Axios

Pope Francis criticized both former President Trump and Vice President Kamala Harris as being "against life" given their respective stances on migration and abortion.

Why it matters: American catholics will need to decide who is the "lesser evil" when casting their votes in the November election, the AP reported the pope as saying.

Boar's Head is shutting down the Jarratt, Va., plant at the center of a deadly listeria outbreak, the company announced Friday.

The big picture: At least 57 people have been hospitalized across 18 states and 9 deaths have been reported in connection to the largest listeriosis outbreak since 2011, according to the Centers for Disease Control and Prevention.

Yes, hospitals are closing around the country, but even more often, hospitals shut down specific services, especially relatively unprofitable ones like maternity care and behavioral health care.

• This leads to what gets referred to as "care deserts," which we covered earlier this week.

Why it matters: Closures may not be all bad, but most of them ultimately make it harder for patients to access care — and some patients are more likely than others to be impacted.

Where it stands: Many experts will tell you that all hospitals can't be all things to all people amid the U.S.'s demographic changes and care advancements, and some argue the closure of some hospitals or services actually has some positive outcomes in terms of efficiencies or quality.

• But a big problem is that hospitals are responding to the financial incentives created by both government and private insurers, and those incentives aren't always aligned with what society writ large wants from a hospital.
• They're also stacked against providing care to certain patients, especially poor ones.

"Think of hospitals not as a charity, but as a business. Imagine anyone running a business. You have options, multiple products; you want to prioritize the products that bring you the highest margin, and you want to get rid of the products that bring loss," said Johns Hopkins professor Ge Bai.

• "I think the business objectives are not aligned with the societal objectives," she added.

The big picture: The issue of specific unit closures is particularly acute within rural settings, although service line closures happen across all hospital types.

• "What it comes down to is really a numbers game. Rural hospitals and the patients they are serving have the decks stacked against them," said Char MacDonald, EVP of public affairs at the Federation of American Hospitals.

The most impacted units include, experts say, labor and delivery/maternity care, psychiatric departments, substance use disorder treatments, pediatric, and — counterintuitively — emergency departments.

• "I think if you ask somebody what a hospital is that doesn't deliver babies or doesn't have an emergency department, then many people would say that's not a full hospital," said Christopher Whaley, a professor at Brown University.

Between the lines: Different kinds of care are reimbursed at different rates by different payers, and that makes providing some care to some patients more lucrative than others.

• Commercial insurance pays more than Medicaid, and imaging centers, for example, generally generate much higher profits than psychiatric departments, which aren't well reimbursed even by private payers.
• Some hospitals also blame private plans' unwillingness to pay for the full cost of services and procedures and Medicare Advantage prior authorization policies.

And some services are low-margin because of the populations they tend to attract: For example, about four in 10 U.S. births are covered by Medicaid, and more than half of U.S. children are insured by Medicaid and the Children's Health Insurance Program.

• Lo and behold, obstetrics, pediatrics, and psychiatric care are services that tend to get cut.
• "If you're trying to improve profitability, what you really want to do is reduce Medicaid patient volume," Whaley said.

The intrigue: Hospitals are required to care for any patient that comes into an emergency room — a rule directly related to the closure of EDs, some experts told me.

• "If you don't have an emergency department, you don't have those same obligations to treat Medicaid patients," Whaley said. But "women with Medicaid need to deliver their babies, and children with Medicaid need pediatric care, and by these sort of selective closures, we're imposing pretty substantial gaps in care among vulnerable patient populations."
• "It's all about balancing. You've got services that are high margin and services that are low margin … emergency rooms are very expensive to keep open and we underpay for emergency services," MacDonald said.

Yes, but: Hospital unit closures don't necessarily cut off access completely, especially in a world where more and more care is moving to outpatient settings.

• Patients still have alternate sites of care in many cases, experts said.

Yes, hospitals are closing around the country, but even more often, hospitals shut down specific services, especially relatively unprofitable ones like maternity care and behavioral health care.

• This leads to what gets referred to as "care deserts," which I wrote about earlier this week.

Why it matters: Closures may not be all bad, but most of them ultimately make it harder for patients to access care — and some patients are more likely than others to be impacted.

Where it stands: Many experts will tell you that all hospitals can't be all things to all people amid the U.S.'s demographic changes and care advancements, and some argue the closure of some hospitals or services actually has some positive outcomes in terms of efficiencies or quality.

One of the most documented trends is the closure of obstetrics departments. But counter to the conventional wisdom, some research shows that women may get better care after such closures.

• One paper published in Health Services Research earlier this year found that after an obstetric unit closure, the physicians relocated to a new hospital less than 20 miles away and used aggressive birth interventions — like C-sections — less often.
• "In the same way we shouldn't assume a service line shutting down is, on net, a bad thing, we also can't assume that we should throw resources to prop up every service line at every place. There may be opportunities to do something lower cost and better," said Michael Richards, an author of the paper and director of the Sloan Program in Health Administration at Cornell.

The CDC is out with new data on the prevalence of obesity by state last year, including for different races and ethnicities.

Why it matters: There are stark racial disparities among obesity rates. Watch to see how closely these disparities are reflected in who gets access to new anti-obesity treatments.

The big picture: The obese patient population has grown rapidly: Last year, at least 35% of the adult population had obesity in 23 different states. Before 2013, there weren't any states with an obesity prevalence at or above 35%.

A sampling of the tabs I opened this week:

• 💰 Private equity is shifting away from health care services — aka providers — toward health care IT, which is expected "to play a growing role in healthcare PE portfolios over the next few years," per a PitchBook report.
• 🩺 Patients are already turning to AI chatbots for medical advice and information, potentially at a rate underestimated by experts, the NYT reports from a KFF survey.
• 🏥 I wanted to, but ultimately did not, find something smart to say about Vice President Harris' talk about tackling medical debt. On the other hand, Stat News' Rachel Cohrs Zhang did, reporting that hospitals could make billions off of the initiative if North Carolina is any indication.

I recently zoomed with Aengus Tran, CEO of Harrison.ai. He was in ... Sydney, Australia. I was in Northern Virginia. You tell me which is cooler.

• Harrison.ai is working on making AI models that can read and interpret medical imaging. In his words, "The AI is like a spell checker for radiologists."
• One thing he said that caught my attention: When it comes to regulatory approvals, "The pace of clearing technology in the U.S. is significantly slower than the rest of the world."

We did our questions. You know the drill by now:

Q: What is transformative about what you are working on?

It is one of the, in my mind, one of the few and only solutions that can solve the capacity constraint in diagnostic medicine by using the AI as the scaling factor … we can't solve that by just training more doctors and radiologists. That would just take too long.