Tuesday report

Congress

Tuesday report

David Ermer–Congress, Medical / Rx research, No Surprises Act, Obesity, OPM, Rx coverage, U.S. Healthcare–

From Washington, DC,

  • The Government Accountability Office informs us
    • “Health care spending is higher in the U.S. than in any other high-income country. Yet, our health outcomes are worse. 
    • “It’s a tough issue to tackle. But when GAO faces tough policy challenges, the Comptroller General of the U.S. (and head of GAO) can convene a forum of experts to get their insights.  
    • Today’s WatchBlog post looks at our recent report about a forum on health care spending and quality of care.” * * *
    • During our forum on health care spending, experts from government, academia, and industry identified five key areas where—if action was taken—costs could be reduced and care improved. We provided approaches in these key areas to Congress in our report as potential options for addressing this issue.   
  • Politico reports,
    • President Donald Trump plans to appoint Dan Scavino, a longtime loyalist and White House deputy chief of staff, to run the Presidential Personnel Office, empowering him with the power to decide who can and cannot serve in the administration.
    • “Dan Scavino is one of President Trump’s most trusted and longest serving advisors,” said White House Press Secretary Karoline Leavitt. “There is nobody better to ensure the president’s administration is staffed with the most qualified, competent, and America First-driven workers. There is much still to be done and Dan’s leadership will ensure the highest quality, most dedicated workforce ever.”
  • Health Affairs Forefront offers a No Surprises Act litigation status check written by Professor Katie Keith.
    • “Nearly five years ago, President Trump signed the No Surprises Act into law, establishing new patient protections against surprise medical bills. Since the law took effect in 2022, millions of consumers have been protected from unexpected bills for out-of-network care—from emergency services to anesthesia to air ambulance rides. While the law has successfully protected consumers from the most common types of surprise out-of-network bills, its implementation has been hobbled by aggressive litigation.”

From the public health and medical research front,

  • The Wall Street Journal reports,
    • “Eli Lilly LLY said a third late-stage study of its experimental anti-obesity pill hit its key goals, paving the way for the drugmaker to begin regulatory submissions.
    • “Eli Lilly on Tuesday said the Phase 3 study of orforglipron in adults with obesity or overweight and type 2 diabetes met the primary and all key secondary endpoints at all three doses, showing significant weight loss, meaningful A1C reductions and improvements in cardiometabolic risk factors at 72 weeks.
    • “The Indianapolis company said study participants lost an average of 22.9 pounds, or 10.5% of their body weight, on the highest dose, with A1C, a measure of blood-sugar levels, reduced by an average of 1.8%.
    • “Eli Lilly said orforglipron also showed a safety profile consistent with injectable GLP-1 medicines, such as its blockbuster Mounjaro and Zepbound drugs.
    • “Eli Lilly said it now has the full clinical data package it needs to initiate global regulatory submissions for orforglipron this year.”
  • BioPharma Dive adds,
    • “An RNA medicine developed by Regeneron Pharmaceuticals and Alnylam Pharmaceuticals helped control symptoms of the chronic autoimmune disease generalized myasthenia gravis in adults enrolled in a late-stage study, Regeneron said Tuesday.
    • “Regeneron also tested the RNA medicine, called cemdisiran, together with an antibody drug it developed and sells as Veopoz for another disease. However, study results suggested the combination was not as effective as cemdisiran alone.
    • “Regeneron, which licensed cemdisiran from Alnylam, plans to submit the drug for U.S. approval in myasthenia gravis sometime in the first quarter next year. It is also testing the drug in paroxysmal nocturnal hemoglobinuria and geographic atrophy that is tied to age-related macular degeneration.”
  • Genetic Engineering and Biotechnology News notes,
    • “Germ cells pass DNA to the next generation and undergo massive reorganization of their DNA packaging to generate totipotency, or the ability to differentiate into any cell type. Understanding the mechanism of germ cell nucleome formation can offer valuable applications for addressing infertility. 
    • “In a new study published in Nature Structural & Molecular Biology titled, “The mitotic STAG3-cohesin complex shapes male germline nucleome,” researchers from Kyoto University have discovered STAG3-cohesin, a new mitotic cohesin complex that helps establish the unique DNA architecture of spermatogonial stem cells, which give rise to sperm. This discovery offers new strategies for treating infertility and certain cancers.”
  • JAMA posted a research letter about “Trends in County-Level MMR [Measles, Mumps and Rubella] Vaccination Coverage in Children in the United States.”
    • “Although the national- and state-level declines in MMR coverage are well documented, MMR vaccination coverage can vary substantially within a state.6 We generated a standardized dataset with annual county-level vaccination rates for children from 2017 to 2024 for all states in the US where this information was available and evaluated spatiotemporal trends in vaccination coverage during this period. This open, high-resolution dataset serves as a resource to explore the US vaccination landscape and its implications for vaccine-preventable disease.”
  • Per MedPage Today,
    • “Moderate-to-severe traumatic brain injury (TBI) increased malignant brain tumor risk in a large retrospective study of civilians.
    • “This risk persisted when findings were meta-analyzed with data from two other cohorts.
    • “The results echoed outcomes that emerged in an earlier study of young U.S. war veterans with TBI.”
  • Consumer Reports, writing in the Washington Post, lets us know “what can make you dizzy? Could it be an inner-ear issue? Your medications? How to figure out the problem — and fix it.”

From the U.S. healthcare business front,

  • Bloomberg Law reports,
    • “Rising health-care costs are fueling the comeback of a strategy to limit hospital bills, but the evolving model requires employers to take on more work and risk in ditching the big insurance companies.
    • “Reference-based pricing” typically determines a provider’s payments from Medicare rates, plus a premium ranging from 25-50%. Those rates fluctuate depending on the market and provider type, but advocates say they usually shave around 30% off a plan’s annual costs.
    • “The strategy is part of employers’ ongoing search for alternatives to traditional health insurance as they confront an expected 9% spike in costs next year. But hospitals say RBP vendors are just middlemen looking to profit at patients’ expense.” * * *
    • “The whole thing is very ugly from a patient perspective in the sense of it’s often not very clear what the rules are,” said Molly Smith, American Hospital Association’s group vice president for policy. “They often don’t understand whether or not they have a network.”
    • “RBP companies blame the bad reputation on early iterations that sparked a series of lawsuits and left patients with steep bills. Many vendors today collaborate more with providers and protect patients, they said.
    • “The differences in the models is how you deal with access issues, how do you deal with balance bills,” said Scott Ray, founder of RBP vendor 6 Degrees Health.”
  • Modern Healthcare adds,
    • “Concierge and direct primary care practices are gaining traction among physicians, employers and patients increasingly frustrated with traditional care pathways.
    • “The growth of these practices, where patients pay membership fees in exchange for increased access to physicians, is a symptom of Medicare and Medicaid reimbursement that has not kept pace with inflation, advisers, doctors and policy experts said. Growing care backlogs, coding and documentation tasks that take doctors away from patients and seemingly ever-rising health insurance premiums are also contributing, they said.
    • “A year ago, I would’ve told you these care models were a slowly evolving, quiet phenomenon,” said Dr. Zirui Song, an associate professor of healthcare policy at Harvard Medical School and a primary care provider at Massachusetts General Hospital. “It is now evolving quite rapidly — it is not so quiet anymore.”
  • Beckers Hospital Review provides us with large for-profit healthcare system “payer mixes by patient service revenue, patient admissions or both in the first six months of 2025,” and tells us about three new drugs that OptumRx, a UnitedHealth subsidiary, is tracking this year. 
  • BioPharma Dive relates “Biopharmaceutical firms in the U.S. and Europe are increasingly turning to China’s biotech sector for new medicines. Follow this year’s dealmaking with this database.”
  • Per Fierce Healthcare,
    • “Health tech company Waltz Health will merge with Eversana with the goal of shaking up access to prescription drugs.
    • “The deal will bring together Waltz’s proprietary drug marketplaces and direct-to-payer model with Eversana’s global pharmaceutical commercialization platform. In tandem, the two platforms will be well positioned to tackle the misaligned incentives in the drug supply chain and close gaps for patients, the companies said.
    • “The combination will be especially critical in driving down the cost of pricey specialty pharmacy products, including GLP-1s, according to an announcement. Financial terms of the deal were not disclosed.”
  • Per Modern Healthcare,
    • “Independent laboratory company Quest Diagnostics and Corewell Health entered a definitive agreement to build a jointly owned lab in Michigan. 
    • “The Diagnostic Lab of Michigan would be based at the Corewell Health Southfield Center in Southfield, Michigan. It would focus on automated microbiology and high-throughput molecular testing.
    • “Quest would also manage Corewell Health’s 21 inpatient and outpatient hospital labs as part of the joint venture. Financial terms were not disclosed.” 

Weekend update

David Ermer–Congress, Generative AI, Government Contracting, Medicare, U.S. Healthcare–

From Washington, DC

  • Congress will return to Capitol Hill for Committee business and floor voting on September 2.
  • JAMA considers Medicare Part D benefit designs following the Inflation Reduction Act.
    • “Question How did prescription drug coverage in Medicare Part D plans change after the Inflation Reduction Act (IRA)?
    • “Findings In this cross-sectional study of enrollees in Medicare Part D stand-alone and Medicare Advantage plans, from 2019 to 2025 mean deductibles and the proportion of patients with coinsurance for preferred brand-name drugs increased. For stand-alone plans, these increases were observed before and after the IRA changes took effect in 2025, but for Medicare Advantage plans, the changes were abrupt in 2025.
    • “Meaning The IRA limited annual out-of-pocket costs to $2000 for Medicare Part D beneficiaries, but concurrent design changes by Part D insurers, particularly among Medicare Advantage plans, may lead to higher cost sharing for some beneficiaries who do not reach this limit in 2025.

From the public health and medical research front,

  • Medscape informs us,
    • “Among hospitalized children and teens, respiratory syncytial virus (RSV) mostly affects younger, otherwise healthy infants, while the lesser-known human metapneumovirus (HMPV) tends to affect older children, many of whom have preexisting health conditions, according to a study published in Pediatrics.
    • “Researchers and other experts said the findings will hopefully promote the development of HMPV vaccines and affordable rapid diagnostic tests for the virus in outpatient settings.
    • “HPMV is not on people’s radar,” said John V. Williams, MD, chair of the Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. “It was the largest prospective apples-to-apples comparison [on RSV and HMPV]; it has tremendous importance in that sense.”
  • The University of Minnesota’s CIDRAP tells us,
    • A study of more than 4 million children in South Korea found no association between antibiotic exposure during pregnancy or early infancy and increased incidence of autoimmune diseases, researchers reported yesterday in PLOS Medicine.
    • The study, conducted by researchers with Sungkyunkwan University in South Korea, is the latest to examine whether early exposure to antibiotics is associated with increased risk of childhood-onset diseases and neurodevelopmental conditions. Antibiotics are the most commonly prescribed medication in young children and are frequently overused, and animal research suggests antibiotic exposure at an early age may increase the risk of these conditions by disrupting the gut microbiome while it’s still developing.
    • To date, studies exploring potential links between early antibiotic exposure and development of autoimmune diseases have produced conflicting results. But the authors of the new study say previous research has been limited by potential confounding variables, such as infection and genetic factors.
  • Healio lets us know,
    • “The prevalence of certain gut-brain interaction disorders increased significantly during the COVID-19 pandemic, with the largest increase observed in irritable bowel syndrome, according to cross-sectional study results.
    • “Earlier studies focused on people who actually had COVID-19 and found a much higher risk of IBS after infection. Our study is different; we looked at the whole adult population, not just those infected, and still found a big jump in IBS rates,” Christopher V. Almario, MD, MSHPM, associate professor of medicine and co-director of Cedars-Sinai Center for Outcomes Research and Education, told Healio. “This suggests it’s not just the virus itself, but also broader effects of the pandemic — stress, isolation, dietary changes — that additionally likely played a role.”
  • and
    • “Three speakers outlined how AI is likely to have a major impact on the future of preventive cardiology.
    • “At the American Society for Preventive Cardiology Congress on CVD Prevention, the speakers discussed the importance of preventive cardiologists being involved in shaping the direction of AI in medical care, ways in which use of AI can promote health equity and how AI programs can be used for early detection of CV conditions.” * * *
    • :A priority for the future is to develop, validate and deploy AI-based screening for CVD, Pierre Elias, MD, assistant professor of cardiology and biomedical informatics at Columbia University and medical director for artificial intelligence at New York-Presbyterian Hospital, said during a presentation. 
    • “We have mammograms, we have colonoscopies; we have no equivalent for most forms of cardiovascular disease,” he said. “Every doctor in this room has had a patient that makes them think, why am I meeting them so late in the disease course? The way that we diagnose most forms of cardiovascular disease is either too expensive or too invasive to do on a population level.”

