Hospitals face 4th straight month of declining operating margins

 Hospitals and health systems in April suffered their fourth straight month of negative operating margins as providers struggle to regroup after the omicron COVID-19 surge, a new report from Kaufman Hall said. 

The consulting firm’s April National Hospital Flash Report (PDF), which offers details on hospital revenues and margins and was released Monday, found declines in patient volumes last month led to lower gross operating revenue. Kaufman found that the rough first four months of 2022 are taking a major toll on systems. 

“Labor shortages, high prices for supplies, and cost increases to treat sicker patients over longer stays are ballooning hospital expenses,” said Erik Swanson, senior vice president of data and analytics for Kaufman Hall. “With a bleak consensus outlook for the U.S. economy, those factors and their effects could be here for a while.”

Kaufman’s calculated median operating margin index for hospitals and health systems was -3.09% throughout last month. The operating margin was down nearly 40% from March and declined 76% from April 2021. 

Operating earnings before interest, taxes, depreciation and amortization declined nearly 27% from March to April and 51.5% compared to the same month in 2021. 

The report also showed that patient volumes and average lengths of stay declined last month as well. 

“Patient days were down 5.7% month-over-month and 1.8% compared to April 2021,” according to the report, which is based on a sample of more than 900 hospitals.

Surgeries were also down in April, with operating room minutes declining nearly 9% from March 2022 and 6.2% from April 2021.

While patient volumes declined, expenses continued to rise for hospitals across the country. Total expenses for April were down slightly from March at 4.3%. 

“Expenses have continued to rise compared to 2020 and are well above pre-pandemic levels,” the report said. “As labor shortages and supply chain challenges continued, total expenses grew by 8.3% [year-over-year] and 9.6% [year-to-date].”

Higher expenses, especially for labor costs, have been a major headwind for hospital systems across the country. Several major for and nonprofit hospital systems reported losses for the first quarter of 2022 during the major surge of COVID-19 fueled by the omicron variant.

Systems are also facing other headwinds such as a historic rise of inflation in April that increased 8.3% year over year. 

Kaufman doesn’t believe things will immediately turn around for the hospital industry this year, as depressed margins and volumes could likely continue in the months ahead. 

“Even if margins cumulatively return to pre-pandemic levels, many will still end up with substantially depressed margins at year’s end,” the report said.

https://www.fiercehealthcare.com/providers/kaufman-hall-hospitals-face-fourth-straight-month-declining-operating-margins

VA now required to report performance, costs of troubled EHR system to Congress

 The Department of Veterans Affairs (VA) will now have to submit regular reports to Congress about the performance of its new $16 billion medical records system, including incidents that risk patient safety, under new legislation headed to President Joe Biden's desk.

The Senate approved a bill (PDF) last week that aims to increase transparency surrounding the VA's electronic health record modernization (EHRM) program, a project that has been plagued with problems as it has been rolled out to three VA locations.

This legislation already passed the House of Representatives and will now go to the president to be signed into law.

“The VA, and consequently our nation, has invested a great deal of time and money into the VA electronic health record modernization program,” Senator Jerry Moran, R-Kansas, one of the sponsors of the bill, said in a statement.“The potential benefits of this program are tremendous, and we have to get it right. This legislation and soon to be law will ensure the VA is providing the proper transparency throughout the EHRM implementation to better allow this committee to conduct oversight during the deployment process to ensure veterans receive the care they deserve and hold the VA accountable for taxpayer dollars.”

Under the legislation, the VA secretary must submit periodic reports to Congress regarding the costs, performance metrics and outcomes for EHRM.

The reports ordered by Congress would have to include "a list of patient safety reports, incidents, alerts or disclosures" at each facility where the new electronic system is in use.

The new EHR system, developed by Cerner, was first rolled out to Mann-Grandstaff VA Medical Center in Spokane, Washington, in November 2020, following two monthslong delays to address the department's information technology infrastructure and training and respond to the COVID-19 pandemic. The EHR system then was brought online at a VA hospital in Walla Walla, Washington, and Columbus, Ohio, earlier this year.

A year ago, in July, the VA scrapped the rollout schedule for its new medical records system for at least six months to overhaul training and fix governance and management problems, recognizing fundamental flaws in the work so far. The planned six-month pause followed a 12-week strategic review ordered by VA Secretary Denis McDonough that looked at problems with the initial go-live of the Cerner electronic health record system at Mann-Grandstaff VA hospital.

