Revised CMS Scores Yield Extra $200M In Bonus Payments For Centene
Centene told investors Tuesday that the company would get additional bonus payments after CMS updated its Medicare Advantage Star Ratings. More health industry news stories report on legal settlements, layoffs, private equity investments, and more.
Modern Healthcare:
Centene Nets $200M In Medicare Advantage Star Ratings Win
Centene will gain $200 million in additional Medicare Advantage Star Ratings bonus payments next year after the Centers for Medicare and Medicaid Services revised its scores, CEO Sarah London told investors Thursday. The updated metrics also awarded Centene its lone four-star contract for 2025. The health insurance company nevertheless continues to pursue its lawsuit challenging the CMS' administration of the quality incentive program. (Tepper, 12/12)
Modern Healthcare:
OptumHealth Backs Out Of 'Dummy Code' Settlement With Aetna
OptumHealth has pulled out of its agreement to settle a class-action lawsuit alleging the company and Aetna used a "dummy code" to inflate workers' medical expenses. The UnitedHealth Group subsidiary withdrew from the agreement after "it became clear that Optum's understanding of one of the negotiated terms was inconsistent with the understand of the Settling Parties," according to a Dec. 6 notice filed with the U.S. District Court for the Western District of North Carolina. Aetna remains in agreement with the settlement made in November, according to the filing. (DeSilva, 12/12)
The Washington Post:
Cedar Hill Execs Are Amending Deal With Physicians For New D.C. Hospital
Executives in charge of a hospital set to open in Southeast Washington next spring said Thursday they have not yet finalized an agreement with the large physicians’ group that is set to staff Cedar Hill Regional Medical Center GW Health. The hospital’s corporate parent and the doctors’ practice signed a deal to provide medical and specialty care at the hospital in 2021 but are amending it to ensure that dedicating 160 clinicians to Cedar Hill will not further imperil the cash-strapped practice overall. (Portnoy, 12/12)
Modern Healthcare:
Masimo Layoffs To Hit 75 Employees In 2025
Patient monitoring company Masimo is laying off 75 employees next month at its Irvine, California, location. The company filed a Worker Adjustment and Retraining Notification in November, which said the layoffs would take effect by Jan. 13. (Dubinsky, 12/12)
Modern Healthcare:
Why Private Equity Investment In Healthcare May Rise In 2025
Private equity investment in healthcare is expected to pick up in 2025 but still fall short of the highs of 2021, merger and acquisition advisers said. Private equity-linked healthcare transaction volume is poised to rebound after a sluggish 2024 as interest rates cool, state-led oversight bills lose momentum and a new presidential administration begins. Corporate investors will likely prioritize deals that involve healthcare information technology and other administrative support services over physician practices, industry observers said. (Kacik, 12/12)
KFF Health News:
Removing A Splinter? Treating A Wart? If A Doctor Does It, It Can Be Billed As Surgery
When George Lai of Portland, Oregon, took his toddler son to a pediatrician last summer for a checkup, the doctor noticed a little splinter in the child’s palm. “He must have gotten it between the front door and the car,” Lai later recalled, and the child wasn’t complaining. The doctor grabbed a pair of forceps — aka tweezers — and pulled out the splinter in “a second,” Lai said. That brief tug was transformed into a surgical billing code: Current Procedural Terminology (CPT) code 10120, “incision and removal of a foreign body, subcutaneous” — at a cost of $414. “This was ridiculous,” Lai said. “There was no scalpel.” He was so angry that he went back to the office to speak with the manager, who told him the coding was correct because tweezers could make an incision to open the skin. (Rosenthal, 12/13)
KFF Health News:
Watch: 'Going It Alone' — A Conversation About Growing Old In America
KFF Health News’ “Navigating Aging” columnist, Judith Graham, spent six months this year talking to older adults who live alone by choice or by circumstance — most commonly, a spouse’s death. They shared their hopes and fears, challenges, and strategies for aging solo. Graham moderated a live event on Dec. 11, hosted by KFF Health News and The John A. Hartford Foundation. She invited five seniors ranging in age from 71 to 102 and from across the country — from Seattle; Chicago; Asheville, North Carolina; New York City; and rural Maine — to talk candidly about the ways they are thriving at this stage of life. (12/12)
In pharma and tech news —
Stat:
AbbVie Drug Offers Hope Against A Persistent Form Of Leukemia
Brian Koffman found himself in a situation a couple years ago that most chronic lymphocytic leukemia patients eventually do: relapse. The expectation in CLL is that, no matter what therapy or how many therapies patients have been on, the cancer will eventually recur if the patient lives long enough. The hope is that by that time, there will be yet another treatment to try. But Koffman, after relapsing or refracting from targeted therapies, immunotherapies, and bone marrow transplant, had just about run through all the options. (Chen, 12/13)
Stat:
Editas Medicine Lays Off 65% Of Staff And Drops A Sickle Cell Program
Editas Medicine said Thursday afternoon it will lay off 65% of its staff — around 180 employees — as it shelves its lead gene-editing program for sickle cell disease and shifts focus. (Mast, 12/12)
Stat:
Tuberculosis R&D Funding Is Up, But Still Falls Short Of Goals, New Report Finds
Although research and development funding for tuberculosis reached new heights last year, the total fell substantially short of goals set by the United Nations and most of the increase came from just two organizations, according to a new report. (Silverman, 12/13)
AP:
Some Breast Cancer Patients Can Avoid Certain Surgeries, Studies Suggest
Some early breast cancer patients can safely avoid specific surgeries, according to two studies exploring ways to lessen treatment burdens. One new study, published in the New England Journal of Medicine, examines whether removing lymph nodes is always necessary in early breast cancer. Another in the Journal of the American Medical Association suggests a new approach to a type of breast cancer called ductal carcinoma in situ, or DCIS. The research was discussed Thursday at the San Antonio Breast Cancer Symposium. (Johnson, 12/12)
