FEHBlog

Thursday Miscellany

David Ermer–Congress, COVID-19, Mental health care, Telehealth, U.S. Healthcare–
Photo by Josh Mills on Unsplash

From Capitol Hill, Roll Call reports

The Senate is expected to begin consideration of Democrats’ climate, tax and health care package on Saturday, leaving about two days for the party to shore up support for the bill.

Senate Majority Leader Charles E. Schumer said Thursday that he’s expecting a vote on the motion to proceed Saturday afternoon, which would follow a nomination vote he scheduled for 12:30 p.m.

The motion to proceed is a simple majority threshold; no Republicans are expected to back it. 

If Democrats can secure the votes to move forward, it would trigger up to 20 hours of debate before a “vote-a-rama,” when senators can offer unlimited amendments and motions to delay the process. The debate time is equally divided between the parties and senators on either side can choose to yield back time in order to get to the vote-a-rama quicker. 

It remained unclear Thursday afternoon whether party leaders had secured crucial backing from Sen. Kyrsten Sinema. * * *

Democrats are also working to wrap up the “Byrd bath,” in which the Senate parliamentarian hears arguments from both parties and issues opinions on whether provisions meet conditions of the budget reconciliation rules. Reconciliation allows the bill to avoid a filibuster and pass with only Democrats’ votes in the 50-50 Senate. * * * [Sen.] Sinema is expected to wait for the process to play out before making her position on the package known.

While the FEHBlog was writing this post, Politico reports

Sen. Kyrsten Sinema announced on Thursday night that she’s signed off on Democrats’ climate, tax and health care legislation after securing a handful of changes. 

The Arizona Democrat was not consulted during July’s dealmaking between Senate Majority Leader Chuck Schumer and Sen. Joe Manchin, but after changes to several tax provisions she okayed the agreement on Thursday. “We have agreed to remove the carried interest tax provision, protect advanced manufacturing, and boost our clean energy economy in the Senate’s budget reconciliation legislation. Subject to the Parliamentarian’s review, I’ll move forward,” Sinema said.

From the Omicron and siblings front

The New York Times explores the question “Is This What Endemicity Looks Like?” The article points out “The basic footprint of the disease has been consistent for a few months.”

We’ve been at roughly the same number of hospitalizations and deaths in the country since the end of the initial Omicron wave in the winter. And because so much of that has to do with how much better our immune systems are working against Covid than in the past, there’s probably no reason to think that those dynamics are going to dramatically change unless there’s an out-of-left-field new variant like the original Omicron.

And I think that fits the layperson’s understanding of what an endemic disease is: It’s circulating, but it’s sort of in the background, and while there are some little peaks and some little valleys, they aren’t so dramatic that they threaten to really upend life at a community level, let alone at a national level. That’s a pretty fair description of where we are right now.

While Omicron remains a dangerous virus, particularly for the elderly, which of course is where we started, we now have vaccines against severe illness and treatments for the virus.

It’s worth reading the article.

MedPage Today tells us

Most patients with smell or taste dysfunction related to COVID-19 reported complete recovery of their senses at 2 years, according to a cross-sectional survey conducted in Italy.

Among 119 patients with smell or taste dysfunction within 4 weeks of COVID onset, 88.2% reported complete resolution at 2 years, 9.2% reported a decline in symptom severity, and 2.5% reported unchanged or worsening symptoms, said Paolo Boscolo-Rizzo, MD, of the University of Trieste, and colleagues.

MedPage also offers us some Omicron miscellany

The CDC may relax guidance for COVID-19 control, including for schools, possibly as early as this week. (CNN)

And Los Angeles schools plan on updating COVID-19 protocols for the upcoming school year by dropping “overly aggressive” testing, masking, and vaccination requirements. (KTLA).

From the monkeypox front,

NPR reports

The White House today declared monkeypox a public health emergency. 

“We are prepared to take our response to the next level in addressing this virus and we urge every American to take monkeypox seriously,” Health and Human Services Secretary Xavier Becerra said to reporters during a briefing on Thursday. 

A public health emergency can trigger grant funding and open up more resources for various aspects of a federal response. It also allows the Secretary to enter into contracts for treatments and other necessary medical supplies and equipment, as well as support emergency hospital services, among other things. Public health emergencies last for 90 days but can be extended by the Secretary.

CDC Director Rochelle Walensky, said the declaration will provide resources and increase access to care. She also said it will expand the CDC’s ability to share data.

STAT News adds

Also Thursday, FDA Commissioner Robert Califf announced the agency was considering allowing Bavarian Nordic’s Jynneos, the only vaccine licensed in the United States to prevent monkeypox, to be given in two doses that are one-fifth the size of the licensed doses, via intradermal administration. Doing so could allow five times as many people to be vaccinated with existing supplies than if the licensed dosage was employed.

The vaccine is licensed as a two-dose product, with the doses administered via intramuscular injection 28 days apart.

“We believe this could be a promising approach,” Califf said.

In other public health news, the Department of Health and Human Services announced

Our nation’s blood and plasma supply dropped to historic lows during the COVID-19 pandemic. While some areas of the country have seen improvement, other areas are still struggling to meet the demand. Blood and plasma are needed on an ongoing basis to treat a variety of life-threatening conditions, which is why the U.S. Department of Health and Human Services (HHS), is launching a new campaign, Giving = Living. * * *

Visit hhs.gov/givingequalsliving to learn more about the importance of donation and make an appointment at a donation location near you.

From the U.S. healthcare business front —

Healthcare Dive tells us

Cigna reported net income increased 6% year over year to $1.6 billion during the second quarter as fewer people were admitted to the hospital, had fewer surgeries and visited the emergency room less. 

The Connecticut-based insurer said medical costs for both COVID-19 and non-COVID-19 care were lower than projected. The insurer’s medical loss ratio, an important measure of how much is spent on medical care, fell to 80.7% for the second quarter. Analysts said price hikes helped the MLR, too. 

As a result of the quarterly performance, Cigna raised financial targets for the year for revenue and income from operations. 

Fierce Healthcare informs us

Telehealth company Amwell is working with CVS Health to roll out the retail drugstore giant’s new virtual primary care service.

CVS announced at the end of May plans to launch a virtual care service that gives consumers access to primary care, on-demand care, chronic condition management and mental health services. Eligible Aetna and CVS Caremark members will be able to use the virtual primary care service to access healthcare services on demand, whether at home or in a retail or community-based setting, the drug store company said.

CVS’ virtual care platform is a “consumer-centric offering designed to bring together the many elements of CVS Health ecosystem services into a single integrated experience with a unified digital front door,” Dr. Ido Schoenberg, chairman and co-chief executive officer of Amwell, said during the company’s second-quarter earnings call Thursday.

and

Elevance Health is betting big on primary care with a new nationwide partnership with Aledade.

The team-up will focus on assisting primary care practices in transitioning to value-based care, to boost health outcomes and lower costs. Independent primary care practices that are within the insurer’s network will be able to access Aledade’s suite of technology and local, in-person services.

Aledade’s platform provides the tools, support and resources that PCPs need to roll out value-based care, the companies said.

Bloomberg reports

Pfizer Inc. will spend $470 million to expand its vaccine research facilities 25 miles northwest of New York City, where the company hopes to maintain its edge in the booming field of messenger RNA, the technology behind its blockbuster Covid-19 shot. 

The drugmaker will construct a new building and renovate existing facilities on its campus in Pearl River, New York, which has been the nexus of laboratory research driving its vaccine programs, including the one for Covid in partnership with BioNTech SE.

From the substance use disorder front, NPR explains

Music festivals once frowned upon naloxone, and some banned it. But even though what’s known as harm reduction — the concept of minimizing the negative effects of illicit drug use without trying to stop it altogether — has gained acceptance, it’s far from embraced. Less accepted than naloxone among concert promoters is helping people test their drugs for fentanyl. Companies don’t want to be seen as condoning drug use. They’re also navigating a legal gray area and battling public perceptions. * * *

Overdose deaths continue to climb in the U.S. Drug fatalities topped 100,000nationwide in 2021, with two-thirds caused by synthetic opioids. This has prompted federal and state governments to try to think of new ways to combat the crisis, with the Biden administration giving $30 million to support programs that have often operated in the shadows. In the past few years, the Substance Abuse and Mental Health Services Administration also has fully embraced fentanyl test kits.

Still, many communities far beyond music festival grounds are resistant to harm-reduction strategies, especially fentanyl-testing tools. Dr. Yngvild Olsen, director of SAMHSA’s Center for Substance Abuse Treatment, said harm reduction requires an evolution in thinking, and she encourages organizations to consider harm reduction a lifesaving tool — especially when mass overdoses are possible.

