The commitment includes a $200 million immunotherapy-focused partnership with the University of Pittsburgh.
UPMC Enterprises said Tuesday that it will "deploy" $1 billion to develop new drugs, diagnostics and medical devices over the next four years.
"The common link among our investments will be that each has a direct and powerful impact on how we care for patients, while generating a significant financial return," UPMC Enterprises Executive Vice President Jeanne Cunicelli said in amedia release.
"As important as the funding is the unparalleled scientific and medical expertise backing our ideas, thanks to resources provided by UPMC and our academic partner, the University of Pittsburgh," Cunicelli said.
Cunicelli said UPMC Enterprises will also look for partners globally that complement the scientific and commercial work already underway.
In the past two years, UPMC Enterprises has created five companies in the translational sciences sector and invested in external biotech company Werewolf Therapeutics, as well as more than 30 research projects internally.
The venture capital and commercialization arm of UPMC initially focused on immunotherapies for cancer, transplantation and diseases related to aging. However, their portfolio has expanded to include retinal and respiratory disease, autoimmune diseases, and neuroinflammation.
UPMC has invested more than $800 million to date, primarily in digital health solutions, which have returned more than $1.5 billion.
Companies formed under UPMC Enterprises include Generian,BlueSphere Bio, and Abound Bio.
AHA, AAMC seek preliminary and permanent injunctions to block $800 million in cuts.
Hospital stakeholders have filed suit in federal court to block the Centers for Medicare & Medicaid Services' plans to cut about $800 million from outpatient services at off-campus, hospital-based departments in 2020.
Arguing that the nation's hospitals would suffer "concrete and imminent" harm if the cuts are applied, the American Hospital Association, the Association of American Medical Colleges, and three hospitals called for a preliminary and permanent injunction against CMS.
"If the 2020 Final Rule is left in place, Plaintiff-Hospitals and Plaintiffs AHA’s and AAMC's members face the prospect of serious payment reductions for affected services, and may have to make difficult decisions about whether to reduce services in response to the lowered payment rate," the plaintiffs wrote in their 26-page complaint, filed with the U.S. District Court for the District of Columbia.
A federal judge in December ruled that CMS had exceeded its authority when it reduced 2019 off-campus outpatient services that were grandfathered in by Congress in 2015, but she stopped short of blocking the cuts for 2020.
The final rule completes the two-year phase-in of the site-neutral rate, which is 40% of the OPPS rate provided for grandfathered off-campus clinics in 2020.
CMS says the site-neutral policy will reduce cost-sharing by Medicare beneficiaries to $9, saving them about $14 for each off-campus clinic visit in 2020.
Medicaid expansion may have prevented up to 8,132 opioid overdose deaths in 2015 to 2017 in the 32 states that expanded Medicaid.
Expanding Medicaid coverage was linked to a 6% drop in opioid overdose deaths nationally, according to new research published in JAMA Network Open.
Researchers NYU Grossman School of Medicine and University of California, Davis, analyzed cause-of-death data from the National Vital Statistics System from 3,109 counties nationwide between 2001 and 2017.
They looked for changes in opioid overdose rates in counties that expanded Medicaid and compared those to changes that occurred in the same time period in counties within states that did not expand Medicaid.
The researchers found that:
Medicaid expansion may have prevented between 1,678 and 8,132 opioid overdose deaths in 2015 to 2017 in the 32 states that expanded Medicaid between 2014 and 2016.
Adoption of Medicaid expansion was associated with a 6% lower rate of total opioid overdose deaths, 11% lower rate of death involving heroin, and a 10% lower rate of death involving synthetic opioids such as fentanyl.
Medicaid expansion states saw an 11% increase in methadone overdose mortality.
"At a broader level, the findings of this study suggest that providing expanded access to healthcare may be a key policy lever to address the opioid overdose crisis," said study senior author Magdalena Cerdá, director of the Center for Opioid Epidemiology and Policy in the Department of Population Health at NYU Langone Health.
Cerdá said Medicaid beneficiaries are more likely to receive prescriptions for methadone to treat pain, compared to the general population, which increases the risk of overdoses.
The researchers noted that their study's limitations include a reliance on misclassified coding of death certificate data. In addition, the study only looked at deaths among the whole population as opposed to just Medicaid beneficiaries and they did not examine how Medicaid expansion affects access to treatment for opioid use disorder.
The draft guidelines outline the agencies' analytical techniques, practices, and enforcement for vertical mergers.
The Federal Trade Commission and the Department of Justice's Antitrust Division have opened a 30-day window for public comment on draft 2020 Vertical Merger Guidelines.
