UHS focusing on lowering premium pay, filling staff roles as it faces inflationary pressure

 Universal Health Services plans to lower premium pay for staff as well as fill workforce vacancies as providers throughout the country continue to struggle with rising labor costs and inflation, CFO Steve Filton told investors Wednesday.

“I think if we can do that, No. 1, that will drive higher volumes which will help us offset some of that inflationary pressure,” he said.

Filton said that while he doesn’t believe premium pay will return to pre-COVID-19 levels in the foreseeable future, a lull in coronavirus cases could give UHS an opportunity to reduce those costs as demand for contract labor drops.

COVID-19 volumes for UHS decreased from 16% of admissions in the third quarter of 2021 to 6% of admissions in the third quarter of this year, the CFO said.

Costs for salaries, wages and benefits were up 4.7% at acute care facilities and nearly 8% for behavioral health hospitals in the third quarter, according to financial statements.

Filton said UHS will take an “aggressive stance” when negotiating with commercial payers as inflation continues to be a concern for the system. He noted, however, that half of the company’s revenue comes from government sources, which are “simply not keeping up with inflation.”

UHS posted net income of $183 million for the third quarter of this year, down 16% from $218 million in the prior-year quarter. The hospital operator boosted revenue by 5.7% to $3.3 billion. Both revenue and profit beat Wall Street expectations.

SVB Securities analysts characterized the results as “better than feared,” noting revenue from acute care hospitals was below their model but behavioral health revenues came in higher than expected, up 8.4% year over year.

The analysts said the numbers “look pretty decent against exceedingly low expectations.”

https://www.healthcaredive.com/news/uhs-third-quarter-2022-earnings-lowering-premium-pay-fill-staff-inflation-labor/635001/

Humana expects Medicare Advantage enrollment to grow almost 9% in 2023

 Humana said it is seeing strong enrollment in individual Medicare Advantage plans, its core insurance product, two weeks into the annual enrollment period for seniors.

The insurer said it expects to add between 325,000 and 400,000 individual Medicare Advantage members for 2023, an increase of between 7.1% and 8.7% year over year, executives said during Wednesday’s third-quarter earnings call.

Executives said better benefits are attracting more members. For certain plans, Humana members have an allowance for healthy foods, over the counter items, transportation, health supplies, rent and utilities, CEO Bruce Broussard said.

These benefits address seniors most urgent needs on affordability, Broussard said, “which is especially important given current economic conditions and knowing many seniors are on fixed incomes.”

Humana’s early positioning for 2023 “might be the strongest in recent history,” Morgan Stanley’s Michael Ha said on Wednesday’s call.

The strong initial sales come after Humana stumbled on retaining MA members during the 2022 plan year and slashed its enrollment forecast in early January, causing shares to tumble. Broussard previously said members were active shoppers during the previous open enrollment period, which created churn in the industry, causing Humana to lose members to other carriers.

Humana expects lower attrition in 2023, executives said.

The insurer said utilization was lower in the third quarter compared with the prior-year period as fewer individual MA members were admitted to the hospital.

CFO Susan Diamond said the company was pleased to see the continued shift in orthopedic procedures from an inpatient to outpatient setting, typically a less costly environment for surgeries.

Humana’s revenue increased 10% to $22.8 billion for the third quarter thanks to higher MA premiums and MA enrollment.

Net income declined to $1.2 billion compared with $1.5 billion during the prior-year period.

Humana said it achieved its “value creation plan,” a cost-cutting initiative to identify $1 billion to reinvest back in its core business, MA.

https://www.healthcaredive.com/news/humana-strong-medicare-advantage-enrollment-2023-outlook/635543/

AMA: Medicare Advantage plans' lack of competition harms patients, physicians

 Medicare Advantage (MA) markets are highly concentrated, which could harm both patients and doctors, according to a new study.

The American Medical Association (AMA) takes an annual look at the competition between health insurers across 380 metropolitan statistical areas (MSAs) in the U.S. and includes for the first time this year MA plans.

The results do not paint a pretty picture, said AMA, because the MSAs tend to be dominated by one or two insurers.

“MA markets have undergone a consistent though gradual decrease in average concentration since 2017,” the study said. “Nonetheless, this remains significantly above the threshold for highly concentrated markets.”

