Health systems: Keep hospital-at-home programs, with better outcomes, saved costs

 Healthcare leaders are calling on Congress to extend a waiver that expanded flexibilities for hospital-at-home programs, saying continued reimbursement is critical to scale up these programs.

Temporary waivers rolled out by the Centers for Medicare & Medicaid Services (CMS) under the public health emergency have allowed Medicare enrollees to receive acute hospital-level care from their own homes.

During a Hospital at Home Week of Action, dozens of organizations including the American Medical Association, the Alliance of Community Health Plans, Mayo Clinic, CardinalHealth, Kaiser Permanente, Mount Sinai at Home and Providence advocated for lawmakers to extend the current waivers, providing certainty for health systems and plans to provide personalized at-home care. 

“This is an example of a successful program that has been critical during the pandemic,” Rep. Earl Blumenauer, D-Oregon, one of the legislators who introduced the legislation extending the waiver. "But it’s still essential and can be a building block as part of our long-term realignment of a healthcare system that prides and rewards value over volume, is open to innovation and the needs of individual patients," Blumenauer said.

Blumenauer and health system leaders spoke about hospital-at-home programs during a webinar last week sponsored by the Advanced Care at Home Coalition and McDermott+Consulting. Other healthcare leaders also addressed providing acute care at home during the Forbes Health in Action Summit.

“This is a space that has chronically lacked a lot of investment,” said Bill Miller, CEO and chairman of the board of WellSky. That has changed in the last five years, he added. 

Three factors today enable the model, explained Medically Home co-founder and CEO Rami Karjian: Clinicians available around the clock for patients getting care at home; technology enabling remote care and communication; and services available for safe delivery at home. “Consumers as patients prefer to be taken care of in their home. They get better outcomes in their home,” Karjian said. 

Even before COVID-19, commercial payers were interested in reimbursing for this model because of its ability to lower costs while maintaining positive outcomes. As an example, Constantinos Michaelidis, M.D., medical director of hospital-at-home for UMass Memorial Health, said the health system's program has been most impactful among Medicaid and Medicare patients, with up to 75% reductions in 30-day readmissions. 

Speakers emphasized at-home care enables clinicians to see patients in a more holistic way, where social determinants of health are clearly evident in a way they cannot be addressed when a patient visits a clinic. That can be more rewarding for nurses, said Mae Centeno, chief nursing officer of virtual care center and virtual care delivery at Texas Health Resources. “They don’t want to wait until they’re burnt out, but they want to have another avenue to use their skill set," she said.

The largest nurses union, National Nurses United (NNU), has been outspoken against at-home care programs, arguing they are a danger to patients and undermine the expertise of registered nurses critical to a safe recovery. The NNU has expressed concern about existing studies purportedly showing benefits of such programs as being selectively chosen and limited in scope and believes the primary driver of these programs is the desire for revenue. The programs, the union says, threaten to exacerbate racial disparities among those under-resourced and may drive inpatient services out of business altogether.

The union has urged payers to invest in the existing healthcare infrastructure and workforce. 

Miller acknowledged the continued need to show data that this model, indeed, generates better outcomes at lower cost. He also called on the U.S. to recognize this as a sustainable operating model. “We need the will to do it—the technology is there," he said. This problem, he added, is why reimbursement is currently “hanging in the balance.” Though he believes the waiver extension will pass, that may take more time than going to payers directly who are usually quicker to adapt, especially if it saves them money.

At-home care offerings can make providers more competitive, too. One patient came to UNC Health “‘because the one down the street does not have this program,’” recalled Matt Smith, the health system’s vice president of digital health/virtual care and well care services.

Apart from reimbursement, another hurdle to scaling home hospital programs is the workforce shortage, speakers said. This could potentially be addressed by having clinicians manage several patients across multiple states through one command center. Programs can also tap into atypical labor pools for care, like paramedics or community nurses. 

https://www.fiercehealthcare.com/providers/experts-call-action-extending-reimbursement-home-care

Biden: Feds to fund ‘100%’ of recovery for wildfire sparked by Forest Service

 President Joe Biden on Saturday said the federal government is “covering 100 percent of the cost” for the response to a massive wildfire in New Mexico that was started by federal burns.

“We have a responsibility as a government to deal with the communities who are put in jeopardy,” Biden said in remarks at the emergency operations center in Santa Fe, N.M. “And today I’m announcing the federal government is covering 100 percent of the cost of debris removal and emergency protective measures for the next critical months.”

The White House later released a statement announcing the president had amended the New Mexico Disaster Declaration to push the percentage of those costs to be covered by the federal government from 75 percent, set by the disaster declaration in May, to 100 percent “for the first 90 days of the incident period.”

The White House said that the 90-day coverage period is meant to serve as a “bridge” from emergency operations to the potential passage of the Hermits Peak Fire Assistance Act, a piece of legislation that has not yet been approved by Congress.