The draft guidelines outline the agencies' analytical techniques, practices, and enforcement for vertical mergers, which combine two or more companies that operate at different levels in the same supply chain.
"While many vertical mergers are competitively beneficial or neutral, both the Department and the Federal Trade Commission have recognized for over 25 years that some vertical transactions can raise serious concern," Assistant Attorney General Makan Delrahim of DOJ's Antitrust Division.
"The revised draft guidelines are based on new economic understandings and the agencies’ experience over the past several decades and better reflect the agencies' actual practice in evaluating proposed vertical mergers," he said.
In a joint media release, FTC and DOJ said the draft guidelines adopt the principles and analytical frameworks in the agencies’ Horizontal Merger Guidelines. That includes defining a market, creating a framework for evaluating entry considerations, the treatment of the acquisition of a failing firm, and the acquisition of a partial ownership interest. .
Stakeholders say 'Pathways to Success' mandates have dampened ACO enthusiasm for the program.
Participation in the Medicare Shared Savings Program held steady for 2020, with 517 accountable care organizations participating in the value-based payment program, the Centers for Medicare & Medicaid Services reported.
The 2020 participation level is one fewer than the 518 ACOs that participated in 2019, and down from the high of 561 ACOs that participated in 2018.
Only 35 Shared Savings Program ACOs are entering their first contract with CMS, compared with an average of 107 new ACOs annually between 2012 and 2018. Last year, overall participation fell to 41 new ACOs.
However, 192 ACOs are taking on downside risk in 2020, more than double the 93 ACOs taking risk at the start of 2019.
In addition, CMS said 11.2 million Medicare beneficiaries–the largest number ever, and representing nearly 30% of Medicare fee-for-service beneficiaries–are being cared for by ACOs.
In an essay Friday in Health Affairs, CMS Administrator Seema Verma wrote that she was "excited to report continued strong interest and robust participation in the redesigned program."
"It’s been rewarding to see that low-revenue (physician-led) ACOs have found the new participation options appealing. As of January 1, there are 270 low-revenue ACOs participating in the program, up 27% from a year ago," she said.
Verma said the mandated downside risk is needed because ACOs aren't generating enough savings.
"Given all the best practices and learnings that emerged from over half a decade of experience, it was time to strengthen the incentives in the program and ensure real accountability while also providing more flexibility for ACOs to innovate," she wrote.
CMS reported in October that MSSP generated $1.7 billion in total savings in 2018. Of that, Medicare netted $739 million, after paying out shared savings bonuses, and collecting shared savings loss payments from ACOs.
However, ACOs that took on downside risk generated more savings than ACOs that did not, with an average $96 reduction in spending per enrollee, compared with $68 per enrollee in ACOs that did not take on risk.
ACO stakeholders had a decidedly different interpretation of the figures put forward Friday by CMS.
Clif Gaus, president and CEO of National Association of ACOs, said his association has predicted in 2018 "that changes CMS made under Pathways would throw off the careful balance of risk and reward for too many ACOs."
"Sadly, those fears may be coming true," he said. “To date, there have been few attractive alternative payment models besides ACOs, so harming participation in the Medicare Shared Savings Program hurts Medicare’s priority of changing how it pays for care."
A 2018 study commissioned by NAACOS found that MSSP ACOs generated estimated gross savings of $1.84 billion during performance years 2013 through 2015; nearly double the $954 million in estimated gross savings CMS had reported.
Gaus urged Congress to review the program "to ensure more damage isn't done."
"If interest in ACOs dwindles, then doctors and hospitals will fall back into a fragmented, fee-for-service system, and any momentum to transform our health system will be lost," he said.
Last June, University of Michigan researchers issued a study which found that high-cost patients and high-cost doctors were much more likely to exit ACOs than low-cost patients and doctors, and that ACOs did not demonstrate improvement in spending or quality after selective dropping of clinicians and their patients from the program.
Healthcare created 399,000 new jobs in 2019, up from 350,000 jobs in 2018.
Nearly one-in-five jobs created in 2019 was in healthcare, which greatly outpaced nearly every other major sector of the economy for the year, federal data released Friday show.
For 2019, healthcare created 399,000 jobs—nearly 33,000 new jobs each month—up from 350,000 jobs in 2018. The 2019 figures include 269,000 new jobs in ambulatory services, up from 219,000 jobs in 2018, and 102,000 new hospital jobs, down from 107,000 new jobs in 2018.
More than 16.5 million people work in the healthcare sector at the end of 2019, which accounts for 11% of all jobs in the overall economy.
