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Wednesday, January 16, 2019

Gastric bypass surgery may aid muscle strength more than previously thought


Gastric bypass surgery improves relative muscle strength and physical performance in people with obesity, according to a study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.
Bariatric surgery helps people who have severe obesity to lose a lot of weight and improve their health. Gastric bypass is one of the most common types of bariatric surgeries. It’s a procedure that reduces the size of the stomach, causes hormonal changes, and can lower the amount of nutrients that are absorbed from food. The digestive tract is rerouted, bypassing most of the stomach and part of the small intestine. The procedure can improve or eliminate related conditions such as diabetes.
“Our research found while Roux-en-Y bariatric surgery patients are likely to see the maximum amount of strength they can exert decline as they lose weight, they actually see an increase in their relative strength — a measure of strength relative to their size,” said the study’s first author, Diana Alba, M.D., of the University of California, San Francisco (UCSF) in San Francisco, Calif. “Our participants’ physical performance also improved following surgery. The findings suggest that postoperative loss of muscle mass and absolute strength may not be a meaningful problem.”
In the prospective cohort study, researchers examined the body composition, handgrip strength, physical activity and physical performance of 47 obese adults before and six and 12 months after gastric bypass surgery. They found that dramatic weight loss causes a decline in a person’s lean mass and absolute grip strength after surgery. However, relative muscle strength, walking speed and other measures of physical function improved meaningfully in these patients.
“Having good muscle strength and physical function is essential to helping people carry out their day-to-day lives,” Alba said.
Other authors of the study include: Lucy Wu, Kathleen Mulligan, Thomas Lang, Jonathan T. Carter, Stanley J. Rogers, and Andrew M. Posselt of UCSF; Peggy M. Cawthon of UCSF and the California Pacific Medical Center in San Francisco, Calif.; Sheena Patel of the California Pacific Medical Center; Nicole J. King of the San Francisco Veterans Affairs Health Care System in San Francisco, Calif.; and Lygia Stewart, Dolores M. Shoback, and Anne L. Schafer of UCSF and the San Francisco Veterans Affairs Medical Center.
The research received funding support from the U.S. Department of Veterans Affairs, the Wilsey Family Foundation, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Center for Advancing Translational Sciences of the National Institutes of Health.
Story Source:
Materials provided by The Endocrine Society. Note: Content may be edited for style and length.
Journal Reference:
  1. Diana Alba, Lucy Wu, Peggy M Cawthon, Kathleen Mulligan, Thomas Lang, Sheena Patel, Nicole J King, Jonathan T Carter, Stanley J Rogers, Andrew M Posselt, Lygia Stewart, Dolores M Shoback, Anne L Schafer. Changes in lean mass, absolute and relative muscle strength, and physical performance after gastric bypass surgery. The Journal of Clinical Endocrinology & Metabolism, 2019; DOI: 10.1210/jc.2018-00952
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Community Health Systems falls short of 2018 hospital divestiture target


Community Health Systems generated $400 million in gross proceeds on hospital divestitures in 2018, less than half of its $1.3 billion target, leaders from the hospital chain said Wednesday.
Thomas Aaron, the Franklin, Tenn.-based hospital chain’s CFO, confirmed before an audience at the J.P. Morgan Healthcare Conference on Wednesday afternoon that the company fell short of its 2018 goal by about $900 million. The hospital chain had repeated the goal on multiple occasions last year, including in its third quarter results.
CHS also missed its goal of divesting hospitals in 2018 that had accounted for $2 billion in combined revenue in 2017. The 13 hospitals CHS sold last year had $1.1 billion in combined 2017 revenue, Aaron said. That $2 billon goal was also cited in CHS’ third quarter results.
CHS’ leaders did not frame those results as having missed their 2018 goals, however.
“That target will continue into 2019 and we expect to complete that,” Aaron said.
The investor-owned chain in a statement said that it had disclosed that its divestiture program would not be completed in 2018 and would continue into 2019 as part of its its third quarter earnings report. “Although it has taken a little longer than initially expected, Community Health Systems remains on track to meet its divestiture goals,” CHS wrote. The statement also said there are definitive agreements in place for five hospital divestitures that are expected to close in the first quarter, and discussions about additional transactions are occurring.
It’s not clear whether CHS fell short of its initial target because it didn’t get as much for the divested hospitals as it had planned, whether the company didn’t sell as many hospitals as it had planned to sell or a combination of both.
Wayne Smith, CHS’ CEO, said during the company’s question and answer session that it will be good to get past the divestitures.
“They obviously are a little bit of a distraction,” he said. “It takes a lot of resources to do this.”
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HCA-Mission Health deal OK’d by N.C. attorney general