The Herfindahl-Hirschman Index (HHI) measures market concentration to determine competitiveness. A competitive market has an HHI score of 1500 or lower; 1500 to 2500 for moderately competitive; and anything over 2500 is considered highly concentrated, and therefore not very competitive. Seventy-nine percent of MSAs had MA markets with low levels of competition.

AMA President Jack Resneck Jr., M.D., said in an AMA press release that “unchecked market power among insurers is a formula for higher premiums, lower coverage, and inadequate levels of patient care, concerns of great relevance to MA. Most large MA insurers are accused of fraud and flouting the authority of federal agencies. The new AMA study shines a light on the lack of competition in MA markets across the country and will help regulators and lawmakers better scrutinize anticompetitive insurer behavior that harms patients and physicians in an industry where exploitative business practices are already commonplace.”

Mary Beth Donahue, president and CEO of the Better Medicare Alliance, an MA research and advocacy group, has a different take on how MA plans perform.

“In 2022, seniors could choose from an average of 39 Medicare Advantage plan options,” she told Fierce Healthcare. “This competition is leading to the lowest average Medicare Advantage monthly premiums in 16 years according to CMS data, and delivers high marks for quality and affordability, with higher average Star Ratings for 2023 than in 2021.”

She said that MA, which covers about 30 million Americans, constitutes a crucial part of the Medicare safety net.

“Unfortunately, some of the claims in this [AMA] announcement are deeply disconnected from the lived experiences of actual Medicare Advantage beneficiaries and risk misleading seniors during open enrollment,” says Donahue. “In reality, premiums are moving down, not up, and seniors on Medicare Advantage are saving nearly $2,000 per year compared to fee-for-service Medicare—providing peace of mind during tough economic times. Meanwhile, Medicare Advantage beneficiaries receive extra benefits unavailable in FFS Medicare, are more likely to report access to a usual source of care, and report an overwhelming 94% satisfaction rate.”

The AMA press release cites an Oct. 8 New York Times article that stated that “eight of the 10 biggest Medicare Advantage insurers—representing more than two-thirds of the market—have submitted inflated bills, according to the federal audits. And four of the five largest players—UnitedHealth, Humana, Elevance and Kaiser [Permanente]—have faced federal lawsuits alleging that efforts to over-diagnose their customers crossed the line into fraud.”

Insurers disputed the allegations, which they said were caused by irregularities resulting from flawed federal audits. They told the NYT that “their aim in documenting more conditions was to improve care by accurately describing their patients’ health. Many of the accusations reflect missing documentation rather than any willful attempt to inflate diagnoses, said Mark Hamelburg, an executive at AHIP, an industry trade group. ‘Professionals can look at the same medical record in different ways,’ he said.”

The AMA study also found that 34% of MSA-level MA markets had one insurer with a share of 50% or more, while 6% of MSA-level markets had one insurer with a share of 70% or more. The 10 states with the least competitive MA markets were:

1. Vermont
2. North Dakota
3. Wyoming
4. Montana
5. Rhode Island
6. South Dakota
7. West Virginia
8. District of Columbia
9. Nebraska
10. Louisiana

The 10 largest health insurers in the U.S. by Medicare Advantage market share were:

1. UnitedHealth Group (28%)
2. Humana (19%)
3. CVS Health, the parent company of Aetna (11%)
4. Kaiser Permanente (7%)
5. Elevance Health, formerly Anthem (6%)
6. Centene (4%)
7. Cigna (2%)
8. Blue Cross Blue Shield of Michigan (2%)
9. Highmark (1%)
10. SCAN Health Plan (1%)

Commercial markets in the MSAs also lack competition, according to the AMA study.

“Although there were some fluctuations in either direction in the intervening years, the share of commercial markets that are highly concentrated rose from 71% to 75% and average market concentration increased from [an HHI of] 3322 to 3504 between 2014 and 2021," the study found.

Several insurers had large market shares in the MA and commercial markets, with UnitedHealth Group being the largest in both. CVS Health is the third largest in both markets. Also among the top 10 in both markets: Kaiser Permanente, Blue Cross Blue Shield of Michigan and Highmark.

