Piper Jaffray analyst Danielle Brill raised her price target on Acadia to $35 and kept her Overweight rating after its better than expected Q1 sales of Nuplazid that was driven by “accelerated growth in new patient starts.” The analyst further cites the management’s increased FY19 Nuplazid midpoint sales guidance and also sees “significant unrealized value” for the company’s dementia related psychosis programs.
Wednesday, May 1, 2019
Organ transport device maker TransMedics prices upsized IPO at $16
TransMedics Group, a medical device company that provides a system for donor organ transport, raised $91 million by offering 5.7 million shares at $16, the midpoint of the $15 to $17 range. The company had originally filed to offer 4.7 million shares at the same range of $15-$17.
TransMedics Group plans to list on the Nasdaq under the symbol TMDX. Morgan Stanley and J.P. Morgan acted as lead managers on the deal.
Almost Half of Physicians Say EHRs Have Hurt Quality of Care
In a Medscape poll of more than 250 clinicians, more physicians said that electronic health record (EHR) systems have decreased quality of care (44%) in their primary workplace than increased it (40%).
Nurses and advanced practice registered nurses (APRNs) saw more benefit than detriment in EHRs: 42% said they had increased quality of care vs 35% who said they had decreased care quality.
The recent poll included 273 respondents — 207 physicians and 66 nurses/APRNs.
Few Involved In Choosing EHR System
The poll also indicated that few physicians or nurses were involved in the decision of which EHR to use in their primary workplace.
Among physicians, 66% had no input, 28% had input, and 7% did not use an EHR system (rounding means totals may pass 100%). Far fewer nurses were part of the decision making: 80% had no input, 18% had input, and 2% did not use an EHR.
Only 2% of physicians, nurses, and APRNs said they had input into the decision and the system they wanted was chosen.
Those who answered that they had input were either the only decision-makers or were part of a group that decided. Those who did not have input answered that the practice, clinic, or hospital chose the system or a group or committee leader chose it.
Views on How EHRs Increase/Decrease Quality
When asked what aspects of EHRs increased quality of care, the top answer among physicians was the ability to locate and review patient information more easily (59%), followed by the ability to electronically subscribe (49%), and portability/access to patient records by all members of the care team (44%).
Portability and access by all on the team was the top reason given by nurses/APRNs for increases of care quality (62%), followed by ability to locate and review patient information more easily (60%), and ability to electronically prescribe (46%).
When physicians and nurses/APRNs were asked what aspects of EHRs decrease quality of care, they gave similar weight to these four reasons: added paperwork/charting; entering data during the patient encounter; lack of interoperability with other systems; and system failures or problems.
A neurosurgeon commented on the poll, “I’m surprised that the tendency to rely on default, boilerplate text and copy-paste were not noted as major problems.”
Most Requested Improvements
Top answers differed among physicians and nurses/APRNs on what they would most like to see change with EHRs.
Physicians’ top answer was to make the systems more intuitive/user-friendly (44%), followed by allowing greater interoperability and record sharing (30%). Nurses/APRNs would most like to see more interoperability and better record sharing (33%), followed by making the systems more user-friendly (30%).
This past February marked 10 years since the American Recovery and Reinvestment Act devoted $35 billion to encourage physicians to use EHR systems.
“Boring, Repetitious Templates”
A family medicine physician summarized what many doctors have said the field of medicine has lost in a decade with such a system — the nuances in narratives about the patient.
They reduce “fascinating human stories to utterly boring, repetitious templates,” he wrote.
Medscape reported earlier this month that the drift from face-to-face care is continuing with the next generation of physicians.
Results from the iCOMPARE trial show that first-year residents spend almost five times more hours on indirect patient care than on face-to-face patient care, and most of that time was spent working with EHRs.
