it expects a “new wave of transaction activity” and a growing number of cross-regional partnerships.
“Pennsylvania-based Geisinger has ten hospital campuses and a health plan that covers more than 500,000 members. It has more than 25,000 employees. Both Geisinger and Kaiser reported operating losses last year, as supply and labor expenses rose.
“Humana posted a 33 percent increase in profits year over year and added more than 500,000 Medicare Advantage members in the past year, according to its first-quarter earnings posted April 26.
“We’ve had a strong start to the year, with our outperformance underpinned by strong membership growth and favorable inpatient utilization trends in our individual Medicare Advantage business,” CEO Bruce Broussard said.
“The company posted $1.3 billion in net income in the first quarter of 2023, up from $930 million in the first quarter of 2022.”
From the public health front,
The National Cancer Institute released a bevy of research articles.
The FEHBlog ran across this helpful Johns Hopkins article about U.S infertility statistics,
“For the new study, Snow and Trent analyzed data on 53,764 women who participated in the federally supported National Survey of Family Growth (NSFG). While the survey did not ask explicitly about infertility, it contained questions about sexual activity, contraception and pregnancy that were not used in previous studies to estimate infertility rates. It also collected information about sociodemographic and healthcare factors.
“Based on the responses, the researchers concluded that the rate of infertility varied slightly from year to year, with a low from 2006 to 2010 of 5.8% and a high between 2017 to 2019 of 8.1%. However, these fluctuations are not considered statistically significant, and the team concluded that overall fertility rates did not significantly change during the study period.
“In particular populations, however, infertility rates were significantly higher than average compared with the general population. Women aged 40 to 44 were about 11 times more likely to be infertile than younger women, women who did not complete high school were twice as likely to be infertile as those with higher levels of education, non-Hispanic Black women were 44% more likely to be infertile than women of other races and women who had not recently received sexual health care were 61% more likely to be infertile. Unlike previous studies, the new data did not show a higher rate of infertility for Hispanic women.
MedPage Today offers an interview with Dr. Atul Gawande about the importance of palliative care.
“The Food and Drug Administration has conditionally approved a new ALS medicine in a decision likely to influence how other experimental treatments for the nerve-destroying disease are tested and reviewed.
“The medicine, known until now as tofersen, is only for ALS patients who have a specific genetic mutation. Estimates cited by the FDA hold that this group accounts for less than 500 of the roughly 30,000 people in the U.S. with the disease.
“Until Tuesday, the few therapies that had secured FDA approval did so because they were shown to help patients live a bit better or a bit longer. Tofersen, which will be sold as Qalsody, is different. It failed the key clinical trial meant to demonstrate it can slow the functional decline associated with ALS, or amyotrophic lateral sclerosis.
“Rather, tofersen’s approval hinged on its ability to lower levels of “neurofilament light chain,” a protein that’s drawn increasing interest from ALS researchers. It’s the first ALS drug approved based on so-called “biomarker” data, setting a precedent that could provide another, perhaps faster path to market for some developers.
“Roche’s new eye drug Vabysmo brought in nearly $500 million during the first quarter, the company said Wednesday. The more than 500% year-over-year sales increase outpaced all other of Roche’s medicines, surpassing top-sellers like the multiple sclerosis treatment Ocrevus and hemophilia therapy Hemlibra.
“Vabysmo’s market launch for age-related vision loss comes as one of the first treatments for the condition, Roche’s own Lucentis, faces copycat rivals, and another, Regeneron’s Eylea, could soon.
“The strong growth from Vabysmo helped propel a 9% increase in pharmaceutical division sales, which contrasted with a 3% decline in first quarter revenue for the overall business due to lower COVID-19 test sales.”
