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This week Medicare regulators released a 79-page report on a pandemic-era home hospital program that allowed approved health systems to deliver inpatient care in people’s homes. Over 300 hospitals enrolled in the program and the goal was to expand capacity at a time when people feared hospitals would be overrun. But many view the programs as a crucial innovation that could help the health care system meet the needs of an aging population.
It’s A LOT of information, so I asked Lee Fleisher, who was chief medical officer at the Centers for Medicare and Medicaid Services when the program was created to help me make sense of it all.
- Broadly, Fleisher said that the study shows that the program was run safely and that patients and their families liked it. He said that it supports an extension of the program but that there should be guardrails to ensure that patients who are admitted to a hospital at home really need hospital care and that payment models are appropriate.
- Hospitals self-select into the program and have significant capabilities. The report notes that they are commonly teaching hospitals and commonly in urban areas. Meanwhile patients who took advantage of the home care were more likely to be white, more likely to live in urban areas, and less likely to receive low-income subsidies.
- By definition, payment amounts were identical for hospital at home versus in-hospital care, so the report looks at post-discharge costs as a way of determining potential financial impact. Overall, people admitted to hospital at home cost less 30-days after discharge than those in comparison groups, but Fleisher notes this finding could be the result of the people and hospitals that chose to participate in the program.
- In general, the report found that caregivers like the program, but occasionally found that it may create more burden on them. Some indicated taking additional time off work or hiring nursing aide assistance. Fleisher said “this can limit who can utilize this program and that it will be selected patients.”
- “From my perspective, Hospital at home is an alternative option to inpatient hospital-based care for the lower end of the acuity spectrum who still require more than home care and requires hospital level care,” Fleisher told me. “It gives some subset of patients and their families more choices about how to receive care, in the same way that patients have choices between PCP, urgent care, and telehealth for low acuity, immediate care issues. How best to implement and pay for this program will require more analysis during any extension.”
The report, which was mandated by Congress, offers some new details but comes rather late to inform legislative conversations around the program that’s set to expire at the end of the year. The current consensus is that a five-year extension will be passed as part of a larger package of flexibility extensions.
The nonprofit caught up in Epic’s antitrust battle
As Epic, the largest vendor of electronic medical records software, and Particle Health, a small data sharing startup, prepare to go to war in court, they’ve dragged a little-know organization into their fight.
Carequality oversees a framework that allow health care organizations to share patient’s’ health records with each other, a critical piece of infrastructure that connects otherwise siloed data — and a critical component of care delivery.
After Particle sued Epic last week over alleged anti-competitive practices, both companies are asking Carequality to release the findings of an investigation after Epic accused Particle of misusing patient data. Particle says it was cleared of wrongdoing but was issued a punishment to appease Epic.
As STAT’s Brittany Trang reports, how Carequality handles the situation has important implications for the future of health data sharing. Read more here
The scientists making brain interfaces happen
Brain-computer interfaces that allow people with paralysis to navigate technology and communicate more effectively has gotten a fair amount of attention recently thanks Elon Musk‘s investment in the space through Neuralink. Behind the hype and science fiction allure of the tech is a cadre of brilliant scientists driving the work forward.
In the latest installment of STAT’s new Who to Know series, Timmy Broderick showcases some of the top minds driving innovation in the BCI space. (A few weeks ago, we profiled 12 people shaping psychedelics drug development.)
Among the researchers Timmy highlights are Sergey Stavisky, who is developing a speech decoder, a device that helps people communicate after they lose the ability to talk, at the University of California, Davis; and Emily Graczyk, who is developing technologies to stimulate the nervous system that can augment or restore sensations like temperature, touch and pain for people with spinal cord injuries, at Case Western Reserve University. Read the whole list here
A data point on lagging clinical AI use
While many people might believe that artificial intelligence tools will make a big impact on clinical care, so far they have landed with a thud, according to an analysis in Trilliant Health‘s always interesting health care trends report.
Using a very large database of payer claims, the analytics company’s researchers looked back at use of the AI CPT codes doctors use to bill for services and found that use has been limited so far: Just over 200,000 patients have received these services. Trilliant’s Sanjula Jain said she didn’t believe that there was a lot of phantom AI use that wasn’t being captured by codes. Fee-based health care incentivizes the creation of codes and billing for services.
“I don’t think it’s people don’t want to bill for it, or don’t know that they can bill for it. Because people have lobbied hard to get these codes,” she said. “I think it’s really a question about clinical utility or clinical value.”
Jain noted that this lagging use didn’t apply to back office and administrative applications for AI that are increasingly getting the attention of investors, entrepreneurs, and importantly, health care organizations. This gels with other recent findings we recently reported on. (If you think Jain is wrong about clinical AI use, let me know!)
ResMed CEO on how wearables, GLP-1s will impact sleep apnea device sales
Earlier this week I interviewed Mick Farrell, CEO of ResMed, the largest seller of continuous positive airway pressure devices that treat sleep apnea. His company has grown to $4.7 billion in revenue and believes it has a lot of head room to grow because only a small fraction of people who might benefit from their devices know they have sleep apnea.
At a fancy event for analysts at the New York Stock Exchange building, the company presented an upbeat outlook. In part Farrell cited what he called “two tidal waves” that would drive patients to the devices: New smartwatch features from Apple and Samsung that alert users that they might have sleep apnea, and the rise of GLP-1s, the wildly popular obesity medications. Read my story here
What we’re reading
- This AI Startup Helps Patients Fight Insurance Denials, Forbes
- Why a map of a fruit fly’s brain has neuroscientists ‘blown away’, STAT
- Exclusive: Diabetes startup Omada Health has confidentially filed its S-1 to go public, Business Insider
- To aid addiction treatment, lawmakers tell DEA to back off buprenorphine enforcement, STAT