The new data is in line with BLS projections that healthcare sector employment will grow 18% from 2016 to 2026, "much faster than the average for all occupations, adding about 2.4 million new jobs."
On the downside, hospital spending will grow about 5.5% each year, from $1.3 trillion in 2018 to $1.8 trillion in 2026, driven largely by those same demographics.
In the overall economy, total nonfarm employment increased by 145,000 in December, lower than expectations, and 2.1 million in 2019, down from 2.7 million in 2018. The unemployment rate ended the year at 3.5%, compared with 3.9% at the end of 2018.
A further breakdown of employment in healthcare shows that the sector ended 2019 with 28,000 new jobs in December, including 23,000 jobs in ambulatory services and 9,000 jobs in hospitals.
At the end of 2019, more than 16.5 million people worked in the healthcare sector, which accounts for nearly 11% of all jobs in the overall economy, including 7.8 million in ambulatory services, and 5.3 million in hospitals.
It's the 10th straight year that DOJ's civil healthcare fraud settlements and judgments have exceeded $2 billion.
The federal government collected more than $3 billion from False Claims Act cases in 2019, and $2.6 billion of it came from the healthcare sector, the Department of Justice announced.
It's the tenth straight year that DOJ's civil healthcare fraud settlements and judgments have exceeded $2 billion, and the recoveries in 2019 came from drug and medical device makers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians.
The $2.6 billion reflect only federal losses, and do not include the additional millions of dollars recovered for state Medicaid programs.
Much of the recoveries were spurred by the 633 whistleblower lawsuits filed in 2019, which DOJ credited with helping in the recovery of $2.1 billion.
Among the larger FCA settlements of 2019:
Opioid maker Insys Therapeuticspaid $195 million to settle civil allegations that it paid kickbacks to clinicians to prescribe Subsys for their patients. The kickbacks allegedly took the form of sham speaker events, jobs for the prescribers' relatives and friends, and lavish meals and entertainment.
DOJ also alleged that Insys improperly encouraged physicians to prescribe Subsys for patients who did not have cancer and lied to insurers about patients' diagnoses to ensure payment by federal healthcare programs.
Opioid addiction treatment maker Reckitt Benckiser Group plcpaid a total of $1.4 billion to resolve criminal and civil liability related to the marketing of Suboxone, which is a formulation of the opioid buprenorphine.
Avanir Pharmaceuticalspaid more than $95 million to resolve allegations that it paid kickbacks and engaged in false marketing to induce long-term care facilities to prescribe the drug Neudexta for behaviors commonly associated with dementia patients, which is an unapproved use of the drug.
Pathology laboratory company Inform Diagnostics, formerly known as Miraca Life Sciences Inc., paid $63.5 million to resolve allegations that it paid kickbacks to referring physicians in the form of subsidies for electronic health records systems and free or discounted technology consulting services.
EHR vendor Greenway Health LLC, paid more than $57 million to resolve allegations that it misrepresented the capabilities of its EHR product "Prime Suite" and provided unlawful remuneration to users to induce them to recommend Prime Suite to prospective new customers.
Inpatient rehabilitation facilities operator Encompass Health Corporation(formerly known as HealthSouth Corp.), paid $48 million to resolve allegations that some of its IRFs provided inaccurate information to Medicare to maintain their status as an IRF and to earn a higher rate of reimbursement, and that some admissions to its IRFs were not medically necessary.
A study compared administrative costs for healthcare in Canada and the United States and found a spending gap that is 'large and widening.'
America's Health Insurance Plans is taking issue with a study this week that blames the bloated administrative costs of healthcare on "the inefficiencies of the U.S. private insurance-based, multipayer system."
The study, published Monday inAnnals of Internal Medicine, compared administrative costs among payers and providers for healthcare in Canada and the United States and found a spending gap that is "large and widening."
In 2017, U.S. insurers and providers spent $812 billion on administration, amounting to $2497 per capita, which represents 34.2% of national health expenditures. Canada, which has a single-payer health system, spent $551 per capita, representing 17% of national health expenditures.
A further breakdown showed that U.S. payers spent $844 on overhead, versus $146 for Canada; $933 for hospital administration, versus $196 in Canada; $255 versus $123 for nursing home, home care, and hospice administration; and $465 versus $87 for physicians' insurance-related costs.
Of the 3.2–percentage point increase in administration's share of U.S. health expenditures since 1999, 2.4 percentage points was due to growth in private insurers' overhead, mostly because of high overhead in their Medicare and Medicaid managed-care plans, the study found.
"The prices that U.S. medical providers charge incorporate a hidden surcharge to cover their costly administrative burden," the study authors said.