From the miscellany front —
Per the American Hospital Association, “The Centers for Medicare & Medicaid Services today announced changes to its enforcement process for the hospital price transparency rule. CMS said it will now automatically impose a civil monetary penalty if hospitals fail to submit a corrective action plan on time or fail to complete the CAP within 45 days. In addition, the agency will no longer issue a warning notice to hospitals that have not posted any machine-readable file or shoppable services list/price estimator tool, but will immediately ask the hospital to submit a CAP.”
its OPM Data Strategy Fiscal Years 2023-2026, which lays out a vision to fully leverage OPM and agency human capital data, and to provide federal agencies, federal employees, and public users seamless access to OPM data products and services. In addition to the overarching strategy, OPM released a set of initial data dashboards to the updated OPM Data Portal at www.opm.gov/data, including FedScope datasets which can now be accessed at www.opm.gov/data/datasets. The OPM Data Portal is a redesigned OPM webpage providing increased access to OPM data products and services.
HIMSS posted a wrap-up page from last week’s conference.
“Sens. Bernie Sanders, I-Vermont, and Bill Cassidy, R-Louisiana, reached a deal on new legislation that aims to increase access to generic drugs and impose transparency measures on pharmacy middlemen.
“The two senators, the new leaders of the powerful Senate Committee on Health, Education, Labor and Pensions (HELP), said the legislative package will “reform pharmacy benefit managers and expand the availability of low-cost generic drugs.”
“The committee will hold a hearing on May 2 to consider the legislative package, which includes four bills.”
“Sen. Tammy Duckworth of Illinois, Reps. Gerry Connolly of Virginia, Eleanor Holmes Norton of Washington, D.C., and Debbie Wasserman Schultz of Florida, all Democrats, and Rep. Nancy Mace of South Carolina, a Republican, [introduced] the Family Building FEHB Fairness Act on Tuesday, marking National Infertility Awareness Week.
“Duckworth said the proposed legislation would cover other IVF-related costs and expand coverage to all the different forms of assisted reproductive technology. The most common type of assisted reproductive technology by far is IVF, but there is also gamete intrafallopian transfer, zygote intrafallopian transfer and frozen embryo transfer.”
The FEHBlog expects that fertility coverage advocates will be pleased with FEHB carrier initiatives for 2025.
The different social determinants of health have different impacts on healthcare quality, utilization, and outcomes, with new Humana data showing that some SDOH are more closely related to poor care quality while others are more closely related to high healthcare utilization.
For other SDOH, like social isolation and limited access to transportation, patients experience both poor care quality and high acute care utilization, the JAMA Network Open report showed. * * *
This latest study looked at which SDOH have the biggest impact on health and well-being, as measured by care quality and acute care utilization, to better determine effective SDOH interventions going forward.
The All of Us Research Program celebrates National DNA Day!
Medscape reminds us that unexpected weight loss can be a health warning.
“Our study emphasizes the importance of weight loss even in relatively healthy individuals who are free from evident cardiovascular disease (CVD), dementia, physical disability, or life-limiting chronic illness,” first author Monira Hussain, MBBS, MPH, PhD, told Medscape Medical News.
“Clinicians should be aware that even minor weight loss of 5% or more in older adults without life-limiting illnesses can increase mortality risk,” Hussain said. “Regular monitoring of weight changes can help early identification of associated risks.”
STAT News tells us, “Consumers turning to melatonin gummies to get some help falling asleep might be getting a lot more help than they bargained for, according to a new study published Tuesday in the Journal of the American Medical Association.”
“However, one dietary supplement lobbying group argued that variability in strength of the gummies studied is to be expected, and is often purposefully done by manufacturers to ensure they do not degrade overtime and thereby run afoul of the FDA’s rules. Dietary supplements are required to demonstrate they contain 100% of the listed ingredient until their expiration date, and thus manufacturers will “put an overage in to start to be sure that six months from now that when that consumer buys the product, they’re still getting 100% of what’s on the label,” according to Steve Mister, the CEO of the Council for Responsible Nutrition.
