| THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
- Twitter no longer policing COVID misinformation. Amid a flurry of policy changes initiated by Elon Musk since his takeover of the social media company last month, Twitter has ceased its formal efforts to combat COVID misinformation. To date, Twitter had removed over 100K posts for violating its COVID policy. The company will now rely on its users to combat disinformation through its “Birdwatch” program, which lets users rate the accuracy of tweets and submit corrections. Many of the 11K accounts suspended for spreading COVID misinformation, including those of politicians like Rep. Marjorie Taylor Greene (R-GA), have also been reinstated.
The Gist: We’ve seen the damage caused by inaccurate or deliberately misleading COVID information, which has likely played a role in the US’s lower vaccination rates compared to other high-income countries. Around one in five Americans use Twitter, far fewer than Facebook or YouTube, but the platform is seen as highly influential, both for the reach of its content and also its moderation decisions. This policy change is worrisome, not only because COVID is still taking the lives of hundreds of Americans daily, but also because COVID misinformation catalyzes broader healthcare misinformation, including antivax sentiments and an overall mistrust of medical experts.
- More health systems are charging patients to message their physicians. A growing number of health systems have begun to bill for certain electronic communications with patients via portals like MyChart. The systems instituting these practices, including Cleveland Clinic and Chicago-based Northwestern Medicine, have justified the billing based on the time demands placed on their providers to answer messages involving additional efforts, including extensive patient chart review. Northwestern shared that fewer than one percent of MyChart messages incurred fees, which are typically covered by insurance, and require patient consent before billing.
The Gist: In a time of significant margin pressure, we understand the instinct to seek additional revenue by collecting whatever reimbursement is available. However, in the ongoing transition to technology-enabled hybrid care, this practice has the potential to confuse, or even drive away, patients, who finally began to embrace virtual provider communication during the pandemic. Viewing portal messaging as a “digital front door” for patients, rather than a revenue-generating service in and of itself, may prove more fruitful in the long run.
- Latest Alzheimer’s drug trials generating mixed results. Pharmaceutical companies Eisai and Biogen published findings from a Phase Three trial, showing that lecanemab, their experimental Alzheimer’s drug targeting amyloid deposits in the brain, reduced cognitive and functional decline by 27 percent in patients with early Alzheimer’s. Though the drug caused severe side effects in some patients, the drugmakers—who are also the makers of the controversial Alzheimer’s drug Aduhelm—submitted an accelerated Food and Drug Administration (FDA) approval request. Also this week, Genentech, a division of drugmaker Roche, released results showing that gantenerumab, its drug that similarly targets amyloid buildup, failed to slow the growth of plaques significantly.
The Gist: As we’ve seen with Aduhelm, accelerated FDA approval for lecanemab won’t necessarily mean it will end up reaching many patients. Given the pervasiveness and severity of Alzheimer’s, the FDA faces a difficult decision each time an experimental drug shows promise, as the lack of viable treatment options creates public pressure for approval. But the study result we’re anxiously waiting for is the one aiming to either prove or disprove whether amyloid plaque actually causes Alzheimer’s—a largely accepted hypothesis that has been increasingly scrutinized in recent years.
Plus—what we’ve been reading.
- Hospice industry awash with for-profit bad actors. An unsparing piece published this week in the New Yorker examines the unscrupulous and exploitative practices of AseraCare and several other for-profit hospice providers, who have gone from controlling 30 percent of the hospice market to more than 70 percent across the last decade. The article outlines the companies’ playbook of delivering the least amount of care to the greatest number of patients, many of whom are not actually in need of hospice services at all. In order to game Medicare’s policy to extract repayments from hospice providers whose average patient stay exceeds six months, many of these companies have employed strategies ranging from recruiting “last breath” patients from oncologists to lower their average length of stay, to “graduating” an absurd 70 percent of enrolled patients once they reach their six-month limit.
The Gist: While it only takes a few bad apples spoil the bunch, the US hospice industry appears to be in a thoroughly rotten state. Caring for the elderly and dying is already a difficult (and expensive) proposition, and the questionable practices detailed in this piece further undermine the good work being done by those providers committed to helping patients and their families during extraordinarily difficult times. Currently subject to only minimal federal oversight, the hospice industry is in dire need of stronger regulation, which might take its cue from California, which recently issued a licensing moratorium for hospice providers while redesigning its auditing process.
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