Weekly Spotlight

Hurricanes in Florida and Presidential politics dominate while health policy trugs along. CMS publications seem to be on their way to crescendo-ing to the release of annual Medicare Advantage rules. Some of MA highlights include:

Humana, UnitedHealthcare, Aetna fall in new MA star ratings

On Thursday, CMS released the latest Medicare Advantage star ratings, and the contrast to just a few years ago is stark. In 2022, 74 Medicare Advantage with prescription drug coverage contracts garnered five-out-of-five stars. For the 2025 plan year, only seven did.

#Payer

Medicare Advantage market expected to grow in 2025, despite big changes from insurers

Next year’s Medicare Advantage market will be two things at once: remarkably stable broadly, but rife with changes under the surface. Health insurance companies will still offer older adults a lot of plan choices with low, or completely free, premiums. That’s why the federal government expects enrollment in the $500 billion Medicare Advantage program to grow once again in 2025

#Payer, #Patient

Insurers went all-in on Medicare Advantage. Now, some are scaling back

For years, health insurers battled to gain market share in the lucrative privatized Medicare program. Now, the opposite is true. Some of the companies say they designed their 2025 plans with an eye toward ditching members.

#Payer, #Patient

Medicare Advantage insurers bank on Special Needs Plans in 2025

Investing in products for individuals with complex medical needs has emerged as a key tactic for health insurers endeavoring to revive Medicare Advantage margins. Leading insurance companies pulled back slightly from Medicare Advantage for the coming plan year amid financial strains but are continuing a big push into the market for Dual-Eligible Special Needs Plans, or D-SNPs, which cover people who are eligible for both Medicare and Medicaid, according to analyses of preliminary data about the 2025 Medicare Advantage marketplace.

#Payer, #Patient

Other Regulatory News

Centers for Medicare and Medicaid Services (CMS)

The Future of Medicare’s Coverage with Evidence Development Policy (event recording)

On September 25, the USC Schaeffer Center for Health Policy & Economics, in partnership with the Tufts Center for the Evaluation of Value and Risk in Health and the Stanford Mussallem Center for Biodesign, hosted a conversation on the future of CED with the Medicare official overseeing the program, key stakeholders and academic researchers.

#All

Monitoring acute heart patients at home linked to considerable cost savings

Patients monitored at home rather than in the hospital for acute conditions may be associated with cost savings and higher patient satisfaction scores, according to a new study released in September by the Centers for Medicare and Medicaid Services (CMS).

#Device, #Hospital, #Patient, #Payer, #Provider

CMS considers Medicare coverage options for tricuspid valve repair at Abbott’s request

The Centers for Medicare and Medicaid Services (CMS) is officially considering whether or not to offer Medicare coverage on a national level for tricuspid valve transcatheter edge-to-edge repair (T-TEER).

#Device, #Patient, #Provider

Harris seeks to tie expanded Medicare drug price negotiation to home care, vision, hearing coverage expansion

Vice President Harris is proposing to use cuts to the pharmaceutical industry’s profits in Medicare to fund new home care, vision, and hearing benefits for people over the age of 65, she announced

#Drug, #Patient

CMS Unveils Sample $2 Generic Drug List for Medicare Part D Enrollees

CMS issued a request for information on a proposed model program that would lower prices to $2 per month for certain generic drugs purchased through Medicare Part D drug plans. The model is designed to provide individuals more certainty about the out-of-pocket costs for these generic Part D drugs for common conditions, such as high cholesterol and high blood pressure.

#Drug, #Patient

Opinion: The Taxpayer-Funded GRAIL Galleri-Medicare Study: A Flawed Design

Last May, GRAIL—the company developing a blood-based screening test for more than 50 cancers—received approval for the Galleri-Medicare study from CMS. Unfortunately, while there are plenty of subjects, the current design will produce a predictably deceptive result.

#Patient

SCAI urges lawmakers to improve cardiac care access for children

The Society for Cardiovascular Angiography and Interventions (SCAI) is pushing for the U.S. Senate to adopt a bi-partisan bill that would expand Medicaid access for children outside of their home states.