“Mister conceded that he did share concerns about two of the products studied — one which included no melatonin and another that included more than 300% of the advertised amount. He maintained, however, that “there is … absolutely nothing in this study that should alarm consumers.”
From the U.S. healthcare business front
Fierce Healthcare relates, Health insurer “Centene Corporation posted $1.1 billion in profit for the first quarter of 2023, up from $849 million in earnings in the prior year quarter. The company’s revenue was also up year-over-year, reaching $38.9 billion compared to $37.2 billion in the first quarter of 2022. The numbers fall short of Wall Street analysts’ expectations on profit but exceed their predictions on revenue, according to analysts at Zacks Investment Research.”
“Tenet Healthcare, one of the largest for-profit hospital operators in the U.S., raised its forecast for full-year profit after posting growth in case volumes that boosted revenue and net income in the first quarter.
“The company said on Tuesday that quarterly profit climbed 2.9% from a year earlier to $143 million, beating an earlier forecast that net income would range between $90 million and $125 million in the period..
“The earnings results also beat Wall Street revenue estimates, according to SVB Securities analysts. Tenet logged $5 billion in revenue, a 5.8% increase compared to the first quarter of 2022.”
“Labcorp on Tuesday reported a 10% increase in its base business revenue in the first quarter and said the proposed spinoff of its clinical development unit would be completed as expected at mid-year.
“The company’s base business benefited from an agreement to manage laboratories for the Ascension health system, Labcorp said. That relationship contributed about 4% of Labcorp’s organic growth in the first quarter, CEO Adam Schechter said on the company’s earnings call.
“Labcorp is now managing laboratories in nearly 100 Ascension hospitals, Schechter said. The partnership, established early last year, covers Ascension hospital-based labs in 10 states.”
Axios updates us with developments from the No Surprises Act front.
“What we’re watching: Lawmakers in the House and Senate said they’re planning to conduct oversight of the law, with Republicans focusing on how the Biden administration is implementing it.
“Senate health committee ranking member Bill Cassidy (R-La.) noted that “the courts continue to toss out the way that the administration has implemented [the law]. So, oversight hearings, we’re going to have some discussions in the HELP Committee. I think that’s all appropriate.”
“Florida Republican Rep. Vern Buchanan, chair of the Ways and Means Health Subcommittee, said the committee would hold a hearing on the topic in June. A GOP committee aide said “the hearing schedule was fluid,” but given the bipartisan interest, “this is a strong potential topic” for a hearing.
“Yes, but: When asked, lawmakers weren’t sure what Congress might be able to do to fix providers’ issues, though some are open to new legislation.”
The FEHBlog is on record favoring that the Administration’s approach to implementing the law in a way that controls healthcare spending.
The Wall Street Journal reports, “Weight-loss drugmakers are lobbying Congress to grant them access to a monster payday for their blockbuster treatments: Medicare coverage.” At last Thursday’s carrier conference, OPM pointed out a related advantage of the Medicare Part D EGWPs that the FEHBP will offer next year. Although the weight loss drugs may not be on the Medicare formulary, those drugs would be made available to FEHB annuitants via the Plan’s formulary, which can gap-fill the Medicare formulary.
CMS announced that the updated MMSE Section 111 GHP User Guide version 6.8 has been posted to the GHP User Guide page on CMS.gov. Refer to Chapter 1 for a summary of updates.”
Per Health Payer Intelligence, AHIP launched a marketing campaign targeting Pharma’s prescription drug pricing. “The payer organization stated that prescription drug pricing is out of control and explained health insurance’s role in reducing the impact.”
The Department of Health and Human Services proposed a rule to extend ACA marketplace, Basic Health Program, Medicaid, and CHIP coverages to 580,000 DACA recipients.
From the healthcare spending and plan design fronts
“About a year ago, Elevance Health launched a pilot program to offer digital concierge care to members who were recovering from COVID-19 infections.
