From Washington, DC

• Roll Call reports,
  • “Speaker Mike Johnson is prepping a stopgap funding extension ahead of this month’s deadline that combines some red meat for conservatives with policies that lawmakers in both parties will likely find attractive.
  • “According to sources familiar with the discussions, the Louisiana Republican’s plan would pair a six-month continuing resolution with House-passed legislation aimed at ensuring noncitizens can’t vote in federal elections.
  • “The length of the stopgap measure, if enacted, would ensure that lawmakers won’t get jammed with a lame-duck omnibus package right before Christmas, while punting final spending decisions into the new year and a new Congress — possibly with more GOP leverage to shape the outcome.
  • “In addition, the measure is expected to include a one-year extension of farm bill programs that would otherwise expire Sept. 30, since neither chamber’s multiyear reauthorization package has reached the floor and won’t be reconciled by the deadline.
  • Billions of dollars to address shortfalls in Department of Veterans Affairs programs identified by the department over the summer as well as in the Federal Emergency Management Agency’s main disaster relief account will be included as well, according to sources familiar with the talks.
  • “The current plan is to take up the measure next week when the House returns from its summer break. At least in theory, that would give a reluctant Senate time to make tweaks and send back a new version before the Sept. 30 deadline to avert a partial government shutdown.”

• Per Modern Healthcare,
  • “Steward Health Care Chief Executive Officer Ralph de La Torre has informed senators he won’t participate in an upcoming hearing probing the hospital operator’s failure until after its bankruptcy has concluded.
  • “Lawyers for de la Torre also said in a Wednesday letter to Bernie Sanders, a Vermont independent, that members of the Senate health committee which Sen. Sanders chairs are attempting to turn an upcoming Sept. 12 hearing “into a pseudo-criminal proceeding in which they use the time, not to gather facts, but to convict Dr. de la Torre in the eyes of public opinion.” The Senate committee in a bipartisan vote authorized the investigation and subpoena of de la Torre to testify.
  • Sanders’ office did not immediately respond to a request for comment.
• and
  • “Telehealth industry and mental health groups are scrambling amid fears the Drug Enforcement Administration is poised to place strict limits on remote prescribing of controlled substances such as Adderall and Vicodin.
  • “The legal authority for clinicians to prescribe DEA-regulated medications through platforms such as Talkiatry expires in less than four months, and the law enforcement agency has moved slowly to issue a final rule after the draft version released last year triggered protests from providers and telehealth companies.
  • “Anxiety among telehealth stakeholders soared last Wednesday, when Politico Pro reported the DEA intends to produce a regulation that would narrow the list of drugs that remote providers can prescribe and require them to verify that patients aren’t seeking medicines to misuse them. That report is unconfirmed and was attributed to an unnamed former DEA official.”

• Per Healthcare Dive,
  • “The three biggest U.S. drug distributors have agreed to pay $300 million to health plans to settle lawsuits over their role in perpetuating the deadly opioid epidemic.
  • “McKesson, Cardinal and Cencora have already shelled out billions to resolve claims that their actions made it easier for people to access highly addictive pain medication. The latest suits brought by health insurers and benefits plans argue the drug distributors’ actions forced them to cover overprescribed pills, along with treatment for their members with opioid use disorder that they would not have had to pay for otherwise.
  • “The settlement — which does not require the distributors to admit wrongdoing — was disclosed Friday in an Ohio federal court, and still requires a judge’s approval.”

• Govexec informs us that, “The USPS inspector general found that despite accurately forecasting air demand and adequately staffing for its busiest period, the agency still saw some on-time delivery and inventory delays.”

From the public health and medical research front,

• MedPage Today tells us,
  • “During the first season of use, respiratory syncytial virus (RSV) vaccination among older adults was associated with a substantially reduced risk of hospitalization, a test-negative, case-control study indicated.
  • “In adults 60 and over, vaccine effectiveness from October 2023 to March 2024 against RSV-associated hospitalization reached 75% (95% CI 50-87), according to researchers led by Diya Surie, MD, of the CDC in Atlanta.
  • “As reported in JAMA, effectiveness remained similar when estimated with inverse probability of vaccination weighting to balance for potential confounders (79%, 95% CI 56-90), and when analyzed across age groups: at 75% (95% CI 31-91) for adults ages 60 to 74 years and 76% (95% CI 40-91) for those age 75 and older.”

