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What We're Reading: More Healthcare Mergers; Expedited FDA Review; $102M CMS Billing Issue
December 06, 2017 – AJMC Staff
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What We're Reading: More Healthcare Mergers; Expedited FDA Review; $102M CMS Billing Issue

AJMC Staff
Humana may also make an acquisition deal and UnitedHealth buys a unit of DaVita; a look at the FDA's expedited review programs; how a billing code discrepancy may have cost taxpayers up to $102 million in Medicare payments to hospitals.

UnitedHealth Makes a Deal; Humana May Be in the Market

After the CVS–Aetna deal was announced, rumors began swirling that Humana may be next in line for a big deal. Earlier this year, the proposal for Aetna to purchase Humana was blocked by federal judges, and now Humana is making moves that seem to indicate a sale, reported Fierce Healthcare. While the most likely deal would be with Cigna, Humana could also be acquired by Walmart or Walgreens, which would follow in the footsteps of Aetna’s merger across business lines. Meanwhile, UnitedHealth announced it will buy DaVita's primary care unit for $4.9 billion. Reuters reported that DaVita's physician network serves 1.7 million patients every year, but had been a draf on the company's financial performance recently.

 

FDA’s Expedited Review Programs

A research letter in JAMA analyzed the FDA’s 4 expedited programs to speed up development and review drugs for certain diseases and the outcomes of these drugs. Overall, 60% of new drug approvals from January 2012 to December 2016 were in at least 1 expedited program. The authors compared development times for drugs with priority review or accelerated approval and compared them with drugs not in an expedited program and found that median time from application to approval was almost a full year (0.9 years) shorter for drugs in an expedited program.

 

A Billing in Issue Cost Taxpayers $102 Million

For 7 years a Medicare billing code issue may have cost taxpayers up to $102 million in wasteful payments to hospitals. CNBC reported that the issue stemmed from a discrepancy in diagnosis codes—a form of severe protein malnutrition that is rare in the United States had the same code number as less severe forms of malnutritions on one list that is a tool for billing. On another list of coding classification, the rare form had a different code. The number of claims using the code rose from 11,000 to 45,000 a year from 2006 to 2009. The number of claims started to drop after 2009 when the American Hospital Association issued guidance and the discrepancy was fixed in 2015 with the International Classification of Diseases, 10th Revision.

 
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