North Carolina’s attorney general approved hospital giant HCA Healthcare’s $1.5 billion acquisition of Asheville, N.C.-based Mission Health on Wednesday, after nabbing commitments from HCA meant to protect the state’s healthcare industry.
“Access to healthcare is truly a life or death issue,” North Carolina Attorney General Josh Stein said in an announcement. “We kept that fact in mind as we conducted our review of this transaction. After extensive negotiations, I am satisfied that this new agreement protects healthcare in western North Carolina, ensures that the full value of Mission’s assets will continue to be used for public purposes, and requires that the Dogwood Health Trust will be independent and representative.”
Stein said Nashville, Tenn.-based HCA also agreed to enforcement measures that allow the attorney general’s office to pursue legal action if the hospital system breaks its commitments, which include providing services at local hospitals for at least 10 years, building new N.C. facilities, and supporting community service programs that Mission supports.
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Medicaid block grant waiver reports revive hospitals’ funding worries


Hospitals are furious that the Trump administration is reportedly exploring allowing states to convert their Medicaid programs into block grants, a policy the industry fervently fought when Congress tried to repeal the Affordable Care Act.
If states take advantage of the block-grant flexibility, first reported in Politico, it would cap federal spending for Medicaid in those states and could leave them on the hook for any expenditures over that limit. States would either have to cut their Medicaid rolls or payments to disproportionate-share hospitals and nursing homes to curb spending, some experts said.
Chip Kahn, CEO of the Federation of American Hospitals, told Modern Healthcare that he is concerned about how block grants will affect access to coverage and questioned whether the CMS can legally allow these waivers.
Other hospital industry groups also were worried about the impact of the grants.
“We have long voiced concerns about how block granting Medicaid could ultimately result in losses of coverage and negatively impact access to quality care,” said Ashley Thompson, senior vice president of public policy analysis at the American Hospital Association.
Both groups said that states have flexibility under federal waivers to make changes to Medicaid and questioned the need to install a block-grant program. Kahn also questioned why a state would willingly sign up for a block-grant waiver if it meant possibly lower federal Medicaid funding if the state goes over the cap.
Patricia Bozang, senior managing director at the consulting firm Manatt Health, said it is too soon to determine how popular block grants would be, adding that the “devil is in the details.”
“Are we talking about a guidance that would have stringent caps on Medicaid spending or are we talking about something that would foster spending targets, which is what states do for waivers now in setting budget neutrality caps,” she said.
So far the CMS hasn’t put out guidance on what flexibility states could receive from block grants.
The agency did not confirm it was looking at a block-grant waiver program, but a spokesperson said that the CMS is open to giving states the option to adopt a block grant.
“As the administrator (Seema Verma) has stated publicly, we believe strongly in the important role that states play in fostering innovation in program design and financing,” the spokesperson said. “We also believe that only when states are held accountable to a defined budget can the federal government finally end our practice of micromanaging every administrative process.”
The exact guidance will be critical to determine whether a state actually signs up.
“I haven’t met the state yet that would volunteer for a cut in its federal Medicaid funding,” tweeted Drew Altman, CEO of the Kaiser Family Foundation. “A few might negotiate a cap on some or all of its program in return for some more flexibility—maybe. Not clear what these new ‘block grant waivers’ will amount to.”
Block grants are not a new fight for hospital groups. In fall 2017, a bill to repeal the Affordable Care Act sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) would have converted Medicaid into a block-grant program.
The lawmakers said that the block grants are key to reining in an out-of-control entitlement program and that it gives more power to states to develop a Medicaid program that meets their needs.
“Instead of a Washington-knows-best approach like Obamacare, our legislation empowers those closest to the healthcare needs of their communities to provide solutions,” Graham said in a statement in September 2017 when the bill was introduced. “Our bill takes money and power out of Washington and gives it back to patients and states.”
Hospital groups vehemently opposed the bill. The AHA wrote to congressional leaders in September 2017 that Medicaid funding cuts could have “serious negative consequences for communities across America” unless the lawmakers made sure alternative coverage is available.
A September 2017 analysis from the consulting firm Avalere Health estimated that Graham-Cassidy’s block-grant program would have cut federal Medicaid funding by $205 billion through 2026 and more than $4 trillion over the next two decades.
GOP Senate leadership eventually scuttled the bill because of insufficient support from Republican senators.
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UnitedHealth loses appeal over underpayments