• The New York Times lets us know,
  • “Experts say most people should get vaccinated [against the flu] between mid-September and late October. The C.D.C. recommends getting your shot by the end of October at the latest.
  • “Generally speaking, your immunity peaks a week or two after a flu shot. Even after it peaks, protection lasts five or six months. This is typically enough protection to get you through flu season, which tends to begin in October and end in March or April.
  • “There are some exceptions to those recommendations. Experts said pregnant women in their third trimester should get vaccinated now to confer flu immunity on their newborns.
  • “Some children between 6 months and 8 years old need two flu shots, four weeks apart. This includes children who have never gotten a flu shot, who have only received one dose or who have an unknown vaccination history. Experts say that for young children, an initial course of two doses provokes the best immune response to flu. Alicia Budd, the team lead of the influenza division at the C.D.C.’s National Center for Immunization and Respiratory Diseases, said children who need two doses can get their first shot now.”

• Per the Haymarket Medical Network,
  • “Cigar and pipe smoking are independently associated with lower aryl-hydrocarbon receptor repressor gene methylation, which is linked to increased mortality and poor respiratory health outcomes, according to study findings published in Thorax.”
• and
  • “Patients with respiratory tract infections were significantly more likely to receive antibiotic prescriptions in virtual vs in-person urgent care visits, with the higher prescription volume in virtual settings primarily driven by sinusitis diagnoses.” 

• The Wall Street Journal reports,
  • “The rate of preeclampsia and other disorders in pregnancy related to high blood pressure more than doubled between 2007 and 2019. “It’s no longer a rare finding,” said Dr. Sadiya Khan, associate professor of medicine at Northwestern University Feinberg School of Medicine. They complicate about 1 in 7 pregnancies a year, she said.
  • “They’re part of what’s become a crisis in healthcare for pregnant women and new mothers in America. The U.S. rate of maternal deaths is the highest among high-income nations and has risen since 2018, even excluding a spike during the Covid-19 pandemic. The rate was 22.3 deaths per 100,000 live births in 2022, up from 17.4 in 2018, according to the Centers for Disease Control and Prevention.
  • “About two-thirds of maternal deaths occur postpartum—a period researchers and doctors increasingly refer to as the “fourth trimester.” Researchers say that postpartum home visits by medical staff and guaranteed paid leave are more common in other high-income nations than in the U.S., factors that can help prevent deadly complications.
  • “Cardiovascular causes—including preeclampsia—were behind about a third of U.S. maternal deaths in 2020. Doctors don’t know why for sure, but possible risk factors include poor diet, obesity, older age and stress. More young people are in worse heart health than in previous generations, said Khan, a cardiologist. Other top causes of maternal death include suicides, drug overdoses and hemorrhages.”
• and
  • “Please clean the microwave! 
  • “That lunchroom advice has been put to the test by researchers who looked for bacteria inside microwave ovens and found a surprisingly diverse ecosystem that is resistant to the appliances’ heat.
  • “It’s not the same thing to warm up fish or pasta, and then to warm up these tiny microorganisms that may be mixed with some fat in a very thin layer on top of this glass tray that is inside the microwave,” said Manuel Porcar, a researcher at the University of Valencia and chief executive of Darwin Bioprospecting Excellence, a Spanish biotechnology firm.” * * *
  • “The kitchen microwaves had a greater mass of microbes, they found, while the laboratory microwaves hosted greater diversity. 
  • “To rid a microwave of the germs, Porcar said using soap or diluted bleach will do the trick.
  • “Microwaves are as clean or as dirty as the surface of your kitchen table,” he said. “This means that you must not forget to clean it.”
  • “The findings were published in August in the journal Frontiers in Microbiology.”