From the U.S. healthcare business front,

  • The New York Times explains why “President Trump’s planned pharmaceutical tariffs threaten to hit many of the most common and well-known drugs that Americans take.”
  • Fierce BioTech reports,
    • “Tempus AI has acquired the digital pathology developer Paige, including its FDA-cleared, artificial intelligence-powered programs for spotting the signs of cancer.
    • “The deal totals $81.25 million, which includes Tempus paying out Paige’s remaining commitment to Microsoft Azure for its cloud-computing services. The transaction will also be “paid predominantly” in Tempus stock, according to the company.
    • “Tempus set its eyes on the former Fierce Medtech Fierce 15 winner in part for its massive, anonymized dataset, which encompasses nearly 7 million digitized pathology slides and clinical data licensed from Memorial Sloan Kettering Cancer Center.” 
  • HR Dive shares an attorney’s opinion pointing out “three DEI approaches employers must reconsider to avoid federal ire. The principles set forth in a recent DOJ memo are likely to be applied by the EEOC to all employers under Title VII, attorney Jonathan Segal writes.”

Thursday Report

David Ermer–CDC, CMS, Congress, FDA, Federal employment benefits, Medical / Rx research, NCQA, NIH, SCOTUS, U.S. Healthcare–

From Washington, DC,

  • The OPM Inspector General recently issued a data brief titled Evaluation of FEHBP Medical Conditions by Premium Expenditure during Contract Years 2019 through 2021. The most expense conditions, representing 10% of spending, was cancer.
  • STAT News reports,
    • “The Centers for Disease Control and Prevention is increasing security after the shooting at its Atlanta headquarters earlier this month, leaders told employees in an email reviewed by STAT.
    • “Additional guards have been added to nearly all campuses, according to the email. CDC is in talks with the Federal Protective Services to increase security at two the campuses where it provides security as well, per the email.”
  • and
    • “Sens. Roger Marshall (R-Kansas) and John Hickenlooper (D-Colo.) are leading a new push to strengthen requirements on price transparency in hospitals, Marshall writes in a new STAT First Opinion article.
    • “The two senators introduced a new bill, the Patients Deserve Price Tags Act, which would require machine-readable files for all negotiated and cash prices, require hospitals to post prices for services, and require patients to receive an explanation of benefits as well as an itemized bill.
    • “It’s part of a years-long movement to crack down on billing practices among providers — one the White House joined in earlier this year via executive order.
    • “But the bipartisan push is far from a guarantee of changes in the current law. Even some widely backed health proposals in Congress have been left behind in must-pass packages. Read Marshall’s piece.”
  • Per a CMS news release,
    • “The U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) are establishing the Healthcare Advisory Committee—a group of experts charged with delivering strategic recommendations directly to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz to improve how care is financed and delivered across Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.
    • “Every American high-quality, affordable care – without red tape, corporate greed, or excessive costs,” said HHS Secretary Robert F. Kennedy Jr. “This new advisory committee will unite the best minds in healthcare to help us deliver real results, hold the system accountable, and drive forward our mission to Make America Healthy Again.” * * *
    • “For more information or to submit nominations, visit the Federal Register Notice at: https://www.federalregister.gov/d/2025-16136.” 
  • Healthcare Dive observes,
    • “White House data sharing plan boasts big ambitions, but has scant details.
    • “Improving health data exchange is a worthy goal, but the initiative has to overcome challenges like data security, under-resourced providers and slow technology uptake, experts say.”
  • Per BioPharma Dive,
    • “The United States and the European Union formalized the terms of the framework trade agreement the two trading partners announced at the end of July, per a joint statement published by the White House Thursday.
    • “The statement provides additional clarity and detail surrounding the terms U.S. President Donald Trump and European Commission President Ursula von der Leyen shared following negotiations in Scotland on July 27, including a 15% tariff on EU imports by the U.S. The two trading partners will “promptly document” the agreement, per the statement.
    • “Under the agreement, the U.S. committed to apply either a tariff of 15% or a “most-favored nation” duty rate on EU imports, with the higher of the two to be enforced. The U.S. will set a cap of 15% on tariffs for imports of pharmaceuticals, semiconductors and lumber, per the statement. Those sectors are currently under Section 232 investigation. Similar probes have led to sector-specific tariffs of up to 50%.
    • “The U.S. also plans to apply only the most-favored nation rate set by the World Trade Organization to aircraft and aircraft parts, generic pharmaceuticals, chemical precursors and “unavailable natural resources,” effective Sept. 1. The two trading partners will “consider other sectors” to add to that group.”
  • The Government Accountability Office tells us,
    • “Over the last decade, federal revenues from tobacco excise taxes have dropped by more than 30%—from about $14 billion to $9 billion from fiscal years 2014 to 2024.   
    • “This loss in revenues is the result of 1) declines in sales for smoking products and 2) differing tax rates for these products. It also coincides with the emergence of new products that aren’t taxed at all.” * * *
    • “If similar tobacco products were taxed the same rate (keeping in mind that some aren’t taxed at all), federal revenues would increase. We estimated that if the tax rate for pipe tobacco were increased to the same rate as roll-your-own tobacco, the federal government could collect at least $1.5 billion dollars in additional revenue for both products from fiscal years 2025-2029.  
    • “Federal revenue would also likely increase if the minimum tax rate for large cigars was the same as that for small cigars. However, it’s a bit trickier to determine a precise estimate because of limited information about the retail prices of large cigars and how consumers might respond to increased taxes.  
    • “We previously recommended that Congress consider leveling (or equalizing) the tax rate on similar tobacco products.  For a more in-depth look at tobacco taxes, check out our new report.” 
  • Tammy Flanagan, writing in Govexec, points out that “Federal employees older than 70 may be leaving thousands on the table. Find out if you or your spouse is missing Social Security benefits.”

From the Food and Drug Administration front,

  • STAT News reports,
    • “Major U.S. drug manufacturing plant did not properly investigate cat hair, pests, and other problems, FDA finds.
    • “Plant, once owned by Catalent and now owned by Novo Nordisk, is widely used by pharma industry.
  • and
    • “The Food and Drug Administration has agreed to decide by late next month whether to approve an ultra-rare disease drug developed by Stealth BioTherapeutics, a significant step after the company claimed it may have to close its doors if an agency endorsement is not made in coming weeks.
    • “The move comes after protracted uncertainty surrounding the fate of the medication, which was developed to treat Barth syndrome, a rare illness that afflicts about 150 people in the U.S. The company and the FDA have struggled to agree on ways to generate enough of the right kind of study data to make the drug available to this tiny population of patients.”
  • PharmaPhorum lets us know,
    • “Iterum Therapeutics has become the first drugmaker to bring an oral antibiotic in the penem class to market in the US, launching Orlynvah as a treatment for uncomplicated urinary tract infections (uUTIs).
    • The launch of the product – which comes a few months after Orlynvah (sulopenem etzadroxil and probenecid) was approved by the FDA – keeps the Dublin, Ireland-headquartered biotech ahead of rival companies bidding to bring new therapies for uUTIs to the US market.
    • That includes GSK with Blujepa (gepotidacin) – which was approved in March by the FDA as the first drug with a new mechanism of action for uUTIs in nearly three decades – as well as Alembic Pharma with Pivya (pivmecillinam), cleared for uUTIs in 2024 and acquired when Alembic bought Utility Therapeutics last month. Both Blujepa and Pivya are due to be launched in the US before the end of the year.
    • Specifically, Orlynvah was given a green light by the FDA for adult women with uUTIs caused by Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis with limited or no alternative oral antibacterial options. It was initially turned down by the agency, which issued a complete response letter (CRL) to Iterum in 2021 with a request for more data.
  • Per MedTech Dive,
    • “NeuroOne Medical Technologies received Food and Drug Administration clearance for a minimally invasive nerve ablation system to treat trigeminal neuralgia, a condition that causes severe, chronic facial pain.
    • “Trigeminal neuralgia is typically treated with medication or invasive procedures. NeuroOne’s OneRF ablation system uses radiofrequency energy to create lesions to interrupt pain signals.
    • “NeuroOne filed its FDA submission in April, earlier than previously anticipated. The Eden Prairie, Minnesota-based company said Monday it now expects to launch the device on a limited basis in the fourth quarter of this year.”
  • BioPharma Dive informs us,
    • “The Food and Drug Administration on Thursday approved a drug Ionis Pharmaceuticals developed for the rare genetic disease hereditary angioedema, making the therapy, known as donidalorsen, the third new medicine to reach market this year for the rare genetic condition.
    • “Donidalorsen, which Ionis will sell under the brand name Dawnzera, is approved to prevent the swelling attacks associated with hereditary angioedema in adults and children at least 12 years of age. Dawnzera has a list price of $57,642 per dose, company executives said in a conference call.
    • “The price is “based on the efficacy, the data and the supporting evidence,” Chief Global Product Strategy Officer Kyle Jenne told analysts on the call. “The payers, we believe, will be very accepting of the price, since it’s in line with the other products that are in the HAE space today.”
  • and
    • “A total of 1,176 products have received the Food and Drug Administration’s breakthrough device designation since 2015, according to the agency’s latest update on Wednesday.
    • “The FDA gives the designation to devices that may provide more effective treatment or diagnosis of life-threatening or debilitating conditions. In its 2025 fiscal year, which began in October, the agency had granted 136 breakthrough designations as of June 30.
    • “The FDA shared the update as medical device companies lobby for faster Medicare coverage of breakthrough devices.”

From the judicial front,

  • Bloomberg Law reports,
    • “A divided US Supreme Court let the Trump administration cut off potentially hundreds of millions of dollars in medical research grants that government officials say don’t align with the president’s policies.
    • “The justices largely put on hold a federal trial judge’s decision that the National Institutes of Health acted in an “arbitrary and capricious” manner when it terminated thousands of grants as part of President Donald Trump’s crackdown on diversity, equity and inclusion.”

From the public health and medical research front,

  • Per an FDA news release,
    • “FDA Advises Restaurants and Retailers Not to Serve or Sell and Consumers Not to Eat Certain Frozen, Raw, Half-shell Oysters from Republic of Korea Potentially Contaminated with Norovirus.”
  • Health Day informs us,
    • “Seniors with known heart-related problems aren’t doing a very good job taking steps to protect their health, a new study says.
    • “Older folks with high blood pressure, stroke survivors and heart failure patients in the United States all have been neglecting Life’s Essential 8 — a checklist of lifestyle factors that can protect heart health, researchers found.
    • “On average, participants with one cardiovascular disease had a Life’s Essential 8 score 9 points lower than those without cardiovascular disease,” lead researcher James Walker, a medical student at Northwestern University in Chicago, said in a news release.
    • “Life’s Essential 8 recommends that people eat healthy, exercise, avoid smoking, sleep better, lose excess weight, and manage their cholesterol, blood sugar and blood pressure levels, according to the American Heart Association.”
  • MedPage Today lets us know,
    • “Patients taking GLP-1 agonists for weight loss had a small but significantly lower risk of developing cancer, a large retrospective cohort study showed.
    • “With follow-up ranging from 1 to 11 years, use of GLP-1 agonists, such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound), was associated with a 17% lower cancer risk as compared with non-users. Cancer incidence was lower for 12 of 13 recognized obesity-related cancers, plus lung cancer. The difference between users and non-users reached statistical significance for endometrial and ovarian cancers and meningioma.
    • “The only outlier was kidney cancer, which occurred more often among users of GLP-1 agonists and was associated with a non-significant 38% increased risk, reported Jiang Bian, PhD, of the Regenstrief Institute in Indianapolis, and co-authors in JAMA Oncology.
    • “Given that more than 137 million individuals in the U.S. are currently eligible for GLP-1RA [receptor agonist] therapies, even modest changes in cancer risk could have substantial public health implications,” the authors stated in their discussion. “This study is one of the first to assess the association between GLP-1RA use and cancer risk in the broad, real-world population with obesity or overweight who are eligible for AOMs [anti-obesity medications].”
  • Per a National Institute of Standards and Technology news release,
    • “Scientists at the National Institute of Standards and Technology (NIST) have developed a new technology for measuring how radiation damages DNA molecules. This novel technique, which passes DNA through tiny openings called nanopores, detects radiation damage much faster and more accurately than existing methods. It could lead to improved radiation therapy for cancer and more personalized care for individuals during radiological emergencies.
    • “With nanopore sensing, we’re not just measuring radiation damage; we’re rewriting the rules on how quickly and effectively we can respond to both cancer care and emergencies,” said NIST physical scientist Joseph Robertson.”
  • Per a National Institutes of Health news release,
    • “In a first-of-its-kind study, researchers found that the brain’s control center for a lost appendage can persist long after surgical amputation, which stands in stark contrast to longstanding theories about the brain’s ability to reorganize itself, also known as plasticity. Scientists from the National Institutes of Health (NIH) and their colleagues examined human brain activity before and after arm amputation and found that the loss of a limb does not prompt a large-scale cerebral overhaul. Published in the journal Nature Neuroscience, this study offers new insight into the mysterious phantom limb syndrome and could help guide the development of neuroprosthetics and pain treatments for people with limb loss.
    • “A team of scientists from NIH and University College London acted on a unique window of opportunity, running MRI scans on three participants in the months prior to a planned amputation (performed for separate medical purposes) and then up to five years after.
    • “It’s not often you get the chance to conduct a study like this one, so we wanted to be exceedingly thorough,” said co-author Chris Baker, Ph.D., of NIH’s National Institute of Mental Health (NIMH). “We approached our data from a variety of angles and all of our results tell a consistent story.”
  • Per NCQA.
    • ‘Chronic kidney disease (CKD) affects nearly 36 million adults in the U.S., yet it remains underdiagnosed and undertreated. NCQA convened an expert panel of clinicians and patient advocates to discuss current challenges and future opportunities associated with the assessment, diagnosis and management of CKD.’
    • This NCQA article discusses this convention.

