Bloomberg reports
Tuesday, January 8, 2019
Creating a Home Gym on the Cheap
A state-of-the-art home gym might not just be beyond the scope of your budget, it also might be beyond the scope of available space. But don’t rule out this convenient fitness option so fast.
According to the American Council on Exercise, if you can clear a 6-foot by 6-foot area for working out, you can outfit a home gym with the basics for under $100. Plus, these space-conscious items can be stored in a closet or under the bed when not in use. Just don’t forget that they’re there once you buy them!
Start with a good mat for floor work, like yoga, Pilates, ab exercises and push-ups. The price typically depends on the thickness you choose, and thickness depends on what you’re using it for.
Next is at least one stability ball for doing a variety of exercises, including balance work and crunches. Choose one made for your weight and height. When you’re sitting on it, your thighs should be parallel with the floor.
Stretchy resistance bands are great for strength training when you don’t want a full set of weights. On their own, they weigh nothing and take up less space than a pair of socks. You might buy them in various tensions to match up with the different strengths of various muscle groups. There are also circular bands that go around your ankles for working the outer hips.
If you’d like to use dumbbells for upper body work, a set with three pairs of graduated weights is an inexpensive option. If you’re a beginner, choose a set with 3-, 5- and 10-pound weights; if you’re more experienced, go for 5-, 10- and 15-pounds.
However, you might get more mileage for your money with a barbell and weight plates — but again, start with low-weight plates and then add as you gain strength.
More information
For details on putting together an inexpensive home gym, check out the website of the American Council on Exercise.
New Drug May Be Hard to Get as Flu Season Heats Up
The number of US states reporting high influenzalike illness activity doubled during the week ending December 29, and a spot-check of major drug chains revealed that only one had a recently approved antiviral medication in stock.
New York City and 19 states reported high influenzalike illness activity, up from New York City and nine states the week before, the Centers for Disease Control and Prevention (CDC) reports.
The US Food and Drug Administration recently approved baloxavir marboxil(Xofluza, Genentech) for those aged 12 years or older with flu symptoms for no more than 48 hours. Baloxavir is a single-dose, oral medication that should be taken within 48 hours of symptom onset to be most effective. It may be more appealing to patients than other antiviral medications that must be taken for several days, such as oseltamivir (Tamiflu, Genentech), zanamivir (Relenza, GlaxoSmithKline), and peramivir (Rapivab, Seqirus).
Baloxavir may be difficult to obtain, based on telephone calls to major drug chains in six locations last week, according to a report by WebMD. Of stores in Los Angeles, Chicago, New York City, Minneapolis, Atlanta, and Kankakee, Illinois, the store in Minneapolis was the only one that had baloxavir in stock. All of the pharmacies offered to order it, but they gave various answers about how long it would take to get the drug.
Influenza Activity Intensifies but Remains Below Last Flu Season
During week 52, the proportion of outpatient medical visits for influenzalike illness was 4.1%, up from 3.3% last week and lower than last season at this time, when the proportion was 5.8%. The national baseline was 2.2% for both seasons.
Since October 1, 2018, the Influenza Hospitalization Surveillance Network (FluSurv-NET) has received reports of 1562 laboratory-confirmed influenza-associated hospitalizations, much lower than the 3927 reported during the same period last year.
All 10 regions had influenzalike illness at region-specific baseline levels or above, as they had at this time last season.
Although the number of states reporting high influenzalike illness activity doubled during week 52, it still remained below this week last year, when high activity was reported in New York City and 26 states.
The levels of moderate influenzalike activity were similar during week 52 of this season and last season: This season, nine states reported moderate activity, up slightly from Puerto Rico and seven states the week before. During week 52 of last season, Puerto Rico and nine states reported moderate activity.
Influenzalike illness activity was low in the District of Columbia and 10 states compared with the District of Columbia and six states at this time during the 2017-2018 influenza season. Activity was minimal in Puerto Rico and 12 states this season and minimal in nine states at this time last year.
The geographic spread of influenza was widespread, in 24 states during week 52, more than twice as high as the previous week, when it was widespread in Guam and 11 states. By week 52 of the 2017-2018 season, influenza was widespread in 46 states — everywhere except Hawaii, Maine, New Hampshire, New Jersey, and the District of Columbia.
