The two California nonprofit health systems have signed a letter of intent and have begun due diligence.
Keck Medicine of USC and Methodist Hospital of Southern California are "exploring an affiliation" that "would bring Methodist Hospital into the Keck Medicine clinical enterprise," the two Southern California-based health systems announced this week.
The two nonprofit health systems signed a letter of intent and are entering a due diligence period for the merger, which both systems say would improve care access in the San Gabriel Valley region.
Financial terms were not disclosed.
Three-hospital Keck Medicine of USC is one of two university-based medical systems in Los Angeles and includes flagship Keck Hospital of USC, USC Norris Cancer Hospital, USC Verdugo Hills Hospital and more than 80 outpatient clinics in Los Angeles, Orange, Kern, Tulare and Ventura counties.
Arcadia-based Methodist is a 348-bed community hospital that during a normal year records about 16,000 patient admissions and 50,000 emergency department visits.
"Methodist Hospital has a longstanding history of providing excellent care in the San Gabriel Valley and has the potential to be a strong partner as we work together to expand services and create easier access to primary and complex care for the people we serve," Keck Interim CEO Rodney Hanners said in a media release.
"This affiliation would not only complement our current satellite in Arcadia, but also provide opportunities to elevate our entire network that we are excited to explore further," he said.
Executives at both systems will speak with Keck Medicine clinical faculty, physician leaders at Methodist Hospital, and other stakeholders across the region in the coming months to finalize the terms of merger.
No date was given for when the affiliation will be finalized.
"This affiliation represents an opportunity to ensure that our hospital remains well-positioned to meet the health care needs of generations to come," said Methodist President and CEO Dan Ausman.
"It would enable our physicians to care for their patients as they always have, with expanded access to the USC network of care teams, clinical services and outpatient facilities throughout the San Gabriel Valley," Ausman said.
Telehealth visits saw a 20-fold increase when the pandemic began in March 2020, as office-based visits fell nearly 50%.
The great promise that telehealth will bring remote care access to rural and underserved communities across the nation isn’t happening yet, a new RAND Corporation study suggests.
The study -- published this month in the American Journal of Preventive Medicine -- looked at more than 6 million employer-based private insurance claims in 2019 and 2020, representing 200 employers across all 50 states. It found that most of the telehealth claims were for more affluent beneficiaries who lived in metropolitan areas.
The study authors said their findings suggest that the pandemic is worsening healthcare access and use disparities.
"This study expands our understanding about the growing use of telehealth as the pandemic progresses," said lead author and RAND researcher Jonathan Cantor. "Given our findings, policymakers should consider increasing efforts to reach populations that are deferring in-office care and not replacing it with telehealth visits."
The study found a dramatic, 20-fold increase in telemedicine use when the pandemic began in March 2020, as office-based visits fell nearly 50%.
The researchers also examined the number and types of care received by enrollees from January 2019 through July 2020.
The increase in telemedicine was greatest among patients in counties with low poverty levels -- about 48 visits per 10,000 people versus 15 per 10,000 people in high-poverty areas -- and among patients in urban areas -- about 50 visits per 10,000 people versus about 31 visits per 10,000 people in rural areas.
Adults were more likely to have a telehealth visit as compared to children aged 12 and younger -- about 65 visits per 10,000 adults as compared to about 50 visits per 10,000 children.
Cantor said the finding suggest that "more intensive training for parents and pediatricians about telehealth, as well as efforts to address barriers to children’s access to telemedicine, may be necessary."
The advisory panel wants more evidence supporting the efficacy of remote care.
The federal advisory panel for Medicare is recommending continuing temporary payments for telehealth services after the coronavirus public health emergency expires, with the additional time used to gather evidence about the efficacy of remote care.
The Medicare Payment Advisory Commission, in its newly released March 2021 report to Congress, applauded the Centers for Medicare & Medicaid Services for "acting rapidly to preserve access to care during the PHE."
However, the panel said questions remain about the effectiveness of remote care.