“Since then, the insurer has expanded that initiative to offer concierge care management to members with a number of chronic conditions, including Crohn’s disease, cancer and diabetes. Anthony Nguyen, M.D., the chief clinical officer at Elevance, told Fierce Healthcare that the program was born from a desire to be “more engaging with our members.”
“The challenge for not only the programs that we have, the traditional ones, as well as others in the market, is that it’s not personalized,” Nguyen said. “It is not tailored to an ‘n’ of one.”
“Greater personalization was built into the foundation of the program, he said. For example, concierge care deploys a nurse matching tool that connects members with a clinician who is likely to connect and resonate well with them, improving the care journey.”
“Healthcare spending declined dramatically in 2020 thanks to the COVID-19 pandemic, but expenditures rebounded the following year, according to new data from the Health Care Cost Institute.
“The group released its annual look at cost and utilization trends last week, which found the average health spending for people with employer-sponsored coverage reached $6,457, up 15% from the 2020 average of $5,630. Spending declined by 4% in 2020 as utilization decreased, the researchers said.
“John Hargraves, director of data strategy at HCCI, told Fierce Healthcare that the 2020 data are an aberration in the long-term spending trends, which had grown steadily prior to the pandemic.
“It’s almost like 2020 is a missing data point in the long-term growth in the healthcare spending and use patterns that we’ve noted,” Hargraves said.”
From the telehealth and fraud waste and abuse fronts, the HHS Inspector General made available a “toolkit intended to assist public and private sector partners—such as Medicare Advantage plan sponsors, private health plans, State Medicaid Fraud Control Units, and other Federal health care agencies—in analyzing their own telehealth claims data to assess program integrity risks in their programs.”
From the Omicron and siblings front, Scientific American discusses how often people should receive the Covid vaccine.
“The bivalent booster now available in the U.S. came out in September 2022. It was formulated to cover the COVID-causing virus’s Omicron strains BA.4 and BA.5 and the original strains from 2020. After an initial wave of people received the booster in the fall and early winter, the rate of vaccinations has dropped.
“A number of fully vaccinated and boosted peoplewould likeanother booster for additional protection, Schaffner says, but a much larger population has not yet received any booster at all. Only 16.7 percent of the U.S. population(about 55 million people) have had the latest one—far fewer than officials had hoped. “That’s clearly been a source of considerable disappointment to everyone in public health,” Schaffner says. “The current public health thrust is not to give people an additional booster but to get people to take the firstbivalent booster.”
“The CDC says it continues to monitor emerging data but maintains its recommendation of one updated COVID vaccine for eligible people aged six months and older. “Too few people, particularly those who are older and at high risk for severe COVID-19, have taken advantage of getting an updated COVID-19 vaccine. And we encourage eligible individuals to speak with their health care provider and consider receiving one,” says CDC representative Kristen Nordlund.”
From the U.S. healthcare business front —
Medscape considers whether doctors will start retiring en masse soon.
“The double whammy of pandemic burnout and the aging of baby boomer physicians has, indeed, the makings of some scary headlines. A recent surveyby Elsevier Health predicts that up to 75% of healthcare workers will leave the profession by 2025. And a 2020 study conducted by the Association of American Medical Colleges (AAMC) projected a shortfall of up to 139,000 physicians by 2033.
“We’ve paid a lot of attention to physician retirement,” says Michael Dill, AAMC’s director of workforce studies. “It’s a significant concern in terms of whether we have an adequate supply of physicians in the US to meet our nation’s medical care needs. Anyone who thinks otherwise is incorrect.”
Revcycle Intelligence discusses healthcare mergers and acquisitions that occurred in the first quarter of 2023.
“Healthcare merger and acquisition activity generated $12.4 billion in the first quarter of 2023, marking a significant year-over-year increase, according to a Kaufman Hall report.
“The M&A Quarterly Activity Report revealed there were 15 transactions in Q1 2023, down only slightly from the post-pandemic high of 17 in Q4 2022. The number of transactions increased compared to Q1 2022, when 12 deals were announced.
