Waystar CEO Matt Hawkins talks about his company's IPO

 Matt Hawkins, CEO of Waystar, talks about his company's IPO in a difficult environment for IPOs. The company raised $968 million, making it the largest IPO of the year for a US company.

The company, which works with more than one million healthcare providers using its software in a variety of settings, also took advantage of the IPO to improve its capital structure by reducing its debt.

Waystar, which made around $800 million in sales last year, relies on its cloud-based software incorporating artificial intelligence to automate and optimise processes for healthcare organisations. Hawkins points to high satisfaction rates and lasting customer relationships as key elements of the company's growth strategy.

Waystar's major investors, including EQT, the Canada Pension Plan Investment Board, Bain Capital and Francisco Partners, hold significant stakes but leave the management team free to run the business on a day-to-day basis.

 https://www.marketscreener.com/quote/stock/WAYSTAR-HOLDING-CORP-170812201/news/Waystar-CEO-Matt-Hawkins-talks-about-his-company-s-IPO-46932107/

Thousands of Amazon Flex drivers file arbitration claims for misclassification as contractors

 Thousands of Amazon.com Flex drivers filed arbitration claims on Tuesday, alleging they were misclassified as independent contractors rather than employees, the lawyer representing the drivers told Reuters.

About 15,800 drivers have submitted arbitration claims with the American Arbitration Association, seeking compensation from Amazon for unpaid wages, overtime and work-related expenses such as mileage and cellphone use, the lawyer said. Other 453 similar cases are already being litigated.

Amazon does not provide Flex drivers with 10-minute rest breaks when their shift lasts longer than 3.5 hours, one of the drivers said in its arbitration claims.

A claim said that Amazon does not provide 30-minute meal breaks for drivers who work more than five hours a day, whereas another claim alleged that Amazon fails to provide itemized wage statements required by California law.

"The Amazon Flex program gives individuals the opportunity to set their own schedule and be their own boss, while earning competitive pay," an Amazon spokesperson told Reuters.

Amazon Flex, which works like on-demand ride-hailing service Uber, handles speedy deliveries of common household goods to customers through programs such as Prime Now and Amazon Fresh. 

https://www.marketscreener.com/quote/stock/AMAZON-COM-INC-12864605/news/Thousands-of-Amazon-Flex-drivers-file-arbitration-claims-for-misclassification-as-contractors-46952741/

'Millions fewer people may need statins, but guidelines have yet to agree'

 It’s a familiar scene for patients during a routine primary care visit. The doctor scans blood test results, notes high cholesterol flagged by a standard calculator to assess risk of heart attack or stroke, then decides — and ideally discusses — whether to recommend taking a statin to cut the risk over time.

That conversation may happen less often if changes in the risk model presented by the American Heart Association in November translate into new guidelines for prescribing statins. Those guidelines haven’t been recalibrated yet, but a new analysis suggests that the new risk model could mean far fewer Americans — as many as 40% less than current calculators say — would be candidates for cholesterol-lowering drugs to prevent cardiovascular disease.

To reach this conclusion, published Monday in a JAMA Internal Medicine study, researchers analyzed data from 3,785 adults who were 40 to 75 years old and took part in the National Health and Nutrition Examination Survey from January 2017 to March 2020. Their 10-year risk of artery-narrowing cardiovascular disease was computed using the AHA’s Predicting Risk of cardiovascular disease EVENTs (PREVENT) equations from 2023 and then compared to risk estimates using the previous tool from 2013, the Pooled Cohort Equations (PCE) on which current guidelines are based.

Chiadi Ndumele, chair of the American Heart Association’s CKM Scientific Advisory Group, emphasized that the actual PREVENT risk thresholds for statin use in cardiovascular prevention will need to be decided in clinical guidelines, and that has not yet occurred. He also acknowledged criticism of the earlier risk model.

“We updated the AHA risk prediction model to PREVENT reflecting the growing influence of inter-related metabolic risk factors (obesity, diabetes, metabolic syndrome) and chronic kidney disease on cardiovascular disease risk,” Ndumele, director of obesity and cardiometabolic research at Johns Hopkins University, told STAT in an email. “It is therefore not surprising that the investigators found about twice the predicted event rate for the PCEs vs. PREVENT, reflecting this difference.”

Under the current guidelines, most people with a 10-year risk of 7.5% or more for developing cardiovascular disease are advised to take a statin, while at a 5% risk, they’re told only that they and their doctors should consider doing so.

“Analyses are underway,” Ndumele said. “Guidelines will have to consider whether and how to update recommendations to include PREVENT risk thresholds to guide clinical decision making.”