Puerto Rico and 18 states experienced regional activity during week 52.
Hospitalizations Edging Up but Still Lower Than Last Season
The cumulative rate of laboratory-confirmed influenza-associated hospitalizations was 5.4 per 100,000 population, up from 3.6 during week 51. The rate was much higher during week 52 of the 2017-2018 season, when it was 13.7 per 100,000 population.
The highest hospitalization rate was among children younger than 5 years, at 14.5 hospitalizations per 100,000 population, compared with 9.9 during week 52 of last year.
The proportion of deaths caused by pneumonia and influenza was below the National Center for Health Statistics Mortality Surveillance System’s epidemic threshold.
The CDC received reports of two influenza-associated pediatric deaths during week 52, both associated with influenza A(H1N1)pdm09 viruses. One child died during the week ending December 22 and the other during the week ending December 29. The total number of pediatric deaths from influenza this season is now 13.
During week 52 last season, one child died from an influenza A virus, bringing the total to 13 at the end of that week.
Cellular Biomedicine initiates recruitment for myeloma study
Cellular Biomedicine announces the initiation of patient recruitment to support the study of anti-BCMA CAR-T therapy targeting relapsed and refractory Multiple Myeloma in China.
https://thefly.com/landingPageNews.php?id=2845893
https://thefly.com/landingPageNews.php?id=2845893
NYC Health + Hospitals consolidates offices in big new $758M 25-year lease
NYC Health + Hospitals signed a deal for more than 500K SF at GFP Real Estate and Northwind Group’s 50 Water St., the groups announced Monday. The lease at the building, previously known as 7 Hanover Square, is for 25 years. The nonprofit corporation, which runs public hospitals and healthcare facilities, is taking a total of 527K SF in a $758M deal. NYC Health + Hospitals will consolidate its offices at the building, reducing its footprint by 20% and saving $17M in real estate costs over the next five years, it said. The companies are rebranding the building as two separate entities with the addresses of 50 Water St. and 100 Pearl St.
Diagnostic coding changes driving reductions in hospital readmission rates
Coding changes may have helped bolster improvements in 30-day hospital readmission rates.
A new study, published Monday in Health Affairs, showed that reductions in readmissions rates corresponded to a change the CMS made allowing hospitals to increase the number of diagnosis codes they could submit for patient claims. That change impacted the risk-adjustment the CMS uses to determine changes in readmission rates, making patients overall appear sicker and therefore caused any readmission improvements made by hospitals to appear better. This is the second study in the past year arguing that some of the improvements seen in readmission rates were caused by changes in coding practices.
According to the newest study, 81% of hospital admission claims reported nine or 10 diagnoses to the CMS in November 2010. But when the CMS changed standards in January 2011 and allowed hospitals to report more than 10 and up to as many as 25 diagnosis codes to Medicare, 70% of admission claims that month reported 11 or more diagnoses while only 15% reported nine or 10. Readmissions declines were much larger among claims that took advantage of the new standards. According to the study, during the period in which hospitals were anticipating the readmissions program—April 2010 to September 2012 —declines in readmissions were 48% smaller when risk adjustment considered nine or fewer diagnosis codes than when risk adjustment considered 11 or more diagnoses.
“The change in risk adjustment is occurring over this narrow time period and it appears to be driven by this increase in coding—coding 10 or more diagnosis codes wasn’t allowed before,” said Christopher Ody, lead author of the study and a research assistant professor in the Kellogg School of Management at Northwestern University.
The authors of the study disclosed ties to Massachusetts Medical Society, pharmaceutical consultancy Precision Health Economics, healthcare consultancy NaviHealth, venture capital firm F-Prime Capital Partners and consultancy Mercer.
A CMS spokesperson said the agency is currently reviewing the analysis. Nonetheless, the Medicare Payment Advisory Commission in June reported that the penalty program successfully led to drops in readmission rates. According to MedPAC, between 2010 and 2016, readmission rates for heart attack patients fell by 3.6 percentage points, 3 percentage points for heart failure patients and 2.3 percentage points for pneumonia patients.
The older study, published in February 2018 in JAMA, concluded about 63% of the reduction in readmission rates in the HRRP program are due to coding more severely.