From the U.S. healthcare business front,

  • Healthcare Dive reports,
    • “UnitedHealth is forming a new board committee to “monitor and oversee financial, regulatory and reputational risks” as the healthcare juggernaut tries to improve its standing with lawmakers, regulators, investors and the U.S. public.
    • “The “public responsibility committee” will “provide an additional layer of governance,” UnitedHealth said in a securities filing on Wednesday. The committee’s key responsibilities include underwriting and forecasting, regulatory relationships, reputational matters and mergers and acquisitions — all areas for which UnitedHealth has been in the public eye.
    • “Michele Hooper, who’s served on UnitedHealth’s board since 2007, will step down as lead independent director to chair the committee. Hooper, who will remain a director, will be replaced as lead independent director by F. William McNabb, the former CEO of investing firm the Vanguard Group who has served on UnitedHealth’s board since 2018.”
  • The International Foundation of Employee Benefit Plans discusses various GLP-1 coverage strategies.
  • Per Beckers Hospital Review,
    • “Philadelphia-based Temple Health has acquired Redeemer Health’s 20% stake in Chestnut Hill Hospital, giving the academic system an 80% ownership interest in the hospital.
    • “This was a planned transaction that comes approximately two and a half years after Chestnut Hill Hospital was acquired by an alliance consisting of Temple Health, [Meadowbrook, Pa.-based] Redeemer and the Philadelphia College of Osteopathic Medicine,” a spokesperson for the health system told Becker’s. “Temple Health manages Chestnut Hill Hospital and now has an 80% ownership stake in the hospital.”
    • “With the transaction, Redeemer has exited the alliance, while the Philadelphia College of Osteopathic Medicine retains a 20% ownership stake in the148-bed hospital.”
  • and
    • “Sacramento-based Sutter Health plans to close its Jackson, Calif.-based Sutter Amador Surgery Center on Oct. 3.
    • “In an open letter to the community, obtained by Becker’s, Sutter Amador Hospital CEO Michael Cureton, Sutter Amador Surgery Center’s ambulatory services administrator, Branden Nelson, and the surgery center’s executive of operations, Johnny Russell, said the outpatient surgery center closure will help “align resources with areas of growing need” in the community it serves.”
  • Radiology Business relates,
    • “A “hybrid” artificial intelligence strategy—using a combination of radiologist readers and standalone AI interpretation of cases—can cut rads’ workloads by nearly 40%, according to new research. 
    • “Such technology has shown great promise in boosting physician performance, including helping to triage scans requiring added attention. However, AI implementation in breast cancer screening remains limited for various reasons, amid concerns it may miss some relevant cases, experts wrote Tuesday in RSNA’s Radiology.” 
  • BioPharma Dive reports,
    • Gilead Sciences is deepening its investment in cancer cell therapy, announcing Thursday a deal to pay $350 million to buy privately held Interius BioTherapeutics for a technology designed to reprogram immune cells in patients’ bodies.
    • If successful, Interius’ “in vivo” approach could yield a simpler alternative to the CAR-T therapies Gilead’s Kite Pharma division have brought to market, each of which includes extravagant production processes that involve manipulating cells in a lab. 
    • Gilead spent $12 billion to buy Kite nearly a decade ago and, since then, has become a leader in CAR-T therapies. That business has sputtered recently amid declining demand and competition from other developers. But Gilead is still investing through acquisitions and partnerships, such as a collaboration with Arcellx in multiple myeloma.
  • and
    • “Sarepta on Thursday said it’s reached agreements that remove about $700 million from a pile of debt due in 2027.
    • “The private agreements with debt holders will allow Sarepta to exchange the 1.25% convertible senior notes due in 2027 for $602 million worth of 4.875% convertible senior notes due in 2030, up to 6.7 million shares of Sarepta stock and about $123 million in cash. Separately, the company entered into a private placement of about 1.4 million shares.
    • “The transaction “significantly enhances our balance sheet flexibility and strengthens our financial position,” Sarepta CEO Doug Ingram said in a statement. Sarepta will still have $450 million in existing convertible notes due in 2027.”
  • and
    • “Xoma Royalty Corp. is acquiring another struggling biotechnology company in further sign of interest among certain firms in buying floundering drugmakers and shutting them down.
    • “Xoma on Wednesday agreed to buy Mural Oncology, a cancer biotech once spun out of Alkermes. Per deal terms, a Xoma subsidiary will acquire Mural for $2.035 per share. Mural stockholders could get up to another $0.205 per share if the company’s net cash holdings at the deal’s closing exceeds $36.2 million.
    • “The deal values Mural at the level of its cash reserves and represents a roughly 13% premium to the company’s closing share price of $1.80 on Tuesday. Xoma will wind down Mural’s business afterwards, according to the announcement.
    • “In acquiring and liquidating Mural, Xoma is extending a pattern among certain firms and investors to shut down drug companies whose depressed share prices leave them worth less than their cash holdings. Historically, these biotech “zombies” would pivot to new projects or merge with another drug company. Of late, however, investors are heightening pressure on company boards to return cash to shareholders instead.”

Monday Report

David Ermer–Congress, FDA, Federal employment benefits, OPM, Rx coverage, U.S. Healthcare–

From Washington, DC

  • The Huffington Post discusses OPM’s August 15, 2025, second addendum to its 2026 call letter for FEHB and PSHB benefit and rate proposals.
  • Bloomberg Law reports,
    • “Drugmakers are responding to President Donald Trump’s call to launch direct-to-consumer sales, sparking questions about how the strategy could upend the industry’s traditional players—or help preserve the status quo.
    • “Trump’s push for drugmakers to offer direct sales at the lowest price offered in other developed nations is stoking a burgeoning tactic by drugmakers aimed at ending rebates they pay to pharmacy benefit managers and health plans. But the strategy’s potential to lower patients’ costs is still unclear.
    • “Manufacturers are building a variety of direct-to-consumer pipelines that can either use patients’ insurance plans or bypass them in favor of cash payments. Industry observers say the range of options makes it hard to predict what the ultimate impact on insurers, pharmacy benefit managers, pharmacies, and wholesalers will be, and whether the new world benefits drugmakers more than consumers.
    • “It looks like they’re offering reduced prices, when, in fact, those prices are still unaffordable for people,” said Anna Kaltenboeck, president of Verdant Research and a former adviser to the Senate Finance Committee under ranking member Ron Wyden (D-Ore.).
    • “If drugmakers were serious about lowering costs for consumers, Kaltenboeck said, they could simply lower their prices across the board.
    • “This is yet another iteration of trying to avoid the conversation that we need to have about the way in which pharma companies set list prices in the United States,” she said.”
  • Reginfo.gov remains under maintenance at 6 pm ET today. P.S. At 8 am ET on Tuesday, reginfo.gov is back online but it’s displaying the Fall 2024 semi-annual regulatory agenda. So, there is more work to be done.
  • Per an HHS press release,
    • The U.S. Department of Health and Human Services (HHS) today launched MAHA in Action—a dynamic new platform showcasing the powerful federal initiatives and state-led reforms advancing President Donald J. Trump and Secretary Robert F. Kennedy, Jr.’s Make America Healthy Again (MAHA) agenda.
    • This interactive tool offers a clear, accessible window into the bold actions reshaping America’s food, health, and public safety systems. MAHA in Action is more than a tracker—it’s a public declaration of the profound changes already underway.
    • “Make America Healthy Again isn’t just a slogan—it’s a mission statement, and we’re delivering results, fast,” HHS Secretary Kennedy said. “The MAHA in Action tracker puts the wins on the map. It gives the public, the press, and policymakers real-time visibility into how we’re restoring health, integrity, and accountability to every corner of our public health agency.”
    • The MAHA in Action webpage features updates on federal reforms being implemented across HHS agencies, including removing petroleum-based dyes and harmful additives from the U.S. food supply, closing the GRAS loophole that allows chemicals into food often with unknown safety data, restoring public trust in vaccine safety and scientific transparency, and finding the root causes of the chronic disease epidemic including autism. * * *
    • “Explore the platform here and find out what changes are happening in your state.”
  • HCP Live tells us,
    • “On August 15, 2025, the US Food and Drug Administration (FDA) approved Tonix Pharmaceuticals’ TNX-102 SL, under the name Tonmya, for treating adults with fibromyalgia, the first new drug for the indication in more than 15 years.
    • “For many years, rheumatologists like myself and other healthcare professionals have had to manage fibromyalgia with limited options that do not adequately meet treatment needs for the majority of patients,” Philip Mease, MD, director of Rheumatology Research at the Providence Swedish Medical Center and clinical professor at the University of Washington School of Medicine, said in a statement.1 “Tonmya is a novel treatment approach that targets nonrestorative sleep that is characteristic of fibromyalgia and can impact core symptoms, specifically pain.”
    • “TNX-102 SL is a sublingual formulation of cyclobenzaprine and is also the first member of a new class of non-opioid analgesic drugs for fibromyalgia. Tonix originally announced the FDA’s acceptance of its new drug application for the medication in December 2024.

