|
PRESIDENT-ELECT TRUMP'S CABINET CHOICES
|
Dr. Janette Nesheiwat, Picked as US Surgeon General |
President-elect Donald Trump has picked Janette Nesheiwat. MD, to serve as the U.S. Surgeon General. A graduate of the University of South Florida, Nesheiwat completed her medical residency at University of Arkansas Medical Center in Fayetteville and completed ER rotations with Johns Hopkins University. She currently serves as a Medical Director at CityMD, a network of urgent care centers in New York and New Jersey. Previously, she served as a physician at Washington Regional Medical Center and at Northwest Medical Hospital. In addition, she's an author of "Beyond the Stethoscope: Miracles in Medicine" and a Fox News medical contributor, hosting an educational medical television show entitled "Family Health Today," as well as "Health Minute" with Dr. Janette on KNWA-TV, an NBC affiliate in Northwest Arkansas. (https://www.usatoday.com/story/news/politics/elections/2024/11/22/trump-fox-news-surgeon-general/76510351007/)
|
|
Former Florida Congressman Dave Weldon Chosen for CDC Director |
President-elect Trump has selected former Florida Republican Congressman Dave Weldon, MD to serve as the director for the Centers for Disease Control. While in Congress from 1995 to 2009, Weldon introduced a bill in 2007 that would give responsibility for the nation's vaccine safety to an independent agency within the Department of Health and Human Services, removing most vaccine safety research from the CDC. After serving seven terms in Congress, Weldon, an Army veteran, went back to private practice. He graduated from Stony Brook University in 1978, and earned his M.D. degree at the University at Buffalo School of Medicine in 1981. (https://www.usatoday.com/story/news/politics/elections/2024/11/22/trump-dave-weldon-cdc-director/76512041007/)
|
|
Jay Bhattacharya Picked to Lead National Institutes of Health |
President-elect Trump has chosen health economist Jay Bhattacharya, MD. a critic of pandemic lockdowns and vaccine mandates, to lead the National Institutes of Health, the nation's leading medical research agency. Bhattacharya was one of three authors of the Great Barrington Declaration, an October 2020 open letter maintaining that lockdowns were causing irreparable harm. He is a former research fellow at the Hoover Institution and an economist at the RAND Corporation. Bhattacharya is a Professor of Medicine at Stanford University, a research associate at the National Bureau of Economics Research, a senior fellow at the Stanford Institute for Economic Policy Research, and at the Stanford Freeman Spogli Institute. He directs the Stanford Center on the Demography of Health and Aging. Bhattacharya's research focuses on the economics of health care around the world with a particular emphasis on the health and well-being of vulnerable populations. He holds an MD and PhD in economics from Stanford University. (https://apnews.com/article/trump-nih-bhattacharya-national-institutes-health-454874e66e842ef8c953ece905c00fe1) (https://profiles.stanford.edu/jay-bhattacharya)
|
|
|
HEALTHCARE & GOVERNMENT
|
CMS Releases 200 New Medicare Residency Slots |
CMS has announced its list of teaching hospitals that were awarded new Medicare-supported graduate medical education positions. The agency will add 200 residency positions to the selected hospitals; approximately 70% of the new positions will go to primary care and psychiatry residency programs. The slots are the third allocation from 1,000 new Medicare-funded residency positions authorized over five years, in 2021. In this round of distributions, 109 teaching hospitals across 33 states received new residency slots, which will go into effect July 1. (https://www.beckersphysicianleadership.com/physician-workforce/cms-adds-200-gme-residency-slots-expands-physician-workforce.html) (https://www.aha.org/news/headline/2024-11-22-cms-awards-third-round-medicare-funded-residency-slots-hospitals)
|
|
One Election Outcome Health System CEOs Can Agree On |
A recent article from Becker's Healthcare editorializes that as economic anxiety dominated voter concerns, both candidates missed a big opportunity by failing to frame healthcare as an economic issue. Recent investigations revealed an estimated $7.5 billion in questionable risk-adjustments for 2023, while Senate findings indicate aggressive prior authorization practices, often denying necessary post-acute care services to seniors. The Heritage Foundation's "Project 2025" vision for the president calls for making Medicare Advantage plans the default enrollment option for Medicare. "As government payments increasingly dominate hospital revenue streams while failing to cover costs, the sustainability of America's healthcare system hangs in the balance." (https://www.beckershospitalreview.com/finance/one-election-outcome-health-system-ceos-can-agree-on.html)
|
|
CMS's Key Pitches for Medicare Advantage Changes |
CMS proposed major reforms on Nov. 26 for the Medicare Advantage and Part D programs for contract year 2026, including these key proposals:
1. Tightened prior authorization rules: CMS is looking to "address concerns about the overuse of prior authorization" by introducing clearer definitions for internal coverage criteria, stricter transparency requirements for insurers, ensuring enrollees are informed about their appeal rights, and collecting more data on initial coverage decisions and appeals.