For commercial markets, the AMA study found that 48% percent of MSA-level markets had one insurer with a share of 50% or more, while 11% of MSA-level markets had one insurer with a share of 70% or more.

https://www.fiercehealthcare.com/payers/ama-study-argues-medicare-advantage-plans-lack-competition-harms-patients-physicians

ACA, Medicare southern call centers ring in the first day of open enrollment with a strike

 Nov. 1 marked the first day of Affordable Care Act (ACA) open enrollment and the beginning of the largest nonunion strike since the beginning of 2021. It is estimated that over 650 workers at Maximus call centers charged with meeting the influx of open enrollment calls have gone on strike in search of fair wages and treatment.

Maximus is the nation’s largest federal call center contractor. Workers from several call centers—in Bogalusa, Louisiana; Hattiesburg, Mississippi; London, Kentucky; and Chester, Virginia—have pledged to strike until they receive a base pay of $25. With a rise in inflation, workers of the Centers for Medicare & Medicaid Services (CMS) contractor wrote in a press release that they have struggled to provide the care necessities for their families.

“We don't want to patch; we want a new foundation,” Tiffany Murray, a worker in the Hattiesburg call center, told Fierce Healthcare. “Fix a flat, we don't need that. We need a whole new tire moving forward. So going out is going to show them that you can't just pacify us with a bonus. We need our rights.”

During open enrollment, call volume substantially increases in facilities that handle Medicare and ACA Federally Facilitated Marketplace calls. Maximus workers also demand clear policies protecting them from abusive calls, such as the ability to disconnect or escalate calls immediately without fear of punishment. 

Workers claim that management has been largely dismissive of racial and sexual harassment from callers. For this reason, their third demand is 30 minutes of allocated time within an eight-hour shift to compose themselves between calls.

ACA enrollment takes place annually between Nov. 1 and in most states lasts until Jan. 15. To access coverage that begins Jan. 1, members must enroll by Dec. 15. ACA coverage helped the nation reach a near-record low uninsured rate with 35 million patients being covered in 2022. Coverage increased by 27 million since 2020.

The Virginia-based employer maintains one of the largest federally contracted workforces in the country through its call center contract with CMS.

Maximus workers are organizing with the Communications Workers of America (CWA).

“It is not by accident that Black women from Mississippi and Louisiana are the ones to call out this injustice of our system that expects them to be essential workers but does not treat them as human beings who matter,” said Charles Taylor, executive director of the NAACP Mississippi state conference, in a press conference with Maximus workers and CWA. “We are seeing the consequences of generational divestment and leadership falling heavy on predominately African American communities.”

CWA states that the current base pay rate at all Maximus CMS call centers is about half the wage rate needed for a parent with one child to meet minimum standards of living, a dollar amount determined by the MIT Living Wage Calculator.

Eight out of 10 Maximus call centers are located in Southern states where inflation increased costs by 8.7% last year, with the price of groceries increasing by 13.2%, household energy costs by 19.9% and gas by 13.9%.

Maximus workers at the relevant call centers were offered $200 from management if they did not join the strike. Management allegedly has communicated anti-union sentiments in worker training sessions by stating that a third party is not needed to maintain a cohesive relationship between workers and employees. CWA has previously accused Maximus of union-busting tactics.

“When that check comes after the two weeks, they're going to tax our bonus check that we worked so hard for as opposed to us going out and striking for our rights and our dignity,” Murray said. “We're standing outside letting them know that this $200 Band-Aid cannot cover up a full-size wound.”

Maximus workers previously wrote letters to their CEO stating that workers delayed healthcare because of the company’s expensive health insurance. In August 2019, workers in a Kansas Maximus facility filed a complaint with the Department of Labor alleging that the company was misclassifying and underpaying its employees, the tenth complaint of such since 2017.  

In 2022, the company made headlines again after workers said they were afraid that co-workers with COVID-19 were still coming into work because they could not afford to take time off.

Steven Meyer, an Oklahoma City Apple employee who was a part of a successful union drive, shared his own experience with Maximus workers during a CWA press conference.