From the public health and medical research front,

  • The American Medical Association lets us know what doctors wish their patients knew about sodium consumption.
  • McKinsey and Company delves into “Closing the Black maternal-health gap: Healthier lives, stronger economies.”
  • The American Hospital Association News informs us,
    • “The Texas Department of State Health Services Aug. 18 announced that the state’s measles outbreak is over. The department said it had been more than 42 days since a new case was reported, surpassing the threshold to declare an end to an outbreak. There have been 762 confirmed measles cases during the West Texas-centered outbreak since late January. Of those, 99 individuals were hospitalized, and two school-aged children had died.”
    • “Nationwide, there have been 1,356 confirmed measles cases in 40 states this year, according to the latest Centers for Disease Control and Prevention data from Aug. 13. The vaccination status of 92% of all cases is classified as “unvaccinated or unknown.” 
  • Per a Senate news release,
    • “Today, U.S. Senator Bill Cassidy, M.D. (R-LA), chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released a statement following the Texas Department of State Health Services formally declaring the end of the measles outbreak in West Texas. It has been more than 42 days since a new measles case was reported in any of the counties that previously had ongoing transmission.
    • “I commend the Texas Department of State Health Services and the Trump administration for their work to stop this measles outbreak, saving lives in Texas and beyond,” said Dr. Cassidy. “But this tragedy was entirely preventable, and work must continue to curb outbreaks in other states. Misinformation about the measles vaccine fueled the spread of this outbreak, killing three Americans and hospitalizing many more. No child in the United States should ever die of a vaccine-preventable disease.”
    • “The measles vaccine is effective, safe, and the best way to protect yourself and your family from contracting this deadly disease. I encourage every parent to vaccinate their child to prevent needless death in the future,” continued Dr. Cassidy.”
  • Amen to that statement.
  • The Wall Street Journal reports,
    • “Gwen Orilio didn’t know how long she had to live after her stage-four lung cancer diagnosis. The disease had already infiltrated her eye, so the 31-year-old didn’t bother opening a retirement account.
    • “Ten years later, Orilio is still alive. And she still has metastatic cancer. 
    • “Keeping her going is a string of new treatments that don’t cure the disease but can buy months—even years—of time, with the hope that once one drug stops working a new one will come along. Orilio started on chemotherapy, and then switched to a new treatment, and then another, and another, and another.
    • “What’s next? What do I have lined up for when this one stops working?” said Orilio, a high-school math teacher who lives in Garner, N.C. “My motto is that the science just needs to stay a step ahead of me, and so far it’s been working.” 
    • “This past winter, she started a retirement fund at age 41. 
    • “Orilio is part of a new era of cancer treatment challenging the idea of what it means to have and survive cancer. A small but growing population is living longer with incurable or advanced cancer, navigating the rest of their lives with a disease increasingly akin to a chronic illness. The trend, which started in breast cancer, has expanded to patients with melanoma, kidney cancer, lung cancer and others.”
  • NBC News relates,
    • “More children died from the flu this past season than any year outside of the swine flu pandemic in 2009. Most of them were unvaccinated. 
    • “That’s why some doctors are hoping that the first nasal flu vaccine available for use at home can improve vaccination rates among people, especially children, who are afraid of needles. 
    • “AstraZeneca’s FluMist Home, which was approved last fall, is now available with a prescription for children ages 2 and over, and adults up to age 49.” * * *
    • “FluMist Home is available only online. People ordering the nasal spray will need to complete a medical screening questionnaire at FluMist.com that is reviewed by a health care professional, according to the drugmaker. FluMist Home’s online pharmacy will then collect the insurance information and bill the health plan directly.”
  • BioPharma Dive points out,
    • “A small, New Jersey-based drug developer plans to push an experimental psychedelic compound into late-stage testing now that it’s scored positive results in a postpartum depression study.
    • “That study enrolled 84 women with moderate to severe postpartum depression, each of whom received a single injection of Reunion Neuroscience’s “RE104” and were then monitored for four weeks. Participants were split into two groups. One got the full, 30 mg dose of RE104, while the other got a far lower dose and served as an “active control” arm.
    • “According to Reunion, the trial achieved its main goal as the 30 mg group showed significantly greater reductions on a widely used depression scale where lower scores indicate less severe symptoms. Seven days after treatment, scores in the experimental arm had fallen by 23 points, versus 17.2 points in the active control arm.
    • “Reunion said researchers also saw “clinically meaningful” responses in the higher dose group that started the day they received their injections and lasted through the 28-day follow up. Just over 77% had scores that improved by 50% or more one week after treatment. In the control arm, 62% hit that milestone. Between the two groups, 71% of the former achieved “remission” of their depression symptoms at Day 7, compared to 41% in the latter.
    • “Reunion said its drug — which functions similar to psilocybin, a molecule found in some psychedelic mushroom species — was well tolerated by patients. There were no serious adverse events, nor was there any treatment-emergent treatment-emergent seizures or suicidal ideation or behavior.”

From the artificial intelligence front,

  • A journalist and mother writing in the N.Y. Times, calls attention to a material weakness in AI chatboxes.
    • “Most human therapists practice under a strict code of ethics that includes mandatory reporting rules as well as the idea that confidentiality has limits. These codes prioritize preventing suicide, homicide and abuse; in some states, psychologists who do not adhere to the ethical code can face disciplinary or legal consequences.
    • “In clinical settings, suicidal ideation like [the journalist’s late daughter Sophie expressed] typically interrupts a therapy session, triggering a checklist and a safety plan. Harry [the AI chatbox] suggested that Sophie have one. But could A.I. be programmed to force a user to complete a mandatory safety plan before proceeding with any further advice or “therapy”? Working with experts in suicidology, A.I. companies might find ways to better connect users to the right resources.
    • If Harry had been a flesh-and-blood therapist rather than a chatbot, he might have encouraged inpatient treatment or had Sophie involuntarily committed until she was in a safe place. We can’t know if that would have saved her. Perhaps fearing those possibilities, Sophie held her darkest thoughts back from her actual therapist. Talking to a robot — always available, never judgy — had fewer consequences.
    • “Harry didn’t kill Sophie, but A.I. catered to Sophie’s impulse to hide the worst, to pretend she was doing better than she was, to shield everyone from her full agony. (A spokeswoman for OpenAI, the company that built ChatGPT, said it was developing automated tools to more effectively detect and respond to a user experiencing mental or emotional distress. “We care deeply about the safety and well-being of people who use our technology,” she said.)”

From the U.S. healthcare business front,

  • Per Fierce Healthcare,
    • “Fierce Healthcare is honoring its 2025 Most Influential Minority Executives.
    • “This year, we’re recognizing 11 leaders who are leading the charge in pushing healthcare forward. They represent influence across sectors, from provider organizations to payers to digital health, and are critical voices both in the U.S. and globally.
  • Check it out.
  • MedCity Dive notes,
    • “GLP-1s have proven to be highly effective for obesity but are extremely expensive and often have serious side effects, such as nausea, vomiting, dizziness and fatigue.
    • “That’s why Noom, a digital weight loss company, has introduced microdosing for GLP-1s. The company’s program involves beginning with a very low dose and gradually increasing to no more than 25% of the standard maintenance dose, with the goal of finding the lowest effective amount that supports weight loss while minimizing side effects and reducing cost.” * * *
    • “Is this microdosing program safe and effective? Noom says that due to the smaller doses, patients reduce the risk and intensity of side effects. The company also provides clinical oversight to ensure safety.
    • “However, at least one obesity medicine specialist isn’t so convinced that Noom’s microdosing offering is safe. And the concern isn’t so much with the prescribing of smaller doses, but the use of compounded GLP-1s, as they are not FDA-approved.
    • “The microdosing itself is not necessarily an issue. … For example, for patients on Ozempic for diabetes, we would off-label do this once in a while, especially when patients had more gastrointestinal side effects or they were losing weight faster than they wanted. … What I sort of take issue with Noom is that, one, I don’t know what medication or even substance somebody’s pumping into their bodies. And then two, what are the actual doses? Or what are the actual equivalents [compared to branded GLP-1s]?” argued Dr. Disha Narang, an endocrinologist and director of obesity medicine at Endeavor Health.”
  • Fierce Healthcare lets us know,
    • “National pricing data show the cost of healthcare services varies greatly by payer, geography, setting and facility, presenting new fiduciary considerations for employers.
    • “Since 2022, health plans have been required to release machine-readable files disclosing negotiated rates of healthcare services with providers. Hospitals are also required to release the costs of shoppable services.
    • “Data analytics firm Trilliant Health ingested UnitedHealthcare and Aetna transparency files from February to April 2025 to create a new report. Now, those massive swaths of information are slowly becoming more actionable for employers, they will need to plan accordingly, said Chief Research Officer Allison Oakes in an interview with Fierce Healthcare.
    • “Because this pricing information wasn’t historically available, employers weren’t necessarily responsible for picking the highest value health plan for their employees,” she said. “This also shifts the onus and responsibility to employers to use the leverage they have in the market to start changing some of this pricing as well.”
  • CVS Health highlights its value-based program for behavioral health care through clinical collaboration.
    • “There is still a clear need for high-quality, evidence-based behavioral health care in the U.S.
    • “One way to get there is through innovative payment models, including value-based care (VBC) models.
    • “The value-based care arrangement between Aetna, a CVS Health company and health plan, and virtual eating disorder provider Equip is an example of success. Of the Aetna members treated by Equip since 2021, 86% have made progress in their eating disorder treatment and the average reduction in eating disorder symptoms is 70%, validated through the Eating Disorder Exam Questionnaire (EDE-Q).
  • Beckers Hospital Review identifies “seven new drug shortages and discontinuations, according to drug supply databases from the FDA and the American Society of Health-System Pharmacists.” 
  • MedTech Dive tells us, “The Food and Drug Administration has authorized more medical devices that incorporate artificial intelligence. Keep track of the latest developments in this database” which MedTech Dive updated today.

Weekend update

David Ermer–ACA, Congress, FDA, Medical / Rx research, U.S. Healthcare–

From Washington, DC,

  • Congress remains on its State / District work break from Capitol Hill until September 2, 2025, roughly two more weeks.
  • The Office of Management and Budget’s reginfo.gov website remains under maintenance at 5 pm ET on Sunday.
  • STAT News reports,
    • “Novo Nordisk’s obesity drug Wegovy was cleared by U.S. regulators on Friday to treat an increasingly common liver disease, adding to the list of conditions for which the blockbuster therapy is now approved. 
    • “The Food and Drug Administration granted accelerated approval to Wegovy for patients with metabolic dysfunction-associated steatohepatitis, or MASH, with moderate to advanced liver scarring. The decision was based on Phase 3 results showing that the drug helped improve liver scarring, or fibrosis, and resolve symptoms.”

From the public health and medical research front,

  • Medscape reports,
    • “Heart disease is still the top cause of death in the US, but the types of heart disease killing people are changing, a new analysis has found. While deaths from acute conditions such as heart attacks have declined, deaths from other types of heart disease such as heart failure, hypertensive heart disease, and arrhythmias have increased.
    • “And that has important implications for primary care physicians (PCPs), who will shoulder much of the burden for caring for these patients who can survive acute threats such as a heart attack but go on to need care for chronic cardiac conditions, sometimes for decades.”
  • and
    • A significant [medical research] issue is under enrollment of women in randomized trials, meaning the percentage of women enrolled isn’t in line with the percentage of women with a particular disease in the real world — so signals that indicate an adverse event are not picked up. From a systems perspective, women do not clear drugs through their kidneys as quickly as men, and women maintain a higher blood concentration of the medication. “Women may be overmedicated,” Neurologist Irving Zucker and others wrote in a 2020 analysis of 86 medications.
    • “This can lead to adverse events (AEs). And they do.
    • “Women experience adverse drug reactions nearly twice as often as men, yet the role of sex as a biological factor in the generation of [these reactions] is poorly understood,” Zucker wrote in that study, published in the journal Biology of Sex Differences, which showed that pharmacokinetics “strongly linked” sex differences in adverse drug events.”

From the U.S. healthcare business front,

  • Beckers Payer Issues informs us,
    • “Mountain Health Co-Op, which insures more than 11,000 people in Wyoming, is exiting the state at the end of 2025, Cowboy State Daily reported Aug. 14. 
    • “Mountain Health CEO Blair Fjeseth told the news outlet that several factors contributed to the decision, but the high cost of healthcare was a top reason.” * * *
    • “The company was one of three insurers available on the ACA’s healthcare exchange in Wyoming, according to the report. 
    • “Mountain Health will continue to offer plans in Montana and Idaho, according to the report.” 
  • MedTech Dive lets us know,
    • “Philips said Thursday [August 14] that it will invest more than $150 million to expand manufacturing in the U.S. of AI-enabled technologies.
    • “The investment includes expanding manufacturing and research and development at a site in Reedsville, Pennsylvania, that makes AI-enabled ultrasound systems. The addition is expected to bring 24,000 more square feet of manufacturing space and 40,000 square feet of warehouse space. 
    • “Philips is making the investment as it expects growth in its ultrasound business and as the company works to optimize its manufacturing sites.“
  • HR Dive tells us,
    • “Regulatory requirements are combining with a cultural shift to push most U.S. companies in a recent WTW survey to adopt pay transparency practices, the consulting firm said in a press release Monday.
    • “WTW’s poll of 388 U.S.-based respondents found that 82% were either communicating, planning or considering communicating pay ranges with employees and 79% were doing so with external job candidates. However, fewer than half said they shared base pay determinations or progressions, and “even fewer” shared how pay ranges are designed or managed or shared the employee’s position within a given range.
    • “More than two-thirds of employers cited regulations as driving their pay transparency efforts, while 44% said the same of company values and culture and 41% pointed to employee expectations. These are signs of a “broader cultural shift” around communicating pay, Lindsay Wiggins, WTW’s North America pay equity co-leader, said in the release.”

Weekend update

David Ermer–CDC, Congress, FDA, Medical / Rx research, U.S. Healthcare–

From Washington, DC

  • Congress continues on its August recess until September 2.
  • The New York Times offers a health insurance guide for young adults coming off of their parents’ employer sponsored health plan who do have their own employer sponsored coverage.
  • The New York Times article assumes that the adult children work for a large employer (typically 50 employees or more, such as FEHBA, then the employer will pay the insurer flat rates for each enrollment tier. If, however, the parents work for a smaller employer (typically under 50 employees), the employer must pay the insurer an age adjusted premium for each covered family member.