“The seller or smaller party had an average revenue of $827 million in Q1 2023, falling below the average size of $852 million in Q4 2022. One mega-merger was announced in Q1 2023—a transaction where the smaller party has an annual revenue exceeding $1 billion. This year’s mega-merger was between New Mexico-based Presbyterian Health Services and Iowa-based UnityPoint Health.”
From the fraud, waste, and abuse front, Fierce Healthcare reports
“Eighteen people, some of them practicing medical doctors, were criminally charged with participating in healthcare fraud schemes that exploited the COVID-19 pandemic and allegedly raked in $490 million.
“The schemes resulted from false billings to federal programs and theft from federally funded pandemic programs, according to the Department of Justice in a news release.
“In the widespread fraud takedown, federal authorities also targeted suppliers of COVID-19 over-the-counter tests who exploited federal partners by shipping tests to patients who did not want or need them. And the feds went after individuals who filed fraudulent claims to the Provider Relief Fund (PRF) and the manufacturers and distributors of fake COVID-19 vaccination record cards.
T”wo of the most significant criminal cases in this latest sweep were filed by federal prosecutors in the Central District of California.
“Dr. Anthony Hao Dinh allegedly bilked the federal government out of $150 million and he used these fraud proceeds for high-risk options trading, losing over $100 million, according to the Justice Department in an announcement on April 20.
“An ounce of prevention may be worth a pound of cure, but medical schools have traditionally given little weight to instruction on how to help patients live healthier lives.
“The future could look different as schools and residency training programs have begun to embrace a field known as lifestyle medicine, weaving teaching on nutrition, exercise and other healthy behaviors into the core curriculum of medical education. This new push aims to provide doctors with tools to tackle chronic but often preventable conditions such as heart disease, stroke and diabetes that affect six in ten adults in the U.S.
“Incorporating lifestyle medicine into medical-school curricula can resolve the inadequacies that exist in preparing physicians for the growing challenge of chronic disease,” says Jennifer Trilk, professor of biomedical sciences and director of lifestyle-medicine programs at the University of South Carolina School of Medicine Greenville, which in 2017 became the first medical school in the U.S. to incorporate more than 80 hours of lifestyle-medicine training over four years of undergraduate education.”
NPR Shots offers an explanation of “Unraveling a hidden cause of [female] UTIs — plus how to prevent them.
Fortune Well explains why “a diet rich in certain foods may help protect against miscarriage, new research says. Here’s what to eat—and avoid—if you’re pregnant or trying to conceive.
“NCR, a payments processor that offers point-of-sale systems to restaurants and retailers, digital banking and ATM services, is still responding to and recovering from a ransomware attack that began impacting systems on April 12.
“The cyberattack caused a data center outage that is impacting some functionality in Aloha, a POS used by restaurants, and Counterpoint, which integrates front- and back-office management systems for retailers, NCR said in an incident report update Monday. The company first publicly disclosed it was hit by a ransomware attack on April 15.”
The average cost of a healthcare ransomware attack was $4.82 million in 2021, according to IBM Security’s “Cost of a Data Breach Report.” In a new report by ThreatConnect, the cyber threat intelligence company suggested that there is more to be discovered about the true cost of a ransomware attack.
“[T]hat average attack figure takes into account a large number of incidents that cost relatively little (less than $25k) and a few that cost a lot,” the report stated. “The question is—does the average apply to you?”
“ThreatConnect analyzed thousands of companies in the manufacturing, healthcare, and utility industries in order to estimate median losses to operating incomes.”
“Premiums for stand-alone cyber insurance rose by 62% in 2022 following a 91% increase in the prior year, according to a recent report by Fitch Ratings.
“The deceleration was driven by a moderation of ransomware incidents, a heightened level of cyber risk awareness among corporate executives, and more strict enforcement of cyber hygiene standards by insurance companies, according to Fitch.