A federal appeals court on Tuesday unanimously ruled against UnitedHealth Group over the insurer’s policy of withholding payments to out-of-network physicians and hospitals in order to recover previous overpayments.
The U.S. Eighth Circuit Court of Appeals upheld a Minnesota district court decision that sided with provider groups against the insurer, saying UnitedHealth overstepped administrative authority over its employer-sponsored health plans with a practice that recoups overpayments to a physician or hospital from one plan by cutting another plan’s subsequent payments to the same provider. This is known as “cross-plan offsetting.”
Circuit Judge L. Steven Grasz said UnitedHealth went too far because the individual health plans under the insurer’s umbrella don’t explicitly allow the company to do this in their plan documents.
UnitedHealth contended that as the administrator of these health plans, it has broad authority to do so.
But Grasz blasted that argument as “akin to adopting a rule that anything not forbidden by the plan is permissible.” He also said it would undermine the ability of the people enrolled in these plans to rely on plan documents to understand the scope of UnitedHealth’s authority.
A UnitedHealth spokesperson said overpayment recovery is an important tool for the insurer to improve affordability. “We will continue to enhance this process for our customers, who support our efforts to recover these funds on their behalf,” the spokesperson said.
The impact of the ruling is limited since the Eighth Circuit fell short of barring this relatively common payment practice as a violation of the Employer Retirement Income Security Act (ERISA) that governs employer-sponsored plans. The plaintiffs did not challenge whether the practice violated overarching federal law.
Nevertheless, Grasz wrote that cross-plan offsetting certainly comes close to a violation, writing that it “approaches the line of what is permissible.”
“Regardless of whether cross-plan offsetting necessarily violates ERISA law, it is questionable at the very least,” Grasz said. “Considering this, alongside the fact that there is no plan language — only broad, generic grants of administrative authority — that would authorize the practice, leads us to conclude that United’s interpretation is not reasonable.”
The court’s position on ERISA law is significant but won’t end these kinds of cases against insurers, said Brian Hufford, an attorney for Riverview Health Institute from the firm Zuckerman Spaeder.
“This ruling alone won’t eliminate the insurance industry’s abusive repayment demand practices, but it’s an important blow against one that has hurt many of our nation’s health providers and the patients they serve,” Hubbard said.
Jason Cowart, another attorney for the plaintiffs, said they will now head back to the district court to lay the groundwork for claiming financial damages from UnitedHealth.
The same attorneys are involved in a similar case against Aetna in New Jersey and another lawsuit against UnitedHealth Group, also in New Jersey, challenging the way the insurer seeks repayments from physicians and hospitals.
The initial lawsuit came after UnitedHealth decided in 2007 to make cross-plan offsetting its policy.
In 2014 a physician sued over the practice and then Ohio’s Riverview Health Institute followed with a separate complaint in 2015. A district court merged the two claims into a class action and the Department of Labor weighed in to support the plaintiffs.
UnitedHealth has asserted that without this practice the insurer would recover far less money than it does now. In its appellate brief, the company said it sampled six of its employer self-funded plans that were under scrutiny in this lawsuit and found that it recovered nearly 25% more through this cross-plan billing method than they would have from just trying to offset payments for any single plan.
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Medicare Advantage industry sees slower growth for 2019