"The Commission has previously recommended that policymakers use the principles of access, quality, and cost to evaluate individual telehealth services before covering them under Medicare," MedPAC said. "There are some clinical trials comparing telehealth and in-person care, but at this time, there is not yet evidence on how the combination of telehealth and in-person care affects quality and costs in the Medicare program."
MedPAC is recommending that Medicare fee-for-service coverage of telehealth services be expanded after the PHE expires for up to two years "to gather more evidence about the impact of telehealth on access, quality, and cost, and they should use this evidence to inform any permanent changes."
During this limited period, MedPAC said Medicare should temporarily:
Pay for specific telehealth services for all FFS beneficiaries regardless of their location;
Cover some telehealth services with services covered before the PHE if there is a potential clinical benefit;
Cover some audio-only telehealth calls if there is potential for clinical benefit.
When the PHE ends, MedPAC said Medicare should return to paying the fee schedule's facility rate for telehealth services and collect data on the cost of providing these services.
The panel added that providers should not be allowed to reduce or waive cost sharing for telehealth services after the PHE, and that CMS should implement safeguards to protect Medicare and its beneficiaries from unnecessary spending and potential telehealth fraud.
Those safeguards could include additional scrutiny to "outlier clinicians" who bill for a high percentage of telehealth visits, mandated face-to-face visits before ordering expensive durable medical equipment or lab, and banning "incident to" billing for telehealth services provided by a clinician who can bill Medicare directly.
Medicare payments will increase from $28 to $40 for one-dose vaccines, and from $45 to $80 for two-dose vaccines, effective immediately.
In a bid to accelerate vaccinations for COVID-19, the federal government is offering Medicare providers a big bump in the reimbursements it pays for the single- and two-dose vaccinations.
The new payments -- which go into effect immediately -- will increase from $28 to $40 for one-dose vaccines, and from $45 to $80 for two-dose vaccines, increases of 43% and 78%, respectively, the Centers for Medicare & Medicaid Services announced Monday.
The exact payment rate will depend on the provider venue that administers the vaccination, and on the geographic location of the providers.
"These updates to the Medicare payment rate for COVID-19 vaccine administration reflect new information about the costs involved in administering the vaccine for different types of providers and suppliers, and the additional resources necessary to ensure the vaccine is administered safely and appropriately," CMS said in a media release.
CMS said the higher payments will incentivize providers to increase the daily volume of vaccines they can administer, expand vaccination sites, conduct community outreach and education, and hire additional staff.
Providers receive the coronavirus vaccines for free from the federal government and cannot charge Medicare, Medicare Advantage or Medicaid patients. Most private health insurers are required to provide the vaccination to their beneficiaries with no out-of-pocket costs.
AMA Cheers
American Medical Association President Susan R. Bailey, M.D. said her group has been pushing for more money since President Joseph R. Biden took office in January.
"The additional resources will increase the number of clinicians who can administer the vaccine," she said. "This has been a trying time for physician practices, and we thank the administration for acknowledging the challenges of practicing medicine during a pandemic."
"The $1.9 trillion coronavirus relief bill will boost the ongoing progress in delivering mass vaccinations, which will likely contribute to a continued decline in COVID-19 infection rates and facilitate a more rapid reduction in curbs on social interactions across the US," Moody's says.
"The bill includes provisions that will be positive for health insurers and healthcare providers should they lead to expanded enrollment in private health insurance plans and reductions in uncompensated care," Moody's says.
The 591-page Rescue Act passed the House on Wednesday on a 220-211 party-line vote. No Republicans in the House or Senate voted for it.
The Act provides billions of dollars for state and local governments, Medicaid, providers, health insurers, and individuals, including stimulus checks of up to $1,400 for most Americans, extended unemployment benefits, increased subsidies for health insurance bought on the federal Marketplace, $8.5 billion in additional funding for rural healthcare, and an increased federal match for home- and community-based services.
"The measures, which aim to make healthcare coverage more affordable for lower and middle-income households, include temporary increases in subsidies to purchase health insurance on the individual marketplaces created by the Affordable Care Act," Moody's says.