If passed, the act would require the Federal Emergency Management System to create a claims office to provide full compensation to those who have been injured or suffered financial losses due to the fire.

“This additional support will help ensure that New Mexico has no financial limitations related to immediate lifesaving and life sustaining operations related to the ongoing wildfires, including urgent debris removal,” the White House said of Biden’s order.

This comes after the Forest Service last month said it was responsible for the two fires that merged last month to form the Hermits Peak/Calf Canyon fire, which Biden emphasized in his address is the “largest, most destructive wildfire in America so far this year and the largest wildfire in New Mexico’s history.”

The Hermits Peak and Calf Canyon fires each formed as a result of escaped federal pile burns, the agency said.

Biden acknowledged the role that the Forest Service played in the fire, saying the agency conducts 4500 prescribed burns each year and that “99.8 percent go as planned.”

“This time, tragically, it did not,” he said.

https://thehill.com/news/state-watch/3520202-biden-federal-government-to-fund-100-percent-of-recovery-for-wildfire-sparked-by-forest-service/

ABVC BioPharma: Termination of Two Contracts

 ABVC Biopharma, Inc. (NASDAQ: ABVC), a clinical stage biopharmaceutical company developing therapeutic solutions in oncology/hematology, CNS, and ophthalmology, today announced that two contracts entered into in the last 45 days have been terminated.

The first of the two contracts, announced on May 3, 2022, was a $3.0 million clinical services agreement between BioKey, a wholly-owned subsidiary of the company based in Fremont, California, and NeuCen BioMed, based in Taipei, Taiwan.  Under the terms of the now terminated agreement, BioKey was to be paid $3.0 million over a 3-year period to guide two NeuCen drug products, CEN501 and NEU001, through completion of Phase II clinical studies under U.S. FDA IND regulatory requirements. ABVC and NeuCen had also agreed, subject to further negotiation, that ABVC would loan NeuCen $1.0 million through a series of convertible debentures.

The second terminated contract was between ABVC BioPharma and Orion Biotech, a Taipei-based affiliate of NeuCen. The second contract, announced on May 25, 2022, called for ABVC BioPharma to identify candidates interested in out-licensing Orion developmental products. Under the terms of this engagement, ABVC was to use its business relationships around the world to identify licensing partners for Orion products and, in return, would receive a monthly retainer fee and 15% of the licensing income and royalties received by Orion for each licensed product. 

The party’s inability to agree to the final terms of the loan between BioKey and NeuCen led to termination of both contracts on June 6, 2022, effective immediately.

“We are disappointed that we will not be working with NeuCen and Orion going forward,” said Dr. Howard Doong, Chief Executive Officer of ABVC BioPharma. “While these agreements were not material to our core mission or our financial strength, they presented opportunities to demonstrate our ability to provide valuable services to the emerging biotech industry in Taiwan.”

https://finance.yahoo.com/news/abvc-biopharma-announces-termination-two-123000110.html

U.S. FTC seeks more information on UnitedHealth's $5.4 bln acquisition of LHC

 LHC Group Inc said on Friday that the company and UnitedHealth Group have both received notices from the U.S. Federal Trade Commission (FTC) for additional information regarding their $5.4 billion deal.

UnitedHealth had in March announced it would buy LHC Group to expand its home health services.

LHC Group did not provide details on what was the additional information and documentary materials sought by the anti-trust agency.

The companies have been working cooperatively with the FTC and will continue to do so, LHC Group said in a regulatory filing https://www.sec.gov/Archives/edgar/data/0001303313/000156459022023014/lhcg-defa14a_20220610.htm.

https://www.marketscreener.com/quote/stock/LHC-GROUP-INC-9875/news/U-S-FTC-seeks-more-information-on-UnitedHealth-s-5-4-bln-acquisition-of-LHC-40698477/

Labor Union Threatens US Foods With 'Work Stoppages,' Could Impact East Coast Restaurants

 Disruptions to US food supply chains could worsen if the Teamsters Warehouse Division and several Teamster locals walk off the job at foodservice distribution centers throughout the East Coast because of unresolved labor contracts. 

Teamsters released a statement revealing contract negotiations with US Foods are souring, and they "put the foodservice giant on notice that work stoppages are imminent." This means that unresolved work contract negotiations between the labor union and the foodservice distributor could result in a strike that may disrupt the flow of food products to tens of thousands of restaurants. 

Teamsters point out US Foods is under investigation by the National Labor Relations Board for allegations of unfair labor practices, including terminations, unilaterally changing working conditions, and bargaining in bad faith with union representatives. 

"US Foods executives seem more interested in how they can violate the rights of their essential employees than they do in offering them a fair return on their work. My members have patiently tried to work in good faith to negotiate an agreement, but they've had enough," said Todd Robertson, President of Teamsters Local 171 in Salem, Virginia.

