Aug 26, 2020

Axios Vitals

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Today's word count: 921, or a 3-minute read.

1 big thing: What's at stake for the FDA

FDA commissioner Stephen Hahn and President Trump. Photo: Chip Somodevilla/Getty Images

The uproar over the FDA's authorization for the use of convalescent plasma in coronavirus patients is only partially about convalescent plasma. It's also about a vaccine that doesn't exist yet, and trust in the FDA's eventual stamp of approval.

Driving the news: The FDA is defending itself on both fronts.

  • Peter Marks, who leads the relevant division within the FDA, said at a news conference yesterday that the evidence of plasma's effectiveness "more than adequately met" the standards for emergency use, noting that there is little question about its safety, per the Wall Street Journal.

And FDA commissioner Stephen Hahn, in an interview with Bloomberg's Drew Armstrong, owned up to a mistake in how he described the effectiveness of convalescent plasma while also addressing bigger-picture concerns about the FDA's independence.

"Yeah, I'm aware of it. I've listened to all the conversations," Hahn told Bloomberg when asked about political pressure. "But what I tell internally our folks is they need to make the decisions based upon the data. I have not reversed one of their decisions, nor do I intend to unless I think it's absolutely wrong."

  • Hahn also said he wasn't present when White House economic adviser Peter Navarro berated FDA officials as members of the "Deep State" and told them to "get on Trump Time."
  • He said he "would not participate in any decision that was made on anything other than the science."

The whole interview is worthy of your time.

2. Private equity's hospital profits

Illustration: Aïda Amer/Axios

Hospitals owned by private equity firms rake in almost 30% more income than hospitals that aren’t, according to new research published this week in JAMA Internal Medicine.

Why it matters: Private equity is gobbling up more and more of the health care industry — including physicians’ practices, hospitals, ambulances, standalone ERs and the firms that negotiate prices with insurers.

By the numbers: Three years after their acquisition, private equity-owned hospitals were bringing in about $2.3 million per year more in income than a control group of hospitals that weren’t acquired, according to the study.

  • Their total charges per inpatient day were about $400 higher, on average, and they saw a bigger gap between their costs and the prices they charged.

Between the lines: Hospitals' charges often don't reflect the rates they actually get paid by insurance plans, but it's safe to assume that higher charges typically translate into higher payments. And uninsured patients often have to pay the entire sticker price.

Hospitals recorded a sicker overall patient population after they were acquired, which could suggest that they're upcoding in search of higher reimbursements, the study’s authors wrote.

  • Acquired hospitals saw some improvement on certain quality metrics, though the authors say that may be a product of "better adherence to compliance standards or efforts to maximize opportunities for quality bonuses under pay-for-performance contracts."

The bottom line: It's no big surprise that hospitals' profit margins would spike once they're taken over by a private equity firm. That's the whole point.

  • But this is just one slice of the market forces driving up the cost of care.
  • Hospitals are consolidating and snapping up doctors' practices even when they're not under private equity's umbrella, and private equity is buying up far more than just hospitals.

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3. Black Americans more wary of COVID vaccine
Data: Axios/Ipsos poll; Note: 1,084 U.S. adults were surveyed between Aug. 21-24, 2020 with a ±3.3% margin of error; Chart: Sara Wise/Axios

Black Americans are less likely than white Americans to say they plan to get a flu vaccine this year, and significantly less likely to say they'll take a first-generation coronavirus vaccine, according to numbers from the latest edition of the Axios-Ipsos Coronavirus Index.

Why it matters: Black Americans have suffered disproportionately from COVID-19, which means they also stand to benefit from a successful vaccine.

  • But a legacy of medical mistreatment, systematic racism in health care and targeted efforts by anti-vaxxers means that a wide trust gap needs to be closed first, Axios' Bryan Walsh writes.

Details: 49% of Black Americans say they are somewhat or very likely to get a flu shot this year, compared 65% of white Americans and 60% of Hispanics.

  • Just 28% of Black Americans say they would be willing to do take a first-generation COVID-19 vaccine, compared to 51% of white Americans and 56% of Hispanics.

Context: During the 1930s, hundreds of Black men were recruited into what became known as the Tuskegee Syphilis Experiment, where doctors permitted the disease to progress without treatment.

  • A 2016 study indicated that Black patients were routinely under-treated for pain compared to whites patients.
  • Just 5% of active physicians identify as Black, compared to more than 13% of the total U.S. population.

The bottom line: "History absolutely plays a role as to why communities of color are hesitant to get the vaccine," says Patrice Harris, a former head of the American Medical Association. "We need to earn their trust."

4. "Long-haul" COVID can lead to big bills

Illustration: Aïda Amer/Axios

Some percentage of coronavirus patients experience symptoms that last well beyond their "recovery" — which can leave them on the hook for thousands in medical bills they may not be able to pay.

Insurers and the federal government have largely agreed to cover COVID-19 testing and treatment without cost-sharing.

  • But it's not clear whether those guarantees will still cover long-term health effects that stem from a COVID infection, as the Wall Street Journal notes.
  • And because some people never tested positive for the coronavirus, if they got sick back when testing was scarce, they don't have a formal diagnosis and their treatment isn't eligible for federal funds that cover the costs of treating uninsured coronavirus patients.
5. Opioid treatment programs fall short

Photo: Spencer Platt/Getty Images

More than 70% of residential treatment programs in the U.S. don't offer the medical standard of care for opioid addiction, a new report published in JAMA shows.

The big picture: Many facilities pushed clinically irrelevant therapies or outright discouraged widely accepted medication-based therapies, Axios' Marisa Fernandez writes.

By the numbers: Researchers called 368 programs posing as uninsured heroin users asking for care options.

  • Just 29% of facilities offered maintenance treatment with buprenorphine, while more than 20% discouraged the drug's use. 31% offered medication-assisted treatment, but only for short term "detox."
  • 92% offered some kind of 12-step programming. Many also offered group therapy.
  • Many also offered yoga, animal therapy or massage — therapies with little to no basis in evidence.