From the U.S. healthcare business front,

• Modern Healthcare reports,
  • “Health Care Service Corp. is offering large employers a simplified healthcare plan that doesn’t include any deductibles or coinsurance and incentivizes using providers with “the highest-quality, cost-effective health outcomes,” the Chicago-based parent of Blue Cross & Blue Shield of Illinois announced today.
  • “The streamlined alternative plan for large, national self-funded health insurance calls for members to select their providers and receive an upfront estimate of what out-of-pocket costs to expect. At the time of service, the patient pays nothing, but instead receives a bill at the end of the month, HCSC said in a press release.”
• and
  • “Humana previewed its Medicare Advantage strategy for the coming plan year, including a decision to quit 13 counties where performance has been unsatisfactory, at the Wells Fargo Healthcare Conference on Wednesday.
  • “The Medicare Advantage heavyweight, which had 6.2 million members in those plans as of the second quarter, expects to lose a few hundred thousand enrollees in 2025 as it prioritizes profitable markets, Chief Financial Officer Susan Diamond told investors at the event in Everett, Massachusetts.
  • “In addition to leaving those 13 counties, Humana will offer fewer plans in some other areas, Diamond said. About 560,000 members will have to choose new policies for 2025, most of whom will have other Humana plans available to them, she said.
  • “The exit itself is positive in the sense that those plans were not contributing. And so just exiting, even if we don’t retain the members, is positive,” Diamond said.”
• and
  • “Companies that have profited from the largesse of Medicare Advantage insurers seeking to lure customers with generous perks are looking ahead to a tough 2025.
  • “Humana and CVS Health subsidiary Aetna are among those signaling that curtailing supplemental benefits such as transportation, fitness memberships, in-home support services, and vision, dental and hearing coverage will be a key part of their strategies to restore margins in a business troubled by high costs and a more restrictive regulatory environment.”

• Per Fierce Healthcare,
  • “After weathering a few years of COVID-19 interruptions, hospitals are now riding a wave of strong demand for acute care services.
  • “Second-quarter earnings from several major health systems have outlined year-over-year gains across several patient volume metrics. Industrywide data reports have outlined a similar demand recovery trend, as well as the accompanying revenue gains.
  • ‘But the recovery can’t and won’t last forever, warned Tenet Healthcare CEO Saum Sutaria, M.D.. Once hospitals and health systems have made it to the other end of the upturn—likely sometime after 2025, he predicted—it’ll be the organizations that grew their service lines or expanded their capacity without increasing their cost base “as aggressively” that find long-term success. 
  • “While the industry is benefitting from a lot of this demand—and probably some of the financial benefit from the expansion of the exchanges … due to redetermination—ultimately, the discipline around operating efficiency when you end up in a normal demand environment is what’s going to allow you to grow earnings,” the CEO said Wednesday at the 2024 Wells Fargo Healthcare Conference. “That has always been the case in this industry, and I think it will always be the case.”

• Per Beckers Hospital Review,
  • “Epic reported $4.9 billion revenue last year while expanding its market share, growing the Cosmos database and adding artificial intelligence-driven capabilities, according to CNBC.
  • “The company would have around $45 billion valuation based on S&P 500’s sub-index of software and services companies, but CEO Judy Faulkner is sticking to Epic’s first two commandments: “do not go public” and “do not be acquired.”

• Health Affairs disclosed,
  • “The rising price of branded drugs has garnered considerable attention from the public and policy makers. This article investigates the complexities of pharmaceutical pricing, with an emphasis on the overlooked aspects of manufacturer rebates and out-of-pocket prices. Rebates granted by pharmaceutical manufacturers to insurers reduce the actual prices paid by insurers, causing the true prices of prescriptions to diverge from official statistics. We combined claims data on branded retail prescription drugs with estimates on rebates to provide new price index measures based on pharmacy prices, negotiated prices (after rebates), and out-of-pocket prices for the commercially insured population during the period 2007–20. We found that although retail pharmacy prices increased 9.1 percent annually, negotiated prices grew by a mere 4.3 percent, highlighting the importance of rebates in price measurement. Surprisingly, consumer out-of-pocket prices diverged from negotiated prices after 2016, growing 5.8 percent annually while negotiated prices remained flat. The concern over drug price inflation is more reflective of the rapid increase in consumer out-of-pocket expenses than the stagnated inflation of negotiated prices paid by insurers after 2016.”