Robertson said drivers at one of US Foods distribution centers have been trying to negotiate a fair contract for nearly a year and have yet to make progress. Workers are getting fed up, which may result in the possibility of a strike. 

"Unfair labor practices and unsettled contracts are not the way to thank your essential workers.

"Local leaders across the country have told me their members have had it with the way US Foods treats them," said Tom Erickson, Teamsters International Vice President and Director of the Teamsters Warehouse Division.

For some context about how serious a strike of drivers and warehouse employees at US Foods would be, we must understand the company has 28,000 employees and more than 70 locations across the country and delivers food products to approximately 300,000 restaurants. 

"We aren't going to be afraid to strike," said Sean M. O'Brien, Teamsters General President.

https://www.zerohedge.com/markets/not-afraid-strike-teamsters-warn-us-foods-east-coast-walkout-could-impact-restaurants

Cantor Fitzgerald Weighs in on 89bio

 Investment analysts at Cantor Fitzgerald issued their FY2023 EPS estimates for shares of 89bio in a research note issued on Monday, June 6th. Cantor Fitzgerald analyst K. Kluska forecasts that the company will earn ($2.83) per share for the year.

ETNB has been the subject of several other reports. Piper Sandler cut their price objective on 89bio from $54.00 to $19.00 and set an “overweight” rating for the company in a research note on Tuesday, May 17th. SVB Leerink cut their price objective on 89bio from $62.00 to $50.00 and set an “outperform” rating for the company in a research note on Friday, March 25th. Oppenheimer lowered their target price on 89bio from $49.00 to $40.00 in a report on Friday, May 13th. HC Wainwright lowered their target price on 89bio from $46.00 to $29.00 in a report on Thursday, May 12th. Finally, Raymond James upgraded 89bio from an “outperform” rating to a “strong-buy” rating and lowered their target price for the stock from $33.00 to $12.00 in a report on Thursday, May 12th. One analyst has rated the stock with a hold rating, six have assigned a buy rating and one has issued a strong buy rating to the company’s stock. Based on data from MarketBeat.com, the stock currently has an average rating of “Buy” and an average price target of $34.88.

https://www.defenseworld.net/2022/06/09/cantor-fitzgerald-weighs-in-on-89bio-inc-s-fy2023-earnings-nasdaqetnb.html

Not Just China: Feds, Universities Hid Evidence On Origin Of COVID

 An article published last week in the Proceedings of the National Academy of Sciences (PNAS) has ignited a new debate over the origin of COVID-19.

Renowned economist Jeffrey Sachs and Dr. Neil Harrison, a professor of molecular pharmacology and therapeutics at Columbia University, laid out one of the most comprehensive overviews of the evidence yet that COVID-19 could potentially have emerged from a lab in Wuhan, China. However, unlike most previous analyses, Harrison and Sachs point out that there are troves of untapped evidence potentially available right here in the United States that have not yet been investigated.

Attempts to investigate what was going on at the Wuhan Institute of Virology (WIV) in the leadup to the COVID-19 pandemic have thus far been stifled by a lack of cooperation from the Chinese Communist Party (CCP). However, the two authors allege that more than a half dozen institutions in the United States have evidence that could prove useful in finding where COVID-19 came from, if only they would make it public.

Most of these institutions are government agencies — the National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), the Defense Threat Reduction Agency (DTRA), Department of Homeland Security (DHS), the Defense Advanced Research Projects Agency (DARPA), and the U.S. Agency for International Development (USAID). The authors also name the University of North Carolina at Chapel Hill (UNC) and University of California-Davis (UCD) as well as EcoHealth Alliance (EHA), the non-profit which worked directly with the WIV on bat-based coronavirus research.

Neither UCD nor UNC, including Baric specifically, responded to requests for comment for this story. (RELATED: Trump’s CDC Director Was Reportedly Sidelined By Fauci After Urging Him To Investigate Lab Leak)

The article has breathed new life into the search for COVID-19 origins, with many in the scientific community applauding Sachs and Harrison for speaking out. “The authors also show how information has been withheld at every turn, even by US taxpayer-funded agencies, and that the “experts” are no longer entitled to the benefit of the doubt. There must be vastly more transparency for trust in science to start to be restored,” Dr. Louis Nemzer, an associate professor researching biophysics at Nova Southeastern University, told the Daily Caller.

The government agencies named were involved in some fashion with funding or overseeing research at the WIV or done by EHA. UNC employs Dr. Ralph Baric, a scientist who developed a groundbreaking method of inserting new genetic code into pathogens without leaving any evidence, and used it to make coronaviruses more dangerous as part of research projects. UCD maintained a substantial database of SARS-like CoV genetic sequences as part of the government-funded PREDICT project, and EHA was the primary intermediary between U.S. government agencies — and their grant money — and Wuhan researchers.