From the telehealth front, Health Payer Intelligence reports

Telehealth flexibilities during the coronavirus pandemic contributed to a 26 percent spike in overall utilization of in-network outpatient behavioral health, according to a report from UnitedHealth Group.

“Prior to the COVID pandemic, telehealth was broadly viewed as a potential strategy for improving access to behavioral health care,” the report explained. 

“During the pandemic—which saw increased rates of depression, anxiety, and substance use disorder—federal and state policymakers and commercial health plans established temporary flexibilities to increase access to care, and patients and providers increased their use of virtual visits as an alternative to in-person office-based care.”

Midweek Update

David Ermer–ACA, CDC, Congress, COVID-19, OPM, Rx coverage, U.S. Healthcare, Wellness–
Photo by Manasvita S on Unsplash

From Capitol Hill, Roll Call reports

Democrats may need to make some changes to the tax portion of their budget reconciliation package to earn the support of Arizona Sen. Kyrsten Sinema, including possible removal of a tax increase on investment fund managers and softening a new minimum tax on the biggest corporations.

The bill could also undergo other tweaks as Senate Parliamentarian Elizabeth MacDonough continues her review of the bill. Changes to the prescription drug pricing provisions are already in the works, but many pieces of the package have yet to go through the formal “Byrd bath” to determine whether the language complies with budget rules.

Despite all the work still underway, several Democratic senators said they anticipated voting on the motion to proceed to the reconciliation package as soon as Thursday and beginning the “vote-a-rama” process, in which senators can offer unlimited amendments to the measure, as soon as this weekend. 

“As soon as possible, but don’t count on going home on the weekend,” Michigan Sen. Debbie Stabenow, a member of Democratic leadership, said. “We’re probably going to be here all weekend, so get lots of sleep.

From the OPM front, Federal News Digest tells us

The Office of Personnel Management is getting a second in command.

President Joe Biden nominated Rob Shriver to be the OPM deputy director on Aug. 3. * * *

Shriver is a political appointee already, having been the associate director for employee services since January 2021.

If confirmed by the Senate, Shriver would be OPM’s first deputy director since Michael Rigas, who held the job from March 2018 to January 2021, but worked in other administration positions from March 2020 until January 2021.

From the Omicron and siblings front —

Bloomberg informs us

[Israeli] Hospital workers who got a fourth dose of Pfizer Inc.’s messenger RNA vaccine were far less likely to get Covid than triple-vaccinated peers in a study. 

The findings published Tuesday in the American Medical Association’s open access journal are the latest to confirm the benefits of a second booster against breakthrough infections caused by omicron. The study’s authors pointed to an extra dose as a tool to prevent medical staff shortages and spare health systems in times of strain.  * * *

Doctors, nurses and other health-care workers who got a fourth mRNA shot in January showed a 7% rate of breakthrough infections. Those with three doses — the third having been administered by the end of September — saw an infection rate of 20%.  

The Department of Health and Human Services released two reports on long Covid to support patients and further research.

From the monkeypox front

  • Beckers Hospital Review explains that the Centers for Disease Control have released isolation guidance “as cases near 6,000.”

The New York Times delves into various aspects of the disease, including what people can do the stay safe.

From the U.S. healthcare business front

Healthcare Dive reports

CVS Health raised its full-year guidance in its second quarter earnings report despite a $77 million decrease in adjusted operating income primarily due to declines in its retail segment.

The company’s Aetna subsidiary boosted earnings with reported gains of 922,000 covered lives compared to the second quarter of last year and growth in all product lines contributing to a nearly 11% rise in revenues year over year.

Adjusted operating income was 9.1% lower in its retail division compared to the year prior due to a decrease in coronavirus vaccinations, “continued pharmacy reimbursement pressure” and the lack of an antitrust legal settlement gain that was recorded in the second quarter last year, according to the earnings report. * * *

In its race to add more primary care services, the executive team further teased acquisition plans, with [CVS Health CEO Karen] Lynch adding that the company could take the “next step on this journey” by the end of this year.

“We can’t be in … primary care without M&A. We’ve been very clear about that,” Lynch said.

[Larry] McGrath [CVS Health senior vice president of business development and investor relations] added that the company has been active in evaluating a wide range of assets around the care delivery space. CVS also signaled that it could potentially pursue multiple acquisitions, adding that there was “no one and done asset” in the market.

Biopharma Dive informs us

Gilead’s cell therapy business outperformed Wall Street expectations during the second quarter. The unit — which currently consists of two products, Yescarta and Tecartus, used to treat various blood cancers — generated $368 million in the three-month period, an increase of 68% year over year, earnings numbers released Tuesday show.

Key to that growth was a recent, first-of-its-kind approval from the Food and Drug Administration. In April, the agency cleared Yescarta as a so-called second line therapy for large B-cell lymphoma that resists or returns within a year of initial treatment with chemoimmunotherapy. Before, Yescarta was used only when patients either relapsed after or hadn’t responded to at least two other kinds of therapies.

Fierce Healthcare adds

CivicaScript’s first product is hitting the market.

The public benefits company and sister to Civica Rx is making its first generic available: 250-mg abiraterone acetate tablets. The drug is used in combination with the steroid medication prednisone as a treatment for prostate cancer that has spread to other parts in the body.

CivicaScript will make the drug available to pharmacies at $160 per bottle of 120 tablets, a typical one-month supply. The company suggests pharmacies sell it to patients at no more than $171 for each bottle. This price is about $3,000 less per month than the average cost for people enrolled in Medicare Part D, which is the largest portion of patients with this type of cancer.

Using CivicaScript’s abiraterone will lead to significant savings for patients both in the deductible phase and in the Part D “donut hole,” where they face the highest out-of-pocket costs, the company said in an announcement (PDF). * * *

“We’re proud the first lower-cost generic drug of our partnership with CivicaScript is entering the market,” said Kim Keck, president and CEO of BCBSA. “This is an important milestone in our shared commitment to help make prescription drugs more affordable for millions of Americans. No one should have to face breaking the bank from buying a life-saving medication.”

From the Affordable Care front, Prof. Katie Keith takes a deep dive into last week’s ACA FAQ 54 on mandated contraceptive coverage under that law.

From the research front —

Benefits Pro points to

A survey of nearly 2,500 U.S. healthcare consumers by PYMNTS.com offered more proof that this remains a barrier to consumer trust of the healthcareThe survey revealed that many consumers continue to under budget for their health care –probably because most have little idea about the cost of various procedures and appointments. * * *

For instance, nearly 20% of those surveyed said they “experienced financial distress due to health care costs because they spent more than they could afford in the past 12 months.” A quarter of respondents who said their advance notice cost estimates were accurate said they still spent more than they could really afford. Not surprisingly, 43% of those who received inaccurate cost estimates said they spent more than they could afford. system. PYMNTS.com, a provider of data, news and insights on innovation in payments and the payment-related, conducted the survey to learn how many respondents fell into the unexpectedly high and inaccurate estimate category, and what the outcome for them was in the aftermath. * * *

Medscape reports

Regular exercise, regardless of intensity level, appears to slow cognitive decline in sedentary older adults with mild cognitive impairment (MCI), new research from the largest study of its kind suggests.

Topline results from the EXERT trial showed patients with MCI who participated regularly in either aerobic exercise or stretching/balance/range-of-motion exercises maintained stable global cognitive function over 12 months of follow-up — with no differences between the two types of exercise.

“We’re excited about these findings, because these types of exercises that we’re seeing can protect against cognitive decline are accessible to everyone and therefore scalable to the public,” study investigator Laura Baker, PhD, Wake Forest University School of Medicine, Winston-Salem, North Carolina, said at a press briefing.

The topline results were presented at the Alzheimer’s Association International Conference (AAIC) 2022.

Tuesday Tidbits

David Ermer–CDC, Congress, COVID treatment, COVID-19, Federal employment benefits, U.S. Healthcare, Uncategorized–
Photo by Patrick Fore on Unsplash

Roll Call reports from Capitol Hill

More than 3.5 million veterans who were exposed to toxic substances on overseas deployments will gain easier access to health and disability benefits under a bill that cleared the Senate Tuesday.

President Joe Biden is certain to sign the bill into law in the coming days.

The bill would make servicemembers who contracted any of 23 conditions — from brain cancer to hypertension — after being deployed to Iraq, Afghanistan and other combat zones automatically eligible for VA benefits. The measure is expected to cost nearly $280 billion over a decade, according to the Congressional Budget Office.