“Even though these are different methods, the punchline is still the same. At best the hospital readmissions program reduced readmissions in maybe half the magnitude we think,” said Dr. Andrew Ibrahim, lead author of the JAMA study and general surgeon at University of Michigan.
The new Health Affairs study also noted that decreases in readmission rates were not significantly larger in HRRP hospitals when compared to those that were not part of the program. The researchers compared baseline readmission rates for that finding.
Ody said considering his study and others linking rises in mortality to the readmissions program, he hopes the CMS will gradually roll out pay for performance programs instead of implementing them nationwide without significant testing.
Providers compare notes on cost cutting at JP Morgan
There was an urgent undertone in some health system leaders’ descriptions of their cost-cutting measures at the J.P. Morgan Healthcare Conference on Monday.
Aside from the usual polished speeches about quality care and expanding outpatient sites, administrators described their strategies to cut spending and in turn lower costs for patients and health plan members, illustrating providers are responding to both internal and external pressure to lower their role in the country’s ballooning healthcare costs.
“We need to be zealots on cost,” Robert DeMichiei, chief financial officer of the UPMC health system, told investors.
DeMichiei criticized the fact that other health system presentations, while touching on lowering costs, placed more emphasis on revenue cycle and growth. At Pittsburgh-based UPMC, administrators track cost at every level—cost per operating room hour, cost per claim and so on—and then work to lower those numbers, he said. People aren’t going to keep paying 5% to 7% rate increases every year, DeMichiei said.
“We need to disrupt ourselves,” he said.
Salt Lake City-based Intermountain Healthcare has made several big announcements around lowering the cost of healthcare, especially with the launch of a health system-led drug company that will make its own generic drugs, Civica Rx. That company just welcomed 12 new health system members, meaning 750 U.S. hospitals are united around the initiative.
Part of Intermountain’s commitment to providing services at a lower cost and being “careful stewards of resources,” has meant outsourcing 2,300 jobs to its revenue-cycle management provider, Chicago-based R1 RCM, Intermountain CEO Dr. Marc Harrison told Modern Healthcare in an interview. Harrison said that transition was hard, but said many of those employees would have lost their jobs to automation if not for the decision to outsource them to R1. That’s because artificial intelligence and machine learning are playing increasing roles in revenue cycle management, he said.
Intermountain will continue to address costs, and Harrison said he hopes that doesn’t result in further swings in employment.
“We’re not anticipating big shifts right now, but we’re being extraordinarily careful about who we hire and why we hire them, because we don’t want to have anybody need to be partnered with another organization unexpectedly,” he said.
Lowering the health system’s costs have allowed Intermountain to reduce its Affordable Care Act exchange plan premiums by an average of 2.7% from 2018 to 2019, Harrison said. He estimates Intermountain’s interventions have saved consumers in Utah $10 million to $15 million.
Before the merger to form Advocate Aurora Health closed nine months ago, both organizations shared the priority of driving down costs, Nick Turkal, the health system’s co-CEO, told investors in the health system’s presentation Monday.
Dominic Nakis, Advocate Aurora’s CFO, told investors that of his system’s roughly 3 million patients, about 1.3 million are in some form of value-based contract, and they’ve performed very well financially, whether in commercial or Medicare.
“We want to accelerate that,” he said.
Leaders with CommonSpirit Health, the forthcoming not-for-profit health system that will result from the planned merger between Dignity Health and Catholic Health Initiatives, emphasized growth in their presentation.
“We know that we can’t cut our way to success,” said Dan Morissette, who will be CommonSpirit’s CFO. “Ultimately this is going to be around smart growth for our combined ministry.”
Morissette described the synergies expected to come from the merger, including pricing relationships on the supply side and eliminating duplicative administrative functions.
Lloyd Dean, who’s currently Dignity CEO and will be the co-CEO of CommonSpirit, told investors he wants CommonSpirit to be the place providers and employees in the audience will want to migrate to, even joking that there will be applications available.
“For those of you that are trying to reduce costs, we are trying to gain quality expertise,” he said.
Dean went on to say that CommonSpirit is trying to recruit the best talent, not just from within Dignity and CHI, but elsewhere in the market.
“We are looking to work with many of you in this audience as well as other people in the community,” he said.
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