“You will likely see rates decelerate further,” Gerald Glombicki, a senior director in Fitch Ratings insurance group, said in an interview.”
From the cyber vulnerabilities front —
The Health Sector Cybersecurity Coordination Center released its March 2023 vulnerabilities report.
“In March 2023, vulnerabilities to the health sector have been released that require attention. This includes the monthly Patch Tuesday vulnerabilities released by several vendors on the second Tuesday of each month, along with mitigation steps and patches. Vulnerabilities for this month are from Microsoft, Google/Android, Apple, Mozilla, SAP, Cisco, Fortinet, and Adobe. A vulnerability is given the classification as a zero-day if it is actively exploited with no fix available or is publicly disclosed. HC3 recommends patching all vulnerabilities with special consideration to the risk management posture of the organization.”
The Cybersecurity and Infrastructure Security Administration (CISA) added two, one, and three known exploited vulnerabilities to its catalog.
CISA and other federal agencies issued a joint advisory about “APT28 (also known as Fancy Bear, STRONTIUM, Pawn Storm, the Sednit Gang and Sofacy), a highly skilled threat actor” that “accesses poorly maintained Cisco routers and deploys malware on unpatched devices using CVE-2017-6742. “
“Threat actors can use ChatGPT to sharpen cyberthreats, but no need to panic yet
“Startling dangers, such as autonomous attack mechanisms and sophisticated malware coding, have yet to materialize. For now, the threat is more specific.”
“a new Malware Analysis Report (MAR) on an infostealer known as ICONICSTEALER. This trojan has been identified as a variant of malware used in the supply chain attack against 3CX’s Desktop App.
“CISA recommends users and administrators to review the following resources for more information, and hunt for the listed indicators of compromise (IOCs) for potential malicious activity:
Here’s a link to the latest Bleeping Computer Week in Ransomware.
From the cyber defenses front —
The Department of Health and Human Services announced
“On April 17, 2023, The U.S. Department of Health and Human Services (HHS) 405(d) Program announced the release of the following resources to help address cybersecurity concerns in the Healthcare and Public Health (HPH) Sector:
“Knowledge on Demand – a new online educational platform that offers free cybersecurity trainings for health and public health organizations to improve cybersecurity awareness.
“Health Industry Cybersecurity Practices (HICP) 2023 Edition – a foundational publication that aims to raise awareness of cybersecurity risks, provide best practices, and help the HPH Sector set standards in mitigating the most pertinent cybersecurity threats to the sector.
“Hospital Cyber Resiliency Initiative Landscape Analysis – PDF – a report on domestic hospitals’ current state of cybersecurity preparedness, including a review of participating hospitals benchmarked against standard cybersecurity guidelines such as HICP 2023 and the National Institute of Standards and Technology Cybersecurity Framework (NIST CSF).”
“Cyber investments have become table stakes for businesses around the world. Cybercrime is increasing, with 91% of organizations reporting at least one cyber incident in the past year. Not only are they growing in numbers, but they are becoming more sophisticated and diverse, with new threats constantly emerging. According to the 2023 Deloitte Global Future of Cyber survey, in this environment, business leaders are changing how they think of cyber, and it’s emerging as a larger strategic discussion tied to an organization’s long-term success.
“Today, leaders should consider how to work cyber into every part of their business—from operations to the employee and the consumer. By creating business strategies that embed cyber, improve employee training, and build cyber into digital transformation initiatives; businesses can stay ahead of the curve and better protect their organizations. [The linked article explains] how some leaders are rethinking their approaches to cyber to help drive long-term growth for their companies.”
“Some of the biggest names in modern computing — including a winner of the prestigious Turing Award — are betting on a new type of operating system they say will be resilient against common cyberattacks and bounce back from ransomware infections within minutes.