This law should save the FEHB Program money as the federal workforce has a large cadre of veterans who use veterans’ healthcare. VA facilities charge the FEHB and private sector plans for non-service connected health care. This law confirms that toxic substances treatment to service-connected care for which the VA is liable.

Govexec adds

The [VA] bill [also] authorizes leases for 31 new medical facilities at VA to help accommodate the expected surge in patients, which is expected to cost nearly $1 billion. The Congressional Budget Office found the slew of pay and other human resources changes would come with a $5.7 billion price tag over the next decade.

The bill will authorize the department to buy out the contract of health care professionals to recruit them to VA, so long as they make a four-year commitment to the department. VA will have $40 million per year for the buyouts. VA’s health care employees will be eligible for pay boosts worth 50% of their base salaries, up from the current cap of 30%. Overall pay would be capped at level two of the Executive Service pay scale, which is currently $203,000 per year. McDonough has called lifting the pay caps essential for VA’s recruiting and retention efforts and has aggressively pushed Congress to pass the reform.

With regard to the Schumer-Manchin reconciliation bill, the Hill reports that Senators Manchin and Simema are exchanging text on the bill.

From the Omicron and siblings front,

McKinsey and Company offer their assessment of when the Covid pandemic will end.

In this update, we discuss the outlook, the current and potential future use of boosters and therapeutics, and the shifts in response strategies to the COVID-19 crisis around the world. We also introduce the McKinsey COVID-19 Immunity Index—a tool for understanding a community’s current level of risk from the disease.

A group of physicians provides their observations in MedPage Today on how best to investigate the Paxolovid rebound issue.

The debate about “COVID-19 rebound” after nirmatrelvir/ritonavir (Paxlovid) treatment is one of these timely areas warranting further investigation. Continuing down the current path of uncertainty has consequences for how and by whom this antiviral should be used. However, by applying lessons learned from the early days of the pandemic — including acknowledging the importance of randomized controlled trials (RCTs) — we can avoid repeating the same mistakes. To do this, it is necessary to start by defining the question, identifying current knowledge gaps, and only then can one propose scientific solutions to bring a rapid resolution to the COVID-19 rebound controversy.

Paxlovid consists of two drugs: nirmatrelvir, which inhibits a SARS-CoV-2 protease inhibiting viral replication, and ritonavir, which slows the inactivation and breakdown of nirmatrelvir. Per a CDC health advisory released in May, COVID-19 rebound is defined as a return of symptoms or a “new positive viral test after having tested negative” occurring “2 to 8 days after initial recovery.” We just saw this over the weekend in the case of President Biden.

This definition of rebound is challenging and prone to inflating the incidence of rebound. It is possible some individuals identified as having “Paxlovid rebound” may have been experiencing a waxing and waning of COVID-19 symptoms while some unknown number of other reported rebound cases could be due to the known limitations of COVID-19 testing.

Precision Vaccinations tells us that in the near future the federal government will make the Omicron antibody based treatment known as Evusheld available through local pharmacies including “Albertsons, Acme, Jewel-Osco, Pavilions, Randalls, Safeway, Star Market, Vons, CPESN, Amber Specialty Pharmacy, Managed Healthcare Associates, and Thrifty White.”

Hugh Montgomery, Professor of Intensive Care Medicine at University College London, UK, and TACKLE principal investigator, commented in a press release, “Despite the success of vaccines, many individuals such as older adults, individuals with co-morbidities, and those who are immunocompromised, remain at risk for poor outcomes from severe COVID-19.”

“Additional options are needed to prevent disease progression and reduce the burden on healthcare systems, especially with the continued emergence of new variants.”

“The TACKLE (study) results show that one intramuscular dose of Evusheld can prevent these individuals from progressing to severe COVID-19, with earlier treatment leading to even better results.”

From the moneypox front, Fierce Healthcare reports

The White House has named Robert Fenton to serve as the response coordinator for the monkeypox outbreak, as calls for a larger federal role intensify. 

Fenton previously helped to coordinate COVID-19 vaccine distribution while working at the Federal Emergency Management Agency. He will work alongside Demetre Daskalakis, M.D., who will be the deputy coordinator. 

The coordinators will lead the administration’s efforts on “strategy and operations to combat the current monkeypox outbreak, including equitably increasing the availability of tests, vaccinations and treatments.” 

From the Affordable Care Act front, the International Foundation of Employee Benefit Plans informs us

The Internal Revenue Service (IRS) has issued Revenue Procedure 2022-34 providing the indexing adjustment for the required contribution percentage. For plan years beginning in 2023, the required contribution percentage is 9.12%, down from 9.61% in 2022. 

The affordability calculation can determine whether an individual can afford employer-sponsored health coverage and affect whether the individual would be eligible for a premium tax credit on the health insurance exchanges. This could affect employers that do not use a safe harbor method to determine whether the coverage they offer is affordable to employees.

For plan years beginning in 2023, employer-provided coverage is considered affordable for an employee if the employee required contribution is no more than 9.12% of that employee’s household income. Because applicable large employers generally do not know their employees’ household incomes, there are three safe harbor methods for calculating affordability.

In the FEHB Program, OPM must assure itself that the lowest premium nationwide FEHB plan premium for the self only option does not cost more than 9.12% of the lowest paygrade federal employee eligible to participate in FEHBP.

From the FEHB front, Fedweek columnist Reg Jones wraps up his series of federal employee and annuitant survivor benefits.

From the Medicare front, Healthcare Dive reports on provider reaction to yesterday’s final CMS rule on Medicare Part A payments to inpatient hospitals beginning October 1, 2022.

Providers remained largely unhappy early this week despite a final ruling issued by the CMS on Monday that increases inpatient payments to hospitals by more than was initially proposed.

Organizations like The American Hospital Association said it was “pleased” by the payment update, a 4.3% bump up from the proposed 3.2%, but added it “still falls short of what hospitals and health systems need to continue to overcome the many challenges that threaten their ability to care for patients and provide essential services for their communities.”

Group purchasing organization Premier agreed, saying the payment update “falls woefully short” of what is needed for health systems. “Coupled with record high inflation, this inadequate payment bump will only exacerbate the intense financial pressure on American hospitals,” SVP of Government Affairs Soumi Saha said in a statement.

Beckers Hospital review offers six takeaways from the final rule.

From the U.S. healthcare business front

Healthcare Dive reports

High operating expenses took their toll on hospitals and physician groups in June, producing negative year-over-year margins for a sixth consecutive month, a new report from Kaufman Hall found. Month-to-month increases in patient volumes were not enough to offset the growing cost of care, the advisory firm said Monday.

Compared with May, operating margins improved, contract labor costs fell as demand slowed, and expenses cooled slightly in the latest month. But the industry has yet to turn the corner on an “enormously difficult year,” the report said.

“Although hospitals are seeing improved volumes and reduced expenses month-over-month, they will likely end up with historically low margins for the remainder of the year,” Kaufman Hall predicted.

and

Louisiana-based Ochsner Health has officially merged with Rush Health Systems, giving the merged system seven hospitals and more than 30 clinics in the east Mississippi and west Alabama region, according to a Monday release.

New names and branding are being rolled out at regional hospitals under the new brand, Ochsner Rush Health, the release said. Ochsner Rush Health will have 250 staff and contracted physicians and 95 advanced practice providers.

Ochsner Rush Health is also boosting its minimum wage to $12 an hour, impacting more than 400 employees and representing a $1.5 million investment, according to the release.

From the public health front,

  • Healio offers a bleak outlook for chronic disease in the US over the next forty years “likely stressing an already burdened health care system.”
  • The Center for Disease Control points to its revamped diabetes website “for people with diabetes or who are at risk for diabetes, and their families and friends.”

From the judicial front,

STAT News tells us

In a significant victory for AbbVie, a U.S. appeals court panel declined to revive a lawsuit that accused the company of using a so-called patent thicket to forestall competition for its Humira medication, a franchise product that generates billions of dollars in sales each year.

The opinion shot down arguments by unions, insurers, and the city of Baltimore, which alleged that AbbVie “abused the patent system” and “erected significant barriers to entry to block biosimilar competition” by filing dozens of patents for the drug. Some of the 132 U.S. patents that the company holds on its medicine extend to 2034, although the basic patent expired in 2016.

The case has been closely tracked over concerns that the use of numerous patents — some of which may offer only marginal improvements or changes to a medicine — are exploited by pharmaceutical companies to protect monopolies at the expense of consumers. This has prompted the Food and Drug Administration and Patent and Trademark Office to jointly examine the issue.

Congress can change the patent system applicable to prescription drugs.

