| THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
- Surging flu and RSV cases suggest difficult winter ahead. Early into flu season, nationwide flu activity is ten times higher than at the same point last year. Meanwhile, cases of respiratory syncytial virus (RSV), a virus most severe in young children and the elderly, have tripled in the past two months, with some children’s hospitals reporting “unprecedented” admissions for the virus. And most experts expect at least some winter COVID surge, possibly involving several different variants. The combined threat of these viruses circulating together has been labeled a potential “tripledemic.”
The Gist: Across the past two winters, the widespread adoption of COVID prevention measures, including masking and social distancing, kept the spread of other viruses at bay. But with return to normal life for most Americans, other viruses have returned to circulation—and with a vengeance, as population immunity toward flu and RSV has weakened. While it’s hard to predict when and where local surges will occur, hospitals struggling with staffing shortages may be forced to hire more contract labor to care for an influx of patients—making this a potentially challenging winter for already stretched facilities.
- Affordable Care Act (ACA)’s required coverage of preventive care services in further jeopardy. The plaintiffs in Braidwood v. Becerra filed a motion on Monday asking a US District Court judge in Texas—the same judge who ruled the entire ACA unconstitutional in 2018—to block enforcement of the ACA’s no-cost requirement for preventive care services. This judge already sided with the plaintiffs in September, ruling the government cannot require a company to fully cover preventive HIV drugs, also known as PrEP therapy, for its employees, on the grounds that doing so violates owners’ religious freedom. In that ruling, the judge also asserted that the government’s system for deciding what preventive care services should be covered under the ACA is unconstitutional. This latest motion now asks him to invalidate all parts of the ACA requiring preventive health services on the grounds that the Preventive Services Task Force was never appointed by Congress, and thus lacks the authority to say which services insurers must cover. The final ruling is expected early next year, after which the case will certainly be appealed, regardless of outcome.
The Gist: Given the judge’s initial ruling in Braidwood last month, this motion from the plaintiffs was expected. While the US Supreme Court reversed a 2018 ruling by this judge that struck down the entire ACA, it could potentially find the narrow targeting of this case more reasonable, making preventive care coverage optional for employers. If that happens, millions of Americans would once again have to pay for some of the most common and highest-value healthcare services, including screening tests for a variety of cancers, sexually transmitted infections, and diabetes. That additional financial burden, along with likely tightening of health plan benefit designs, would create barriers to access and exacerbate health disparities.
- Two health systems partner to form new virtual and in-home care company. Cleveland, Ohio-based MetroHealth and the Medical University of South Carolina (MUSC) Health in Charleston have announced the creation of Ovatient, a nonprofit company that will provide a comprehensive virtual-first and in-home care delivery model to other health systems. While Ovatient will begin to deliver care to patients in Ohio and South Carolina early next year, the founding systems’ goal is to extend its reach by recruiting other health systems to join the venture.
The Gist: This new venture follows in the footsteps of other collaborations between health systems to tackle areas of common need, such as Civica RX, which develops generic medications, and Truveta, which aggregates and analyzes patient data for research and drug development. Although it does not have the backing of a large national health system, it’s possible that Ovatient’s modest scale may allow for more agility in ironing out the difficulties of virtual and at-home care delivery and demonstrating the company’s value. We’ll be watching closely to see how the new initiative continues to evolve.
Plus—what we’ve been reading.
- Purported Medicare profits spark criticism of North Carolina hospitals’ charity care spending. Drawing on a report published by the North Carolina State Health Plan for Teachers and State Employees, a recent Kaiser Health News article shines a light on the lack of transparency in financial reporting of not-for-profit hospitals’ community benefit obligations. The report claims many North Carolina hospitals—including the state’s largest system, Atrium Health—show profits on Medicare patients in their cost report filings, while at the same time claiming sizable unrecouped losses on Medicare patients as a part of their overall community benefit analyses.
The Gist: These kind of reporting discrepancies draw attention to the controversial issue of whether not-for-profit hospitals provide sufficient community benefit to compensate for their tax-exempt status, which was worth nearly $2 billion in 2020 for North Carolina hospitals alone. Greater transparency around charity care, community benefit, and losses sustained from public payers could go a long way toward shoring up stakeholder support for not-for-profit institutions at a time when their political goodwill has deteriorated. Hospitals should be proactive on this front, as political leaders increasingly train their sites on high hospital spending in the current tight economic environment.
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