Medicare Advantage insurers added 1.4 million members to their rosters for 2019 coverage, as they looked to grow membership in a market known for being politically safe and predictably lucrative. But Advantage membership is growing at slower pace compared with previous years.
According to the latest federal data showing enrollment as of January 2019, 22.4 million people are enrolled in Medicare Advantage for 2019 coverage—an alternative to the traditional Medicare program in which private insurers contract with the federal government to administer program benefits. That’s an increase of 6.8% since January 2018. Health insurers, however, managed to grow their membership base by more than 1.5 million in 2016 and 2017.
Some industry experts were expecting more. “The formula was there: health plans were aggressive, they got nice rate increases, the rules around benefit design relaxed a little bit,” explained Jeff Fox, president of Gorman Health Group, which provides technology and other services to Medicare Advantage plans.
Fox expected Advantage enrollment to increase by double-digits over the past year, as health plans invested heavily in marketing and the federal government provided one of the biggest rate increases for the plans in years at 3.4%. The Trump administration also granted Medicare Advantage plans the flexibility to provide more supplemental benefits in 2019, such as transportation and in-home care.
But Fox said distraction from the craziness of the November midterm elections may have kept some seniors from enrolling during the annual open enrollment period that lasted from Oct. 15 to Dec. 7, 2018. While the CMS data captures some of the sign-ups from open enrollment, enrollment figures out next month are likely to be higher.
Despite the slower pace, many Medicare Advantage insurers still experienced big enrollment increases as they picked up more market share. About half of all members are covered by just three companies. UnitedHealth held onto the top spot, adding nearly 500,000 Advantage members in the past year for a total 5.7 million. UnitedHealth holds more than a quarter of the total Medicare Advantage market share.
Humana remained the No. 2 Advantage insurer with 3.9 million members, an increase of 10.4% over Jan 2018. But thanks to its acquisition of Aetna, CVS Health took the No. 3 spot with 2.2 million Advantage enrollees. Kaiser Foundation Health Plan and Anthem rounded out the top five insurers with the most Advantage members.
On a percentage basis, Anthem and Aetna grew membership the fastest. Anthem’s Medicare Advantage membership spiked 53% to 1.1 million members compared with the same time last year. The Indianapolis-based health insurer has long focused on serving large employers, but recently turned its sights to growing Medicare Advantage rolls through acquisitions and expansions in places where it already operates.
Anthem bought Florida-based Medicare plans HealthSun in December 2017 and America’s 1st Choice in February 2018, together giving Anthem about 170,000 Advantage members. Anthem CEO Gail Boudreaux told investment analysts in July that the company would focus on selling group Medicare Advantage plans and serving medically-complex dual-eligible members in 2019.
CVS-Aetna, meanwhile, grew its Medicare membership by 26.7% in 2018 to 2.2 million. In a research note Monday, Barclays equity analyst Steve Valiquette noted that Aetna’s membership growth was driven by its expansion into about 360 new counties. Valiquette wrote that the enrollment growth experienced by some public health insurers during the annual enrollment period for 2019 coverage was driven more by market share gains than by industry growth.
Medicare Advantage enrollment is climbing as the Baby Boomer generation ages rapidly into Medicare. Those seniors are used to employer-sponsored managed-care plans and are choosing Medicare Advantage over traditional Medicare more often than previous generations did. Seniors also often get more benefits, including dental care, eyeglasses and gym memberships, with a Medicare Advantage plan.
Medicare Advantage also enjoys support from both political parties and is able to weather swings from one federal administration to the next, whereas insurers who sell plans in the individual market, for example, may have to deal with more volatility.
Moreover, Medicare Advantage margins tend to hover between 4% to 5%, whereas Medicaid margins come in at 2% to 3% and the individual market historically has had even lower profit margins, S&P analyst Deep Banerjee told Modern Healthcare in August. The group employer business has higher margins, but that market isn’t growing like Medicare Advantage is.
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Amicus upgraded to Buy from Neutral at Citi


https://thefly.com/landingPageNews.php?id=2849891
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