By midday Monday, AHIP issued a statement to "provide some important context to this report," and noted that more than 80% of premium dollars goes toward the costs of care.
"Study after study continues to demonstrate the value of innovative solutions brought by the free market. In head-to-head comparisons, the free market continues to be more efficient that government-run systems," AHIP said.
They cited a MedPAC report which showed that Medicare Advantage plans deliver benefits at 88% of the cost of traditional Medicare, including administrative costs.
AHIP also cited a Center for American Progress study which found that "the lowest possible level of administrative spending for the U.S. health care system is not necessarily the optimal level of spending." That's because innovations such as bundled payments require significant upfront investment to develop.
AHIP also cited an article in JAMA which estimated that 25% of waste in the healthcare system could be reduced through investments in interventions that are considered part of administrative costs, such as addressing fraud and abuse and improving patient safety.
A whistleblower suit alleges that Community rewarded physician referrals with compensation way above fair market value.
The Department of Justice has joined a whistleblower lawsuit leveling False Claims Act allegations against Community Health Network, Inc., accusing the Indianapolis-based health system of violating the Stark Law prohibitions against improper financial relationships with physician.
The DOJ alleges that Community employed physicians under terms that did not meet any Stark Law exception because the compensation was well above fair market value, and because Community paid bonuses to physicians who achieved a minimum target of referral revenues back to the hospital.
The complaint also alleges that Community received referrals from these physicians in violation of the Stark Law and submitted claims to Medicare knowing that the claims for those referred services were not eligible for payment.
"Improper financial relationships between hospitals and physicians corrupt clinical decision-making, threaten patient care, and ultimately drive up Medicare costs," Assistant Attorney General Jody Hunt of DOJ's Civil Division said in a media release.
Community issued a lengthy statement saying it is "committed to upholding the highest regulatory and ethical standards in all our business practices, including physician compensation."
"We have cooperated fully with the government's requests leading up to this point, and we are disappointed with their decision. We believe that it is a waste of the government's time and resources to pursue these meritless claims," the system said.
"This lawsuit involves certain administrative issues that are completely unrelated to patient care. We are confident that we have complied with the laws and regulations that govern the way we operate our health network. We are committed to fighting these allegations which have no merit."
"We are confident that we have complied with the law and regulations that govern the way we pay our physicians for the services they provide to our patients and to the communities we serve – services such as teaching, research, providing education to patients and developing protocols to enhance care delivery."
"Community recognizes that physician compensation is very complex and highly regulated. Our physician compensation practices are a key part of our overall compliance efforts. We are confident that we operate in a legally compliant manner. To ensure compliance, as is standard in the industry, Community uses a variety of resources including independent, third parties to evaluate physician compensation to ensure it is fair, as the law requires."
Defenders of the ACA say the stakes are too high to allow the suit to ping-pong between the district and appeals courts.
A coalition of attorneys general defending the Affordable Care Act have asked the U.S. Supreme Court for an expedited review of the Fifth Circuit Court's ruling last month that sent Texas v. U.S. back to the trial judge.
"We're asking the Supreme Court to swiftly resolve this repeal lawsuit for the sake of saving lives and ending uncertainty in our healthcare system," California Attorney General Xavier Becerra said in a media release.
In a 2–1 decision December 18, the Fifth Circuit Court of Appeals agreed with the trial court that the ACA's individual mandate is unconstitutional, but it sent the rest of the expansive law back to the U.S. District Court for the Northern District of Texas for a more detailed analysis of which ACA provisions, if any, should be severed from the mandate and upheld.
Rather than cueing up an expected showdown before the Supreme Court, the appellate decision calls for another round of complex litigation that could again be appealed to the Fifth Circuit.
Led by California, the coalition of 20 states and the District of Columbia have said the stakes are too high to allow the case to ping pong between the district and appeals courts. On Friday they filed the petition asking SCOTUS to take the case before the end of the court's current term in June.
"This ruling jeopardizes the health care coverage of millions of Americans who depend on the Affordable Care Act," said Massachusetts AG Maura Healey. "We are asking the Supreme Court to review the Fifth Circuit's decision and quickly resolve the uncertainty it has caused for our families and our health care system."
Texas Attorney General Ken Paxton called an expedited review by the Supreme Court "premature."
"The Fifth Circuit agreed with our commonsense argument that the individual mandate is unconstitutional," Paxton said. "It remanded the case to the district court to determine whether any portion of Obamacare remains valid in light of the unconstitutionality of the mandate at the heart of the law."
"The Fifth Circuit has ordered the case back to district court, so that's where we're headed. We intend to demonstrate in district court that Obamacare is invalid in its entirety," he said.