What’s changed in the JAMA Internal Medicine analysis is how many people might be at risk, based on the new components put into the calculator. Overall, 4% of people had a 10-year risk of developing cardiovascular disease, compared to the 8% previously predicted by the PCE. The number of adults recommended for statins could drop from 45.4 million to 28.3 million.

Race, now recognized as a social not biological construct, was excluded in the newer equations. That meant 5.1% of Black adults were computed to be at risk, compared to 10.9% from the previous calculator. For older adults ages 70 to 75, the proportion at risk was 10.2%, down from 22.8%.

In a paradox, the study found that while fewer people might be eligible for statins, which now can cost as little as $40 a year, the estimates also say most people who would be advised to take them aren’t doing so.

“The prior risk equations and the PREVENT equations that we focus on in this study really seek to give doctors and patients sort of a starting percentage to say, is it worth having a conversation about statins?” lead study author Timothy Anderson, a primary care physician and an assistant professor of medicine at University of Pittsburgh Medical Center, told STAT. “When we’re seeing risk rates cut in half, I think that really is something that’s likely to impact how doctors and patients talk about these meds.”

The biggest predictor of risk remains age, Anderson said. “If you’re a borderline risk now, you’re likely to be higher risk in five years. And that’s a complicated set of conversations for primary care doctors and patients to have.”

That concerns Steven Nissen, a cardiologist at the Cleveland Clinic, who was not part of the study. “Age is the most powerful factor in the calculators, so if you wait until somebody is 60 or 65, you’re playing catch-up,” he said. “I tend to lean toward treating rather than not treating when it’s a borderline case, but only when the patient and I have a conversation.”

Nissen has been leading an effort in collaboration with AstraZeneca to make the 5-milligram dose of its drug, rosuvastatin, available without a prescription. He urged shared decision-making between doctor and patient, aware that busy primary care physicians may be pressed for time.

“Good medicine involves judgment. And the calculator is not a replacement for good medical judgment, which may come to a different conclusion,” he said. “I’m not very supportive of either calculator because I think that in general, it’s good to have a lower LDL,” or “bad” cholesterol.

There are a multitude of factors affecting cardiovascular health, and statins are just one piece, said Gregg Fonarow, chief of cardiology at UCLA, citing the AHA’s recent projection that 61% of the U.S. population will likely have cardiovascular disease. He did not take part in the current study.

“So many cardiovascular events are preventable, not just through medication but through lifestyle modification. We need to do such a better job with prevention,” Fonarow said. “This really represents an opportunity to use the new enhanced PREVENT risk score and better inform individuals of risk, but importantly, not just for 10-year risk, but their lifelong risk for disease.”

Ndumele said PREVENT will help guide use of preventive therapies beyond statins, relevant for people with cardiovascular-kidney-metabolic syndrome, a disorder in which metabolic risk factors, chronic kidney disease, and the cardiovascular system interact to cause multi-organ dysfunction and poor cardiovascular outcomes.

“I think the challenge with this paper is the assumption that the same threshold will be used for the recommendation of statin use,” Ndumele said. “Risk estimates from PREVENT are much closer to what is observed in reality than they were for PCEs, but there is need for discussion about the optimal risk threshold for preventive statin use in guidelines.”

Nissen said any changes should be thought through carefully, with this caveat: “The take-home message is that any of these calculators are the best guess about risk,” he said, “but the decision to treat is different from simply calculating a risk.”

https://www.statnews.com/2024/06/10/cardiovascular-disease-statins-aha-guidelines/

Duke Of Moral Hazard: Biden Agency To Hide Medical Debt From Credit Reports

In a move that can only add risk to the financial system, the Biden administration is proposing a rule which will ban medical debt from credit reports.

The rule, announced on Tuesday by Vice President Kamala Harris and Consumer Financial Protection Bureau Director Rohit Chopra, will improve the ability for millions of Americans to take out more debt to purchase things like homes and cars.

According to Chopra, the rule - which has been in the works since September, could go into effect sometime next year.

"Our research shows that medical bills on your credit report aren't even predictive of whether you'll repay another type of loan. That means people's credit scores are being unjustly and inappropriately harmed by this practice," Chopra told ABC News.

CFPB’s research estimates that the new rule would allow 22,000 more people to get approved for safe mortgages each year — meaning lenders could also benefit from the positive impact on peoples’ credit scores, by being able to approve more borrowers.

Some major credit report companies have already stopped using medical debt to calculate peoples’ credit worthiness, including Equifax, TransUnion and Experian. FICO and VantageScore also recently started factoring medical debt less heavily into their scores. -ABC News

There are currently 15 million Americans with roughly $49 billion of medical debt, according to the CFPB, affecting roughly two in every five Americans according to KFF, a health policy research organization. The vast majority have debt in the thousands - which, when they go into collections, affect credit scores. This in turn hampers the ability to take out car and home loans - with those who can obtain them offered high interest rates.