2. Weight loss drug coverage: Part D plans and Medicaid programs could provide coverage of GLP-1s for obesity after previously being excluded (unless they were being used to treat conditions such as diabetes).
3. Medicare Shared Savings Program adjustments: CMS is proposing new standards for MA medical loss ratio reporting to better align with Medicaid and commercial requirements. "In addition to the proposed changes, we are issuing a request for information on potential policies that CMS could adopt regarding how the MA and Part D MLRs are calculated in order to enable policymakers to address concerns surrounding vertical integration in them."
4. Marketing: CMS is proposing to expand the definition of "marketing" to cover more materials and activities related to MA and Part D plans, requiring more advertisements and communications to be reviewed by the agency before being shared with the public. Improving consumer tools on Medicare.gov. Brokers must discuss additional topics, such as Medigap rights and low-income subsidy eligibility.
5. Artificial intelligence: CMS aims to enforce equitable access to care, regardless of delivery by humans or AI tools. MA plans using AI must comply with anti-discrimination laws and provide fair, unbiased access to services.
(https://www.beckerspayer.com/policy-updates/cms-pitches-major-medicare-advantage-changes-10-notes.html)
MEANWHILE, Biden Administration Proposes Medicare Coverage for Weight Loss Drugs: The White House is pitching broader coverage of weight loss drugs for millions of Americans on Medicare and Medicaid. The proposal would expand coverage for weight loss drugs to an estimated 3.4 million Medicare beneficiaries, according to a Nov. 26 news release. Becker's Healthcare published 10 things to know about the proposal; including
> Currently, Medicare only covers weight loss drugs to treat diabetes or other conditions. A handful of state Medicaid programs already choose to pay for weight loss drugs.
> GLP-1s, including Wegovy and Ozempic, can cost over $1,000 a month without insurance coverage.
> Medicare coverage of the drugs could cost the federal government $35 billion by 2034, according to estimates published by the Congressional Budget Office in October. CBO estimates the cost of the drugs will decline over time.
> In May, Sen. Bernie Sanders, chair of the Senate committee on Health, Education, Labor and Pensions, warned GLP-1s could bankrupt the U.S. healthcare system.
