January 26, 2024

2023 Bankruptcies Highest In Five Years

As was reported earlier, another report also shows that bankruptcies were very high in the healthcare arena in 2023.  Hospitals, pharmaceutical and senior care companies were on the list.

Additional articles here: https://www.modernhealthcare.com/finance/healthcare-bankruptcies-2023-gibbins-advisors and https://www.healthcaredive.com/news/healthcare-bankruptcies-spike-2023-gibbins-advisors/705738/

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#hospitals #healthcare #bankruptcies

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Biden Administration Strikes Again On Mergers

The Federal Trade Commission opposes another prominent merger – Novant Health’s purchase of two Community Health Systems hospitals.

Additional article here: https://www.healthcaredive.com/news/federal-trade-commission-sues-block-novant-health-community-health-systems-hospital-acquisition/705648/

#mergers #acquisitions #ftc #antitrust

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Drug Maker CEOs To Appear On Capitol Hill

A day after some very bad press, Johnson & Johnson CEO Joaquin Duato, Merck CEO Robert Davis and Bristol Myers Squibb CEO Chris Boerner all said they would appear at  hearing on drug pricing. 

Additional article here: https://www.statnews.com/2024/01/26/merck-johnson-johnson-ceos-drug-prices/

(Some articles may require a subscription.)

#drugpricing #branddrugmakers

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Medicaid Enrollment Losses Under Redeterminations Reaches Almost 15.8 Million

The Kaiser Family Foundation (KFF) finds that at least 15,755,000 Medicaid enrollees have been disenrolled as of January 22, 2024, based on the most current data from all 50 states and the District of Columbia.

#kff #medicaid #redeterminations #coverage

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New Medicare Advantage Challenges

Some new Medicare Advantage (MA) challenges are hitting plans just as new mandates hit. 

  • Congressional policy arm MedPAC is calling for standardization of benefits and perhaps limits on the number of plans.  While some reform may be called for, major changes would hurt innovation and the value to consumers.
  • Capitol Hill lawmakers want to pass a statute on reporting of supplemental benefits after the Centers for Medicare and Medicaid Services (CMS) already announced some major reforms in the area for 2025. Why is this necessary if CMS is acting.
  • Sen. Elizabeth Warren and Rep. Pramila Jayapal are calling for an investigation into alleged MA overpayments and Star bonuses. Watch out for continuing calls – political and budgetary – to adjust MA rates.

MedPAC presentation: https://www.medpac.gov/wp-content/uploads/2023/10/MedPAC-MA-standardized-benefits-Jan-2024.pdf

Article on overpayments: https://www.statnews.com/2024/01/26/medicare-advantage-overpayments-elizabeth-warren-pramila-jayapal/

(Some articles may require a subscription.)

#medicareadvantage #overpayments #supplementalbenefits

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Preventive Benefits Can Lead To Surprise Billing

Fresh off its Bill of the Month article on surprise bills from preventive colonoscopies, Kaiser Health News’s article tells us about surprise billing that can occur from annual checkup. I blame hospitals and private equity firms (which own many practices) looking for new ways to bill as well as health plans for giving in on contracts.

In other news, lawmakers are seeking to tackle a loophole in the premiums subsidy law in the Exchanges when a family member joins Medicare and pays Medicare premiums: https://insidehealthpolicy.com/daily-news/levin-sanchez-bill-addresses-subsidy-loophole-medicare-aca-enrollees

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#aca #prevention #surprisebilling

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Senators Investigating Assisted Living And Calling For Probe by GAO

After the Dying Broke series from The New York Times and Kaiser Health News, the Senate is now probing assisted living and calling for a Government Accountability Office (GAO) investigation. The problem with lawmakers are they are always looking for headlines.  They are crying about margins in the industry and calling for federal oversight, but the true investigation would look at how to build an aging agenda for America. There is a crying need for an agenda with public and private skin in the game.  I devote a full chapter to aging in America solutions in my book, The Healthcare Labyrinth (available at this site).

Additional article: https://www.modernhealthcare.com/politics-policy/assisted-living-facility-costs-us-senate-committee-probe-gao-study

(Some articles may require a subscription.)

#aging #assistedliving #medicaid

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Kudos to MedPAC Chair For His Balance In An Interview

I have had some issues with MedPAC and members, but I want to congratulate MedPAC Chairman Michael Chernew, PhD, for his very balanced responses to clearly provider-friendly (perhaps viscerally anti-MA) questions from a MedPage Today contributing writer. I wished there would have been more information on the benefits of MA overall, but what could have been a hit piece on MA turned out to be – well — rather nothing.

#medicareadvantage #medpac

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Drug Shortage Bill and Recommendations

The Senate Finance Committee is crafting bipartisan legislation to tackle drug shortages via numerous means, some of them including payment changes and purchasing reform.  Some note that three wholesalers control 90% of the drug market.

In addition, Health Affairs Forefront Blog has a good article on recommendations for ways drug shortages could be addressed without new legislation.  It also has a good discussion on supply-side and demand side incentives. Blog here: https://www.healthaffairs.org/content/forefront/demand-side-reforms-prevent-drug-shortages-medicare-s-role-successful-national-strategy

(Articles may require a subscription.)

#drugshortages #cms #fda

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Ugly Underbelly Of 340B

A new study in the New England Journal of Medicine finds the following on hospitals participating in the 340B drug discount program:

  • The markup at 340B hospitals on some of the most used doctor-administered infusion drugs was 6.59 times higher than markups at independent doctor practices. In contrast, markups at non-340B hospitals were 4.34 times higher than those at the same physician practices.
  • 340B hospitals retained 64.3% of insurer drug expenditures associated with the drugs, while non-340B hospitals held on to 44.8% and private practices retained 19.1%.
  • The median price markup for 340B hospitals was about 3.08 times higher than the cost of acquiring an outpatient infusion drug.

All of these statistics will be great fodder for a Senate investigation into 340B. It clearly is not working or at least is being abused by hospitals. The 340B program is meant to help ensure that everyone has access to life-saving medications. What this article seems to point out is that many hospitals use access to 340B simply as a cash cow.

I especially like a secondary finding by an author, who indicated that the way the program is working it provides… “

incentives for hospitals to increase the volume of drugs administered, primarily through the purchase of physician practices and the direction of patients from lower-cost community settings to higher-cost hospital outpatient infusion clinics.” 

In conclusion 340B hospitals mark up a great deal and hospital physician purchases are driving costs up by having procedures done at higher cost hospital-owned settings.  A double whammy.

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#340b #hospitals #siteneutral

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— Marc S. Ryan

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