From the HHS agencies front,

  • STAT News reports,
    • “A gunman attacked the main campus of the Centers for Disease Control and Prevention in Atlanta on Friday, further shaking an agency in the midst of a tumultuous year.
    • “One police officer died in the shooting. Atlanta police said the shooter was killed and there was no ongoing threat in a release at 6:40 p.m.
    • “Susan Monarez, the agency’s director, who was sworn in just last week, said in a post on X that the agency was working with federal, state, and local law enforcement to investigate the shooting.
    • “Our top priority is the safety and well-being of everyone at CDC,” Monarez wrote.”
  • BioPharma Dive tells us,
    • “Vinay Prasad will return to lead the Food and Drug Administration office that oversees vaccines and gene therapy in a stunning reversal that comes less than two weeks after he abruptly left the job. 
    • “Andrew Nixon, a spokesperson for the Department of Health and Human Services, confirmed Prasad’s return in an emailed statement Saturday. “At the FDA’s request, Dr. Vinay Prasad is resuming leadership of the Center of Biologics Evaluation and Research,” Nixon wrote.
    • “The news was reported earlier by Endpoints News and Stat news. 
    • “Prasad’s return marks the latest dramatic twist in what’s already been a tumultuous run leading CBER, which in addition to vaccines and some genetic medicines also reviews blood products.” 

From the public health and medical research front,

  • NPR Shots informs us,
    • “A new federal report finds that the percentage of adults with suicidal thoughts and attempts remained about the same between 2021 and 2024.
    • “But the analysis of the National Survey on Drug Use and Health did offer some good news: Over that same time period, depression and suicidal thoughts and behaviors in teens declined.
    • “I think it’s very promising, and we’re very hopeful about it,” says Jill Harkavy-Friedman, senior vice president of research at the American Foundation for Suicide Prevention.” * * *
  • The Wall Street Journal reports
    • “The author ignored pain, thinking it was nothing, due to recent surgeries and not wanting to burden family.
    • “After experiencing severe symptoms, the author went to the ER and was diagnosed with pulmonary embolisms.
    • “The author is recovering with blood thinners and lifestyle changes, grateful to have taken symptoms seriously.”
  • On’e of the author’s experts describes blood clots as the people’s disease.
    • “About 900,000 people are diagnosed with blood clots—deep vein thrombosis or pulmonary embolism—in the U.S. each year, according to the American Lung Association. For many, the first symptom is sudden death.
    • “I call it the people’s disease. It doesn’t spare anyone—rich, poor, male, female,” says Dr. Parth Rali, director of the pulmonary embolism response team at Temple University Health System in Philadelphia, who wasn’t involved in my care. “You could be the healthiest person in the world and unfortunately it can still happen to you.”
  • Following up on a superagers study discussed in the FEHBlog, the New York Times informs us,
    • “Scientists at Northwestern University have been studying this remarkable group since 2000, in the hopes of discovering how they’ve avoided typical age-related cognitive decline, as well as more serious memory disorders like Alzheimer’s disease. A new review paper published Thursday summarizes a quarter century of their findings.
    • “Super-agers are a diverse bunch; they don’t share a magic diet, exercise regimen or medication. But the one thing that does unite them is “how they view the importance of social relationships,” said Sandra Weintraub, a professor of psychiatry and behavioral sciences at the Northwestern Feinberg School of Medicine, who has been involved in the research since the start. “And personality wise, they tend to be on the extroverted side.”
    • “This doesn’t surprise Ben Rein, a neuroscientist and the author of the forthcoming book, “Why Brains Need Friends: The Neuroscience of Social Connection.”
    • “People who socialize more are more resistant to cognitive decline as they get older,” Dr. Rein said. And, he added, they “have generally larger brains.”

From the U.S. healthcare business front,

  • Per Beckers Hospital Review,
    • “Chicago-based Weiss Memorial Hospital closed the morning of Aug. 8 amid CMS’ plan to terminateits Medicare program participation, Huy Nguyen, chief of staff for state Rep. Hoan Huynh of the 13th District, where Weiss Memorial is located, confirmed with Becker’s.
    • “IDPH is aware that Weiss Memorial Hospital has suspended operations and we continue to monitor the situation closely,” a spokesperson for the Illinois Department of Public Health said in an Aug. 8 statement shared with Becker’s. “There were no patients hospitalized at Weiss at the time this took effect. IDPH is committed to ensuring patient safety and quality of care at healthcare facilities in Illinois, and we continue to assess the impact of this on the local healthcare system.”
    • “CMS said in a late July public notice that Medicare will stop reimbursing the 239-bed acute care hospital for inpatient care delivered to patients admitted on or after Aug. 9 due to it being out of compliance with federal standards with respect to emergency services, nursing services and physician environment.” * * *
    • “The closure of Weiss Memorial comes amid a slew of Chicago hospital closures over the last few years.
    • “In 2022, Chicago Policy Review reported that 20 hospitals have closed in the city since 2000, accounting for nearly one-fourth of its hospitals. Most recently, Ascension St. Elizabeth in Chicago closed in mid-February prior to Ontario, Calif-based Prime Healthcare’s purchase of it and eight other St. Louis-based Ascension hospitals in Illinois.” 
  • BioPharma Dive points out,
    • “Arvinas may soon be looking for a new partner for a breast cancer medicine awaiting Food and Drug Administration approval after years of working with Pfizer, as company executives revealed Wednesday [August 6] that the partners are reworking their existing deal.
    • “The two companies first joined up in 2018, inking a potential $830 million deal to find and advance medicines that break down disease-causing proteins. In 2021, they entered another contract specifically for vepdegestrant, agreeing to a 50-50 collaboration for development and commercialization.
    • “Arvinas and Pfizer had hoped that the medicine could be used as an adjuvant first-line therapy and as a second-line treatment alone. But study results released earlier this year suggest that the drug only benefits a subset of breast cancer patients with a specific mutation, and the companies narrowed their focus to advancing the drug as just a second-line monotherapy.” 
  • HR Dive notes,
    • “U.S. salary budget increases are expected to stay put at 3.5% in 2026, down just 0.1% from 2025, signaling a cooling talent market, as well as increased budgetary pressure on employers, according to data published Thursday by compensation vendor PayScale.
    • “Equal shares of employers said they would either raise or lower their budgets compared to this year, PayScale said. Among those who expected an increase, many cited the rising cost of labor. Approximately two-thirds of those who expected a decrease in their budgets cited concern about economic conditions or business performance.”

Weekend update

David Ermer–Congress, Medical / Rx research, U.S. Healthcare, Uncategorized–
  • Roll Call adds,
    • “President Donald Trump gave Senate Republicans permission to begin their August recess Saturday night [August 2, 2025], shortly before Democratic and Republican leaders agreed to quickly vote on seven final civilian nominees but none of the more than 100 still pending on the calendar.
    • “The agreement allowed for votes to begin on cloture and confirmation of the nominees without debate. Among those confirmed under the deal was Jeanine Pirro, who was nominated by Trump to be U.S. attorney for the District of Columbia.
    • “The directive from Trump took pressure off of Senate Majority Leader John Thune, R-S.D., to clear the executive calendar and confirm all of Trump’s pending nominees before the recess.” 
  • The Wall Street Journal reports,
    • “The Senate late Friday [August 1, 2025,] passed more than $180 billion in funding for veterans programs, new military facilities, the Agriculture Department and the Food and Drug Administration, as lawmakers moved to reassert their control over federal spending amid challenges from the Trump administration.
    • “The Senate approved the bulk of the spending in a 87-9 vote. It separately cleared a measure funding Congress’s own operations as well as related entities that audit federal spending and evaluate the budgetary implications of federal laws. The legislation must go back to the House, which is on recess and will return for legislative business in September.
    • “We are on the verge of an accomplishment that we have not done since 2018, and that is, pass appropriations bills across the Senate floor prior to the August recess,” Senate Appropriations Committee Chair Susan Collins (R., Maine) said shortly before the measures passed. “That is exercising our constitutional responsibility for the power of the purse.”
    • “Sen. Patty Murray (D., Wash.), the top Democrat on the panel, said, “I believe Congress should decide how to spend taxpayer dollars. This is how we do it.”

From the public health and medical research front,

  • The Wall Street Journal points out,
    • “Falls are the leading cause of injury for people 65 and older, but the factors that lead to falls can start much earlier.
    • “The risk of falling in a given year doubles with every additional related issue—including reduced muscle strength, balance problems, medication side effects and even forgetting to take that medicine—according to a recent research paper.
    • “That’s why medical experts say that, beginning at age 65, everyone should have an initial screening to determine their personal risk level.
    • “Many people think only frail older people in nursing homes fall. But even the youngerold—those who are healthy and active—can fall,” says Emily Nabors, associate director of innovation at the National Council on Aging.
    • “The nonprofit offers a short online questionnaire that provides a fall-risk score, but Nabors suggests people also get a more comprehensive assessment from a doctor or physical therapist.
    • “Even if you’re at low risk now, there are things you can do to stay that way. And they go beyond removing trip hazards in your home.”
  • The Washington Post lets us know,
    • “Shortly after finishing breakfast six years ago, Brian Farrington felt some discomfort and thought it was heartburn. He popped a few Tums but hours later began perspiring profusely and experiencing chest pain.
    • “The next morning, Farrington, who was 53 and seemingly healthy, headed to the hospital and was shocked to learn he had suffered a heart attack. He had several blockages in his right artery. Previously, Farrington had been told his cholesterol was “borderline high” but did not require medication.
    • “As the resident of Columbus, Ohio, recovered, he considered a nagging question: Why was there so much premature heart disease in his family? His grandfather and three great-uncles had died of heart disease in their 40s, and his father had gotten a stent in his 60s. He decided to dig deeper.
    • “Farrington eventually discovered he had a heart threat that he — and many other people — had never even heard of: High levels of a fatty particle called Lipoprotein(a). The molecule is similar to LDL, the “bad” cholesterol that circulates in the blood and can promote coronary plaque, increasing the risk of heart attacks.
    • “But Lp(a) carries an extra protein that makes it an even bigger cardiac risk factor than LDL, studies have shown. Higher-than-normal levels encourage the development of blood clots as well as plaque, sharply raising the risk of stroke, heart attack and other severe problems — even among younger people with normal levels of LDL, doctors say.“
  • and
    • “In March 2024, radiation oncologist Sanjay Mehta had been dealing with painful Achilles tendinitis on his left ankle for over a year. He’d tried steroid injections and PRP (platelet-rich plasma) injections, which Mehta said eventually did the trick.
    • “But when his right Achilles started hurting three months later, he opted for a different approach. He had recently started offering low-dose radiation therapy to treat some patients suffering from inflammatory conditions and thought: Why not try it himself? After six self-administered low-dose X-rays, covered by insurance, he found he was pain-free — and he began offering the therapy to more patients with similar noncancerous conditions.
    • “The main surprise was … why didn’t I think of this earlier?” he said.
    • “Mehta is part of a growing trend among U.S. radiation specialists, who have begun offering low-dose X-ray therapy for benign conditions such as arthritis, plantar fasciitis, Peyronie’s disease and thick raised scars, or keloids.
    • “After the American Society for Radiation Oncology discussed the use of low-dose radiation therapy for nonmalignant conditions in its spring 2024 quarterly newsletter, its use began to pick up steam, Mehta said. Unlike radiation therapy for cancer, LDRT, as its name suggests, uses low doses to suppress inflammatory cells. Mehta said six LDRT treatments expose the patient to about the same amount of radiation as in one cancer treatment or what someone might get from “a few” CT scans.”
  • The New York Times tells us that “‘Japanese Walking’ Is a fitness trend worth trying. The workout is simple, and its health benefits are backed by nearly 20 years of research. Check it out.
  • Per MedPage Today,
    • “An investigational subcutaneous autoinjector showed comparable efficacy and safety to the IV formulation of lecanemab (Leqembi) for maintenance treatment in early Alzheimer’s disease, researchers said here.
    • “Continued lecanemab treatment with 360 mg subcutaneous dosing resulted in a similar additional reduction of amyloid PET over 4 years of treatment as continuing biweekly IV lecanemab, reported Larisa Reyderman, PhD, of drugmaker Eisai, at the Alzheimer’s Association International Conference (AAIC).