The bill also subsidizes COBRA premiums for up to six months to help laid-off workers keep their employer-sponsored health insurance. However, it does not cover copays or deductibles.
Moody's says the financial assistance for households in the form of $1,400 direct payments for most American, and the extension of $300 weekly unemployment compensation – all of which represent the bulk of the Act's spending – should reignite the sputtering economy.
"The financial assistance to individuals will also support a rebound in demand for services, underpinning Moody's Investors Service's forecasts of 4.7% real GDP growth in the US this year and 5% next year," Moody's says.
"Additionally, the potential for a broad resumption of activity this spring – which would be earlier than our current expectations – would be an upside to our 2021 growth forecasts," Moody's says.
The $1.9 trillion Rescue Act is the equivalent of about 8.5% of Moody's U.S. GDP forecast for 2021.
The Rescue Act provides billions of dollars for state and local governments, Medicaid, providers, health insurers, and individuals, including stimulus checks of up to $1,400 for most Americans, extended unemployment benefits, increased subsidies for health insurance bought on the federal Marketplace, $8.5 billion in additional funding for rural healthcare, and an increased federal match for home- and community-based services.
Bruce Siegel, MD, president and CEO of America's Essential Hospitals, said he was grateful for the stimulus but offered caveats.
"While we welcome this support, we also stress that the fight against COVID-19 continues and that our hospitals need more," he said. "They face persistent financial and resource challenges, and we will continue to work with Congress to secure appropriate and timely support for essential hospitals in future legislation."
Federation of American Hospitals President and CEO Chip Kahn called the Rescue Act "a substantive step towards all Americans having the security of healthcare coverage."
"It makes ACA health coverage more affordable, ensures that the newly unemployed can retain their insurance through COBRA and offers new incentives for states to expand Medicaid to low-income adults," he said.
Kahn said the $8.5 billion earmarked for rural providers "will protect and support care for many of the nation's most vulnerable patients, especially those who live in rural, underserved communities."
"Meanwhile, funding for vaccine distribution and testing included in the legislation takes direct aim at COVID-19's grip on the nation," he said.
Jacqueline W. Fincher, MD, president of the American College of Physicians, said "the health-related provisions in this new COVID-relief law will help relieve that pressure on both patients and physicians."
"It substantially increases funding for vaccines, including money to promote education and vaccine confidence. It provides money to improve testing and contact tracing, allowing us to better detect and monitor the spread of COVID-19," Fincher said. "The bill will also require state Medicaid programs to fully cover COVID-19 vaccines and treatments, helping to better protect vulnerable populations who rely on Medicaid coverage."
Fincher said the extent of the Rescue Act will be felt beyond the COVID-19 pandemic, including provisions to subsidize COBRA coverage and tax credits for Affordable Care Act plans.
"It will increase funds sent to states to expand Medicaid and it will extend Medicaid coverage for post-partum women an important move in the effort to improve maternal mortality rates," she said.
"It provides funds to help improve access to healthcare coverage, critical in a time when so many have lost their health insurance."
Margaret A. Murray, CEO of the Association for Community Affiliated Plans, said the relief act "will preserve crucial access to healthcare for working families."
"It gives states financial incentives to extend Medicaid to low-income, working adults, which includes many home health aides and others who work on the front lines," she said.
Murray cheered a provision that will encourage states to provide women with one year of continuous coverage through Medicaid or CHIP after they deliver a baby.
"This policy will go a long way toward addressing the maternal mortality epidemic as well as health inequities," she said.
"It is also an important step toward full 12-month continuous eligibility for all people covered by Medicaid and CHIP, protections that ACAP has led the charge on for more than a decade. We hope that in the coming months even more people will benefit from continuous-eligibility provisions."
Hospitals say the drug policies serve no purpose other than enriching payers through their PBMs and pharmacy business lines.
Health insurers are increasingly adopting new policies that restrict provider supplies of prescription drugs and instead funnel revenues from drug buys through payer-owned or affiliated pharmacy benefits companies, the American Hospital Association said Tuesday in a new white paper.