The new rule also takes aim at incorrect, confusing or complicated medical bills which often lead to protracted disputes.

"Too often, we see that people are receiving bills that are inaccurate. Many patients are fighting over these bills for months, only to find that it then appears on their credit report," said Chopra.

Meanwhile, experts who support the new rule cite the already-low rate of collections on medical debt.

"We know empirically that the repayment rates are incredibly low for medical debt, and so it's already the case that people aren't really paying it down. So I don't think this policy change is going to change the behavior that dramatically," said University of Chicago’s Booth School of Business' Matt Notowidigdo.

To Notowidigdo and many other health economists, addressing the root cause of America’s medical debt issue would mean enrolling more people in adequate health care coverage on the front end, “rather than dealing with unpaid medical bills from lack of insurance or not generous enough insurance on the back end,” he said.

Of course, for now, those large bills and low repayment rates are already a challenge for hospitals and health care systems. -ABC News

That said, if the CFPB rule leads to fewer people paying their bills, hospitals will have to make up for those losses in other ways - such as requiring payment before patients receive medical care, a move which could leave low-income patients worse off.

"I think in the short run, it will be great news for patients, and probably we’ll see patient advocacy groups pushing it. However, I think in the long-run, when the long-term negative effects emerge, probably we're going to see more pushback," said Ge Bai, a professor who studies accounting health policy at Johns Hopkins University.

Industry group also oppose the move.

"There’s too much at stake for Americans’ access to quality health care by taking actions that only negatively affect the cash flow to the health care community without finding ways to replace those funds," said Association of Credit and Collection Professionals CEO Scott Purcell.

Chopra, however, rejects that notion - suggesting that medical debtors will still have to face other penalties.

"Those individuals will still be subject to collection actions, lawsuits and more. There are plenty of ways that people get penalized for not paying their bills. I just don't want to see the credit reporting system be weaponized against people who already paid them."

https://www.zerohedge.com/political/duke-moral-hazard-biden-hide-medical-debt-credit-reports

'New Long COVID Definition Proposed by National Academies'

A new reportopens in a new tab or window from the National Academies of Sciences, Engineering, and Medicine (NASEM) offers a new definition of long COVID in an effort to streamline the diagnosis and treatment of the condition, which has serious medical, social, and economic consequences for patients, according to the authoring committee.

Long COVID should now be defined as an infection-related chronic condition that occurs after COVID-19 and remains present for at least 3 months "as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems," the committee wrote. The definition does not require laboratory confirmation or other proof of initial infection.

The committee developed the report with input from more than 1,300 participants from a range of interdisciplinary specialties, as well as patients. It was initiated at the request of the Administration for Strategic Preparedness and Response and the Office of the Assistant Secretary for Health (OASH).

"Despite the fact that there have been many efforts to characterize this condition and many different definitions put forward, there has not yet been a common definition that has been widely agreed upon," said Committee Chair Harvey Fineberg, MD, PhD, president of the Gordon and Betty Moore Foundation, during a briefing.

For example, the CDC has its own definitionopens in a new tab or window, as does OASH and the NIH, and the World Health Organization has separate criteria for adultsopens in a new tab or window and childrenopens in a new tab or window.

"The lack of a considered uniform definition that's widely accepted hampers individual patients' ability to get the care they need," he added. "It hampers research, surveillance, and the availability of support for our patients who have this condition."

Fineberg explained that one notable distinction from previous definitions is a more clear path to diagnosis for patients, which means that clinicians don't have to wait for a diagnosis of exclusion to begin treating their patients.

He said the committee wants this new definition of long COVID to quickly be adopted by all federal, state, and local government authorities, as well as clinicians, medical societies and organizations, public health practitioners, employers, and educators. Specifically, the committee highlighted the importance for several government agencies -- such as HHS, the NIH, CDC, and the Social Security Administration -- to begin using this new definition to improve research and services for patients with long COVID.

NASEM released another reportopens in a new tab or window last week focused on the long-term effects of COVID-19, and potential disability benefits for patients with long COVID.

The committee said that its new definition can be applied to many purposes, including clinical care and diagnosis; eligibility for health services, insurance coverage, disability benefits, and school or workplace accommodations; public health; social services; policymaking; epidemiology and surveillance; private and public research; and public awareness and education, especially for patients and their families and caregivers.

