Court Ruling Brings an End to Proposed New Jersey Hospital Merger

April 19, 2022 - The tides appear to be changing with regard to healthcare mergers and acquisitions in both federal courts and the court of public opinion. 

Interoperability Holding Back Healthcare Digital Transformation

A Morning Consult of 75 US healthcare executives found that while 95 percent of healthcare executives were intending to transform their business digitally, many are dealing with a crisis related to data readiness, with 97 percent calling for more healthcare data interoperability.

Data readiness is also key to unlocking the full potential of artificial intelligence (AI) in healthcare, according to the report. Healthcare executives expect to see AI have a large impact on care delivery in the next several years. About 60 percent of respondents expect it to impact clinical outcomes, and 17 percent said it would affect financial outcomes. In addition, 13 percent said AI would impact their operation outcomes, and 9 percent administrative outcomes.

The survey also shows that 61 percent of executives hope to bring about a complete digital transformation in their organizations within three to five years. The reason why this transformation has yet to occur is due to the lack of interoperability, one of three obstacles alongside financial issues and staff capacity. READ MORE

FDA Draft Guidance Takes Aim at Increasing Clinical Trial Diversity

FDA recently issued draft guidance to enroll more participants from underrepresented racial and ethnic populations in the United States into trials, expanding overall clinical trial diversity. 

READ MORE: Value-Based Care is Improving Chronic Disease Management

The draft guidance, “Diversity Plans to Improve Enrollment of Participants from Underrepresented Racial and Ethnic Subgroups in Clinical Trials,” recommends that sponsors of medical products develop and submit a Race and Ethnicity Diversity Plan to FDA early in clinical development.

Most recently, FDA’s 2020 data snapshot on diversity and inclusion among trials found that 75% of participants enrolled in trials were White. Among 32,000 patients participating in these trials, just 11% were Hispanic and less than 10% were Black or Asian.

Barriers to trial access may include mistrust of the clinical research system due to historical abuses, trial design, frequency of study visits, time and resource constraints for participants, transportation, and conflicts with caregiver or family responsibilities. READ MORE

Court Ruling Leads to Termination of Merger Plans for NJ Hospitals

New Jersey-based Hackensack Meridian Health and Englewood Health have terminated their hospital merger agreement after a federal appeals court blocked the deal from moving forward.

In March 2022, the US Court of Appeals for the Third Circuit ruled against the transaction, stating that the hospital merger would hurt competition and increase healthcare prices for consumers. Specifically, the ruling noted that the merger would have eliminated the incentive for Englewood Health to outperform Hackensack Meridian Health in hospital safety, patient experience, nursing recognition, and healthcare-associated infection rates.

READ MORE: Skilled Nursing Facilities Are Facing a Staffing Crisis

The hospital transaction also faced pushback from the Federal Trade Commission when the agency filed an administrative complaint in December 2020, alleging that the deal would hurt competition. If the transaction had been finalized, the merged health system would have controlled three of the six inpatient general acute care hospitals in Bergen County, New Jersey.

In their recent motion to dismiss, Hackensack Meridian Health and Englewood Health requested that FTC dismiss its complaint as the health systems are no longer proceeding with the merger deal. READ MORE

New Data Reveals Gaps in Preventive Screenings Among Cancer Survivors

Breast cancer survivors have shown low adherence to preventive screenings like annual mammograms, a trend that has been developing over the last several years, according to new research from the Journal of the National Comprehensive Cancer Network.

Between 2009 and 2016, the annual mammography rates declined by 1.5 percent per year, with the lowest adherence showing in breast cancer survivors under 50 years old.

Annual mammography rates were approximately 70 percent from 2004 to 2009 for survivors between 40 and 49, but those rates slipped to 57 percent by 2016. This finding is particularly concerning given that missed preventive screening can have severe implications on patient outcomes, especially for younger patients who are more likely to develop aggressive tumors and also have a longer remaining life expectancy, the researcher noted.

READ MORE: Largest Hospital Networks Fail Price Transparency Tests

For survivors between ages 50 and 64, nearly 74 percent were getting annual mammograms from 2004 to 2009, but the rate dropped to 57 percent by 2016. READ MORE

Florida Physician Group Settles Allegations of Telehealth Fraud and Abuse

Physician Partners of America (PPOA) and two of its leaders will pay $24.5 million to resolve allegations that they fraudulently billed federal and state healthcare programs for unnecessary medical services, including some conducted via telehealth, the Department of Justice (DOJ) announced.

The United States and the state of Florida alleged that from April 1, 2020, through Nov. 8, 2021, the medical group — which provides care for a wide array of musculoskeletal pain conditions — submitted false claims to the Medicare, Veterans Affairs, and Medicaid programs for medically unnecessary evaluation and management (E/M) telemedicine services, thereby violating the False Claims Act.

The telemedicine visits occurred after non-emergency medical procedures were paused statewide on March 20, 2020. The US and the state of Florida further alleged that PPOA physicians subsequently scheduled telehealth appointments every two weeks "regardless of patient need." READ MORE

Expiration of ARPA Tax Credits Could Lead to 3M Uninsured

The uninsured population may increase by more than 3 million if policymakers do not extend the premium tax credits under the American Rescue Plan Act (ARPA), according to an Urban Institute issue brief.

ARPA introduced premium subsidies for individuals and families on the Affordable Care Act (ACA) marketplace. The legislation also expanded eligibility for these subsidies to individuals and families with incomes higher than 400 percent of the federal poverty level (FPL).

The premium tax credits allow enrollees with incomes below 150 percent of FPL to receive silver health plan coverage at no cost. The ARPA subsidies led to a record increase in Marketplace enrollment, with 5.8 million new enrollees signing up for coverage during the 2022 open enrollment season.

The premium subsidies under ARPA are currently set to expire on December 31, 2022, which may lead to significant coverage losses for many Americans. READ MORE