These policies -- known as "white bagging" and "brown bagging" -- serve no purpose other than enriching health insurance companies through their PBMs and specialty pharmacy business lines, the AHA said, adding that the policies should be heavily restricted and even banned.
"In some cases, the providers are barred entirely from administering drug therapies to their critically ill patients and instead must direct their patients to seek care at unknown specialty pharmacies owned or affiliated by the payers," the AHA said.
"These actions pose significant risks to quality of care as providers have inadequate control in ensuring patient access to high quality drugs, as well as the appropriate storage and handling of those drugs."
Under a traditional "buy and bill" drug payment model, hospitals buy, store, and administer drugs and are reimbursed by payers.
Under the new brown bagging and white bagging models, "insurers are upending the traditional system, potentially sacrificing patient safety and quality care to benefit their profit margins," AHA says.
White bagging disallows hospitals and physicians from buying and storing prescription drugs and instead requires that drugs be acquired through third-party pharmacies on a one-off basis.
Brown bagging is similar to white bagging, but it requires third-party pharmacies to dispense drugs directly to patients, who then bring the drugs to the hospital or physician's office for administration.
The AHA is calling for brown bagging to be prohibited, and that restrictions be placed on white bagging.
"Shipping pharmaceutical products that require provider administration directly to patients presents significant and serious patient safety issues," AHA said of brown bagging. "Specifically, there is no method to guarantee proper storage of these drugs and the risk of drug diversion increases."
AHA said restrictions should be placed on white bagging "when the dosage or compounding of a pharmaceutical product is dependent upon the results of a patient's lab tests."
AHIP Responds
Kristine Grow, spokesperson for America's Health Insurance Plans, said payers are merely trying to lower out-of-control drug prices for patients.
"That means advocating with Big Pharma for lower prices, as well as ensuring that patients are prescribed prescription drugs and therapies that are right for them," Grow said.
"Let’s be clear: In every case, drugs must be safely dispensed. Specialty pharmacies play an essential role – meeting stringent safety and handling requirements for prescription drugs, particularly for specialized medications," she said. "Many specialty pharmacies employ clinical specialists (i.e. physicians, PAs, NPs, nurses, etc.) that are available 24/7 to support their patients and even directly administer these medications in some cases."
In addition, Grow said not all specialty drugs are subject to white or brown bagging.
"Specialty pharmacies will only employ such practices for those drugs that can be safely handled and dispensed in such ways, and only when the patient is an appropriate candidate for such forms of dispensing," she said.
"The bottom line is the problem has long been – and still is – the price," she said. "There are many innovative strategies being used to lower drug costs for patients. Hospital and prescription drug costs together represent 63.5 cents – nearly two-thirds – of every health care dollar. We should not be stifling innovation.
The partnership links ABT's on-line, evidence-based telehealth education with ATA's member health systems, academic institutions, vendors, payers, and partner organizations and gives ATA members discounted access to the ABT's certificate programs.
"We share a common goal with ATA, that is to weave telehealth into the everyday fabric of health care," said Deanna Larson, CEO of Avera eCARE and a founding board member of the ABT.
"By improving access to quality education, we can help ensure effective care for all patients, particularly those in rural and underserved communities," Larson said. "We are thrilled to provide ATA's fast-growing membership with the educational tools they need to ensure a successful future for telehealth,"
ATA CEO Ann Mond Johnson called "ABT's certificate program the gold standard for telehealth education, preparing healthcare providers to use telehealth and virtual care in the delivery of safe, effective, quality care to their patients, wherever and whenever they need it."
The ABT recently launched a CORE Concepts in Telehealth Certificate that breaks down into seven training modules with topics that range from licensing to reimbursement to ethical considerations.
ABT will also soon add a new tele-behavioral certificate and tele-primary certificate to its portfolio. Course models are available online and may be used for Continuing Medical Education or Continuing Nursing Education credits.
Mental health continues to be the No. 1 telehealth diagnosis.