The American Hospital Association reports

The Department of Justice today filed a lawsuit challenging an Idaho law restricting abortion. The complaint seeks a declaratory judgment that the law conflicts with and is preempted by the Emergency Medical Treatment and Labor Act in situations where an abortion is necessary stabilizing treatment for an emergency medical condition. It also seeks an order permanently enjoining the law to the extent it conflicts with EMTALA, which requires hospitals that receive federal Medicare funds to provide necessary stabilizing treatment to patients who arrive at their emergency departments while experiencing a medical emergency.

The FEHBlog hopes that the federal court hearing the case seeks a decision from the Idaho Supreme Court on the scope of Idaho’s abortion law before proceeding with the case. The FEHBlog finds it hard to believe that any U.S. court would interpret its state’s abortion law as overriding obligations created by EMTALA and for that matter the Hippocratic Oath.

Monday Roundup

David Ermer–CMS, Congress, Medicare, U.S. Healthcare–
Photo by Sven Read on Unsplash

From the Capitol Hill front, the Hill reports

Senate Democrats are growing more anxious over maverick Sen. Kyrsten Sinema’s (D-Ariz.) five-day silence on a sweeping proposal to reform the tax code, tackle climate change and reduce the federal deficit.

Democratic lawmakers are privately worried that Sinema’s not happy about being left out of the negotiations between Senate Majority Leader Charles Schumer (D-N.Y.) and centrist Sen. Joe Manchin (D-W.Va.), which resulted in a surprise announcement last week of a major deal.   

Govexec.com reports on the Republican response to the Senate Appropriations Committee’s release of its twelve fiscal year 2023 appropriations bills last week.

From the Medicare front, Fierce Healthcare informs us

The Biden administration finalized a 4.3% bump for inpatient payments for the federal fiscal year 2023, an increase compared to the 3.2% that was originally proposed back in April. 

The Centers for Medicare and Medicaid Services released on Monday the final Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System rule that updates payments to hospitals. The rule also details health equity quality measures hospitals must now meet for participation in the Inpatient Quality Reporting program. 

Here’s a link to the CMS fact sheet on this final rule.

Revcycle Intelligence tells us that last week “CMS released FY23 final rules for hospice providers, inpatient psychiatric facilities, and inpatient rehabilitation facilities. The final rules for fiscal year 2023 include a 3.8% payment increase for hospice providers, 2.5% increase for inpatient psychiatric facilities, and 3.2% boost for inpatient rehabilitation facilities.

Also, last week, CMS released the FY 2023 final rules for skilled nursing facilities. The rule represents a 2.7% payment increase for SNFs.

Fierce Healthcare adds “CMS said Friday [July 29] that it expects the average premium to decrease to $31.50 in 2023, or about 1.8% from the 2022 rate of $32.08.

From the healthcare quality front, the National Committee for Quality Assurance released its Measurement Year 2023 HEDIS and CAHPS guidelines today. NCQA made publicly available a list of adds, drops and other significant changes for MY 2023.

From the U.S. healthcare business front, Bloomberg reports

Labcorp, a diagnostics and laboratory company, is spinning off its clinical trials division into a separate publicly traded company.

Labcorp will house the company’s existing global laboratory business while the new company will manage clinical trials for drug companies. Management said in a release Thursday [July 28] that this structure will allow each division more flexibility to grow within their individual markets.

From the post-Dobbs front, Healthcare Dive tells us

Abortion access nonprofit Just the Pill plans to build a fleet of mobile clinics offering mobile procedural abortion “for the first time in U.S. history,” the nonprofit said. * * *

The group currently operates two mobile clinics in Colorado and plans to build out its network of vans and deploy them in states where abortion is legal but surrounding states have banned the procedure, such as New Mexico, Pennsylvania and Illinois.

“Our mobile clinics will travel to parts of these states based on where the need is greatest,” Julie Amaon, medical director of Just The Pill, told Healthcare Dive. * * *

Mobile health clinics have been held up as an avenue to cut costs and expand healthcare access, especially in underserved or marginalized communities. One 2009 Boston study found that a mobile health clinic, The Family Van, had a return on investment of $36 for every $1 invested in the program. Mobile clinics can also provide primary and preventative care, an important feature given that many regions in the U.S. lack healthcare access.

Currently, there are an estimated 2,000 mobile clinics in America, providing almost 7 million visits each year.

From the wellness front, Morning Consult provides advice on offering wellness services to younger employees.

While benefits like annual raises and an employee assistance program (EAP) with appointment limits have been alluring, these perks are now expected by many Millennial and Gen Z employees, who will soon make up 75% of the U.S. workforce. 

Improving hiring and retention for the shifting workforce starts with understanding the core values that drive younger generations to join, or leave, organizations in the first place – and that’s health and mental well-being, as a whopping 83% of employees place their benefits as a main deciding factor in whether they will stay at their current job.

As a baby boomer, the FEHBlog prefers to refer to the younger crowd as Zoomers over Gen Z.

From the medical research front —

Medscape reports “A simple blood test that looks for a combination of specific RNA snippets may become a novel way to screen for early-onset colorectal cancer, suggests a new study published online in Gastroenterology.”

“The point would be to use this test as a routine part of annual healthcare, or for people in high-risk families every 6 months,” study senior author Ajay Goel, PhD, MS, chair of the Department of Molecular Diagnostics and Experimental Therapeutics at the City of Hope Comprehensive Cancer Center, Duarte, California, told Medscape Medical News.

“It’s affordable, it can be done easily from a small tube of blood, and as long as that test stays negative, you’re good,” Goel said, because even if patients miss a test, the next one, whether it’s 6 months or a year later, will catch any potential cancer.

Health IT Analytics informs us

A study published this week in Nature Communications shows that an automated clinical decision support tool for genetic disease diagnosis and treatment can provide accurate results and disease management guidance within 13.5 hours.

The tool, known as Genome-to-Treatment (GTRx), is a virtual disease management system that integrates whole genome sequencing to provide diagnostics and guidance for 500 diseases, according to a press releasediscussing the study’s findings. The study was completed in collaboration with multiple organizations, vendors, and health systems.

The study states that the 7,200 genetic disorders currently known to medical science result in high levels of morbidity and mortality in children, specifically in neonatal, pediatric, and cardiovascular patients. Approximately 140 million children worldwide suffer from rare genetic diseases, and experts estimate that 30 percent of them will not survive until their 5th birthday.

From the miscellany department, STAT News asks why monkeypox does not have a new name yet. The FEHBlog wonders if monkeypox’s name is changed, then what’s next chickenpox? swine flu?

Weekend Update

David Ermer–CDC, Congress, COVID-19, U.S. Healthcare–
Thanks to Alexandr Hovhannisyan for sharing their work on Unsplash.

While the House of Representatives starts its August recess / District work break this week, the Senate will remain in session for Committee business and floor voting. The Senate will be focusing on its reconciliation bill spurred by a compromise between Senate Majority Leader Chuck Schumer (D NY) and Sen. Joe Manchin (D WV). The Senate is scheduled for to begin its August recess / State work break next week.

Bloomberg reports that tomorrow the Justice Department’s antitrust case against Optum’s proposed merger with Change Healthcare begins in federal district court in Washington, DC. The Bloomberg article notes

Testing new theories in court is part of the Biden administration’s antitrust push. “Settlements do not move the law forward,” Jonathan Kanter, the Justice Department’s antitrust chief, said in a January speech. “We need new published opinions from courts that apply the law in modern markets in order to provide clarity to businesses.”

Last Friday, the FEHBlog linked to a Health Payer Intelligence article on anticipated premium spikes for 2023.

Fierce Healthcare adds

Executives from some of the country’s largest for-profit health systems say it’s likely their organizations will be able to pass rising cost pressures along to commercial insurers during the next round of contract negotiations. * * *

Looking to the coming year’s commercial negotiations, [Sam] Hazen said HCA has already seen “some early success and recognition by the payers” and that some of its recently renegotiated contracts reflected higher price escalation than those of the past.

“I think it’s reasonable to assume that we were in 3.5% to 4% zone previously with our commercial pricing,” he told investors. “We’re in a competitive positioning as a company globally and that allows us to negotiate based upon the inflationary pressures. … I believe our relationships will allow us to get to a number that makes sense for both organizations, but I do anticipate it being somewhere around the mid-single-digits.”

Universal Health Services Chief Financial Officer Steve Filton said his company is “aggressively” looking to trim under-earning managed care contracts and seek out higher prices in the coming year.

Both its acute and behavioral care hospitals are identifying contracts that “are not even remotely” keeping pace with inflationary and labor pressure and giving those payers notice of terminations “at a pace faster than, quite frankly, I can really remember,” he told investors.

