Leigh Vinocur, MD, MS, FACEP

Endpoints News summarizes some of the findings by the #FTC report om #PBMs that came out this morning. While disappointed that no anti-trust action is being taken - the FTC report is described as an "interim" product. It lists many of the PBM actions that are raising prices for the system and patients alike, and driving independent pharmacies out of business, all for the sake of profit. It is stated that more scrutiny and investigations are warranted. As expected the FTC is not getting much information from the big 3's rebates aggregators (GPOs) 2 of which are off shore. This not surprising as it appears these may have been created in response to much of the legislation that is demanding transparency. Let's hope that anti-trust actions will be taken by the FTC in the future.

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Anyone else just swallow another healthcare cost increase in choosing benefits this month? This newly released NEJM Catalyst article is timely https://lnkd.in/exWdtwZq. Improving affordability is broadly seen in the U.S. as our #1 healthcare policy issue. Mark McClellan offers great insights here. Ultimately, without inappropriately stifling the juggernaut of tech innovation, we need to be laser focused on achieving the quintuple aim through new processes AND tech (and some appropriate gov regulation) that address this elephant in the room of massive expense. There are few studies that have shown such promise more than the hospital at home care model. Acute care alone constitutes over half of all Medicare costs. The opportunity is real. We at the Hospital at Home Tech Council are working diligently with partners to ensure that we build and enhance current/emerging tech (POC diagnostics, RPM, virtual visits, supply chain, etc) to leverage this opportunity to achieve the quintuple aim. Please join with us! And if you're heading to HLTH Inc. conference next week, ping me to connect on this topic. #patientsfirst #healthcareaffordability #healthcarepolicy #hospitalathome #healthcaretech #futureofheatlhcare #poc #diagnostics #remotepatientmonitoring #supplychain #nejm

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My next Signal takes a closer look at the latest antitrust probe into large dialysis companies and the shifting role of non-competes in kidney care. A recent POLITICO article provides helpful background around topics like NCAs in dialysis and impacts on the adoption of home dialysis technologies. This is an important discussion, so I'd love to hear from you. If you have something you'd like to share, whether it's an anecdote, comment or question for other readers, please leave a comment or send me a message. H/t to Tom Mueller for sharing the article last week. https://lnkd.in/e95a23JF

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🚨 Unmasking the Real Culprits: How PBMs and Insulin Manufacturers Drive Up Healthcare Costs, Not Physicians 🚨 A recent article in Politico sheds light on a significant lawsuit unfolding in federal court, involving major pharmacy benefit managers (PBMs) and insulin manufacturers. Eighty states, cities, counties, school boards, and unions are part of the case against CVS Caremark, Express Scripts, OptumRx, Eli Lilly, Novo Nordisk, and Sanofi. Allegations of a "multibillion-dollar price-fixing scheme" lie at the heart of the lawsuit. Local governments claim they were overcharged for insulin due to hidden payments and mislabeling of rebates by PBMs, violating contracts and depriving them of negotiated rebates that could lower costs. The outcome of this litigation could have a profound impact on healthcare costs, especially for millions of Americans with diabetes dependent on insulin. A favorable ruling could pave the way for more transparent pricing and potentially lower insulin prices, alleviating financial strains on patients and insurers. While PBMs and insulin manufacturers argue that counties were aware of the rebate system, the case continues with ongoing discovery, leaving the timeline for a ruling uncertain. This lawsuit has the potential to reshape pharmaceutical pricing and healthcare costs nationwide. Stay informed for further updates on this evolving situation! 💼💊 #Healthcare #Insulin #Litigation #PharmacyBenefitManagers #CostContainment https://lnkd.in/gSCXnTur

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Enjoyed joining Adam Conover on the Factually! podcast to discuss the health, economic, and cultural effects of the new GLP-1 drugs. Tune in below if interested!