> Insurance coverage for GLP-1s is broadly popular, according to a survey from KFF published in August 2023. Four in 5 adults say insurers should cover the drug for adults diagnosed as overweight or obese. (https://www.beckershospitalreview.com/glp-1s/biden-administration-proposes-medicare-coverage-for-weight-loss-drugs-10-things-to-know.html)
HOWEVER, Payers are 'deeply concerned' by Medicare weight loss drug coverage proposal: Some insurers are sounding the alarm that Medicare coverage of weight loss drugs could increase premiums. The White House estimated more than 7 million people would be eligible for weight loss drugs if coverage is expanded. Ceci Connolly, president of the Alliance of Community Health Plans (which represents 30 nonprofit health plans), called the proposal "irresponsible, without further analysis and stakeholder engagement." As Senator Bernie Sanders said, "If this proposal is to be financially responsible for seniors and taxpayers, Medicare and Medicaid cannot pay up to 10 to 15 times more for these drugs than they cost in Europe and other major countries." (https://www.beckerspayer.com/payer/payer-group-deeply-concerned-by-medicare-weight-loss-drug-coverage-proposal.html)
|
|
CMS Ups UnitedHealth, Centene Star Ratings After Court Challenges |
Following a successful court challenge from UnitedHealthcare, CMS has updated the star ratings for some UnitedHealthcare and Centene Medicare Advantage contracts. On Dec. 2, the agency published updated star ratings for 12 UnitedHealthcare and seven Centene Medicare Advantage contracts. Two UnitedHealthcare contracts were upgraded from 4.5 to five stars. Turns out, on Nov. 22, a federal judge ruled that CMS must recalculate UnitedHealthcare's MA star ratings without including a disputed customer service phone call. UnitedHealthcare filed a lawsuit in September, alleging CMS downgraded its star ratings based on one secret shopper phone call. UnitedHealthcare alleged the call never connected to its call center. The downgraded ratings cost UnitedHealthcare $190 million in bonus payments, the company alleged. Centene also challenged the inclusion of a secret shopper phone call in its star ratings in court. A ruling has not been issued in the case, yet CMS upgraded seven of Centene's contracts on Dec. 2. (https://www.beckerspayer.com/payer/cms-ups-unitedhealth-centene-star-ratings-after-court-challenges.html)
|
|
|
HEALTH SYSTEMS & PROVIDER NEWS
|
Risant Health Closes Cone Health Transaction, Adds Second Health System in 9 Months |
Risant Health announced that it has received all required regulatory approvals and has completed its transaction with Cone Health. This is the second nonprofit health system to become part of Risant Health this year - Geisinger became a part of Risant in March. Risant Health was created by Kaiser Foundation Hospitals to bring together like-minded organizations, increase access to value-based care and coverage, and raise the bar for approaches that bring the best health outcomes. Risant Health's goal is to expand and accelerate the adoption of value-based care in multipayer, multiprovider, community-based health system environments and improve the health of millions of people in communities across the country. (https://risanthealth.org/news/risant-health-closes-cone-health-transaction)
|
|
Largest Health Systems with a Presence in California |
Becker's has published the largest health systems in the U.S. based on the number of hospitals reported on the system's website. From that list, here are those with a presence in California and their spot on the list: (1) HCA Healthcare (Nashville, TN): 187 hospitals. (2) Veterans Health Administration: 170 hospitals. (3) CommonSpirit Health (Chicago): 137 hospitals. (4) Ascension (St. Louis): 136 hospitals. (11) Tenet Healthcare (Dallas): 52 hospitals. (13) AdventHealth (Altamonte Springs, FL): 51 hospitals. (14) Providence (Renton, WA): 51 hospitals. (18) Prime Healthcare (Ontario, CA): 44 hospitals. (21) Kaiser Permanente (Oakland, CA): 40 hospitals. (29) Adventist Health (Roseville, CA): 28 hospitals. (38) Sutter Health (Sacramento, CA): 22 hospitals. (https://www.beckershospitalreview.com/rankings-and-ratings/40-largest-health-systems-in-the-us-2024.html)
|
|
Male Nurses Are On the Rise |
The number of men in the U.S. with the job of registered nurse has nearly tripled since the early 2000s, increasing from about 140,000 in 2000 to about 400,000 in 2023. This means that about 14% of nurses are now men, up from about 9% roughly two decades ago. Many came into the field after working in the military or in jobs, such as paramedics or firefighters, that exposed them to the work of nurses. Nursing is a high-demand field with strong job security, attracting more men due to its stability and earning potential. Men gravitated towards higher-paying specialties, with about 46% of nurse anesthetists, who administer anesthesia and help patients recover from it, are men. (https://www.wsj.com/economy/jobs/male-nursing-boom-high-demand-field-7733dfaf)
