Things to know in healthcare this week. 3.3.2020 Edition

Colorado’s Public option woes.

Colorado’s first-ever public option health insurance plan revealed its payment rates — and hospitals aren’t happy with the base payment rate of 155% of Medicare. In fact, Colorado’spublic option woes may be a microcosm for what will happen with any sort of federally mandated public option.(Remind me — what’s a public option?)

Walmart’s Primary Care Disruption.

Walmart’s pilot primary care clinics are already performing above expectations. In fact, the number of patients coming through the doors is “substantially higher” than what Walmart’s thought would happen. They’re now looking to expand the project.

Some interesting Walmart clinic things:

• Clinics have separate entrances from the main supercenter.
• They’re run by physicians.
• They involve little to no paperwork — a lot of appointments don’t involve insurance at all (although they do accept it), and scheduling/billing has been outsourced.
• They provide medical, dental, and eye care, along with x-rays and other routine diagnostic services.
• They disclose transparent pricing — the patient knows exactly how much everything will cost.

Read more about Walmart’s move into healthcare here.

The mistreated pharmacist saga continues.

In the February 3rd edition, we touched on a NY Times article reporting that most pharmacies appear understaffed and the pharmacists working the counters are stretched thin — potentially putting patients at risk. Take a quick gander at ther/pharmacy subreddit to get a better picture.

Both CVS and Walgreens have pushed back against the NYT reporting. But the damage is already done — the prescription drug chain duopoly will more than likely face increased scrutiny over its treatment of pharmacists.

Any medication errors from these chains are sure to make local news as patient safety is put into question.

Big Coronavirus updates.

Here are the latest stories & numbers from Axios’ live coverage tracker. The White House is requesting emergency funding. The coronavirus might affect the summer Olympics in Japan. And the CDC is bracing for a U.S. outbreak that might lead to medical supply shortages. Here are some general coronavirus tips: wash your hands for 20 seconds and stay at home if you’re sick.

SmileDirectClub isn’t smiling much this quarter; and an update on recent healthcare IPOs.

The direct-to-consumer dental brand missed sales and profitability expectations and dropped close to 30% on the report.

How have recent digital health IPOs fared since going public?

• One Medical: -2.0%
• Change Healthcare: -9.4%
• Phreesia: 23.8%
• Livongo: -34.4%
• Health Catalyst: -22.4%
• SmileDirectClub: -55.1%
• And for good measure, Peloton: 3.6%

Keep in mind the returns listed above are after the quickest market correction in history.

Election 2020 Weekly Update.

Supreme Court will review the ACA case during and after the 2020 Election.

This week’s big election news: The SCOTUS announced its intention to review whether the ACA is constitutional (WSJ paywall) — again. They’ll take up the case during its next session.

What you need to know.

• Remember that tax cut we all got back in late 2017? As a part of that act, Obamacare’s individual mandate — AKA, the part of the ACA that forced everyone to have health insurance or pay a fine — was removed.

Why would THAT make it unconstitutional?

Because this part of the ACA was repealed, several states led by Texas challenged its legality. Their argument, per the WSJ: “Without a monetary penalty, Congress [can’t] justify the insurance mandate based on its power to levy taxes.”

Experts think the argument is somewhat weak, but we’ll leave that up to the SCOTUS to decide. It’s a huge case — if found unconstitutional, there would be quite the volatile scramble.

Joe Biden wins South Carolina ahead of Super Tuesday.

• Joe Biden, champion of the public option and expanding the ACA, won the South Carolina primary in a landslide. Who else is excited for Super Tuesday?

Pete Buttigieg and Amy Klobuchar are out.

2 days before Super Tuesday, Pete Buttigieg announced the end of his 2020 presidential campaign. From a healthcare perspective, he shared quite a few moderate views with Bloomberg and Biden.

Klobuchar just announced plans to drop out today (March 2) and is endorsing Joe Biden. These appear to be excellent developments for Joe.

Sanders finally releases funding details for Medicare for All.

In other news, Bernie Sanders released his funding plans for Medicare for All, which includes about $17.5 trillion in tax revenue over the next decade stemming from increased income taxes on businesses and individuals. Then, federal, state, and local governments would foot the rest ($30 trillion).

The Sanders camp estimates total healthcare expenditures of $47 trillion under Medicare for All, which they calculate would save an estimated $5 trillion over the next decade in the current U.S. healthcare system.