What’s more, the Wall Street Journal catalogs the large array of costly healthcare problems that “have grown in the pandemic’s shadow.”

It’s also worth calling attention to

  • An NPR article reporting on an animal sedative xylazine that is now “is showing up in illegal street drugs up and down the East Coast.” What a mess.
  • A Kaiser Family Foundation article explaining how the CDC is handling a polio case that paralyzed a man in a vaccine-resistant community in Rockland County, NY.

The chances of a major outbreak tied to the Rockland County case are slim. The virus can spread widely only where there is low vaccine coverage and poor surveillance of polio cases, said Dr. David Heymann, a professor of epidemiology at the London School of Hygiene and Tropical Medicine and former director of the world’s polio eradication effort.

Rockland County has ample experience battling vaccine-preventable outbreaks. In 2018 and 2019, the county fought a measles epidemic of 312 cases among followers of anti-vaccine Hasidic rabbis.

“Our people defeated measles, and I’m sure we’ll eliminate the latest health concern as well,” County Executive Ed Daly told a news conference July 21.

Cybersecurity Saturday

David Ermer–Cybersecurity–

From the cyber breaches front, Health IT Security reports

Healthcare data breaches cost an average of $10.1 million per incident last year, IBM Security found in the 2022 edition of its “Cost of a Data Breach Report.” The figure signified a 9.4 percent increase from the 2021 report and a 41.6 percent increase from 2020. For the 12th consecutive year, the healthcare sector suffered the most expensive data breach costs compared to any other industry examined in the report. * * *

The use of stolen or compromised credentials remained the top cause of a data breach in the 2022 report, accounting for 19 percent of all analyzed breaches.

[P]hishing attacks emerged as the second most common cause of a breach, accounting for 16 percent of all analyzed breaches. Additionally, phishing was the most expensive breach type, averaging $4.91 million.

Business email compromise (BEC) averaged $4.89 million in costs, making it nearly as expensive as a phishing attack. Unsurprisingly, incidents that had the longest average times to identify and contain them were also the most expensive.

From the cybervulnerabilities front —

Cybersecurity Dive tells us

Threat actors are increasingly distributing malware via container files, including ISO and RAR, as well as Windows shortcut files (LMK), following prior decisions by Microsoft to block macros by default in Microsoft Office, according to Proofpoint research released Thursday.  

Microsoft previously disclosed plans to block XL4 and VBA macros in Office by default in October 2021 and February, respectively. 

Proofpoint researchers said the use of VBA and XL4 macros fell by 66%  between October 2021 and June of this year. The researchers call the movement one of the “largest email threat landscape shifts in recent history.”

CISA added another known exploited vulnerability to its catalog. Hackers News explains

The vulnerability, tracked as CVE-2022-26138, concerns the use of hard-coded credentials when the Questions For Confluence app is enabled in Confluence Server and Data Center instances. “A remote unauthenticated attacker can use these credentials to log into Confluence and access all content accessible to users in the confluence-users group,” CISA notes in its advisory.

From the ransomware front, while regrettably Bleeping Computer’s The Week in Ransomware is off again this week, Bleeping Computer does report

Ransomware statistics from the second quarter of the year show that the ransoms paid to extortionists have dropped in value, a trend that continues since the last quarter of 2021.

Ransomware remediation firm Coveware has published a report today with ransomware data from the second quarter of 2022 showing that although the average payment increased, the median value recorded a significant drop.

This continues a downward trend since Q4 2021, which represented a peak in ransomware payments both average ($332,168) and median ($117,116).

“This trend reflects the shift of RaaS affiliates and developers towards the mid-market where the risk to reward profile of attack is more consistent and less risky than high profile attacks,” comments Coveware in the report.

“We have also seen an encouraging trend among large organizations refusing to consider negotiations when ransomware groups demand impossibly high ransom amounts.” The median size of the companies targeted this quarter dropped even further, with the actors looking for smaller yet financially healthy organizations to disrupt, the company says.

Security Week adds

Cybersleuths at Microsoft have found a link between the recent ‘Raspberry Robin’ USB-based worm attacks and EvilCorp, a notorious Russian ransomware operation sanctioned by the U.S. government.

According to fresh data from Redmond’s threat intelligence team, a ransomware-as-a-service gang it tracks as DEV-0206 has been caught rigging online ads to trick targets into installing a loader for additional malware previously attributed to EvilCorp.

Even more ominously, Microsoft said its research teams discovered EvilCorp malware distribution tactics and observed behavior all over the ‘Raspberry Robin’ worm seen squirming through corporate networks earlier this week.

The connection suggests the cybercriminals behind the EvilCorp operation are working with other groups to get around the U.S. Justice department sanctions that block ransomware extortion payments.

“The use of a RaaS payload by the ‘EvilCorp’ activity group is likely an attempt by DEV-0243 to avoid attribution to their group, which could discourage payment due to their sanctioned status,” Microsoft said. EvilCorp is allegedly run by Russian nationals Maksim Yakubets and Igor Turashev, who were charged by the United States in 2019. 

Friday Stats and More

David Ermer–CDC, COVID-19, Rx coverage, Telehealth, U.S. Healthcare–

Based on the Centers for Disease Controls Covid Data Tracker and using Thursday as the first day of the week, here is the FEHBlog’s weekly chart of new Covid cases for 2022:

The CDC’s weekly review of its Covid statistics notes “As of July 27, 2022, the current 7-day moving average of daily new cases (126,272) decreased 0.9% compared with the previous 7-day moving average (127,478).”

Here is the CDC’s chart of daily trends in new Covid hospital admissions:

The CDC’s weekly review notes “The current 7-day daily average for July 20–26, 2022, was 6,340. This is a 1.7% increase from the prior 7-day average (6,231) from July 13–19, 2022.

Also, “CDC Nowcast projections for the week ending July 23, 2022, estimate that the combined national proportion of lineages designated as Omicron will continue to be 100% with the predominant Omicron lineage being BA.5, projected at 81.9% (95% PI 79.9-83.8%).”

STAT News reports

[New Yorker Janet] Handal and the roughly 200,000 other Americans to receive Evusheld have had to recalibrate their hopes. Although the Food and Drug Administration doubled the recommended dose to compensate, and the drug — when given along with the full complement of vaccines — still offers protection against severe disease, gone are hopes that the most vulnerable could ditch masks or return to their pre-Covid lives.

Although the problem is now eight months old, few other prophylactic drugs for people with compromised immune systems are on the horizon. Several companies have announced plans to bring forward new Covid-19 antibodies, but they virtually are all either still in animal studies or are being principally developed as therapeutics.

The absence is particularly notable given the potential size of the market: Although Evusheld has remained vastly underused, a fact some physicians attribute to its hazily defined efficacy, between 7 and 10 million Americans are immunocompromised — a huge market by drug industry standards.

Here’s the FEHBlog’s weekly chart of new Covid deaths for 2022:

The CDC’s weekly review notes “The current 7-day moving average of new deaths (364) has decreased 4.8% compared with the previous 7-day moving average (382).”

Here’s the FEHBlog’s weekly chart of Covid vaccinations distributed and administered from the 50th week of 2020, when the Covid vaccination era began to the 30th week of 2022:

The CDC’s weekly review notes, “About 223.2 million people, or 67.2% of the total U.S. population, have been fully vaccinated.* Of those fully vaccinated, about 107.9 million people have received a booster dose, but 50.1% of the total booster-eligible population has not yet received a booster dose.”

Reuters reports

The U.S. government said on Friday it agreed to a $1.74 billion deal for 66 million doses of a Moderna COVID vaccine updated for the Omicron subvariant for use in a fall and winter booster campaign ***. Combined with 105 million doses the government already agreed to buy from Pfizer Inc and partner BioNTech SE for $3.2 billion, the latest deal puts the U.S. booster dose supply at about 171 million shots. read more

In CDC Communities News

As of July 28, 2022, there are 1,474 (45.8%) counties, districts, or territories with a high COVID-19 Community Level, 1,144 (35.5%) counties with a medium Community Level, and 602 (18.7%) counties with a low Community Level. Compared with last week, this represents a moderate increase (+3.9 percentage points) in the number of high-level counties, and a small decrease (−2.11 percentage points) in the number of medium-level counties and also a small decrease (−1.74 percentage points) in the number of low-level counties. 49 out of 52 jurisdictions* had high- or medium-level counties this week. Rhode Island, New Hampshire, and the District of Columbia are the only jurisdictions to have all counties at low Community Levels.

To check your COVID-19 Community Level, visit COVID Data Tracker. To learn which prevention measures are recommended based on your COVID-19 Community Level, visit COVID-19 Community Level and COVID-19 Prevention.