FDA approves Dengvaxia for dengue prevention in people ages 9-16
The U.S. Food and Drug Administration approved Dengvaxia for the prevention of dengue disease caused by serotypes 1 – 4 of the virus in individuals 9 through 16 years of age living in endemic areas of the U.S. with a laboratory-documented prior infection. Dengvaxia is the first and only vaccine approved for protection against dengue in endemic areas of the U.S. Dengvaxia is also approved for use in several endemic countries in Latin America and Asia where reducing the human and economic burden of dengue is a public health priority. In December 2018, the European Commission granted marketing authorization for Dengvaxia to prevent dengue in individuals living in endemic areas with a documented prior infection. “Dengue is endemic and prone to outbreaks in several U.S. territories, including Puerto Rico, the U.S. Virgin Islands and American Samoa. Despite this public health threat, there is no treatment and there has been no previously approved vaccine available in these areas,” said David Greenberg, MD, Regional Medical Head North America, Sanofi Pasteur. “Today’s FDA approval of Dengvaxia allows us to bring a critical medical prevention tool to at-risk populations, helping combat and prevent dengue among children living in U.S. dengue endemic areas.”
https://thefly.com/landingPageNews.php?id=2901609
https://thefly.com/landingPageNews.php?id=2901609
Teladoc expects to be cash-flow positive for the first time this year
Teladoc posted $128.6 million in revenue for the first quarter of 2019, driven by rises in both domestic and international subscription fees.
That’s up 43% from the $89.6 million in revenue the company reported during same period last year, according to earnings results released Tuesday. Net loss for the quarter totaled $30.2 million, compared with $23.9 million in the same period last year.
Subscription fees accounted for more than 82% of the company’s total first-quarter revenue at $106 million, with the remaining $22.6 million attributed to visit fees. Teladoc’s total visits were up 75% year-over-year at nearly 1.1 million.
Gorevic said he sees the U.S. health plan market as “one of the greatest potential areas for growth” in terms of population and visit volume. Health plans generally tend to expand their relationship with Teladoc over time after seeing initial savings, according to the company.
Teladoc’s expanding international footprint also played a role in its growing revenue and visit volume.
The company’s revenue from international subscription fees was up 133% at $25 million for the quarter. Total international visits topped 282,000, up from roughly 1,000 international visits reported during last year’s first quarter.
Teladoc took numerous steps to expand its international presence in the quarter, entering into an agreement to acquire a Paris-based telemedicine provider and rolling out a virtual care service in Canada.
Teladoc is scheduled to bring its first client live on the Canada service during the third quarter.
“We have continued to execute on our strategy of positioning Teladoc as the only global virtual care solution,” Gorevic said. Last year, Teladoc purchased of virtual care provider Advance Medical for an estimated $352 million.
Teladoc reaffirmed its financial expectations for 2019, projecting revenue to be in the range of $535 million to $545 million and net loss per share to be in the range of $1.52 and $1.66. In 2018, net loss per share was $1.47.
Gabriel Cappucci, Teladoc’s chief accounting officer, said that Teladoc also expects to be cash-flow positive for the first time in 2019.
Cappucci is coordinating the company’s finance activity until it names a permanent chief financial officer. Mark Hirschhorn, Teladoc’s former CFO and chief operating officer, resigned in December after investors filed a class-action lawsuit alleging he engaged in insider trading.
Gorevic said the CFO search remains a “high priority.”
“We’re seeing some great candidates, although our process is not yet concluded” he said. “I’m confident in Gabe and the finance team, which gives us the time we need to find the right fit for our organization.”
AHA asks DOJ to halt Centene-WellCare merger
The American Hospital Association urged the Trump administration on Wednesday to halt Centene’s $17.3 billion acquisition of WellCare Health Plans, claiming it will reduce competition in Medicaid managed-care and Medicare Advantage services.
Centene and WellCare are both major players in government-sponsored health plans, with both having a presence in Medicaid and on the Affordable Care Act’s exchanges. All told the two insurers would cover nearly 22 million people in Medicare, Medicaid and the exchanges.
The insurers’ markets overlap in several states, the AHA said in its letter, and they control over half of the Medicaid market in Florida, Georgia and Illinois.
Centene CEO Michael Neidorff has previously commented that there are states where the insurers have three plans each, and acknowledged they will have to divest some plans.
While the companies have said the merger should clear antitrust reviews because Medicaid rates are set by the states, the AHA said that shouldn’t negate DOJ’s scrutiny of the deal.
“There is no service more important to American consumers than healthcare, and vigorous competition among health insurance companies is necessary to ensure that consumers receive high quality at affordable rates,” the AHA wrote.
WellCare is the fourth-largest provider of Medicaid managed-care plans and Centene has more than 2 million members on the exchanges.
Both companies reportedly competed to purchase Aetna’s Medicare Advantage business when that insurer attempted to merge with Humana, which the AHA said is a sign they want to “enroll the exact same consumers in the exact same plans.”