Friday report

David Ermer–CDC, CMS, Congress, COVID-19, FDA, Medical / Rx research, Medicare, NCQA, OPM, U.S. Healthcare–
  • OPM Director Scott Kupor explains “What They Got Wrong About the Deferred Resignation Program.”
    • “We designed the DRP as a practical, humane, and voluntary option to accelerate workforce transitions in a system that desperately needed movement. Employees were given the option to retire early and receive eight months of paid leave; in return, the government will save $20+ billion in costs, annually.
    • “By the way, the DRP isn’t unusual. It mirrors what employers in the private sector across the country do every day, offer certainty and clarity to employees while restructuring in a responsible, mission-first way. What’s “unusual” is pretending government is exempt from the same pressures every other organization faces in a rapidly changing world and not understanding the simple difference between one-time severance costs and ongoing annual cost savings.”
  • The Plan Sponsor Council of America lets us know,
    • “The Senate Committee on Health, Education, Labor and Pensions (HELP) held a hearing on Thursday to discuss lowering health care prices. The hearing was entitled “Making Healthcare Affordable: Solutions to Lower Costs and Empower Patients.”
    • “Testifying witnesses and Senators agreed universally that price transparency is an important area of reform. “We all agree that price transparency is important,” noted Sen. Bill Cassidy (R-La.) the Chair of the Committee.
    • “[Sen.] Cassidy highlighted one proposed bill, the Patients Deserve Price Tags Act.”
  • Healthcare Dive informs us,
    • Regulators finalized an interoperability and technology rule on Thursday that aims to lessen administrative burden on providers, including through updates to prior authorization processes.
    • The Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology’s HTI-4 rule lays out new and updated health IT certification criteria for electronic prior authorization, electronic prescribing and real-time prescription benefit checks. 
    • The regulation should help clinicians spend less time on paperwork, the ASTP said. “We believe that this work will help patients and providers determine patient benefits at the point of care,” Dr. Thomas Keane, assistant secretary for technology policy and national coordinator for health IT, said during a press briefing Friday.
  • Beckers Health IT tells us,
    • “Several health systems are voicing support for a new federal initiative to improve data exchange and expand access to digital health tools, following a July 30 White House summit that formalized a public-private partnership aimed at building a more connected health ecosystem.
    • “The Centers for Medicare & Medicaid Services, alongside the Department of Health and Human Services, convened more than 60 organizations — including EHR vendors, technology firms and provider networks — to sign onto the CMS Interoperability Framework. Eleven health systems, including Cincinnati-based Bon Secours Mercy Health, Renton, Wash.-based Providence, Cleveland Clinic, Salt Lake City-based Intermountain Health, Sioux Falls, S.D.-based Sanford Health and Atlantic City, N.J.-based AtlantiCare, committed to promoting adoption of digital tools among their patients.” * * *
    • “CMS said it plans to roll out the first phase of its interoperability framework — allowing patients to access claims data from participating provider networks — in early 2026. Future components include AI-powered care navigation tools, upgrades to Medicare Plan Finder and a digital health app library.”
  • The American Hospital News reports,
    • “The Trump administration July 31 announced modified reciprocal tariffs for several nations that would begin Aug. 7, updating those previously announced in April. Countries not listed in yesterday’s announcement will be charged a 10% baseline tariff. The executive order notes that the administration could modify tariff rates further in the future, depending on whether trade agreements are reached or if the administration determines the circumstances warrant it. 
    • “In a separate announcement, the administration raised tariffs on goods from Canada to 35%, effective Aug. 1. The tariff would not apply to Canadian goods that qualify for duty-free exemptions under the trade agreement between the U.S., Mexico and Canada.”
  • and
    • The Centers for Medicare & Medicaid Services Aug. 1 released the fiscal year 2026 final rule for inpatient rehabilitation facilities. The rule will increase payments by 2.6% overall, which includes a 3.3% market basket update reduced by a 0.7 percentage point productivity adjustment. CMS also finalized a decrease in the outlier threshold, from $12,043 to $10,062. For the IRF Quality Reporting Program, CMS finalized removal of four patient assessment data elements and removed the COVID-19 vaccination measures for both patients and health care personnel. Payment changes are effective Oct. 1, 2025.
  • and
    • “The Centers for Medicare & Medicaid Services Aug. 1 issued a final rule for the inpatient psychiatric facility prospective payment system for fiscal year 2026. CMS will increase IPF payments by a net 2.4%, or $70 million, in FY 2026 compared to FY 2025. The payment update reflects a market-basket update of 3.2% minus a productivity adjustment of 0.7 percentage points, as well as an additional cut of 0.1% due to the updated outlier threshold. In addition, the agency will increase the adjustment factors for IPFs with teaching status and in rural locations and recognize increases to IPF teaching caps as required by law. For the IPF Quality Reporting Program, CMS will remove three measures related to health equity and one on COVID-19 staff vaccination and revise the reporting period for its emergency department visit following IPF discharge measure.”
  • Per an HHS news release,
    • “Health and Human Services Secretary Robert F. Kennedy, Jr. today announced additional repeals of federal policy that financially rewarded hospitals for reporting staff vaccination rates – an incentive that was coercive and denied informed consent.
    • “Medical decisions should be made based on one thing: the wellbeing of the person – never on a financial bonus or a government mandate.” said Secretary Kennedy. “Doctors deserve the freedom to use their training, follow the science, and speak the truth-without fear of punishment.”
    • “The policy, established under the Biden administration’s Centers for Medicare & Medicaid Services (CMS) inpatient payment rule, tied hospital reimbursement to staff vaccination reporting. The data was published on CDC’s National Healthcare Safety Network as a tool for public shaming, not public health.”
  • The Washington Post reports,
    • “Some obese Americans on Medicare and Medicaid could get access to expensive weight loss drugs under a five-year experiment being planned by the Trump administration.
    • “Under the proposed plan, state Medicaid programs and Medicare Part D insurance plans would be able to voluntarily choose to cover Ozempic, Wegovy, Mounjaro and Zepbound for patients for “weight management” purposes, according to Centers for Medicare and Medicaid Services documents obtained by The Washington Post. * * *
    • “The experiment is expected to start in April 2026 for Medicaid and January 2027 for Medicare plans, according to the documents. It will be conducted through a testing lab called the Center for Medicare and Medicaid Innovation (CMMI), which tries new ways of paying for health care with the goal of lowering costs and improving care.”
    • The pilot should shift some costs from the FEHB Program to Medicare.
  • NCQA today revealed its HEDIS changes for Measurement Year 2026.

From the Food and Drug Administration,

  • MedTech Dive tells us,
    • “The Food and Drug Administration has cleared Cardiosense’s CardioTag wearable heart monitor, the company said Wednesday.
    • “CardioTag captures electrocardiogram, photoplethysmogram and seismocardiogram signals, plus heart and pulse rate, to enable physicians to noninvasively monitor a patient’s cardiac function.
    • “Cardiosense is planning to combine the data with AI models for cardiovascular parameters. The company has published a paper on a pulmonary capillary wedge pressure algorithm.”

From the judicial front,

  • Bloomberg Law reports,
    • “Trump administration restrictions on transgender care for minors have drawn a new legal challenge from a coalition of states.
    • “The lawsuit, filed Friday in the US District Court for the District of Massachusetts, argues that what it calls President Donald Trump’s “Denial of Care” executive order and subsequent implementation actions are trying to block the provision of health care for transgender youth to minors without any basis in federal law. 
    • “No federal law prohibits, much less criminalizes, the provision or receipt of gender-affirming care for transgender adolescents,” the lawsuit said.
    • Michigan, Massachusetts, Nevada, New Jersey, and New Mexico are among the states listed on the lawsuit. Also among the plaintiffs is Pennsylvania Gov. Josh Shapiro, a Democrat whose attorney general is a Republican.
    • The case is Mass. v. Trump, D. Mass., No. 1:25-cv-12162, 8/1/2025.

From the public health and medical research front,

  • The Centers for Disease Control and Prevention announced today,
    • “COVID-19 activity is increasing in many Mid-Atlantic, Southeast, Southern, and West Coast states. Seasonal influenza activity is low, and RSV activity is very low.
    • “COVID-19
      • “COVID-19 laboratory percent positivity is increasing nationally. Emergency department visits for COVID-19 are increasing among all ages. COVID-19 wastewater activity levels and model-based epidemic trends (Rt) indicate that COVID-19 infections are growing or likely growing in most states.
    • “Influenza
    • “RSV
      • “RSV activity is very low.
  • The University of Minnesota’s CIDRAP adds,
    • COVID-19 activity is picking in the United States, according to the latest update from the Centers for Disease Control and Prevention (CDC). Although wastewater levels are low nationally, the CDC said cases are rising in many Mid-Atlantic, Southeastern, Southern, and West Coast states. According to the CDC COVID Data Tracker, test positivity for the week ending July 26 rose to 6.5%, up from 4.9% the previous week, while the rate of COVID-related emergency department visits for all ages climbed from 0.6% to o.7%. The percentage of US deaths from COVID rose from 0.3% to 0.4%. Seasonal flu and respiratory syncytial virus (RSV) activity remain low. The CDC also noted that respiratory infections caused by Mycoplasma pneumoniae remain elevated in some parts of the country.
  • and
    • “The 2024-25 COVID mRNA vaccines targeting JN.1 were highly effective in protecting against hospitalization and death for at least 4 months in a cohort of Danish citizens aged 65 and older by October 1, 2024. The new analysis estimating the vaccine efficacy (VE) of last season’s COVID vaccines was published earlier this week in The Lancet Infectious Diseases. 
    • “In total, 894,560 Danish residents were included in the study, with a median age of 76. By Jan 31, 2025, 820,229 (91.7%) of the participants had received a JN.1 vaccine. Among those without updated JN.1 vaccination (74,331), 278 COVID-19 hospitalizations and 84 deaths were observed during 25.6 million person-days. 
    • “In contrast 197 COVID-19 hospitalizations and 56 deaths in 62.9 million person-days were observed in residents who received Pfizer’s Comirnaty (among 728,868 recipients). And 10 COVID-19 hospitalizations and 1 death were observed during 9.2 million person-days in those vaccinated with Moderna’s Spikevax vaccine (91,461 recipients).”
  • Per Medscape,
    • “Does drinking alcohol increase the risk for pancreatic cancer? Researchers have long suspected it does, but the evidence has remained inconsistent.
    • “Now, a global study of more than two million people is firming up the case that a link exists.
    • “The study, which pooled data from 30 prospective cohorts, found that daily alcohol intake was associated with a “modest” increased risk for pancreatic cancer in both women and men, regardless of smoking status.”
  • Per Genetic Engineering & Biotechnology News,
    • “The Notch signaling pathway plays a pivotal role in determining cell fate, especially in the development and function of T cells. But mimicking this highly mechanical, contact-dependent pathway in the lab has been a formidable challenge—until now.
    • “A team of researchers at Boston Children’s Hospital and Harvard Medical School has developed a solution by designing a synthetic protein using AI-powered tools to activate Notch signaling. These soluble protein agonists can replicate Notch activation in suspension culture, opening the door to scalable, precision-controlled T-cell therapies.
    • “The study published in Cell, “Design of Soluble Notch Agonists that Drive T Cell Development and Boost Immunity” was led by George Daley, MD, PhD, Dean of Harvard Medical School and co-founder of the Stem Cell and Regenerative Biology Program at Boston Children’s Hospital. The researchers used AI-based computational design tools to build synthetic molecules with similar geometry and multivalency required for Notch activation.”