From the monkeypox front, the FDA provides an update on the agency’s response to this outbreak.

From the mental healthcare front —

MedPage Today brings us encouraging news

Local outpatient mental health providers are doing fine handling the increased demand from the newly launched nationwide “988” Suicide and Crisis Lifeline, despite fears that they wouldn’t be ready, according to a senior administration official.

“The states and call centers across the country absolutely rose to the increased volume that we saw,” the official said Thursday evening during a background briefing on distribution of federal grants to shore up mental health services in schools. “We can see a 45% increase in the volume of calls that came in the week of the launch, compared to the week prior, across the country — an additional 23,000 … calls, texts, and chats that came in across the lifeline.”

Healthcare Dive reports that CVS Health has appointed its first chief psychiatric officer. “Taft Parsons, MD, who has previously worked for Molina Healthcare and Henry Ford Health System, will be tasked with focusing on mental well-being for patients and will lead the Aetna Medical Affairs Behavioral Health organization.” Good luck, Dr. Parsons.

From the medical research front —

  • HealthDay informs us  “Obesity, depression, high blood pressure, asthma: These are just a few of the chronic health conditions that are now affecting almost 40 million Americans between the ages 18 and 34, new federal data shows.”
  • Mhealth Intelligence adds “While discovering new methods of care during the COVID-19 pandemic, Stanford Medicine researchers found that a smartphone app known as SkinIO is highly resourceful when detecting skin cancer among older people.”

From the telehealth front —

  • UPI reports “Using telehealth to supplement or replace in-person maternal care services, such as postpartum depression and diabetes and hypertension monitoring during pregnancy, leads to similar — and sometimes better — clinical outcomes and patient satisfaction compared to in-person care. That’s the gist of a study whose findings were published Monday in Annals of Internal Medicine.”

Finally, Health Payer Intelligence discusses a strategy for communicating relating high health plan premium increases for next year.

There are two key factors that will influence employer-sponsored health plan premiums in 2023, Jim Winkler, chief strategy officer at the Business Group on Health, told HealthPayerIntelligence by email: 

* Market inflation on prices of healthcare services

* Utilization rate of healthcare services

“Heading into 2023, employers face uncertainty in terms of the impact of market inflation on the prices of health care services and potential increases in utilization of those services,” Winkler said. 

“This all comes at a time when employers also have a heightened focus on attracting and retaining key talent while addressing the overall health and well-being needs of the workforce and their families.” * * *

“As employers prepare to communicate with their workforce, they will see that employees tend to be focused on what any cost increase means to them, both in terms of out-of-pocket costs and paycheck deductions. Employers will therefore need to assist employees on understanding how best to manage their own costs,” Winkler recommended.

Omnichannel communication with health plan members can be particularly useful for improving member engagement in employer-sponsored health plans. With omnichannel communication, payers and employers coordinate communication across multiple channels and platforms, improving the timeliness and convenience of member interactions.

Thursday Miscellany

David Ermer–ACA, Congress, COVID-19, COVID-19 vaccine, Federal employment benefits, HIPAA Privacy and Security Rules, Medicare, OPM, Telehealth, U.S. Healthcare, Uncategorized–
Photo by Josh Mills on Unsplash

From Capitol Hill, the Wall Street Journal reports that the Senate majority’s leadership is rallying the caucus to pass the Schumer – Manchin compromise reconciliation bill that would address climate and healthcare concerns while raising taxes. The goal is for the Senate to pass the bill next week which immediately precedes the Senate’s August recess.

The Hill adds that

A day after Sen. Joe Manchin (D-W.Va.) stunned Washington by endorsing hundreds of billions of dollars for President Biden’s domestic agenda, House Democrats are rallying behind the nascent package as a crucial — if incomplete — strategy for tackling the climate crisis and easing working class economic strains.

Both articles discuss the flies remain in the reconciliation ointment.

Govexec informs us

The odds that Congress would increase the average 4.6% pay raise planned for federal employees in 2023 got a little longer Thursday, after Senate appropriators revealed that they would effectively endorse President Biden’s pay increase proposal.” The Senate Appropriations Committee on Thursday revealed all of their initial versions of fiscal 2023 spending bills, including the package governing financial services and general government, which is the vehicle by which Congress weighs in on federal employee compensation. That bill makes no mention of changes to career federal employees’ pay, effectively endorsing the pay raise plan offered by Biden in his fiscal 2023 budget proposal.

Here is a link to the Senate Appropriations Committee’s press release unveiling those bills. What caught the FEHBlog’s eye is the statement in the press release that the Senate appropriations bills, like the House appropriations bills, do not include the Hyde amendments limiting federal funding of abortions to cases of rape, incest, or endangerment of the mother’s life. That tectonic change would draw the FEHBP into the post-Dobbs controversy.

From the Affordable Care Act front, Prof. Katie Keith does her usual outstanding job breaking down the proposed ACA Section 1557 individual non-discrimination rule in Health Affairs Forefront. In the FEHBlog’s view, the rule is unnecessarily complicated. It is the FEHBlog’s understanding that this HHS rule would not apply to FEHBP and that HHS would refer Section 1557 complaints involving FEHB plans to OPM. As the preamble points out, Section 1557 is a law that doesn’t need an implementing rule. Nevertheless, HHS recommends that other agencies with programs covered by Section 1557 adopt their own implementing rule using the HHS rule as a template.

The ACA regulators issued a 13-page long ACA FAQ 54 describing in detail the ACA rule requirements under which health plans must cover contraceptive drugs and services for women without cost sharing.

On a related note, Healthcare Dive tells us

Melanie Fontes Rainer is now acting director of HHS’ Office of Civil Rights. Fontes Rainer will replace Lisa Pino, who oversaw rulemaking related to patient safety, reproductive rights and other healthcare issues and issued policy regarding health equity, long COVID and firearm injury and death prevention, the agency said in an emailed statement.

From the federal employee benefits front, Fedweek explains the circumstances under which survivors of federal employees (as opposed to federal annuitants) are eligible for federal survivor benefits.

If you are an employee who was married when you die and you had at least 18 months of creditable civilian service, your spouse will be entitled to a survivor annuity.  * * * f you were enrolled in either the self plus one or self and family options of the Federal Employees Health Benefits program when you died, the person(s) on your enrollment could continue that coverage. If you weren’t enrolled in the program (or were enrolled but in the self only option), any otherwise eligible survivors would be out of luck.

From the Omicron and siblings front, the American Medical Association offers a helpful Q&A on Covid boosters.

From the monkeypox front, Reuters makes two reports

  • The United States has the capacity to conduct 60,000-80,000 tests for monkeypox virus per week, Health and Human Services Secretary Xavier Becerra said on Thursday. When the monkeypox outbreak began, the U.S. was able to conduct only 6,000 tests per week, Becerra told reporters during a telephone briefing.
  • The U.S. Centers for Disease Control and Prevention (CDC) said on Wednesday it plans to make the rapidly spreading monkeypox disease a nationally notifiable condition. The designation, which is set to take effect on Aug. 1, updates criteria for reporting of data on cases by states to the agency and would allow the agency to monitor and respond to monkeypox even after the current outbreak recedes, the CDC said.

From the U.S. healthcare business front —

The American Hospital Association issued a report attacking the commercial health insurance industry, which in the FEHBlog’s view is akin to strangling the golden goose.

Healthcare Dive reports

Teladoc beat Wall Street expectations for revenue in the second quarter, with a topline of $592 million, up 18% year over year. Chronic care membership came in higher than analysts expected, while member utilization improved year over year.

But “all eyes” are on the vendor’s guidance for the rest of the year, which implies a third-quarter miss and a steep ramp-up for earnings in the fourth quarter, SVB Securities analyst Stephanie Davis wrote in a note on the results.

STAT News chimes in

Telehealth giant Teladoc is bracing for disappointing earnings this year as it faces headwinds that could also thwart competitors struggling to turn a profit — including increasingly frugal employers delaying or dropping contracts for virtual care.

“The challenge that we’re seeing is in these times of economic uncertainty, all purchases are just getting a significantly higher level of scrutiny,” CEO Jason Gorevic said in an earnings call Wednesday.

Gorevic also noted that declining yield on advertising suggests that individual patients may start spending less on direct-to-consumer services like BetterHelp, the company’s mental health care offering. Those hurdles aren’t unique to Teladoc. Competitors like Amwell and Talkspace could also have to grapple with cutbacks.

Healthcare Dive also delves into Amazon’s planned acquisition of One Medical. “The deal fast-tracks Amazon’s ambitions in healthcare, while giving One Medical a cushion in today’s tricky economic environment.”