Telehealth claims were up 2,817% nationally in December, when compared with claims in pre-COVID-19 December 2019, with mental health conditions continuing as the top remote diagnosis for the month, a new analysis of privately billed medical claims shows.
Overall, telehealth's December year-over-year increase in claims grew from 0.22% of all medical claims in December 2019 to 6.51% of all medical claims in December 2020. The telehealth share of all privately billed claims in December 2020 rose 8.3% when compared with November.
Data from the four U.S. census regions tracked by the report -- Midwest, Northeast, South and West -- were like that of the entire nation. Each region had big increases in telehealth volumes from December 2019 to December 2020, with smaller bumps from November to December 2020 everywhere but the Midwest, where claims volumes fell 0.3%.
"Higher telehealth utilization from March to December 2020 in comparison with the same months in 2019 was likely a result of the COVID-19 pandemic, as patients and providers turned to telehealth as a way of reducing the risk of disease transmission associated with in-person visits," the report said.
The Tracker also found that COVID-19 for the first time became one of the top five telehealth diagnoses nationally and in every region.
"Its prominence may reflect the surging number of COVID-19 cases and relatively fewer telehealth visits for other conditions, such as the flu, cases of which have been unusually low this season," the report said.
From November to December 2020, mental health conditions continued to be the number one telehealth diagnosis nationally and in every region. Exposure to communicable diseases remained number two on the national list of telehealth diagnoses and in the top five in all regions.
"Exposure to communicable diseases was likely related to the pandemic, as patients contacted providers via telehealth out of concern they had been exposed to COVID-19," the report said.
The report also found that there was no change in the top five procedure codes by utilization, and no changes nationally or by region from November to December 2020 in the top five procedure codes, even though there had been changes in at least some regions in previous months.
"This suggests that the telehealth procedures being performed might have stabilized by December," the report said.
The Eagan, Minnesota-based health insurer alleges that Phoenixus and its U.S. subsidiary Vyera schemed to raise the price of its toxoplasmosis treatment.
Blue Cross and Blue Shield of Minnesota has filed a class action lawsuit against the drug company founded by Martin Shkreli, alleging that the infamous "Pharma Bro" schemed to monopolize the market for the drug Daraprim, and then jacked up the price by 4,000%.
Baar, Switzerland-based Phoenixus AG and its U.S. subsidiary Vyera Pharmaceuticals were named in the complaint, which was filed this month in a federal district court in New York City on behalf of BCBS Minnesota and other third-party payers in more than 30 states, Washington D.C. and Puerto Rico.
Attempts by HealthLeaders to get a comment from Vyera were not successful.
The suit, which seeks damages based on the alleged overcharges, claims that Vyera "executed a multifaceted plan to enrich themselves and maintain their monopoly" by refusing to allow generic drug makers to develop lower-cost alternatives.
"Everyone deserves access to safe, effective, and affordable medication," BCBS Minnesota President and CEO Craig Samitt, MD, said in a media release. "This lawsuit is an important step in advancing that goal. Drug companies need to be held accountable for their role in making sure healthcare costs are sustainable for all," he said.
Vyera Pharmaceuticals was founded and led by Shkreli as Turing Pharmaceuticals in 2015. The company was sold to Phoenixus in 2017. The alleged scheme occurred when Shkreli was CEO of Turing in 2015.
A federal jury in August 2017 convicted Shkreli on two counts of securities fraud. He was sentenced to seven years in prison, where he now resides.
Daraprim is the leading treatment for toxoplasmosis. Under Turing Pharmaceuticals, the price for one Daraprim pill rose from $17.50 to $750 for treatments that often require multiple doses each day for weeks and months.
The suit alleges that Vyera, Phoenixus, Shkreli and fellow executive Kevin Mulleady "specifically targeted Daraprim for the price hike due to the relatively small patient population and ability to tightly control who could access the drug."
The suit noted that, from the time of its purchase of Daraprim rights in 2015 until the first generic option was available in March 2020, Vyera maintained a 100% share of the market for pyrimethamine products approved for sale in the United States.