In March, the EHR system at Mann-Grandstaff crashed, and the hospital was forced to suspend patient admissions and most outpatient appointments, according to media reports.

The Cerner EHR system at Mann-Grandstaff VA Medical Center has gone down more than 50 times since the VA implemented it in 2020, according to recent reporting from The Spokesman-Review.

Also in March, the VA inspector general flagged a number of patient safety issues in a series of scathing reports about the VA's EHR system. The medical records system failed to flag patients who had been identified as suicide risks, gave doctors inaccurate information about patients' medications and caused delays in scheduling appointments, the department's watchdog said in one report.

"We found serious deficiencies and failures in the implementation of the new electronic health record at the Mann-Grandstaff VA Medical Center, which increased the risks to patient safety and made it more difficult for clinicians to provide quality health care," VA Inspector General Michael Missal said in a video statement.

There have also been media reports of glitches and shortcomings, including dozens of crashes. The issues have prompted some lawmakers to call on the VA to halt the rollout of the program.

The VA signed a $10 billion deal with Cerner in May 2018 to move from the VA’s customized VistA platform to an off-the-shelf EHR to align the country’s largest health system with the Department of Defense (DOD), which has already started integrating Cerner’s MHS Genesis system.

For the VA, the Cerner EHR will replace the approximately 130 operational instances of VistA currently in use across the department. While the initial EHR contract signed with Cerner was for $10 billion, the VA has pushed the estimated 10-year cost for implementing the system past $16 billion.

However, in a pair of 2021 reports, the Office of Inspector General said the VA's $16 billion cost estimate could be an underestimate by as much as $5 billion.

The VA's troubled multibillion-dollar technology project has been plagued by delays, leadership turnover, and infrastructure problems since it kicked off in 2018.

"The EHR has been very frustrating, very disruptive and even dangerous for some of our patients," Sen. Patty Murray, D-Washington, told McDonough at a congressional hearing earlier this month, as reported by Military.com. "I do not want EHR to move an inch further in my state until all of this is fixed and ready to go."

https://www.fiercehealthcare.com/health-tech/va-now-required-report-performance-costs-troubled-ehr-system-congress

Medi-Cal delivers ready meals in grand healthcare experiment

 Every Friday, Frances De Los Santos waits for a shipment of healthy, prepared meals to land on her front porch at the edge of the Mojave Desert. From the box, the 80-year-old retired property manager with stage 4 chronic kidney disease unpacks frozen food trays that she can heat in the microwave. Her favorite is sweet-and-sour chicken.

In the three months since she began eating the customized meals, De Los Santos has learned to manage her diabetes by maintaining a healthy blood sugar level.

Two hours to the south, in Indio, Vidal Fonseca gets ready for his third dialysis appointment of the week. He, too, battles kidney disease and diabetes. The 54-year-old former farmworker was released from the hospital in November with an order to follow a strict diet, but he makes a mess in the kitchen and struggles to get his glucose under control. He doesn’t receive the prepared meals.

Here in California’s vast Inland Empire, where more than half of adults have diabetes or are at risk of developing diabetes, one health plan is delivering medically tailored meals to select patients. In bringing food straight to their door for a few months, state officials hope patients will develop healthier eating habits long after the shipments stop. It’s all part of a grand state experiment to improve the health of some of its sickest and costliest patients.

California’s five-year initiative, known as CalAIM, will test whether Democratic Gov. Gavin Newsom can slow public spending on Medi-Cal, the state’s Medicaid program for people with low incomes, which skyrocketed to $124 billion this fiscal year, up nearly threefold from a decade ago. Medi-Cal managed-care insurers will try to keep people out of expensive health care institutions by delivering social services, such as helping patients find housing, removing toxic mold from their homes, and delivering medically tailored food.

CalAIM, which is expected to cost $8.7 billion, is unconventional because it is being carried out primarily by health plans, not county social service departments. It will serve only a sliver of the 14.5 million Californians enrolled in Medi-Cal. And the state is still developing a way to track health outcomes, meaning nobody knows yet whether it will save money.

“This is a new program, and often with new programs, you’re building the plane as you’re flying it,” said Shelly LaMaster, director of integrated care at Inland Empire Health Plan.

The health plan is one of two Medi-Cal managed-care insurers serving San Bernardino and Riverside counties and has about 1.5 million enrollees. Inland Empire Health Plan says about 11,000 of its enrollees will be eligible for deliveries of meals and food boxes. The average meal benefit has a value of $1,596 and lasts three months, though health insurers can choose to extend food deliveries.