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Out today in JAMA Health Forum, Wayne Winegarden and I envision 340B reform that follows the patient instead of going directly to the institution: https://lnkd.in/gnt6hC6i Imagine if SNAP funds went to restaurants and grocery stores instead of beneficiaries, or if TANF funds went to banks instead of beneficiaries. The 340B program should fund patients, not institutions. If patients controlled the powerful discount, hospitals would need to provide services that attract those patients. This approach would curb program abuse and reduce the $54 billion in annual rents extracted by large hospital corporations. These rents are passed on to the public through increased insurance premiums, the drawdown of the Medicare trust fund, and inflated pharmaceutical costs. Cutting back on abuse would benefit everyone. We must shift our mindset in healthcare. Funding institutions with massive subsidies has only led to a large, consolidated, sclerotic system. By funding patients instead of institutions, we allow the end-users of healthcare services to direct where those funds are applied, promoting quality and efficiency through market forces. Most importantly, this approach prioritizes patients. Isn't that who healthcare is meant to serve? Meanwhile, the hospital industry insists they need #340B subsidies to maintain operations. Does that include starting a film studio? Northwell Health, a 340B entity, is going to be producing its own movies and TV shows: https://lnkd.in/gnsmJdWk When I testified on 340B in front of the House Committee on Energy and Commerce, the argument in favor of 340B kept coming back to: hospitals need the subsidy! Look at all these great things we are doing with your money! They forgot to mention they were purchasing a movie studio. So, you are paying more for pharmaceuticals due to 340B exploitation. You are paying more for insurance premiums due to 340B exploitation. And in return, the health system is focusing on its mission of providing high-quality entertainment... Maybe it's time to rein in the 340B abuse? Adam Fein Deborah Williams Tom Romeo, MPH Mercatus Center at George Mason University Stand Together John Strom Colin Yokanovich Peter Stein Joanne Spetz William Sarraille Jesse Ehrenfeld MD MPH

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Healio had the pleasure of speaking with Clyde Yancy, one of the most prominent KOLs in #cardiology, on a variety of topics at the American College of Physicians Internal Medicine Meeting. Check out a summary of what he told us below, at the bottom of which there are links to six videos that he shot with us. Northwestern University - The Feinberg School of Medicine The topics he discussed include: ❤️ Cardio-kidney-metabolic syndrome ❤️ Social determinants of health ❤️ The heart-related benefits of the newer weight-loss drugs ❤️ The promise of small interfering RNA technology in heart care ❤️ Using incidental calcification findings to assess heart disease risk ❤️ The benefits of following the American Heart Association's Life Essential 8 lifestyle parameters https://lnkd.in/egv_RtGp

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I’m thankful that I could share my thoughts at that very hearing. There is so much misinformation about 340B. For me, it comes down to two main points: 1- if hospitals need that money as a subsidy to fund everyday activities, they should just ask for a subsidy. Let’s open up the books of these institutions, which already get a huge subsidy with their non-profit status, and see why they are running in the red. Are they really losing money on Medicaid patients or are they just bloated and inefficient? 2- let the subsidy follow the patient. This is a drug benefit program. Why does the funding go to an institution? Imagine if we did that with SNAP, giving a bunch of money to large restaurant chains in exchange for their promise to use the revenue to provide food for poor people (with no oversight to ensure that’s done). We don’t do that; instead we give the benefit to the person who needs it. Let’s change 340B to match that model. Adam J. Bruggeman, MD, MHA, FAAOS, FAOA Daniel Choi Colin Yokanovich John Strom Peter Stein Adam Fein Deborah Williams Lisa Grabert Maya Babu, MD, MBA Katie Orrico Larry Bucshon, M.D. Ann M. Richardson, MBA

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If you subscribe to Ambulatory Surgery Center News, you'll find this story from Audrie Martin, M.A. leading your weekly newsletter today. It's a great example of the original, in-depth reporting you'll get regular access to from ASC News: https://lnkd.in/gHyKGzPR Here, Audrie explores some of the most prominent regulatory and legislative topics shaping the #AmbulatorySurgeryCenter market in 2024. How will the ban on #noncompetes affect #ASCs? What would the elimination of facility fees mean for operators? These are just some of the areas ASC News examines. Subscribe here 👉 https://lnkd.in/gea4nj6M

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I had the pleasure of joining Dian Griesel, Ph.D. on her incredible #podcast, and the episode is LIVE! I shared some of my story, insights, and wisdom that I hope you'll find inspiring and actionable. Tap the link below to listen in - and don't forget to share your thoughts! https://buff.ly/3MT8hUt

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State Attorney Generals team up for a $4.5 million settlement. Another interesting investigation that exposed an organization's failure to monitor employee login credentials. In this case, Enzo Biochem, Inc. agreed to adopt more stringent cybersecurity measures to include establishing stronger password policies and conducting annual risk assessments. Some organizations view the risk assessment process as a one and done. Although the HIPAA Security Rule does not mandate annual risk assessments, I always recommend these assessments be conducted yearly. A lot can change in an organization within a year such as employee turnover, new technologies getting implemented, and ownership changes. If your organization needs to conduct an accurate and thorough HIPAA Security Risk Assessment, give our office a call at 844-740-7100 to schedule this regulatory requirement.

