healthy muse healthcare news.
This week in healthcare: one year into the pandemic, Ambulnz going public, bad press for nursing homes, vaccinations go exponential, cases stable, lots of policy, hospital consolidation is good? and some more interesting top reads.
Ambulnz going public via SPAC at a $1.1 billion valuation
In what sounds like a terrible hip-hop group name, non-urgent care transport firm Ambulnz is going public via SPAC merger at a $1.1 billion valuation. (Link)
- Not much is known about the company right now, but it seems to me to be an Uber that’ll cost you an arm and a leg and take you to the hospital slightly faster. Here’s an article detailing the operation. (Link)
- Probably the most interesting part of the firm is that health professionals can select a vehicle option that fits the patient’s needs from an acuity standpoint (e.g., a wheelchair patient receives a handicap-accessible vehicle). Nifty, but worth a billion?
A bad week for nursing homes.
The 5-star rating system is broken: The pandemic really seems to have exposed major flaws in U.S. nursing homes. Just this week, the New York Times published a pair of hard-to-read stories related to nursing home operators’ ability to game the Medicare star rating system. (Link)
- The first report alleges the following and more:
- Much of the data nursing homes report to CMS is incorrect
- Staffing numbers are often understated
- Nursing home data is rarely audited by CMS
- Nursing homes often know when their ‘surprise’ inspections will take place
- Inspectors may find serious infractions anyway but rarely does it cause a drop in the home’s star rating (why not just…turn it into a 10-star system?)
Brookdale sued: As a closely related story, today, Brookdale Senior Living, the largest nursing home operator in California, was sued by the state for similar veins of ‘Medicare manipulation,’ including inappropriately discharging patients to allegedly fill those beds with higher paying patients. Brookdale denies any wrongdoing. (Link)
Coronavirus updates.
Cases: Continue to declining big-time. The U.S. seven day average is 54k – down from 60k last week – as of this writing. (Link)
Vaccines: are trending at 2.4 million per day, up from last week’s 7-day average of 2.2 million. (Link).
- Novavax recently unveiled positive vaccine data. That means we’ll soon have FOUR vaccines for the global supply. (Link)
- In an address to the nation this week, Biden outlined a path to a more normal society by the Fourth of July. He also mandated that states open up vaccinations to the general public by May 1. (Link)
One Year: This week marked the one-year mark since the beginning of the coronavirus pandemic. In that year in the U.S. alone, we’ve experienced over 29 million cases, over 500k deaths, economic lockdowns, mental health struggles, and more.
- But we’re nearing the end here. The light is just outside our windows, baby. Humans are resilient AF, and the roaring 20’s are coming. (maybe without the whole Great Depression part).
Quick Hits
Biz Hits
Optum: This Bloomberg piece was a great business profile on Unitedhealthcare and specifically Optum’s plans to continue scooping up physician practices. (Link)
Centene: The state of Ohio has sued Centene, accusing the managed care payor of increasing drug prices through its PBM and resulting in the state overpaying for drugs on its Medicaid plans. (Link)
‘Rona: Read this article discussing what hospital executives have learned during the year long pandemic, including leveraging data, shifting supply chains, working remote, and more. (Link)
SGRY: Surgery Partners is planning $400 million in surgery center investments in 2021. Some other interesting Q4 tidbits here. (Link)
Hospital merger: This week, ou Health announced a merger with its hospital partner in order to create one unified health system this week. (Link)
Insurance: Another digital health insurer Health IQ is considering going public via SPAC for a $1.5 billion valuation. The firm recommends individuals to life insurance companies and Medicare Advantage plans based on a questionnaire they fill out (activity level, etc.) – (Link)
- Side note: everything seems to be worth at least a billion these days.
Policy Hits
Mental health: President Biden is allocating $2.5 billion to address the U.S. mental health and addiction crisis, according to Axios. (Link)
Subsidies: Read this breakdown from the Commonwealth fund on the stimulus provisions that relate to healthcare coverage – including COBRA subsidies and expanded ACA subsidies. Interesting that all of these subsidies expire in September 2022, which I believe is right before the midterm elections. (Link)
Medicaid work requirements: After the Biden Admin said they were no longer interested in defending the case, the Supreme Court cancelled oral arguments in the Medicaid Work Requirements court case. Side note – the ACA decision is expected any week now. Wouldn’t that be wild if the SCOTUS dismantled the ACA right after the stimulus expanded it? Ha. (Link)
CMS: pushed back its new kidney care payment model start date to January 2022. The new dialysis model for Medicare was scheduled to go into effect in 2019 but has been pushed back a couple of times now. When it finally gets enacted, the new payment model will force providers to receive capitated payments. (Link)
Other Hits
Medicaid: A recent analysis by Avalere found that Medicaid networks are super narrow – much more narrow than commercial plans in certain areas. For instance, in Miami, Medicaid networks had 72% fewer primary care providers than commercial plans did. It makes sense because a lot of providers don’t accept Medicaid. (Link)
Planned Parenthood: In what I’m sure will end up at the Supreme Court, a judge ruled this week that Texas could remove Planned Parenthood from its state Medicaid program. (Link)
SPACs: This article was a pretty decent overview of SPACs vs IPOs with a specific focus on the healthcare industry. (Link)
Telehealth: I thought this was a pretty interesting read about the impact of the public health emergency’s decision to remove state licensing barriers, and how telehealth is now threatening the viability of in-state providers. The threat is likely overstated in my humble opinion. (Link)
Thought-Provoking Editorials
‘Rona: The Pandemic Will Fuel Consolidation in U.S. Health Care. (Link)
Nutrition: Medicine, Not Healthy Food, Is Still the Best Medicine. (Link)
Healthy Muse Top Picks
Transparency: Here’s a super interesting read on the wide variation in pricing by hospital for the same procedures. Personally, I’d like to look at a hospital’s holistic charge-master with an insurer before I jump to conclusions about individual procedures because I think that would make more business sense. But at the end of the day, an x-ray is an x-ray. Honestly I wonder if a patient could sort through these files to find the cheapest hospitals for various procedures and take advantage of the wide pricing disparities. (Link)
Logistics: Read this informative summary from Acute Condition of the vaccine distribution and absolute pandemonium of the patient intake process. (Link)
Consolidation: Probably my favorite read of the week, this Health Affairs article offers a somewhat contrarian viewpoint of health system consolidation in healthcare by arguing that consolidation allowed these health systems the scale to efficiently allocate resources to fight COVID. Quick actions included rapidly expanding ICU capacity and managing cases over a wide region. The article goes on to argue that maybe consolidation isn’t so bad – when it doesn’t increase consumer prices. (Link)
Teens: My final pick for the week comes from ProPublica – highlighting the emotional toll the pandemic took on crucial developmental years for teens. (Link)
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