Because plans decide which enrollees receive services, many worthy patients—even those enrolled in the same plan or who live in the same county—are being left out. In the Inland Empire, some patients have started receiving food while others are still getting enrolled. So far, 40% of the recipients are Hispanic, 35% are white, and 18% are Black, which tracks with the region’s demographics. (Hispanics can be of any race or combination of races.)

Initial deliveries for most participants will be frozen meals, varying from taco bowls to chicken curry. Later, they may receive boxes filled with fresh fruits, vegetables, whole-grain bread, pasta, and rice so they can prepare their own meals.

De Los Santos is among the lucky 720 enrollees who have been approved for the benefit since January. Participants must be referred to the program, but referrals can come from doctors, community groups, and family members—Medi-Cal enrollees can even refer themselves.

De Los Santos’ case manager identified her need after conducting an assessment. Then a dietitian screened her for her food preferences and health concerns to develop a nutrition plan.

Her first box of nutritionally tailored meals arrived in February from Mom’s Meals, one of two prepared-meal companies contracted by the Inland Empire Health Plan. Each week she receives convenient, microwave-ready meals and an information sheet with the macronutrient breakdown of each dish.

“I’m on an eating schedule now,” she said. “I’m eating lots of meats and salads and vegetables, like broccoli and cauliflower, that are good for me.”

Meanwhile, Fonseca, also an Inland Empire Health Plan enrollee, relies on his wife and daughter to figure out how to get his diabetes under control. After he was diagnosed in November, they scrambled to learn how to cook for him by looking up recipes online.

“Before he was diagnosed with renal disease, he was eating a diet high in iron-rich foods that are typical for us to eat, like lentils and beans, but not good for kidney disease,” said his 29-year-old daughter, Maria Cruz. “We were giving him poison.”

Fonseca said he had heard about food banks but not home-delivered meals. “The menu for someone in my condition with both renal failure and diabetes is very limited and specific,” he said in Spanish. “Talking to a nutritionist and receiving meals specifically made for me for free would be a huge help.”

But even though his conditions would qualify him for meal delivery, it’s up to the insurer to enroll him.

Participating in the program would alleviate the guesswork for his wife and daughter. Fonseca’s wife, Eufracia Constantino, still works in the fields. She wakes up at 4:30 a.m. to cook his breakfast every morning before she leaves for work. His daughter prepares lunch for him, which typically consists of chicken or fish, stir-fried vegetables, and hard-boiled eggs.

“I would usually be driving trucks with a burrito in one hand and the steering wheel in the other,” said Fonseca, who was an agricultural truck driver.

De Los Santos, who up until recently was the family breadwinner, has had to adjust to becoming a patient. Two months ago, her husband, Fermin Silva, became her state-funded paid caregiver and the couple struggles to pay rent and utilities. To save money, they will move into a two-bedroom mobile home next month.

“Now I don’t have to worry about buying my meals,” she said. “I would say I’ve saved about $150 a month.”

While she saves money, Fonseca spends an extra $100 a week to buy the healthy food his wife and daughter prepare for him.

“We’ve had to stretch my wife’s paycheck,” Fonseca said. “We don’t fill the grocery cart up like before.”

The California Department of Health Care Services, which runs Medi-Cal, hopes the patients who receive medically tailored meals will tap the health system less often. The goal is to make people healthier by empowering them to adopt better eating habits and learn to sustain a good diet. Although some recipients may have irreversible conditions, such as congestive heart failure or severe diabetes, officials still see opportunities to reduce hospital admissions and emergency room visits.

Studies have shown that providing meal delivery services helps reduce health care costs. State officials note that food benefits will be expanded over time and that there’s no price cap on the initiative.

But the health agency could not provide data on how many Medi-Cal patients are eligible for food delivery and won’t report the number of people receiving the service until later this year. The state plans to gauge the cost-effectiveness of these social services as the program expands, according to agency spokesperson Anthony Cava.

Inland Empire Health Plan officials say it could be challenging to identify the impact of an individual benefit since many members receive multiple services. And it takes time to realize health consequences.

De Los Santos’ meals will end soon. She declined an extension, saying she has learned enough about portioning and self-control. She feels confident about continuing her healthy diet with the help of her husband, who will cook for her.