“Over time, I noticed my co-workers at Apple quit not because they liked the job but because their individual efforts to maintain the good parts of it and improve the bad parts got lost in the corporate system of feedback that seems designed to lose such concerns,” Meyer said.

The Apple branch in question was the second of the tech giant’s stores to complete a successful drive since June. Both have yet to receive recognition from the tech giant. In recent months, Apple workers' strikes have spread, most notably in Australia.

Tech employee strikes have increased in recent years with one Amazon fulfillment facility now being unionized. Recent months have also brought the stepping out of healthcare workers, especially nurses and behavioral health providers, demanding better pay and working conditions as burnout soars.  

https://www.fiercehealthcare.com/payers/aca-medicare-southern-call-centers-ring-first-day-open-enrollment-strike

CMS locks in court-ordered 340B drug payment rates for 2023

 Next year’s Medicare outpatient payment rate increases will land alongside restored payments for drugs discounted under the 340B program, the Center for Medicare and Medicaid Services (CMS) announced Tuesday.

CMS’ 2023 Medicare Hospital Outpatient Prospective Payment System (OPPS) final rule is the agency’s latest step toward compliance with a June Supreme Court ruling, in which the top court unanimously ruled against a nearly 30% pay cut for outpatient drugs purchased by 340B hospitals at discount.

The news was welcomed by hospital groups that said the resumed payments will help hospitals continue to provide care in underserved areas.

“We are very pleased to see that CMS has restored equity to the Medicare [OPPS],” Maureen Testoni, president and CEO of 340B Health, an industry group representing hospitals participating in the 340B program, said in a statement. “For 30 years, 340B has supported hospitals in serving patients living with low incomes, and full Medicare payments for those services are essential for the healthcare safety net.”

The American Hospital Association (AHA), which had brought the suit that eventually overturned the cuts, also said the end to CMS’ “unlawful” policy “will help 340B hospitals provide important comprehensive health services to their patients and communities.”

Both groups, however, said that the agency still needs to rectify more than four years of underpayments.

“We continue to urge the Administration to promptly reimburse those hospitals that were harmed by their unlawful cuts in previous years,” AHA said.

Whereas CMS generally paid hospitals the average sales price (ASP) plus 6% for covered outpatient drugs, the agency adopted a policy in 2018 that paid 22.5% below ASP for certain drugs acquired through the 340B program.

The 2023 Hospital OPPS rule released Tuesday restores the 6% over ASP for the coming calendar year “consistent with our policy for drugs not acquired through the 340B program,” CMS said. To stay budget neutral, CMS said it would also be implementing a –3.09% reduction to the payment rates for non-drug services.

Though the Supreme Court had also instructed CMS to make good on years of reduced payments, it tasked lower courts with determining potential remedies. In late September a U.S. District Judge ordered CMS to vacate the rate cut for the remainder of the 2022 calendar year, but a repayment plan has yet to be specified by the courts.

CMS said in Tuesday’s final rule release that it plans to address a remedy in future rulemaking that will come before it proposes next year’s OPPS rule.

AHA, however, said it does not believe CMS “needs more time to put forth a separate rule on a remedy as it has had more than adequate time to correct its mistakes."

In August, AHA submitted several court filings warning against a budget-neutral recoupment plan that would require hospitals unaffected by the cuts to foot the bill. It reiterated those concerns in its most recent statement.

“We continue to call on the agency to ensure the remainder of the hospital field is not penalized for the prior unlawful policy, especially as hospitals and health systems continue to face immense financial pressures and workforce shortages,” the industry group said.

Beyond the 340B payments, Tuesday’s final OPPS rule set payment rates for hospitals that meet applicable requirements for quality reporting at 3.8%, up from the 3.1% CMS had proposed earlier in the year.

It also finalized a new “Rural Emergency Hospital” provider type designation. Proposed back in June, the designation offers small rural hospitals and critical access hospitals a 5% boost in Medicare payments and monthly facility payments of more than $270,000 in 2023 should they meet certain conditions of participation.

https://www.fiercehealthcare.com/providers/cms-locks-court-ordered-340b-drug-payment-rates-2023-though-back-payments-still-come

'Considerable' monkeypox transmission happens before symptoms, study

Monkeypox can spread before symptoms appear, British researchers said on Wednesday, providing the first evidence indicating the virus can be transmitted this way.