Yesterday, the FEHB wrote about the hospitals receiving five stars from Medicare. Today Becker’s Hospital Review lists the 192 hospitals receiving a single start from that program.

Finally STAT News lists the 41 best books and podcasts on health and science to check out this Summer.

Midweek Update

David Ermer–Congress, COVID-19, COVID-19 vaccine, Medicare, Mental health care, Telehealth, U.S. Healthcare–

From Capitol Hill —

The Wall Street Journal reports

Sen. Joe Manchin (D., W.Va.) agreed to back a package aimed at lowering carbon emissions and curbing healthcare costs while raising corporate taxes, marking a stunning revival of core pieces of President Biden’s economic and climate agenda that the West Virginia Democrat had seemingly killed earlier this month. 

The deal, negotiated privately between Messrs. Manchin and Senate Majority Leader Chuck Schumer (D., N.Y.) since the start of last week, would raise roughly $739 billion, with much of the revenue coming from a 15% corporate minimum tax and enhanced tax enforcement efforts at the Internal Revenue Service, as well as projected savings from allowing Medicare to negotiate some prescription-drug prices.

Of that new revenue, roughly $369 billion would be spent on climate and energy programs, with another $64 billion dedicated to extending healthcare subsidies for three years for some Affordable Care Act users. The bill would dedicate the rest of the new revenue toward reducing the deficit, according to a summary provided by Messrs. Schumer and Manchin. * * *

The deal will still need the support of almost every other Democrat in Congress. Passing the agreement into law will test Mr. Schumer and the ability of House Speaker Nancy Pelosi (D., Calif.) to convince an ideologically diverse group of lawmakers to accept a deal announced by one of the party’s most conservative members. 

The announcement of a deal on Wednesday appeared to catch other Democrats off guard.

The Hill informs us

The House passed a bill Wednesday to expand telehealth services that were first introduced during the COVID-19 pandemic.

The legislation, titled the Advancing Telehealth Beyond COVID–19 Act, passed in a 416-12 vote. Eleven Republicans and one Democrat objected to the measure. Two Republicans did not vote.

The measure seeks to continue a number of telehealth policies established under Medicare that were first implemented at the beginning of the COVID-19 pandemic. If passed by the Senate and signed into law, the provisions would continue through 2024.

Fierce Healthcare adds

A key House panel advanced legislation to create an electronic prior authorization process for Medicare Advantage plans and several other reforms.

The House Ways and Means Committee unanimously advanced on Wednesday the Improving Seniors Timely Access to Care Act of 2022. The legislation has more than 300 co-sponsors and wide support across the healthcare industry.

From the Omicron and siblings front, Medpage Today asks “Can I boost with Novovax?”

While the Novavax shot is not yet authorized by the FDA as a booster, several experts told MedPage Today it could be headed that way.

“Probably the best niche now for Novavax’s purified protein vaccine is as a booster strategy for mRNA vaccines,” Paul Offit, MD, of Children’s Hospital of Philadelphia, who served on the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) on Novavax, told MedPage Today.

Robert “Chip” Schooley, MD, an infectious disease expert at the University of California San Diego who has served on VRBPAC in the past, said since there “aren’t many people left who have been neither vaccinated nor infected … it will likely be mainly used as a booster.”

NPR Shots tells us

The Biden administration may scrap plans to let more younger adults get second COVID-19 boosters this summer. Instead, officials are trying to speed up availability of the next generation of boosters in the fall, NPR has learned.

The new strategy is aimed at trying to balance protecting people this summer with keeping people safe next winter, when the country will probably get hit by yet another surge.

But the possible shift is being met with mixed reactions. The Food and Drug Administration could make a final decision by the end of the week. 

The dilemma facing the FDA is that the immunity many people have gotten from getting vaccinated or infected has been wearing off. At the same time, the most contagious version of the virus to emerge yet — the omicron subvariant BA.5 — is making people even more vulnerable.

So as COVID is starting to become more serious than a cold or flu again, most people younger than age 50 aren’t eligible for fourth shots — second boosters — to protect themselves. In response, the FDA was considering opening up eligibility for second boosters for all adults.

But letting more people get boosted with the original vaccine now could interfere with plans to boost them with updated, hopefully more protective vaccines in the fall to blunt the toll of the winter surge. 

It’s quite a conundrum for the experts.

From the monkeypox front

  • NPR provides a helpful FAQ on the disease.

The Centers for Disease Control and Prevention (CDC) has expanded access to vaccines, tests, and treatments for monkeypox, agency officials said in a webinar Tuesday.

The CDC expects to release more than 750,000 doses of the JYNNEOS vaccine from its strategic stockpile within days, said panelists at the Clinician Outreach and Communication Activity (COCA) call.

In addition, by working with commercial labs, the agency has expanded US testing capacity and streamlined requirements for administering the antiviral tecovirimat, they said.

Encouraging news from the HIV front. The Wall Street Journal reports

A 66-year-old man in Southern California and a woman in her 70s in Spain are the latest in a small group of people who appear to have beaten their HIV infections, providing researchers new clues to a possible cure at a time when Covid-19and other crises are slowing progress against the spreading virus.

Doctors caring for the man said they haven’t found any human immunodeficiency virus that can replicate in his body since he stopped antiretroviral drug therapy in March 2021 after a transplant of stem cells containing a rare genetic mutation that blocks HIV infection. He was given the transplant for leukemia, for which people with HIV are at increased risk. Details of his case were made public Wednesday and will be presented at a large international AIDS conference in Montreal that opens Friday.

“He saw many of his friends and loved ones become ill and ultimately succumb to the disease and had experienced some stigma associated with having HIV,” she said. His success “opens up the opportunity potentially for older patients to undergo this procedure and go into remission from both their blood cancer and HIV.

Also from the medical research front, STAT News informs us

[F]or several years, a small New Haven, Conn.-based startup has quietly been building technology to move the needle on suicide rates among the people at highest risk: those with a history of attempts or who have suicidal thoughts and have expressed a strong desire to die.

The company, called Oui Therapeutics, has raised roughly $26 million from high-profile investors like CVS Health Ventures and First Round Capital to develop and launch an app designed to train people how to quell their suicidal impulses. It pulls from in-person therapy methods that have shown dramatic reductions in suicide attempts — nearly 60% — in a randomized trial of soldiers at high risk. * * *

If the research bears out and the app secures buy-in from regulators, it could become a powerful tool in curbing suicide, which kills over 45,000 people in the U.S. each year. Oui is part of a broader constellation of efforts — including a new national suicide prevention hotline number and the development of prevention frameworks like Zero Suicide — in recent years that aim to address rates that have risen stubbornly high.

Fingers crossed for both worthy efforts.

From the Medicare front, Beckers Hospital Review reports

CMS updated its Overall Hospital Quality Star Ratings for 2022, giving 429 hospitals a rating of five stars.

CMS assigned star ratings to hospitals nationwide based on their performance across five quality categories. This year:

* 192 hospitals received a one-star rating

* 692 hospitals received a two-star rating

* 890 hospitals received a three-star rating

* 890 received a four-star rating

* 429 received a five-star rating

The article lists all of the five star hospitals by state.

From the U.S. healthcare business front, Healthcare Dive tells us

Humana raised its profit estimates for the full year after reporting lower than expected medical costs during the second quarter.

“The lower utilization trends and lack of COVID headwinds seen to date, give us confidence in raising our full year adjusted [earnings per share] guide,” Humana CFO Susan Diamond said Wednesday on a call with investors.

Humana’s net income increased 18% to $696 million for the second quarter as the Louisville-based insurer recorded increased revenues of $23.6 billion amid enrollment growth in both Medicare and Medicaid.

The insurer noted lower inpatient utilization among Medicare members for Q2.

But the lower-than-anticipated inpatient utilization has been partially offset by higher unit costs, Diamond said. * * *

The company’s total medical membership of 17.1 million was up 0.8% year over year.

As the company continues on its value creation plan to trim $1 billion in costs, Humana said it will restructure its organization into two distinct units as it looks to simplify the company’s overall organization.

Revcycle Intelligence reports on how healthcare spending varies by region and payer type.

There is substantial variation and low correlation in healthcare spending across Medicare, Medicaid, and private insurance plans within different US regions, a study published in JAMA Network Open found.

The US spends around $3.8 trillion per year on healthcare funded by Medicare, Medicaid, and private insurers. However, spending and healthcare utilization are rarely the same for all three payers. * * *

Healthcare spending per beneficiary varied across payers. The mean private insurance spending per beneficiary was $4,441, while the Medicare mean was $10,281, and the Medicaid mean was $6,127 per beneficiary. The overall mean for the three payers was $5,782 per beneficiary.