“My husband tells me to slow down,” she said, “but I have so much more energy.”

Fonseca fears a lifetime of poor eating combined with a physically demanding job has taken a toll on his body. He used to work two fields in one day and traveled depending on the crop season. He never took time off. “Now all I have is time,” he said, “but the dialysis makes me feel exhausted.”

He asked his nurse about getting medically tailored meals.

“He has to be healthy to qualify to get on a kidney transplant waiting list,” said his daughter. “That’s our hope.”

https://www.fiercehealthcare.com/payers/taco-bowls-and-chicken-curry-medi-cal-delivers-ready-meals-grand-healthcare-experiment

Computer glitches, human error spur insurance headaches for Californians

 Since California expanded health coverage under the Affordable Care Act, a large number of people have been mistakenly bounced between Covered California, the state’s marketplace for those who buy their own insurance, and Medi-Cal, the state’s Medicaid program for low-income residents.

Small income changes can cause people’s eligibility to shift, but when bad information is typed into a computer system shared by the two programs—or accurate information is deleted from it—enrollees can get big headaches.

Long-standing tension between the state, which oversees Medi-Cal, and county officials who do the nitty-gritty work of determining eligibility and enrolling those who qualify doesn’t help. And, sometimes, people applying for coverage unwittingly answer questions in a way that causes eligibility officers to switch them from one program to the other.

Legal aid attorneys, patient advocates, and insurance agents say computer glitches are not as common today as they were in the several years after California’s 2013 launch of ACA coverage. The exchange was new and millions of people were newly eligible for Medi-Cal. State officials have tackled computer glitches and other problems as they’ve arisen.

But eliminating all human and computer errors isn’t possible.

Just ask Andrea Veltman, who received a notice in December that her subsidized Covered California health plan was being terminated. The letter directed the 57-year-old Oakland resident to apply for Medi-Cal. When she called the program, she learned that Medi-Cal coverage for her 25-year-old son, Merlin, was also being terminated. He needed to reapply.

Veltman, who owns a landscaping business, was confused. She made some calls and found out that a Medi-Cal eligibility officer had logged into both of their accounts and somehow the two accounts had been merged into one. All her husband’s information was deleted, her business was removed, her son’s income was zeroed out, and some of his income was attributed to her.

No one contacted her to verify the changes.

Veltman doesn’t know whether human or computer error was to blame. She suspects that a review of the accounts was triggered when her son applied for food assistance and listed her as a contact person.

“Even if something triggers them to look at it, they still have to verify it is accurate information — and it was so incredibly wrong,” she says. “And that’s just not OK. Why don’t they just ask me?”

Veltman’s son didn’t regain his Medi-Cal coverage until mid-May. Her Covered California coverage was quickly restored in late December, but then the same thing happened in late April. She learned last week that her Covered California coverage was set to be reinstated this month, but she doesn’t know yet whether she will be retroactively covered for treatments in May.

Kevin Knauss, an insurance agent in Granite Bay, says he has heard of similar complaints in recent months from residents in Alameda, Los Angeles, Orange, San Diego, and Santa Barbara counties. “These are calls about information getting messed up in the computer that affects their eligibility,” he says.

Perhaps the most egregious aspect of Veltman’s case is that her son’s Medi-Cal termination violated a rule that prevents people from being disenrolled from Medicaid during the federal public health emergency that was declared at the start of the COVID-19 pandemic.

“This shouldn’t be happening. It’s against the rules during the pandemic,” says Jack Dailey, an attorney at the Legal Aid Society of San Diego. “We tell people to push back immediately, and they will get reinstated immediately.”

The rule, which suspends the annual reviews normally conducted to determine enrollees’ eligibility, has enabled many Californians to maintain their Medi-Cal coverage during the pandemic. Those reviews will resume after the public health emergency ends, and millions of people could lose Medi-Cal coverage. The public health emergency is scheduled to expire July 15, but it is almost certain to be extended.

Medi-Cal took months to effectively implement the procedures required to comply with the rule. During several months in 2020, 131,000 enrollees were mistakenly dropped from coverage but were ultimately reinstated, according to the state Department of Health Care Services, which administers Medi-Cal. And such incidents have slowed sharply since.

They have “definitely been less of a problem in the last year or so,” says Skyler Rosellini, a senior attorney at the National Health Law Program. “But they still pop up.”

