October 04, 2022

Good morning, Vitals readers. Today's newsletter is 995 words or a 4-minute read.

1 big thing: Nursing homes and home health providers plead their case

Illustration: Annelise Capossela/Axios

Long-term care and home health providers are ramping up pleas for financial relief in a year-end congressional spending deal, testing their influence against other health interests trying to tuck favorable provisions in the must-pass bill, Axios' Victoria Knight and Arielle Dreher report.

Why it matters: The wrangling over health care "extenders" is an annual rite, but there are higher stakes this year due to labor and supply chain issues and the after effects of the pandemic.

  • Nursing homes accounted for nearly one-quarter of COVID-19 related deaths in the U.S and were targeted for reforms in President Biden's State of the Union address. But the industry is a vital cog in the health care system, caring for more than 1.4 million residents, as well as discharged hospital patients.
  • Demand for home and community-based care surged during the pandemic, but a severe shortage of workers is threatening the option, even for people who have the financial means, per the Washington Post. Almost 5 million patients received home health services in 2017, per the Centers for Disease Control.
  • Big home health companies like Amedisys, LHC and Aveanna that were poised to benefit from a shift to more in-home care could be hit by a steep proposed Medicare payment cut for 2023.

Where things stand: Congress has punted key funding decisions to the "lame duck" session, and Democrats have resisted repurposing unspent COVID-19 funds from earlier relief packages.

  • Nursing homes say there will be closures without reliable government funding as the industry grapples with negative margins and a median occupancy rate around 77%.

The bottom line: With a pileup of health spending requests packed into a post-election session, the industries will be vying with doctors, hospitals and other provider groups for year-end gifts.

  • "December is going to be a mess," said Raymond James analyst Chris Meekins.

Read the rest.

2. Geographic mismatch of caregivers

States in the Southeastern U.S. have the highest percentage of adults with conditions that interfere with daily activities like dressing or getting around — and the fewest personal care aids per capita to help them, according to a study in Health Affairs.

Why it matters: There's already a well-documented dearth in the provider workforce, but the findings show how a geographic mismatch is leaving needs unmet — particularly in rural areas.

The details: The study, led by the University of California, San Francisco, found the number of adults with self-care disabilities were highest in the South, as well as parts of Maine, the Pacific Northwest, and New Mexico, ranging from 3.9% to 8.7% across the U.S.

  • Meanwhile, the states with the lowest number of personal care aids per 1,000 adults with a self-care disability were mostly southern, including Mississippi, Alabama, Georgia, Florida, North and South Carolina, Arkansas, Oklahoma, Tennessee and Kentucky.

What they're saying: The authors listed possible remedies including increasing wages and benefits, improving training and career development options, adding flexibility to state Medicaid waiver programs to pay family caregivers for providing personal care services and providing incentives and compensation for travel.

3. FTC examining options for PBM regulation

Photo illustration: Sarah Grillo/Axios. Photo: Graeme Jennings-Pool/Getty Images

The Federal Trade Commission is considering all its tools, including law enforcement or market-wide rulemaking, as it scrutinizes the business practices of pharmacy benefit managers, FTC chairwoman Lina Khan said on Monday, according to Endpoints News.

What she's saying: "One of the key parts of that revisiting is taking a fresh look at how we approach vertical mergers in particular," Khan told the National Community Pharmacists Association convention, per Endpoints.

  • "I think there have been all sorts of instances in which enforcers have allowed deals to go through and then realize that many of the benefits or efficiencies that were promised didn't actually end up manifesting."
  • The FTC is teaming up with the Justice Department to revise its guidelines that identify whether mergers are legal or illegal, she said, according to the report.

The context: While PBMs have been under fire from the hospital and drug industry for years, Congress and the FTC have been turning up the heat in recent months.

  • As Axios' Adriel Bettelheim previously reported, over the summer, the FTC unanimously voted to launch a probe into the business practices of PBMs and how they influence drug prices and the pharmacy business.
  • They said they would require the six biggest PBMs — CVS Caremark, Express Scripts, OptumRx, Humana, Prime Therapeutics and MedImpact Healthcare Systems — to turn over information and records.

4. Data du jour: Transgender disabilities

Transgender adults have a 27% chance of reporting they have at least one physical disability at 20 years old and a 39% chance at 55 — nearly twice as high as people who identify with their birth sex, Axios' Oriana Gonzalez writes, according to new research in Health Affairs.

Why it matters: The threat of discrimination can lead patients to avoid seeking care, said author Madeleine Smith-Johnson, a doctoral student at Rice University's sociology department.

  • Some health providers may decline to care for trans people, citing religious or moral beliefs.
  • Scholars have found a link between stigma and stress that leads to negative health outcomes.

Details: The study looked at a sample from the Behavioral Risk Factor Surveillance System, a CDC telephone survey administered by state health departments.

  • Overall, 30% of trans adults in the sample reported higher rates of physical disability, compared to 24% for cisgender women and 18% for cisgender men.
  • As age increases, transgender people are nearly twice as likely to report a disability than cisgender men. They're also more likely to have a disability than cis women.

5. Catch up quick

📉 Bluebird Bio may have two of the world's "most expensive" approved gene therapy drugs on the market, but the company's financial future is uncertain. (Wall Street Journal)

🚨 Leading medical groups called on U.S. Attorney General Merrick Garland Monday to investigate growing threats of violence against children's hospitals for offering gender-affirming care. (Axios)

💰 UnitedHealth and Change Healthcare completed their $13 billion merger after overcoming DOJ challenge. (Modern Healthcare)

Medicare Advantage plans may shorten nursing home stays to less time than Medicare covers – and less than providers recommend. (KHN)

👋 Thanks for reading, and extra thanks to senior editor Adriel Bettelheim and senior copy editor Bryan McBournie for all the edits. Please ask your friends and colleagues to sign up.

🎧 Hear the story of Elon Musk's meteoric rise — and why it matters for us all if he takes over Twitter — on the newest season of Axios podcast "How it Happened: Elon Musk vs. Twitter." Listen to episode two tomorrow and subscribe here.