From the U.S. healthcare business front,

  • STAT News reports,
    • “If you’ve followed health insurance earnings over the past few weeks, you might be experiencing some whiplash. 
    • “Four of the biggest players — top names like UnitedHealth Group and Elevance — lowered their profit expectations for the year, while two others — Humana and CVS Health — raised them. One, Cigna, reaffirmed its previous outlook. 
    • “It turns out, the returns health insurers saw in the first half of 2025 were largely determined by what they did in the previous two years. Some saw the writing on the wall early and shook off unprofitable plans in specific counties, emerging with more stable, albeit slimmer, profiles. Others weren’t as proactive, and they’re now paying the price. 
    • “It’s sort of like where you came from in ’24 matters,” said Brad Ellis, a senior director at Fitch Ratings who leads its health insurance sector. “None of the companies I would say are doing really well, but it’s just a matter of who is doing less bad.” 
    • “Another big factor at play is everything insurers do besides insurance. Most of them now have booming pharmacy benefit managers and care delivery segments that in some cases draw more revenue and are more profitable than their insurance businesses. 
    • “One thing that unites them all: They are footing bigger bills as people get more medical services than before, and those services get more expensive. It’s happening across Affordable Care Act plans, Medicaid, and Medicare Advantage, the private form of Medicare. Some of the higher expenses stem from higher prices from hospitals and providers’ ramped-up coding tactics.”
  • World at Work adds,
    • “Healthcare costs in 2026 are expected to continue to trend upward within employer-provided coverage plans, according to recent reports from consulting firms PwC and Mercer. And, as in years past, the primary employer challenge will be how to best mitigate those expected higher costs.
    • “For instance, PwC reported in a recent survey that the overall increase in the cost of healthcare, or the “medical cost trend,” may be around 8.5% or higher for 2026. Medical cost trend is a metric that shows how much a health plan’s medical claim costs would change if it kept its plan design the same. The projection is similar to what PwC analysts have seen for the U.S. group health market so far for 2025. 
    • “PwC also noted that one force that could increase employers’ health plan costs are looming federal spending cuts to Medicaid and Affordable Care Act (ACA) subsidies as a result of the recently signed H.R. 1 (also known as the “One Big Beautiful Bill Act”).
    • “In its survey, Mercer found that as health plan costs continue to increase, more employers intend to change or reduce their 2026 benefit offerings to control spending.
    • “For example, 51% of respondents said they’re “likely” or “very likely” to make plan changes that would shift more costs to employees, such as raising deductibles or out-of-pocket maximums. The percentage increased from 45% in 2024.”
  • Here is a link to Milliman’s July 2025 report titled Commercial health insurance: Detailed 2023 financial results and emerging 2024 and 2025 trends.
  • Healthcare Dive lets us know,
    • “UnitedHealth announced on Thursday it will replace its CFO, another significant executive change for the healthcare behemoth as it mounts a financial turnaround. 
    • “Wayne DeVeydt, most recently a managing director and operating partner at investment firm Bain Capital, will take up the CFO role on Sept. 2, according to a press release. 
    • “John Rex, the company’s CFO since 2016, will become a strategic advisor to CEO Stephen Hemsley, who returned to the top job in May after UnitedHealth’s previous CEO stepped down.”
  • Beckers Hospital Review points out the 20 highest, lowest paid physician specialties | 2025.
  • The Wall Street Journal reports,
    • “President Trump demanded pharmaceutical companies lower drug prices, aligning them with other advanced countries.
    • “Analysts believe the proposals’ impact may be limited, facing legal challenges and requiring Congressional approval.
    • “PhRMA opposed the plan, advocating for addressing healthcare middlemen and urging other countries to pay their fair share for drug innovation.”
  • Per BioPharma Dive,
    • “Biotechnology companies specializing in psychedelics research saw their share prices rise after rumors of a billion-dollar acquisition hinted that big pharma is now more open to betting on this area of drug development.
    • “Bloomberg News reported early Thursday that AbbVie is in talks to buy privately held Gilgamesh Pharmaceuticals. If agreed to, the deal would hand AbbVie a small slate of experimental therapies for depression, anxiety and mental health conditions. Gilgamesh’s most advanced drug, code-named GM-2505, works by latching onto a brain protein known to interact with psychedelics like LSD and psilocybin.” * * *
    • “Analysts note, too, the inroads psychedelics are making with drug regulators. Martin Makary, commissioner of the Food and Drug Administration, and Robert F. Kennedy Jr., head of the Department of Health and Human Services, both support speeding up the testing — and possible approval — of psychedelics. The FDA, under former president Joe Biden, also issued guidance in 2023 for psychedelic drug developers.”

Tuesday report

David Ermer–AHRQ, CDC, CMS, Congress, FDA, Generative AI, HSA, Medical / Rx research, Medicare, Mental health care, No Surprises Act, OPM, Rx coverage, U.S. Healthcare–

From Washington, DC,

  • The Senate confirmed Susan Monarez to be Director of the Centers for Disease Control and Prevention today by a 51 to 47 vote. The AP adds,
    • “She holds a doctorate in microbiology and immunology from the University of Wisconsin and did postdoctoral research at Stanford University. Prior to the CDC, Monarez was largely known for her government roles in health technology and biosecurity.”
  • MedCity News tells us,
    • “On Thursday, a coalition of 28 healthcare organizations sent a letter to leaders in Congress calling on them to extend the Affordable Care Act enhanced premium tax credits, which are set to expire at the end of the year.
    • “The letter was addressed to John Thune, Senate majority leader; Chuck Schumer, Senate minority leader; Mike Johnson, speaker of the House; and Hakeem Jeffries, minority leader of the House. The letter was led by Keep Americans Covered and was signed by healthcare organizations including AHIP, Blue Cross Blue Shield Association, the American Medical Association, Kaiser Permanente, Families USA and more.” 
  • STAT News reports,
    • “Health secretary Robert F. Kennedy Jr. could “imminently” overhaul a key federal advisory panel that recommends which preventive services insurers must pay for, according to a person familiar with the plans. 
    • “The person said that federal health officials are actively vetting new members for the U.S. Preventive Services Task Force. David Mansdoerfer, an adviser to a Kennedy-aligned group of physicians, said he’s aware of people being considered for the panel, but declined to name them.” * * *
    • “Mansdoerfer added that the existing panel is “M.D. heavy” and a reconstituted panel is more likely to include “allied health professionals,” which are health care providers who aren’t nurses or physicians, like physical therapists and dietitians.” 
  • Following up on yesterday’s post about Medicare Part D, here is a link to the CMS guidance upon which the Wall Street Journal relied.
  • World at Work informs us,
    • “Health savings accounts (HSAs) have become a staple total rewards offering over the last decade, but a new study by the Employee Benefit Research Institute (EBRI) showed employees are still leaving the full value of these accounts on the table.
    • “The June 12 EBRI report pulled data from 14.5 million accountholders, containing more than $48 billion in total assets — roughly 40% of the entire HSA universe. The analysis revealed:
      • “Low balances. End-of-year balances increased in 2023 (the most recent analysis period) to $4,747 but are still modest compared with average out-of-pocket maximums for HSA-eligible health plans ($8,300 for individual coverage in 2025, $16,600 for family coverage)
      • “Low contributions. Relative to 2022, average HSA contributions increased in 2023. However, after adjusting for inflation, both employer and employee contributions were higher in the 2010s. Also, notably, the average combined HSA contribution was $760 less than the statutory maximum contribution for individuals and $4,660 less than the statutory maximum contribution for accountholders with family coverage.
      • “High withdrawals. More than half of accountholders withdrew funds, and the average distribution rose to $1,801.
      • “Low investment. Only 15% of accountholders invested in assets other than cash. 
    • EBRI found that, essentially, employees use HSAs as specialized checking accounts rather than investment accounts, and in doing so, miss out on the triple tax advantage available if they maximize contributions, minimize withdrawals and invest their balances.
    • “The good news is that, here we are 20-plus years after HSAs launched, and they’ve become pretty standard. They’re a typical plan offering from most employers of all sizes — not just large or small companies, or in certain industries,” said Alexander Domaszewicz, a principal and healthcare consultant at advisory firm Mercer. “If we live long enough, we’ll have healthcare expenses, and we want to be prepared for that. But while awareness and visibility of HSAs have grown, they’re still intimidating to folks.”
  • Beckers Payer Issues calls attention to recent No Surprises Act developments.
  • Federal News Network lets us know,
    • “The Trump administration is detailing how it expects agencies to recruit more political appointees through the new “Schedule G” hiring category, while also reminding agencies that all non-career hires must be approved by the White House.
    • “The Office of Personnel Management on Tuesday outlined how agencies should adopt the federal employment classification President Donald Trump created earlier this month. Generally, the new Schedule G broadens agencies’ options for hiring political appointees, beyond the avenues already available to presidential administrations for picking their own staff members.
    • “In its guidance on Trump’s new hiring authority, OPM said agencies will have to run any Schedule G hires they want make by the White House for review and approval.
    • “As a matter of practice,” OPM said, agencies will have to send all their political hires to their White House liaison — a position that coordinates with the White House on hiring and retention of political appointees — before agencies can advance any Schedule G appointments.”

From the Food and Drug Administration front,

  • Bloomberg Law informs us,
    • “Vinay Prasad, a top regulator at the US Food and Drug Administration, has left the agency after a controversy over his handling of Sarepta Therapeutics Inc.’s gene therapy. 
    • “Dr. Prasad did not want to be a distraction to the great work of the FDA in the Trump administration and has decided to return to California and spend more time with his family,” Department of Health and Human Services spokesperson Andrew Nixon said in a written statement. 
    • “Prasad did not immediately respond to a request for comment about his departure.” 
  • The Washington Post reports,
    • “The Food and Drug Administration pushed Tuesday to restrict a synthetic opioid found in tablets, gummies and drinkable shots commonly sold in convenience stores.
    • “Health officials announced they will seek to add 7-OH — a potent substance synthesized from a compound in the kratom leaf — to the tier of controlled substances reserved for the most addictive drugs, such as heroin and LSD.
    • “The FDA, researchers and kratom companies have grown increasingly alarmed by the rise of 7-OH products they say are distinct from all-natural teas and powders derived from a leaf that grows on trees native to Southeast Asia.
    • “FDA Commissioner Marty Makary said at a news conference that the agency is not asking to restrict natural products made from kratom, which contains trace amount of the compound. In a report released Tuesday, the agency said it maintains concerns about kratom broadly but needed to act urgently on 7-OH because of its risk of sedation, nausea, breathing problems and addiction.”
  • From the judicial front,
    • Fierce Healthcare reports,
      • “A new law in Arkansas banning pharmacy benefit managers from owning pharmacies has been blocked by a federal judge, the latest development in one of the industry’s most-watched new pieces of legislation.
      • “Judge Brian Miller said the law may violate (PDF) the Commerce Clause in the constitution and is likely preempted by TRICARE, a health care program for military families. The state is barred from enforcing the law until final disposition, a ruling shows.
      • “Act 624 appears to overtly discriminate against plaintiffs as out of state companies and the state has failed to show that it has no other means to advance its interests,” said Miller, adding other enacted state laws already can properly restrict PBMs.
      • “Arkansas Attorney General Tim Griffin said he plans on appealing the decision, reported the Associated Press.
      • “We’re pleased with the Court’s decision to grant a preliminary injunction to stop the implementation of Act 624,” a CVS Health spokesperson said in a statement. “We continue to be focused on serving people in Arkansas and are actively looking to work together with the state to reduce drug prices and ensure access to pharmacies.”

From the public health and medical researach front,

  • KFF considers whether our country’s measles elimination status is at risk.
  • The Agency for Healthcare Research and Quality released a medical expenditures survey report titled “Healthcare Expenditures for Heart Disease among Adults Aged 18 and Older in the U.S. Civilian Noninstitutionalized Population, 2022.”
    • “In 2022, 7.8 percent of adults aged 18 and older were treated for heart disease, and men were more likely than women to have treated heart disease (8.4 % vs. 7.2%).
    • “Among age groups, the treated prevalence of heart disease was highest for those aged 65 and older (22.8%) compared to only 6.0 percent for adults aged 45-64, and 1.4 percent for adults ages 18-44.
    • “In 2022, healthcare expenditures to treat heart disease for adults in the US totaled $100.0 billion (with an average cost of $4,900 per adult with diagnosed and treated heart disease).
    • “The largest portion of heart disease expenditures were incurred through hospital inpatient stays (46.1%) and prescribed medications (20.5%).
    • “The majority of heart disease treatment costs were paid by Medicare (57.6%) and private insurance (24.2%).”
  • Per MedPage Today,
    • “The global incidence of liver cancer is projected to double by 2050.
    • “Sixty percent of liver cancers are preventable by controlling risk factors including hepatitis B and C, alcohol consumption, and MASLD.
    • “The Lancet Commission estimated that a 2-5% reduction in the age-standardized incidence rate of liver cancer could prevent up to 17.3 million new cases and save up to 15.1 million lives.”
  • Per Neurology Adviser,
    • “Urinary tract infections (UTIs) may be a trigger for myocardial infarction (MI) or stroke, with an increased risk for both within the first 7 days of infection, according to the findings of a study published in BMJ Open.”
    • “Growing evidence suggests that acute infection plays a role in the pathogenesis of cardiovascular disease.
    • “Researchers from Cardiff University in the United Kingdom conducted this self-controlled cases series using data from the Secure Anonymised Information Linkage (SAIL) Databank which houses nation-wide data from Wales. Patients (N=105,930) with MI (n=51,660) or stroke (n=58,150) between 2010 and 2020 were evaluated for general practitioner suspected or confirmed UTI before or after MI or stroke event. The peak risk period was defined as up to 90 days after UTI.
    • “The MI and stroke cohorts consisted of 63% and 49% men, with mean ages of 69 and 74 years for men and 77 and 79 years for women, respectively.”
  • STAT News reports,
    • “A major Alzheimer’s disease medical group is recommending that specialists may use certain blood tests to help diagnose patients with cognitive impairment in lieu of more complex and invasive tests, a move that could lead more people to get treated for the devastating disease.
    • “The Alzheimer’s Association, in its first clinical guidelines on blood biomarker testing, said Tuesday that tests that have over 90% sensitivity (ability to identify positive results) and 90% specificity (ability to identify negative results) can be used instead of current diagnostic methods like PET scans and cerebrospinal fluid tests.
    • “The group said that tests that have over 90% sensitivity and 75% specificity can be used to triage patients, meaning negative results rule can rule out Alzheimer’s with high probability but positive results should be confirmed with the standard diagnostic methods, given that these blood tests have a higher likelihood of false positives.
    • “The authors stressed that the guidelines should not be considered a substitute for a full clinical evaluation and that they apply only to people who are in the care of specialists and have already been confirmed to have cognitive impairment. The authors also noted that there’s wide variability in the blood tests on the market and that many do not meet the accuracy thresholds.”
  • Per Benefits Pro,
    • “Researchers at Cigna’s Evernorth Research Institute are seeing early signs that offering patients semaglutide and other GLP-1 agonists might cut the cost of managing mental health problems.
    • “Duy Do and two other Evernorth researchers found that using Ozempic or similar drugs to control blood sugar reduced use of office visits to treat depression by 13% and reduced use of office visits to treat anxiety by 15%.
    • “Use of GLP-1 agonists did not reduce use of emergency room visits or inpatient care for depression or anxiety, but the researchers say their work shows the need for understanding how GLP-1 agonist use affects people’s mental health and use of mental health services.
    • “Given the high economic burden of mental health disorders among patients with T2DM, further research is needed to confirm the clinical and cost-effectiveness of [GLP-1s] in reducing the overall health care burdens for this patient population,” Do and colleagues conclude.”