#Patient, #Provider

Food and Drug Administration (FDA)

CDRH Proposed Guidances for Fiscal Year 2025

The FDA’s Center for Devices and Radiological Health (CDRH) is sharing lists of guidance documents that 1) they intend to publish in fiscal year 2025 (FY 2025), 2) they intend to develop, and 3) were previously issued as final guidances and they would like to receive feedback about whether they should be revised or withdrawn

#Device

FDA grants AI-powered ECG screening tool for aortic stenosis its breakthrough device designation

AccurKardia, a New York-based healthcare technology company, has received the FDA’s breakthrough device designation for new screening software that uses artificial intelligence (AI) to evaluate electrocardiogram (ECG) data for signs of aortic stenosis (AS). The software was trained on millions of ECGs, according to AccurKardia, and was designed to provide insights in underserved parts of the world where more advanced imaging modalities are not readily available.

#Device, #Patient, #Provider

Health and Human Services (HHS)

GAO wants CMS to check whether hospitals’ price transparency data are actually usable

The Biden administration could stand to take a firmer hand on hospital price transparency, especially when it is unclear whether the price data being published are even accurate, the Government Accountability Office (GAO) wrote.

#Hospital

Hill Happenings

Lawmakers search for path to finally fix Medicare doctor payments

For the fifth year in a row, doctors are urging Congress to nix a cut to their Medicare payments.

#Provider

Notable Notes

Medical journal peer reviewers are paid millions by industry, study finds

Nearly 60% of the experts reviewing manuscripts for four major journals — The BMJ, JAMA, The Lancet, and The New England Journal of Medicine — received substantial payments from industry during a recent three-year period, according to a new study. This new analysis highlights how fraught the world of peer review can be with conflict of interest.

#All

Implantable PA sensor for heart failure linked to positive 1-year outcomes

Endotronix, now an Edwards Lifesciences company, has shared updated data on the safety and effectiveness of its Cordella Pulmonary Artery (PA) Sensor System for managing heart failure patients.

#Device

New-look TAVR valve recently acquired by Edwards may reduce risk of coronary obstruction

Performing transcatheter aortic valve replacement (TAVR) with a new transcatheter heart valve (THV) may help limit the risk of coronary artery obstruction (CAO) in high-risk patients, according to a new study published in Clinical Interventions in Aging.

#Device, #Patient

Long-term survival after valve-in-valve TAVR similar with self-expanding, balloon-expandable valves

Self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves are associated with comparable long-term survival rates after valve-in-valve transcatheter aortic valve replacement (ViV-TAVR), according to new data published in The American Journal of Cardiology.[1]

#Device, #Patient

Two reports, two dramatically different views of nonprofit hospitals’ tax breaks

Hospitals face questions on whether they provide enough benefit to justify their nonprofit status.

#Hospital

Disparities in Heart Failure Rates Found Among Asian American Subpopulations

A new data analysis of heart failure among Asian Americans showed that disparities exist between ethnic subgroups, and the differences between Southeast and East Asian patients were larger than those between Black and white patients, according to a study in JAMA Network Openopens in a new tab or window.

#Patient

‘An excellent outcome’: TAVR safe and effective for patients in their nineties

Bleeding and vascular complications were more common, but one-year outcomes confirmed patients in their nineties should still be considered for TAVR.

#Patient, #Device, #Provider

Family premiums for employer-based health insurance rose 7 percent this year, according to a KFF survey released today.

Annual premiums for employer-sponsored family health coverage reached $25,572 this year, 7% higher. On average, workers contributed $6,296 toward the cost of family coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,787 for single coverage.

#Patient, #Payer

Physician compensation trends: housing assistance, more bonuses

Physician compensation continues to rise across most specialties as the talent pool shrinks, furthering a need for employers to get creative to stay ahead of the competition.

Hiring organizations are shifting to offer more than just higher salaries to attract clinicians, according to respondents to Modern Healthcare’s 2024 Physician Compensation Survey.

#Provider

Highest Paid Medical Specialties in 2024

The Physician Compensation Report from Doximityopens listed 12 medical specialties that now make over $500,000 a year. 1)  Neurosurgery ($763,908), 2) Thoracic Surgery ($720,634), 3) Orthopaedic Surgery ($654,815), 4) Plastic Surgery ($619,812), 5) Oral & Maxillofacial Surgery ($603,623), 6) Radation Oncology ($569,170), 7) Cardiology ($565,485).

#Provider

Feds back healthcare workers in noncompete lawsuit

The federal government intervened in a lawsuit against the University of Pittsburgh Medical Center, backing allegations from current and former UPMC workers that the nonprofit health system violated antitrust law by using restrictive employment policies such as noncompete provisions to suppress wages.

#Provider