In the unlikely event this kind of mistake happens to you, a quick call to your county eligibility office might sort things out. You can find a list of county offices on the Department of Health Care Services website (www.dhcs.ca.gov).

If that doesn’t work, or if your patience wears thin, you can get advice and legal help from the Health Consumer Alliance (888‑804‑3536 or www.healthconsumer.org). Insurance agents can also bring lots of expertise to help resolve your problem. You can find agents through the California Agents and Health Insurance Professionals group (www.cahu.org/find-a-member).

If you still don’t get satisfaction, you can request a “fair hearing” before an administrative law judge through the state Department of Social Services (call 855-795-0634 or fill out a request online).

You can also ask for a fair hearing to resolve a dispute over eligibility for a subsidized Covered California health plan or to contest the amount of tax credits you are granted to help pay your premium.

But before you do that, call the marketplace’s customer service line (800-300-1506) to try to fix your problem. Covered California also has an ombudsperson (888-726-0840 or ombuds@covered.ca.gov).

Finally, Veltman has some practical advice: Keep the income information that you submit, or take a screenshot of it — otherwise, you’ll have to calculate everything again if it is erased.

“Also, just keep calling,” she says, “because they sometimes tell you, ‘We’re going to call you back,’ and that almost never happens.”

https://www.fiercehealthcare.com/payers/computer-glitches-and-human-error-still-causing-insurance-headaches-californians

Ampio to end Covid program

Ampio Pharmaceuticals, Inc. (NYSE American: AMPE), a biopharmaceutical company focused on the advancement of immunomodulatory therapies for the treatment of pain resulting from osteoarthritis in the knee and potentially other articular joints, today released the following letter to stockholders from its Chief Executive Officer, Mike Martino. ... How did we go from "positive results" for inhaled Ampion in the 40-patient AP-014 trial to "no signal" in these trials? In general, small exploratory studies may show a large treatment effect because of the small denominator and should always be viewed as hypothesis generating rather than definitive. Historically, across all drug development categories, only a minority of phase 2 trials can be confirmed in larger phase 3 trials. This is the reason why FDA requires two successful pivotal phase 3 trials. Specific to Ampion, the AP-019 trial enrolled 129 participants and could not show a beneficial effect of Ampion compared with placebo as only 3 deaths or progression to respiratory failure occurred (the original primary endpoint). The AP-017 trial which studied intravenous Ampion compared with placebo enrolled only 35 participants and had a very slow enrollment rate. We determined that the evolving treatment landscape combined with the reduced incidence and severity of COVID had significantly curtailed our ability to enroll the required 200 subjects and, as such, the trial was closed because of the projected time to completion and financial commitment. AP-018 was a small Phase 1 study to document safety that enrolled 32 patients and failed to show a benefit.

Given these results and the changing Covid treatment landscape, we believe it would be an unwise use of investor funds to continue the COVID-19 program at this time. As a reminder, AP-017 and AP-019 were initiated on the premise they might support an Emergency Medical Use Authorization (EMUA) in what was then a bleak landscape for Covid treatments. However, several treatments have recently been approved for the treatment of COVID-19, including antibodies that inactivate the SARS-cov-2 virus that causes Covid, as well as drugs that prevent viral replication, and corticosteroids that have demonstrated a reduction in the severity of the disease. Additionally, the prevalence of vaccines and multi-shot vaccination protocols and the diminishing severity of emerging variants of Covid-19, such as Omicron, have all converged to confer immunity and reduce the number of ICU patients requiring respiratory support. These developments make Covid prevention and treatment a very crowded competitive space in which Ampion simply hasn't demonstrated sufficient benefits to be competitive.

I would like to highlight the following positive takeaways which should not be minimized. We now know that nebulized (inhaled) Ampion has an excellent safety profile, which can potentially open up additional target indications that involve lung inflammation which are potentially more promising than COVID-19. Additionally, we have been issued four significant patents in the space. If, how or when we continue to pursue development of Ampion for treatment of respiratory inflammation has yet to be determined; although, I can say it is not a near term project or priority.

https://finance.yahoo.com/news/ampio-pharmaceuticals-ceo-mike-martino-203000147.html

Transcript: Gilead at Bernstein Strategic Decisions Conference

 https://www.marketscreener.com/quote/stock/GILEAD-SCIENCES-INC-4876/news/Transcript-Gilead-Sciences-Inc-Presents-at-Bernstein-38th-Annual-Strategic-Decisions-Conference-40627299/

WTO seeks fish, vaccine deals as war ignites trade tensions

 

The World Trade Organization will host ministers from across the globe this month with the aim of striking deals on fish and vaccines, testing the world's ability to set trade rules at a time of mounting tensions.