|
|
Maternity Care Deserts are Growing in Rural Areas |
Over the past two years, more than 50 rural hospitals across the country have stopped delivering babies, contributing to the 57% of rural U.S. hospitals that lack labor and delivery services, according to the Center for Healthcare Quality and Payment Reform. "Over 80% of pregnancy-related deaths are preventable with appropriate prenatal, labor & delivery, and post-partum care," a CHQPR report notes. In California, there are a total of 58 rural hospitals - 34 (59%) do not have OB services. (https://www.beckershospitalreview.com/care-coordination/57-of-rural-hospitals-lack-maternity-care-19-states-with-the-biggest-gaps.html)
|
|
A Growing Concern - Behavioral Health Urgent Care Centers |
Behavioral health urgent care clinics are growing in popularity in the last five years as a way to provide mental health care outside of EDs. More than half of adults report they or a family member have experienced a severe mental health crisis, KFF survey data from 2022 shows. From 2018 to 2020, the average rate of mental health-related ED visits among adults was 53 per 1,000 adults, according to CDC data. Among children, the rate was 14 per 100,000. The first mental health urgent care center was opened by Edison, NJ-based Hackensack Meridian Health in 2019. In about two years, at least 77 more behavioral urgent care sites were opened across the nation, with about 20 of those opening in 2024. Systems praise the model for freeing up ED beds and lowering patient costs. (https://www.beckersbehavioralhealth.com/behavioral-health-news/the-pros-cons-of-behavioral-health-urgent-care-centers-beckers.html)
|
|
To Stay Cybersafe, Eliminate the Ten Most Common Passwords |
As healthcare faces a rash of cyberattacks, some hackers still break into computer networks the old-fashioned way: by guessing passwords. Here are ten of the most common passwords in the U.S., according to a November report from cybersecurity firms NordPass and NordStellar that analyzed 2.5 terabytes worth of publicly available data, including on the dark web: (1) Secret (2) 123456 (3) Password (4) qwerty123 (5) qwerty1 (6) 123456789 (7) password1 (8) 12345678 (9) 12345 (10) abc123 (https://www.beckershospitalreview.com/rankings-and-ratings/20-most-common-passwords.html)
|
|
|
EHR NEWS
|
Most Expensive EHRs, Ranked |
EHRs are among the largest investments health systems will ever make. Becker's Healthcare has published a list of the EHRs that cost $500 million or more; here are the top ten:
1. U.S. Department of Veterans Affairs (Washington, D.C.): $16 billion (Cerner aka Oracle Health)
2. Military Health System (Washington, D.C.): $5.5 billion (Cerner)
3. Kaiser Permanente (Oakland, Calif.): $4 billion (Epic)
4 (tie). Catholic Health Initiatives (Englewood, Colo.): $1.5 billion (Cerner and Meditech)
4 (tie). Mayo Clinic (Rochester, Minn.): $1.5 billion (Epic)
6 (tie). Mass General Brigham (Somerville, Mass.): $1.2 billion (Epic)
6 (tie). Northwell Health (New Hyde Park, N.Y.): $1.2 billion (Epic)
8 (tie). Dignity Health (San Francisco): $1 billion (Cerner and Meditech)
8 (tie). NYC Health + Hospitals (New York City): $1 billion (Epic)
8 (tie). Sutter Health (Sacramento, Calif.): $1 billion (Epic) (https://www.beckershospitalreview.com/ehrs/most-expensive-ehrs-ranked.html)
|
|
Epic's Intensified Pursuit of Interoperability |
Epic has intensified its pursuit of interoperability in recent months. The EHR vendor pledged to have all its customers commit to joining the Trusted Exchange Framework and Common Agreement, or TEFCA, a government-sponsored interoperability network, by Dec. 31, and go live by the end of 2025. The goal is to have patients easily share and access their health data no matter which EHR vendor their hospital, health system or clinic uses. TEFCA is the "North Star the industry is going toward" for health data exchange, Epic interoperability director Rob Klootwyk told Becker's. So far, 84 Epic health system customers have gone live on TEFCA, while another 136 health systems have pledged their commitment. Also, 1,521 of Epic's 3,000 hospitals and 33,139 of the 69,000 clinics on the EHR have gone live or made the pledge. (https://www.beckershospitalreview.com/ehrs/epics-new-interoperability-push-explained.html)
|
|
|