It was previously thought that monkeypox was almost entirely spread by people who were already sick, although pre-symptomatic transmission had not been ruled out and some routine screening had picked up cases without symptoms.

Monkeypox, a relatively mild viral illness that is endemic in several countries in western and central Africa, exploded around the world earlier this year, with outbreaks in dozens of countries where it had never previously appeared.

There have been almost 78,000 confirmed cases and 36 deaths since, according to the U.S. Centers for Disease Control and Prevention. Although cases have peaked in many countries, this week the World Health Organization said the outbreak still represented a global health emergency.

The virus is known to spread through close contact and causes symptoms including fever, body aches and often painful pus-filled skin lesions.

To find out more about how monkeypox was transmitting in Britain, a team from the UK Health Security Agency used routine surveillance and contact tracing data for 2,746 people in the country who tested positive between May and August.

Their average age was 38, and 95% of the patients reported being gay, bisexual or men who have sex with men.

https://www.marketscreener.com/news/latest/Considerable-monkeypox-transmission-happens-before-symptoms-study-suggests--42183980/

HHS renews public health emergency for monkeypox outbreak

 The Department of Health and Human Services (HHS) on Wednesday renewed the national public health emergency for the monkeypox outbreak, with officials stating that the virus is still very present in the U.S. even as cases continue to drop.

HHS Secretary Xavier Becerra cited the “continued consequences of an outbreak of monkeypox cases across multiple states” as well as a “consultation with public health officials” for his decision to renew the public health emergency.

The public health emergency for monkeypox was first signed on August 4. Public health emergencies from HHS end after 90 days unless they are renewed.

An HHS spokesperson told The Hill that the decision to renew was also prompted by the need to maintain the flow of data from states and jurisdictions as well as to allow vaccine effectiveness studies to take place.

There are currently no vaccines or treatments specifically meant for monkeypox, but treatments for smallpox, which is part of the family of viruses that monkeypox belongs to, have been mobilized to at-risk communities. These include the smallpox vaccine Jynneos as well as the antiviral tecovirimat, better known as TPOXX.

Since peaking in early August, monkeypox cases in the U.S. have continued to drop, with the most recent seven day moving average for cases standing at 30 per day. Experts have attributed this swift drop in cases to changes in behavior among men who have sex with men, the demographic that has been largely affected by the global monkeypox outbreak.

More than 28,000 monkeypox cases have been confirmed in the U.S., as well as six related deaths. More than 77,000 cases have been reported globally.

The Centers for Disease Control and Prevention in September expressed “moderate confidence” that monkeypox cases would plateau or continue to decline going forward, though the agency said it was unlikely that monkeypox would be entirely eliminated in the U.S.

LGBTQ public health experts who spoke with The Hill shortly before Becerra’s decision was announced voiced their support for a renewal of the public health emergency.

Vanessa Castro, associate director of HIV and health equity for the Human Rights Campaign, said the emergency should be renewed because other challenges associated to the outbreak are still ongoing.

“One of the biggest things that we are continuing to hear about is really the disproportionate access to vaccine distribution, which especially impacts our Black, Latinx and people living with HIV communities,” Castro said.

According to federal data, Black individuals account for the largest share of reported monkeypox cases at 44 percent. This proportion has grown as the monkeypox outbreak has gone on, with the White and Hispanic or Latino communities following behind in terms of cases.

Sean Cahill, director of health policy research at the Fenway Institute, similarly acknowledged that while case rates are going in the right direction, racial and ethnic disparities in disease prevalence and vaccine uptake are still occurring.

Speaking to The Hill on Tuesday, Cahill said he feared that allowing the public health emergency to expire would “send the wrong message.”

“Just like COVID-19 is not over — and Congress should appropriate sorely needed funding for COVID-19 vaccination, care and public education — so too the monkeypox outbreak is not over,” said Cahill.

Castro echoed these sentiments, noting that many community organizations that are working to fight the outbreak, particularly those in the South, are already “working on fumes” with limited resources.

https://thehill.com/policy/healthcare/3715547-hhs-renews-public-health-emergency-for-monkeypox-outbreak/