Global trade discord, COVID-19 and the crippling of its dispute settlement mechanism had already weakened the Geneva-based body, which was twice forced to cancel the ministerial conference due to the pandemic.

The normally biennial meeting, last held over four years ago, will now take place after Russia's invasion of Ukraine triggered commodity price hikes and food export bans and China's zero-COVID policy exacerbates worldwide supply chain difficulties.

Global trade is meanwhile set to slow this year, with the Ukraine war adding to uncertainty.

Against that backdrop, the ministers will seek to conclude 20 years of negotiations to reduce fishing subsidies, forge a deal on fairer sharing of COVID-19 vaccines, push agricultural trade reform and set a path for reform of the WTO.

Dmitry Grozoubinski, director of the Geneva Trade Platform, said there was a sense that the meeting, dubbed MC12, was "a little bit cursed".

"This was always going to be a ministerial with modest outcomes at best. The invasion has made things harder, but things were hardly easy beforehand," he said.

Several members have said they will not negotiate with Russia, while Moscow would be expected to block any attempt by Ukraine's allies to formulate a ministerial statement on the crisis, such as its impact on food.

"In the background there is the possible total disruption from the Ukraine war," said Peter Van den Bossche, director of studies at the World Trade Institute. "I have no doubt Russia will demonstrate that, without it, no progress can be made."

DIFFICULT VACCINES, FISH SUBSIDY TALKS

Ministers will ideally sign a declaration on trade's role in current and future pandemics at the meeting but a dispute over how to redress vaccine inequity has dominated discussions even as the coronavirus crisis has eased.

Developing countries have sought since 2020 a waiver of intellectual property (IP) rights for vaccines and other COVID-19 treatments.

It is not yet clear if a vaccine compromise forged by India, South Africa, the EU and the United States will transform into a full agreement.

At the same time, members are negotiating a deal to end subsidies for fishing fleets, a potential landmark deal to reverse a dramatic decline in fish stocks.

One unresolved issues is the transition period for developing countries. Many say this should be five to seven years, but some suggest as much as 25 years.

From past experience, the prospects are not bright. The WTO has only managed one update of its global rules in its 27-year history, the red-tape cutting Trade Facilitation Agreement.

Some observers say the WTO itself needs a deal to save fish stocks as much as the fish, to show it is still relevant.

The WTO's constant challenge is to find consensus. Just one of its 164 members can block a decision.

Views vary on the prospects of a successful 'MC12'.

Roberto Azevedo, the Brazilian head of the WTO from 2013 to 2020, said achieving consensus today was "impossible".

"Even when you have issues where you can discern the consensus, or discern the area where members may converge, even then it's impossible to get a consensus," he said.

By contrast, John W. H. Denton, secretary general of the International Chamber of Commerce, said he was optimistic the WTO could strike an agreement on fishing.

U.S. VS CHINA

The administration of U.S. President Joe Biden will arrive in Geneva with a more conciliatory tone than that of his predecessor. However, it is not about to relaunch the WTO's appeals chamber Donald Trump dismantled and says the Geneva-based body needs reforms.

Washington says the WTO has failed to hold China accountable for unfair practices and wants the June WTO meeting to tee up a discussion about the reform of global trade rules.

It also argues that it is time for China to relinquish its status as a developing country given it has grown to become the world's second largest economy from sixth place when it entered the WTO in 2001. Developing countries have privileges at the WTO, such as more time to implement agreements.

Pascal Lamy, WTO chief from 2005 to 2013, said the WTO's rules were lagging behind in terms of addressing present obstacles to trade.

"WTO rules today reflect the world where obstacles to trade were what they were 30-40 years ago - tariffs, subsidies, quantitative restrictions, etc. These classical obstacles to trade are less and less relevant," he said.

Still, global trade hit a record of $28.5 trillion in 2021, 13% above pre-pandemic levels, much of its based on existing WTO rules.

"In that sense, the WTO remains relevant, but it needs to be more relevant, with new rules," said the World Trade Institute's Van den Bossche.

https://www.marketscreener.com/news/latest/Analysis-WTO-seeks-fish-vaccine-deals-as-war-ignites-trade-tensions--40628728/