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I was honored to be on this great panel discussion, led by Jamy Ard, alongside Lydia Alexander, MD, DABOM, DACLM, MFOMA, Daniel Bessesen, and Sean Hashmi, MD, MS, FASN to discuss the use of #obesity medications in the era of #GLP1 agonists. This was a great discussion, covering important topics such as: How GLP-1s have changed clinical practice, health systems, and society as a whole Whether GLP-1s should be first-line therapy for obesity Understanding the goals and target outcomes for obesity treatment Long-term effectiveness and safety The use of lifestyle therapy The cost and coverage of GLP-1s Check it out here: https://lnkd.in/gadkSAQb

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Uhhhh, if we simply used advanced primary care (DPC, On-site/near-site clinic, VPC) we would not need as many (PE backed) hospitalists staffing the Emergency Rooms. This should not be a difficult issue to resolve. #highperformance #healthcare https://lnkd.in/gkYkPQt8

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Health insurance companies Medicare Advantage plans subsidy and premium based EBITDA and Profits can only be guaranteed and expanded by taking from the physicians who manufacture preventive, medical, surgical and palliative outcomes with their patients and also taking from the hospitals in which clinical outcomes are manufactured and produced. #quadrupleaim, #medicare #medicareadvantage #healthcarecosts

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Full Medicaid expansion needed to retain Georgia’s physicians Georgia was ranked 5th worst place to practice in a recent Medscape article (“Best and Worst Places to Practice 2024”), using five criteria: physician compensation, cost of living, malpractice premiums, the health of the state’s residents, and physician burnout levels. As current and future physicians and health advocates, this column will add context by detailing our experiences practicing in Georgia. It is no surprise that three of the five worst-ranked states for practicing are among those that have not expanded Medicaid. In Georgia, refusal to expand Medicaid means that nearly 12 percent of residents (well over a million people) are uninsured, significantly limiting their access to healthcare. Only in Texas is coverage worse. Due solely to political concerns, Georgia chose to submit a Medicaid waiver and develop its own Medicaid expansion program, Pathways to Coverage. The governor’s office projected that the program would cover an additional 100,000 Georgians in its first year. But it has been an utter failure, with fewer than 3,500 covered at a cost to taxpayers of $26 million. Full Medicaid expansion would have added over 350,000 Georgians while cutting state spending by $710 million. These three states that refused to expand Medicaid are not surprisingly red. It is also unsurprising that the states with the greatest percentage of unhealthy residents are red. Hopefully, Georgia who thought they had a better way of expanding access to care with their own plan that squandered $26 million to cover 3,500 residents will realize that retaining physicians requires a more sensible approach to expanding access to care. #expandinghealthacess, #accesstocare, #limitingcoveragetoresidents https://lnkd.in/eefqH-9Y

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1/ Weight loss drugs like Ozempic & Wegovy are more popular, but most physicians haven't been trained to use them https://lnkd.in/e5W4CHbe with CBS News' @AMGreenCBS 2/ Patients need to be monitored for side-effects, such as nausea, vomiting, diarrhea, and abdominal pain, which could be symptoms of serious conditions like pancreatitis or gastroparesis (i.e. stomach paralysis). They should also have regular blood work including blood glucose & kidney function tests. 3/ If a patient's side-effects aren't well managed, they may get discouraged & stop taking the medication, which means that whatever weight they've lost, they're likely to put back on. 4/ If people can't stay on these meds long enough to accrue the long-term health benefits (e.g. reduced risk of cardiovascular disease & stroke, reduced risk of chronic kidney disease), insurance companies may be less likely to cover them.

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We are finally getting some answers ladies!!!!! We now know insulin resistance develops due to decreased levels of estrogen in peri/postmenopausal women! Insulin resistance makes it harder to use sugars/ carbs as immediate energy and stores more as fat! For so many years women have been told to accept it, eat less, workout more, try this try that blah blah blah, or to just accept it. But we know central obesity leads to metabolic syndrome, cardiac and lipid disorders so how can we keep telling women to accept it! Well research is here and we do have medications to treat it of course lifestyle and diet changes help, but if you want a medication to kickstart your weight loss there are options! Metformins been around for years well tolerated, affordable, well studied, and now is being studied even further for not only its effects in menopausal weight loss but also longevity medicine. Metformin seems to have antinflammatory effects that are cardiovascularly beneficial! https://lnkd.in/gH5q7W_y

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There's a lot to unpack in this 2023 snapshot of obesity rates in the US. Further monitoring and investigation is needed to fully understand the causal impact of GLP-1s, the effects on cardiovascular risk and long-term health, the extent of rebound weight gain after discontinuation, and a wider range of appropriate use cases across cardiometabolic health. #obesity #glp1 #healthcareonlinkedin

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