“Those are bold claims. But the people behind the project include Michael Stonebraker, a serial tech entrepreneur and computer scientist at the Massachusetts Institute of Technology whose groundbreaking work on database systems earned him the Turing honor in 2015. He’s teaming up with Matei Zaharia, an associate professor at Stanford University and creator of the Apache Spark project, and Jeremy Kepnew, head of the MIT Lincoln Laboratory Supercomputing Center.
“It’s a total new paradigm,” said Michael Coden, associate director of cybersecurity at MIT Sloan School of Management, who took a part-time position at Boston Consulting Group as senior adviser in order to help lead the database-oriented operating system, or “DBOS” for short. “
“Stonebraker and Coden plan on demonstrating the open-source operating systems during the RSA Conference, the annual cybersecurity gathering San Francisco, next week and show in real time how it will bounce back from a simulated ransomware attack.”
The NIST Cybersecurity and Privacy Program made available,
“Enterprise application environments consist of geographically distributed and loosely coupled microservices that span multiple cloud and on-premises environments. They are accessed by a userbase from different locations through different devices. This scenario calls for establishing trust in all enterprise access entities, data sources, and computing services through secure communication and the validation of access policies.”
From the end of the PHE front, the CDC’s daily Covid tracker continues to point down; flu activity remains low nationally, and OPM released its end of PHE guidance for FEHB carriers yesterday.
From the post-Dobbs front, the Wall Street Journal reports,
“The Supreme Court on Friday allowed the widely used abortion pill mifepristone to remain on the market indefinitely, granting emergency requests from the Biden administration and the brand-name manufacturer of the drug.
“The high court blocked the effect of a lower-court order that was poised to limit access to the pill, which is used in more than half of U.S. abortions. The Supreme Court’s action wasn’t a decision on the merits of the case; instead, the justices were deciding whether the pill could remain available during a continuing legal challenge brought by antiabortion groups.
“The court’s order was unsigned and provided no reasoning, as is typical in emergency actions. But it indicated that FDA-approved access to mifepristone would remain until litigation concludes in the lower courts and the Supreme Court itself has an opportunity to review those decisions—a timeline that likely will take many months.”
Patient volumes are back in a big way, at least for the country’s largest for-profit hospital operator.
HCA Healthcare beat Wall Street’s expectations of profitability in the first quarter of 2023, as more people flocked to HCA’s hospitals, surgery centers, and physician clinics. Inpatient admissions, all types of surgeries, and emergency room visits were each up significantly in the first quarter of this year, compared with the same period last year, when the Omicron variant of the coronavirus stymied a lot of patient care.
Financial reserves play an important role for not-for-profit hospitals and health systems in ensuring that they can continue to serve their communities in the face of challenging operational and financial headwinds, according to a new report prepared for the AHA by Kaufman Hall. The report explains how financial reserves enable struggling not-for-profit hospitals and health systems to make needed investments, borrow at affordable interest rates, cover operating expenses and remain available to their communities as surging labor and supply costs, investment losses and other challenges persist.
Amid a scramble to assemble a health care policy package in the Senate, a pair of key senators have significantly changed a proposal to cap insulin costs.
The new legislation by Senate Diabetes Caucus co-chairs Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) would cap insured patients’ insulin costs at $35 per month for at least one insulin of each type and dosage form, and require pharmacy benefit managers to pass through rebates they collect from insulin manufacturers to the insurance plans that employ them.
The legislation also includes several provisions related to biosimilar policy. The bill would create a new, expedited pathway for the Food and Drug Administration to consider biosimilars that would be alternatives to biologics without adequate competition and would allow Medicare drug plans to put biosimilars on their formularies as soon as they come on the market.
That is a major shift from the version of the bill that the senators released last year, which was structured differently around offering incentives to get drug manufacturers to voluntarily lower the prices of insulin.
Politico discusses a bipartisan bill to shift some Medicare coverage to home.
From the miscellany front, Healthcare Dive offers a potpourri of wrap-up stories on the HIMSS conference that ended yesterday.
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