None of these institutions have fully publicized the work they’ve done involving coronavirus research. According to Sachs and Harrison, releasing their internal communications, biological samples and other research findings could prove critical in determining if COVID-19 is in fact naturally occurring, or same from a lab in Wuhan, China.

“DARPA has never funded directly, nor indirectly as a subcontractor, any activity or researcher associated with the EcoHealth Alliance or Wuhan Institute of Virology,” the agency told the Daily Caller. The other government agencies mentioned in the PNAS article did not offer comment when contacted.

Some of the information which could be of use is, for instance, the data removed from an NIH gene database at the request of Chinese researchers in early 2020, or a full accounting of Baric’s research involving enhancing pathogens to make them more dangerous, or details on the fieldwork conducted by EHA with their Chinese colleagues.

Sachs and Harrison call for a full release of this information, and, if necessary, a Congressional inquiry. (RELATED: Chemical Weapons Expert: UK Government Officials Secretly Believe Lab-Leak Caused COVID Pandemic)

“The PNAS article, wonderful as it is, is just an article. What will prompt an investigation of the origins of Covid-19 is when members of Congress from both political parties come together and make it happen. It is regrettable and embarrassing that House and Senate Democrats have been largely unwilling to do so thus far,” said Gary Ruskin, executive director and co-founder of nonprofit public health watchdog U.S. Right To Know. “We need our members of Congress to unearth NIH top to bottom, figure out what went wrong and restore public trust.”

Republican Kentucky Sen. Rand Paul told the Daily Caller that if Republicans win control of Congress in November, investigations may be in order: “Throughout the pandemic, I’ve repeatedly called for Congress to fully investigate the origins of COVID-19. When Republicans retake the majority in November and I’m chairman of a committee, I will have subpoena power and the ability to thoroughly investigate the origins of this virus that has plagued our nation for far too long.”

This step is particularly notable for Sachs. He was once the chair of The Lancet’s COVID-19 commission, which was formed by the elite scientific journal to investigate the origins of COVID-19. However, in 2021, Sachs dissolved the commission, saying that too many of its members had conflicts of interest with EHA to proceed.

The Lancet itself had a conflict of interest with EcoHealth. Early on in the pandemic, it published a letter spearheaded by Peter Daszak, the head of EcoHealth, calling the lab-leak theory a conspiracy theory harmful to Chinese researchers.

“The fact that Jeffrey Sachs wrote the article shows that people are tired of making apologies for Peter Daszak’s egregious conflicts of interest,” Nemzer said.

Now, Sachs is singing a different tune. In the PNAS article, he and Harrison point out a number of coincidences that seem too strange to explain away under the natural origin theory. SARS-CoV-2 has a sequence of eight amino acids on its spike protein that are exactly identical to an amino acid sequence vital for human lung function. The closest bats in the wild that carry similar coronaviruses are at least 1,000 miles away from Wuhan, where the first outbreak of the pandemic occurred. In 2014, Baric, EHA and WIV received a grant from NIAID to enhance the infectiousness of bat-based coronaviruses.

“Blanket denials from the NIH are no longer good enough. Although the NIH and USAID have strenuously resisted full disclosure of the details of the EHA-WIV-UNC work program, several documents leaked to the public or released through the Freedom of Information Act (FOIA) have raised concerns,” Sachs and Harrison write.

“These research proposals make clear that the EHA-WIV-UNC collaboration was involved in the collection of a large number of so-far undocumented SARS-like viruses and was engaged in their manipulation within biological safety level (BSL)-2 and BSL-3 laboratory facilities, raising concerns that an airborne virus might have infected a laboratory worker.”

There was already one U.S.-led investigation into COVID-19’s origins. In 2021, President Joe Biden ordered an intelligence community investigation which ultimately turned up nothing conclusive. But the methods used and materials reviewed in that investigation, the PNAS article points out, have not been made public.

The momentum for a second look, this time from independent observers, is growing. “EcoHealth Alliance, USAID, DTRA, and the NIH have made it clear that they will not voluntarily release unredacted information to, and will not voluntarily cooperate with, members of Congressional oversight committees. The Perspective by Sachs and Harrison will not change their position.,” Rutgers University microbiologist Dr. Richard Ebright told the Daily Caller.

“The target audiences for the Perspective by Sachs and Harrison are not EcoHealth Alliance, USAID, DTRA, and the NIH. The target audiences are the National Academy of Sciences, the White House, and the majority party in Congress, which, to date, have resisted calls for an investigation with subpoena power and compelled testimony.”

https://dailycaller.com/2022/05/24/wuhan-institute-virology-coronavirus-covid-lab-leak-daszak-baric/