Medicaid had the most variation in spending per beneficiary across the [241 hospital referral regions] HRRs, with a coefficient of variation of 0.233, according to the study. Private insurance had a coefficient of variation of 0.160 and Medicare had a coefficient of variation of 0.126.

Medicaid and private insurance plans likely saw more variation in spending than Medicare because Medicare relies on regulated payments to hospitals, while Medicaid and privately insured prices are generally determined by the region’s market.

In addition to spending variation among the payers individually, there was low spending correlation within regions across all three payers.

For example, the correlation coefficient between HRR level spending was 0.020 for private insurance and Medicare, 0.213 for private insurance and Medicaid, and 0.162 for Medicare and Medicaid.

Tuesday Tidbits

David Ermer–CMS, Congress, COVID-19, U.S. Healthcare–

From Capitol Hill, EndPoints News reports

Photo by Patrick Fore on Unsplash

A bill that would cap out-of-pocket insulin costs for the insured at $35 per month remains in limbo as the Congressional Budget Office told the two Senate sponsors of the bill that it will likely increase net prices for insulin, and will increase premiums for commercial health insurance and Medicare Part D.

The comments from the CBO may spell the end for the bill, which is effectively a Band-Aid for a segment of the pharma market that has ballooned in recent years, driving many to ration their life-saving drug.

“Spending for insulin and other pharmaceutical products would increase, CBO estimates, because overall medication use would increase in response to lower cost-sharing requirements,” CBO director Phillip Swagel wrote to Sens. Jeanne Shaheen (D-NH) and Susan Collins (R-ME) on Friday. “Some use of insulin might also shift to newer and more expensive insulin products. Increased spending for pharmaceutical products would result in increased spending for health care overall.”

STAT News adds

Democrats are closer than ever before to finally achieving a goal they’ve been pursuing for nearly two decades — allowing Medicare to negotiate prescription drug prices. Skeptical lawmakers seem to be on board; the bill text is already under review by the Senate’s rules referee. Congressional leadership and the White House have come up with a plan to barrel toward a vote that could come as soon as next week.

Drugmakers, in turn, are intensifying their opposition efforts.

From the Omicron and siblings front

The Wall Street Journal informs us

Charley Ding spent weeks early in the pandemic intubating patients sick with Covid-19. The 42-year-old anesthesiologist in South Barrington, Ill., said he has since watched most of the doctors and nurses he works with get infected at some point.

But he has never gotten Covid-19, he said. “It’s probably a combination of being careful, maybe being blessed with a good immune system,” he said. “But also just luck.”

Dr. Ding is a member of a shrinking club of people who are pretty sure they have never been infected with SARS-CoV-2, the virus that causes Covid-19. Geneticists and immunologists are studying factors that might protect people from infection, and learning why some are predisposed to more severe Covid-19 disease.

For many, the explanation is likely that they have in fact been infected with the virus at some point without realizing it, said Susan Kline, professor of medicine at the University of Minnesota Medical School. About 40% of confirmed Covid-19 cases are asymptomatic, according to a meta-analysis published in December in the Journal of the American Medical Association.

More than two years into the pandemic, most people worldwide have likely been infected with the virus at least once, epidemiologists said. Some 58% of people in the U.S. had contracted Covid-19 through February, the Centers for Disease Control and Prevention has estimated. Since then, a persistent wave driven by offshoots of the infectious Omicron variant thas kept daily known cases in the U.S. above 100,000 for weeks. 

As someone who is a member of Dr. Ding’s shrinking club, the FEHBlog thinks that he may have had Covid at some point and in any event, it’s a matter of time before officially contracts it. Covid is gaining similarity to its cousin the common cold.

The FEHBlog has moved his residence inside the Capital Beltway to Dripping Springs, Texas. His Texas residence has a home office. He has come back to work at his DC law firm this week. When working in DC, he stays at a hotel next to his office building. All of this has cut into his commuting time when he listened to Russ Robert’s Econtalk. This evening he traveled up to have dinner with one of his sons outside Baltimore. This allowed him to listen to the July 18 episode of Econtalk during which Russ Roberts discussed Covid with Dr. Vinay Prasad of the University of California San Francisco. Their conversation is very insightful into the public health aspects of the Covid pandemic. It’s worth a listen or read the transcript on the website.

From the public health front, the Department of Health and Human Services announced

Today, the Centers for Medicare & Medicaid Services (CMS) unveiled its Maternity Care Action Plan to support the implementation of the Biden-Harris Administration’s Blueprint for Addressing the Maternal Health Crisis. The action plan takes a holistic and coordinated approach across CMS to improve health outcomes and reduce inequities for people during pregnancy, childbirth, and the postpartum period. CMS’ implementation of the action plan will support the Biden-Harris Administration’s broad vision and call to action to improve maternal health.

“Strengthening maternal health is key to strengthening the health and wellbeing of communities across America,” said HHS Secretary Xavier Becerra. “At HHS, we are taking unprecedented action to advance the Biden-Harris Administration’s vision to improve maternal health and tackle disparities, and I’m proud of the bold action plan CMS has laid out to contribute to our goals. Today is just the beginning: we will tirelessly work to make sure all mothers get the care and support they need.”

Through the action plan, CMS Administrator Chiquita Brooks-LaSure also encouraged industry stakeholders – including health care facilities, insurance companies, state officials, and providers – to consider key commitments the private sector can make to improve maternal health outcomes. Industry can submit proposed commitments at http://cms.gov/maternalhealthcommitments .

From the U.S. healthcare front, Healthcare Dive tells us

The Mayo Clinic earned the No. 1 spot for a seventh straight year in U.S. News & World Report’s best hospitals ranking published Tuesday. Cedars-Sinai Medical Center, NYU Langone Hospitals and the Cleveland Clinic followed next, with Johns Hopkins Hospital and UCLA Medical Center tied in fifth place.

In the specialty rankings, University of Texas MD Anderson Cancer Center was named best in cancer, Cleveland Clinic was first in cardiology and heart surgery, and NYU Langone Hospitals led in neurology and neurosurgery.

U.S. News added three service areas of evaluation this year, for ovarian, prostate and uterine cancer surgeries. The publication also introduced “home time” as an outcome measure in certain ratings, reflecting patients’ preference for recovering at home.

Becker’s Health IT looks at the Amazon – One Medical deal from the perspective of Amazon v. Optum.

From the U.S. healthcare business front, Fierce Healthcare reports

In its latest earnings results, [health insurer Centene] posted a $172 million loss in the second quarter, still beating the Street and slimming its losses compared to the prior year’s quarter. In the second quarter of 2021, Centene reported a $535 million loss, according to its earnings report released Tuesday morning. * * *

The company added about 200,000 members in the second quarter, reaching 26.4 million in total membership. That’s up by more than one million from the second quarter of 2021, when the insurer reported 24.7 million members.

“Our strong second quarter results reflect the consistency of Centene’s product performance,” Centene CEO Sarah London said in a statement. “The second quarter reflects continued execution on our Value Creation Plan with tangible actions and results, providing an excellent foundation from which we will continue to build over the next couple of years.”

From the reports and studies (tidbits?) department —

Health Leaders Media informs us

It’s payers, not providers, that American turn to when seeking out pricing information for healthcare services, according to a survey on price transparency.

The poll, conducted by YouGov on behalf of AI for healthcare operations company AKASA, highlights the need for both insurers and providers to follow pricing regulations for the sake of the patient experience.

Of the 2,026 adults surveyed nationally in March, just 36% indicate they have researched prices for services, of which 60% say they would look to their insurance company for pricing information.

When seeking out information through a payer, 44% would look on the insurer’s website and 29% would call their insurer.

InsuranceNews Net reports

A majority of those who receive health insurance through their employer-provided plan said they are more satisfied with the coverage they receive through work than they are with the current health insurance system overall.

That was one of the key takeaways from research conducted by Locust Street Group and presented at a webinar by America’s Health Insurance Plans. The research was part of AHIP’s Coverage@Work campaign, which aims to educate policymakers and the public about the value of employer-provided coverage.

The survey showed that although 54% of the 1,000 adults surveyed said they are satisfied with the current health system overall, 67% said they were satisfied with the coverage they receive through their employer.

What makes someone satisfied with their coverage? The top three reasons given were:

* Affordability – 45%

* Comprehensive coverage – 45%

* Choice of providers – 44%

Other factors that rounded out the list of reasons for being satisfied included: free preventive services, consistency, customer service, the ability to receive care locally, wellness incentives and innovation.