From the U.S. healthcare business front,

  • The Wall Street Journal reports,
    • “UnitedHealth Group anticipates its 2025 earnings to fall below expectations due to rising costs and operational issues.
    • “CEO Stephen Hemsley aims to restore UnitedHealth to high performance, projecting earnings growth for the coming year.
    • “UnitedHealth is facing industry upheaval with rising healthcare costs, government actions, and ongoing Justice Department probes.”
  • Modern Healthcare tells us,
    • “Humana is offering certain employees voluntary early retirement buyouts.
    • “Employees age 50 or older with at least three years of service are eligible for the program, although those working in certain business-critical areas will be ineligible, a company spokesperson said Tuesday. He said the window to apply for voluntary early retirement will be open for several weeks.
    • “The Louisville, Kentucky-based health insurer said the offers are part of ongoing evaluations Humana conducts to adjust staffing and drive organizational efficiency.”
  • Beckers Hospital Review lets us know,
    • “U.S. News & World Report released its 2025-2026 Best Hospitals rankings and ratings July 29, which included its list of 504 Best Regional Hospitals across 49 states and 95 metropolitan areas.
    • “The latest edition of Best Hospitals, now in its 36th year, evaluated more than 4,400 hospitals on measures such as risk-adjusted mortality rates, preventable complications and level of nursing care.” 
    • The article lists the no. 1 ranked hospitals in each eligible state.
  • Cardiovascular Business points out the best heart hospitals according to U.S. News and World Report.
  • Fierce Healthcare informs us,
    • “Earlier this year, CVS Health announced that it would invest $20 billion in improving the consumer experience and making the healthcare journey simpler.
    • “Now, its health benefits arm, Aetna, is unveiling its new Care Paths program, which connects members who have certain health needs—launching with diabetes, joint health and maternity care—to a more personalized view of their benefits and more directly with the care team supporting them. The platform is powered by artificial intelligence and offers users individualized recommendations for health and wellness programs related to their conditions as well as care kits when available.
    • “The goal, the insurer said, is to make members’ interactions with their health plans feel less transactional and instead more holistic. Aetna offered an exclusive look at the new offering to Fierce Healthcare.”
  • and
    • “Sword Health, a company that provides virtual physical therapy and mental health, is now offering an AI assistant for payers and providers to tackle operational and administrative tasks.
    • “The new AI division marks a notable expansion from the company’s core business of virtual care services like digital musculoskeletal care, pelvic health and movement health.
    • “The launch of the new division, called Sword Intelligence, marks a “pivotal evolution” in Sword Health’s strategy, according to the company.
    • “Sword Intelligence allows us to move beyond delivering care to our own members to enabling the entire healthcare industry to scale it efficiently and effectively,” Virgilio “V” Bento, founder and CEO of Sword Health, told Fierce Healthcare when reached via email.”
  • The Wall Street Journal further reports,
    • “Merck & Co. said it is embarking on a multi-year cost-savings plan, which includes cuts to its workforce and real-estate footprint, as it looks to redirect resources toward new product launches.
    • “The plan comes as the drug company on Tuesday logged lower revenue and sales in its latest quarter and narrowed its full-year guidance.
    • “The company said it expects the plan to result in $3 billion in annual cost savings by the end of 2027, which it plans to reinvest to support new products as well as its pipeline across multiple therapeutic areas.
    • “As part of the cost-savings plan, Merck expects to eliminate certain administrative, sales and research-and-development positions.
    • “The company didn’t disclose how many workers would be affected but said it would continue to hire employees in new roles across strategic growth areas of its business.
    • “Merck said it also would reduce its global real-estate footprint and continue to optimize its manufacturing network.
    • “The company expects the workforce cuts and real-estate reductions to result in annual cost savings of about $1.7 billion, which would be substantially realized by the end of 2027.”
  • and
    • “Novo Nordisk shares plunged after losing its lead in the weight-loss drug market to competitors like Eli Lilly.
    • “The company lowered its 2025 sales growth forecast due to copycat versions of Wegovy and slower Ozempic sales.
    • “Maziar Mike Doustdar was named chief executive, effective Aug. 7, succeeding Lars Fruergaard Jorgensen.”

Weekend Update

David Ermer–Congress, Generative AI, Medical / Rx research, U.S. Healthcare–

From Washington, DC

  • Roll Call discusses likely Senate activities this week.
  • Congress in the July 4, 2025, budget reconciliation act (§ 90101, at 291) did enact a law requiring OPM to place more internal controls over family member eligibility.
    • – No later than 12/31/25, OPM must develop a process by which any [ineligible] individual enrolled in, or covered under, a [FEHB or PSHB] shall be disenrolled or removed from enrollment in, or coverage under, that plan.
  • This requirement should include implementation of the HIPAA 820 standard enrollment roster transaction. 
    • – No later than July 3, 2026, OPM must issue regulations and implement a process to verify – (1) the veracity of any qualifying life event through which an enrollee seeks to add a member of family to his/her coverage; and (2) that, when an enrollee in the Program seeks to add a member of family to his/her coverage, including during any open season, the individual so added is a qualifying member of family with respect to the enrollee.
  • It would be sensible for OPM to implement a program similar to TRICARE’s DEERS program which places the reporting burden on the TRICARE enrollee. 
  • HIPAA Suite explains,
    • “The HIPAA 820 transaction set [which has been around since 2008] handles the [electronic] communication between a sponsor that is an entity that pays for someone’s health care, and another entity that manages health care benefits, such as an insurance company.
    • “For example, a large employer that has a contract with an insurance company or a government agency that handles social and health benefits will use the 820 transaction to manage premium payments. This information can either be very detailed and contain demographic information on each individual that is covered or just contain a summary of the payment for all members.
  • The HIPAA standard transaction law requires health plans to be able to process the HIPAA 820. What’s more nearly half of FEHB and PSHB enrollees have self only coverage.

From the public health and medical reseach front,

  • MedPage Today reports,
    • “For years, we’ve told our patients that human papillomavirus (HPV) vaccination works best when administered before sexual debut — and rightfully so. But what happens when a woman has already developed high-grade cervical dysplasia and undergoes surgical treatment?
    • Our recent study, published in The Lancet Regional Health – Europe, explored that very question. And the results were striking: women who received the HPV vaccine after surgical excision (conization) experienced a 74% reduction in recurrent high-grade cervical lesions (CIN2+), with the most dramatic benefit seen within the first 6 months after surgery.
  • and
    • “Cases of “Ozempic mouth” and “Ozempic teeth” have recently been described in the news, with most of the problems — inflammation affecting the gums, tooth decay, and even bad breath — linked to a dry mouth.
    • “All of the GLP-1 agonists that we use now cause changes in how everything is secreted in your GI tract,” Ann Marie Defnet, MD, who specializes in obesity medicine and bariatric surgery at Northwell Health’s North Shore University Hospital and Long Island Jewish Medical Center in New York City, told MedPage Today. And this “definitely has an impact on saliva.”
    • “People taking GLP-1 drugs also tend to be a bit dehydrated because they are often not hungry or thirsty, she noted.
    • “I haven’t seen too many horrible cases of periodontal disease, gingivitis, or anything like that, nor have I had any patients really complaining about dry mouth,” she noted. “But definitely I have patients all the time that [say], ‘Oh yeah, I can tell I’m dehydrated.'”
    • “Defnet said she believes some of the serious oral health issues that have been reported are likely representative of “more of a later stage issue with patients who maybe just aren’t staying hydrated in general.”
    • “One of the big things I always counsel my patients on is they just have to remember to continue to drink water, even if they’re not thirsty, even if they’re not hungry,” Defnet said. “That seems to help with all of these symptoms.”
  • The New York Times discusses “Coronary artery calcium testing [which] can reveal plaque in arteries, offering a more precise estimate of a patient’s risk [of having a heart attack]. Yet the test remains underused.”
    • “A brief and painless CT scan, it would show whether the fatty deposits called plaque were developing in the arteries leading to her heart.
    • “When plaque ruptures, it can cause clots that block blood flow and trigger heart attacks. The scan would help determine whether Ms. Hollander would benefit from taking a statin, which could reduce plaque and prevent more from forming.
    • “The test is used by more people every year,” said Dr. Michael Blaha, co-director of the preventive cardiology program at Johns Hopkins University. Calcium scans quadrupled between 2006 and 2017, his research team reported, and Google searches for related terms have risen even more sharply.
    • “Yet “it’s still being underused compared to its value,” he said.
    • “One reason is that although the test is comparatively inexpensive — sometimes up to $300, but often $100 or less — patients must pay for it out of pocket. Medicare rarely covers it, though some doctors argue that it should.”

From the U.S. healthcare business front,

  • Radiology Business lets us know,
    • “Physicians are increasingly exiting Medicare, according to new research published in JAMA Health Forum. 
    • “Radiology and other specialties have expressed concern in recent years that inadequate payment rates could push practices to close or stop accepting the federal program for seniors. Since 2001, Medicare reimbursements to physicians have fallen 33%, when adjusting for inflation, according to the American Medical Association. 
    • “Researchers recently sought to test this theory, analyzing 100% of fee-for-service Medicare Part B claims logged between 2010 to 2024. They found the share of physicians exiting Medicare increased “significantly” from 1.8% to 3.6% by the end of the study period. 
    • “The findings may reflect multiple factors, including the greater burden of new communication methods (e.g., portal messages) and demands for clinical documentation,” Hannah T. Neprash, PhD, and Michael E. Chernew, PhD, healthcare policy experts with the University of Minnesota and Harvard Medical School, respectively, wrote July 18. “More rapid growth in exit[s] among small practices likely contributes to consolidated physician markets, given that new physicians increasingly work for large practices.”
    • “Researchers excluded docs who on average billed for fewer than 100 Medicare claims annually. They defined an exit as the absence of any claims in the payment program for 12 consecutive months. Altogether, the study sample included over 791,000 physicians at an average age of nearly 45. Physician Medicare exits displayed a gradual increase from 2010-2013 before stabilizing between 2014-2016. They saw another gradual increase from 2017-2019 and then spiked amid the COVID-19 pandemic in 2020-2021 before returning to regular levels by 2023.” 
  • The boilerplate in an FEHB or PSHB brochure (meaning its OPM policy) reads,
    • If you are enrolled in Medicare Part B, a physician may ask you to sign a private contract agreeing that you can be billed directly for services ordinarily covered by Original Medicare. Should you sign an agreement, Medicare will not pay any portion of the charges, and we will not increase our payment. We will still limit our payment to the amount we would have paid after Original Medicare’s payment. You may be responsible for paying the difference between the billed amount and the amount we paid.
  • MedCity News informs us that “Sentara Health has rolled out Regard’s AI-powered chart review and discharge summary tool across all 12 of its hospitals [located in Virginia and North Carolina]. The tool has delivered consistent benefits when it comes to patient safety and documentation accuracy, said Joseph Evans, Sentara’s chief health information officer.