CBO warns of complexities, disruption of a single-payer system
The Congressional Budget Office’s highly anticipated report released Wednesday largely put a damper on the idea of a U.S. single payer healthcare system.
While the office didn’t present a formal cost estimate, the analysis laid out ideas policymakers should consider as they design a potential single payer universe.
Specifically, the CBO issued familiar warnings that a single payer system could increase demand and overtax hospitals and clinicians while imposing hefty new costs. The report also echoed hospital arguments that adoption of universal Medicare fee for service rates for hospitals would “probably reduce the amount of care supplied and could also reduce the quality of care.”
Yet in highlighting the potential economic disruption of a single payer overhaul, the agency pointed to one of the key reasons Medicare for All is gaining traction: the costs in the status quo.
“Because healthcare spending in the United States currently accounts for about one-sixth of the nation’s gross domestic product, those changes could significantly affect the overall U.S. economy,” the report said.
Its release came on the heels of a high-profile House committee hearing on Medicare for All.
Throughout the analysis, the CBO showed reasons for the current costliness. For instance, the office found that in 2013 the “three major insurers” paid hospital rates that were 89% higher on average than Medicare rates for the same services.
Additionally, the federal government’s administrative costs for Medicare were about 1.4% of total Medicare expenditures in 2017. For Medicare Advantage and Part D plans, administered by commercial insurers, those costs rose to 6% of total expenditures.
For commercial insurers, those expenditures averaged about 12% of total costs.
The CBO said that the projected administrative savings could be one of the “opportunities” of developing a single payer system. The report also said the system would have more incentive to invest in preventive medicine and improve overall population health if it could eliminate the turnover seen in the employer and individual markets.
“Whether the single-payer plan would act on that incentive is unknown,” CBO analysts wrote.
The CBO’s report also argued the benefits of expanding coverage using the Affordable Care Act model of guaranteed issue, heavily regulated insurance markets and an individual mandate, which is effectively gone with the 2017 tax bill.
Many elements of the report will likely be embraced by industry, which is pushing for policies to build on subsidies for the ACA, particularly as it comes while momentum is building for Medicare for All. This policy has remarkably and rapidly taken hold among Democrats in Washington over the past few months although House Speaker Nancy Pelosi (D-Calif.) has stayed focused on ACA-building proposals.
After the report’s release Chip Kahn, CEO of the Federation of American Hospitals that represents investor-owned health systems, said the analysis “raises sobering questions.”
“But what needs to be asked, is it worth the risk of upending healthcare for every American when the law on the books already contains a roadmap to universal coverage?” Kahn said. “Instead of such a high stakes gamble, lawmakers should build upon the current foundation so we can continue to improve quality and affordability for families across the country.”
Single payer advocates have embraced the same points made in the CBO report about administrative costs, insurance industry costs and poor general population health despite the expense of the U.S. system.
These arguments were a key part of testimony in Tuesday’s Medicare for All hearing by the House Rules Committee.
Dr. Doris Browne, a retired military medical officer and immediate past president of the National Medical Association representing black physicians and their patients, argued that a universal coverage option would force widespread adoption of preventive medicine, which has so far baffled the U.S.
“I think you would practice medicine in a more appropriate way, increase the educational components and practice prevention,” Browne told the committee. “If you put prevention into practice, you’re not going to have many of these hospitalizations that end up in the ICU. We have not practiced prevention. We have been talking about it for years and years and it has gone by the wayside.”
New York City emergency physician Dr. Farzon Nahvi also homed in on these arguments before the committee, using personal anecdotes from the treatment room to advocate for single payer.
In one instance, he said he treated a woman who had overdosed on fish antibiotics she bought from a pet store to manage a fever, as she didn’t think she could afford seeing a doctor. The overdose affected her brain, and she fell down a staircase and was rushed to the emergency room.
In another story, a patient who had a urinary infection treatable with antibiotics couldn’t get her insurer to cover the $300 medicine. She bought cranberry juice instead only to come to the emergency room with sepsis from a subsequent infection — costing thousands of dollars.
“We’re paying more for bad outcomes, and that needs to be part of the discussion too,” Nahvi said. “There’s no way to account for what we’re seeing on the ground level.”
The Medicare for All debate has heated up simultaneously with an alternative measure to consolidating and capping costs. Last week the Trump administration unveiled an ambitious proposal to cap traditional Medicare spending through direct contracting with health systems and others.
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