"We believe this definition deserves wide dissemination and implementation," Fineberg said. "It is important also to monitor how well the definition works in practice: what problems emerge, how well it can be utilized both nationally and in promoting understanding globally about the role and relevance of long COVID in the lives of patients."

In addition to the new definition, Fineberg and the committee noted that their report strongly encourages all researchers, policymakers, and clinicians to use long COVID as the preferred name for this diagnosis.

Furthermore, the committee emphasized that long COVID can manifest in many ways and can involve any organ system. For example, patients can experience one or more of the following symptoms: shortness of breath, coughing, persistent fatigue, post-exercise malaise, difficulty concentrating, memory changes, recurring headache, lightheadedness, fast heart rate, sleep disturbances, problems with taste or smell, bloating, constipation, and diarrhea. However, the definition does not list any specific symptoms as being associated with long COVID as "studies estimate the prevalence of over 200 symptoms in multiple organ systems," according to the report.

The report also explained that long COVID patients can present with one or multiple diagnosed conditions, including hypoxemia, cardiovascular disease, cognitive impairment, mood disorders, postural orthostatic tachycardia syndrome (POTS), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and autoimmune disorders such as lupus, rheumatoid arthritis, or Sjögren's syndrome.

During the briefing, committee members pointed out that including these conditions in the overall definition is not a suggestion that there is a causal association between any specific diagnosis and long COVID.

In addition to other conditions that might signal long COVID, the committee noted several important features of the condition that clinicians can use to make a diagnosis.

First, the condition can follow asymptomatic, mild, or severe SARS-CoV-2 infection, so previous infections may be unknown to patients and their healthcare providers. It is also possible for long COVID symptoms to be continuous from the initial infection or delayed for several weeks or months, according to the report.

Long COVID can affect any individual regardless of age or other demographics. It can also be exacerbated by pre-existing conditions. The committee said long COVID can be diagnosed on clinical grounds and that no biomarkers currently exist.

Ultimately, the report emphasized that long COVID is a condition that can have a profound impact on a person's life, including limiting their involvement in everyday work, educational, family, or personal activities.

"The committee strove to put forward a definition that would have a number of qualities -- precision, feasibility, acceptability, accessibility -- one that would balance benefits and harms, one that would recognize the impact on health equity, and understood unintended consequences," Fineberg said.

https://www.medpagetoday.com/infectiousdisease/longcovid/110595

Admission Of Failure? Democratic Cities Stop Reporting Crime Stats To FBI

 The Biden administration's statisticians at the Bureau of Labor Statistics have painted a rosy economic picture for the job market. Yet, voters know damn well the economy is in a persistent inflation storm sparked by Bidenomics. That's why President Biden's reelection odds are sinking by the month. The most recent BLS jobs report shows just how absurd these reports get by the month, and there is no shame by the gov't statisticians as working poor Americans struggle to pay rent and put food on the table. 

Context about the political BLS is crucial to understanding that data massaging doesn't stop there. The White House has recently unleashed its propaganda cannons, claiming nationwide crime has plunged to a half-century low. The problem with this narrative is that it's at odds with imploding progressive cities that do not uphold law and order and fail to arrest and prosecute criminals. Plus, on top of this all, Democrats have flooded the nation with ten million illegal aliens.

Let's begin with MSNBC's Kyle Griffin, who posted on X the latest FBI crime stats that show murder, rape, robbery, theft, and property crime has plummeted across the board nationwide. 

The data is at odds with reality. Recently, White House Press Secretary Karine Jean-Pierre touted: "Violent crime is at a near 50-year low…" 

Responding to Griffin's post on X, Red State's Bonchie said, "Pretty amazing what happens when left-wing cities just stop reporting crime to the FBI." 

Bonchie cited a recent NRA-ILA report explaining how the Crime Prevention Research Center found that "one factor contributing to the ostensible dip in violent crime is that almost 40% of local law enforcement agencies are no longer transmitting their information to the national Federal Bureau of Investigation (FBI) database." 

You heard that correctly. 

Violent crime across America must be so out of control in failed leftist metro areas that radical leftists in local governments just stopped reporting crime data to the FBI. This is an admission the woke utopia of criminal and social justice reforms is an utter disaster.

Here's more from the NRA-ILA report:

In "2021, 37% of police departments stopped reporting crime data to the FBI (including large departments for Chicago, Los Angeles, and New York)," and for other jurisdictions, like Baltimore and Nashville, crimes are being underreported or undercounted. This leaves a large gap; by 2021, the real crime data collected by the FBI represented only 63% of police departments overseeing just 65% of the population. When compared to pre-2021 data, the result is a questionable "decline" in crime.