Expect a response from Republicans on healthcare soon.

At a retreat between Trump advisers and GOP senators, the parties reportedly discussed a need to get behind popular bipartisan reform bills prior to the general election. On top of that, the Republican officials discussed the need for the party to have its own healthcare vision rather than just slamming ‘Medicare for All,’ a tactic they considered weak.

Trump is reportedly frustrated with the delay in lowering drug costs and getting a bipartisan bill through Congress. Remember — drug pricing, surprise billing, and overall healthcare costs are top of mind for voters. And the coronavirus isn’t helping Trump in the economy.

Other Policy Stuff.

The FTC is coming after hospital mergers.

On Feb. 27th, the FTC sued to block a health system merger between Philadelphia-based Jefferson Health and Einstein Health Network.

The FTC is suing to block a big hospital system merger in Philly. FTC hasn’t opposed a hospital merger since 2016 and hasn’t formally challenged one in court since 2015. https://t.co/1s0tMkCmXs

- Bob Herman (@bobjherman) February 27, 2020

The bigger picture: more partnerships.

Surprise billing resources.

A few surprise billing resources were published this week by the Commonwealth Fund, covering the major issues. Read below if you’re interested in taking a deeper dive:

• How States Are Using Independent Dispute Resolution to Resolve Out-of-Network Payments in Surprise Billing
• Addressing Surprise Billing by Setting Payment Standards for Out-of-Network Providers

Large Medicaid Cuts inbound?

Finally, there’s a somewhat ‘hidden’ Medicaid proposal, called the Medicaid Fiscal Accountability Rule, floating around.

It seems complicated, but a recent analysis conducted by industry consultants claim that the proposal could cut Medicaid funding between 6 to 8% — which is quite extreme as far as regulatory changes go.

In the miscellaneous bucket…

• Trump admin heats up interoperability talking points.
• Supreme Court allows ‘public charge’ rule to take effect nationwide.

Digital Health Stories

• These are the most disruptive companies shaking up healthcare, executives say: Cedar, Jvion, and more.
• Apple and JnJ announced a new heart study centered around the Apple Watch. They want to see whether the Apple Watch can reduce the risk of stroke.
• Scientists are turning to A.I. to discover new antibiotics that can fight superbugs (Soft Paywall)
• RenalytixAI, a digital health firm focused on applying artificial intelligence to kidney care, has made some promising diagnostic tools aimed at kidney disease detection and rejection/acceptance of new kidneys. Read more here.
• Inside Google’s contract to gather de-identified patient data from UCSF for free

Quick Hits

Biz Hits

• This CEO running clinics for Apple and Facebook wants to ‘flip’ the primary care model (PAYWALL)
• Where have the many hospital inpatients gone? Healthcare vocabulary lesson. What does inpatient/outpatient mean? Inpatient = you’re admitted to a hospital on doctor’s orders. Outpatient = your visit to a healthcare facility is less than 24 hours (EVEN if those hours go overnight). Learn more here.
• Envision Healthcare named its new CEO this week — Jim Rechtin, an executive previously at OptumCare.
• SmileDirectClub is laying off workers and slowing its growth.

State Hits

• Texas might consider expanding Medicaid after all under CMS’ new block grant policy.
• A healthcare price transparency bill breezed through the Georgia state Senate on Wednesday, February 26th.
• Children’s Hospital of Philly is planning a $3.4 billion expansion.

Other Hits

• Heads up: the British just banned youth soccer players from heading the ball in practice.
• America’s mental health crisis hidden behind bars. (NPR)
• Bain released its annual global private equity report this week.
• Healthcare spending stats: 1% of people account for 22% of total healthcare spending. 5% of people account for 50% of total healthcare spending.
• Blue Cross reported that dementia among adults aged 30–64 has tripled over a recent 5-year period. Scary.
• Seniors are growing increasingly lonely, and it might not be adequately addressed. (WSJ)

Thought-Provoking Editorials

• American Primary Care and My Soviet Era Class Trip: Sensing the Inevitable Collapse of a Top Down Bureaucracy (THCB)
• The Supreme Court procrastinates: No decision now on a baseless challenge to the Affordable Care Act (Brookings)
• Private healthcare to the rescue: the Feds are calling on academic labs and Big Pharma for help. (WSJ)
• Coronavirus makes the case for Medicare for All. (WaPo)

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Originally published at https://thehealthymuse.com on March 3, 2020.