One X user provides the three easy steps under progressive control to reduce crime:

1. Don't arrest criminals.
2. Don't prosecute criminals
3. Don't report crime statistics

Massaging economic data, like in the BLS' case, or, Democratic cities just not reporting data to the FBI achieves the intended result:

Or better, create this narrative:

We all know this is nonsense data. 

A former alleged FBI agent on X explained: 

"The problem is, that all the cities didn't stop sending arrest data in at the same time.  The problem has been getting worse and worse as mayors got tired of claiming crime was down and then being called liars by people pulling up the FBI reported crime.  Their answer increasingly  became to just stop reporting the crimes (and also there was some reclassifying of violent crimes as well, like calling an armed robbery a larceny).  And, even the murder rates suffered from a data problem that's really not anyone's fault.   Trauma care just keeps better and better and a whole lot  of shooting victims who have died just a few years ago, now are saved.  (Baltimore saw this phenomena when they opened their shock trauma center and murders inexplicably went down while attempted murders went up.)" 

The Epoch Times' Jeffrey Tucker had this to say last fall about falling crime statistics: 

"Mass statistical ignorance is extremely costly. It allows a ruling class to toss around numbers all the time to sound vaguely sciency but without having any real substance behind the claims. This is what enabled the Biden administration to say daily that the job market is great, that economic growth is strong, that Americans are growing wealthier, and now, that crime is down. It's all completely gibberish and contradicted by every bit of reality that we observe with our own eyes." 

And more recently RealClearInvestigations' James Varney wrote in a note, "Baltimore department acknowledges its numbers may not be the same as those it submits to the FBI, but states on its website that "any comparisons are strictly prohibited."

To sum it up, the government is rigging statistics—be it about the economy or crime. You're living in one giant matrix. This time, the bullshit is clearer than ever.

https://www.zerohedge.com/political/admission-failure-democratic-cities-stop-reporting-crimes-stats-fbi

United is rolling out targeted in-flight ads – what to know and how to opt out

 If you’re flying United the ads you see in the app and on the seat-back screen may soon be a little more … personal.

The airline announced Friday that it will target ads to individual customers who decline to opt out.

United spokeswoman Remy Milburn confirmed to Nexstar that personalized ads are already being served to some United passengers on the airline’s app and nearly 100,000 in-flight screens, with plans to expand over the next several months.

Milburn added that advertisers aren’t able to access personally identifiable information of customers, and won’t include any data from passengers under the age of 18.

United’s Kinective Media will use customer demographic information that includes their city of residence, flight information and general age group to create “anonymized audience segments,” according to a news release.

“We’ve built a first-of-its-kind, real-time, ad tech-enabled traveler media network where brands have already started connecting to premium audiences at an unmatched scale,” said Richard Nunn, CEO of MileagePlus, in the release. “Unlike some commerce media platforms, United gives brands across a wide range of industries the ability to reach engaged customers throughout the entire marketing funnel – from brand consideration to conversion – in a way that’s highly personalized and relevant, and we’re already seeing impressive results.

How will it work?

While browsing the catalog on the seat-back screen facing you, the ads may not feel as random as they once did.

“For example, a customer who regularly flies between Chicago and Los Angeles might see an advertisement for an event in Los Angeles,” according to Milburn. “Importantly, Kinective Media does not use categories of information like race and ethnic origin, disability, biometric data, and personal health information.”

At the moment, the number of ads that show up on United’s nearly 100,000 in-flight screens is the same, only personalized, Milburn said.

“Airlines and ticket agents regularly collect personal information from passengers in the course of business that may not be otherwise publicly available such as name, date of birth, and frequent flyer number,” according to the U.S. Department of Transportation (DOT). “Mishandling the private information of consumers may be considered an unfair or deceptive practice.”

Practices that could result in a DOT investigation and potential fines include an airline violating its own privacy policy, a DOT rule or the Children’s Online Privacy Protection Act, among others.

In March, Secretary Pete Buttigieg announced that the DOT will be reviewing the top 10 U.S. airlines’ privacy policies to see how well they protect passengers’ personal information and whether or not they are “unfairly or deceptively monetizing” or sharing that data with third parties.

How do I opt out?

If you’d rather not have your data used by marketers seeking to serve you targeted ads, you can opt out.

Customers who wish to do so can request that United stop using their information by filling out this form.

Residents of all 50 states can request to opt out, but United passengers who live in California, Colorado, Connecticut, Virginia and Utah live in states with laws that may provide specific, additional privacy protections.

See more information about United’s privacy policy on the airline’s website.

https://thehill.com/homenews/nexstar_media_wire/4714793-united-is-rolling-out-targeted-in-flight-ads-what-to-know-and-how-to-opt-out/