3/19/21 Weekly Update
Summarizing the week that was in the business of healthcare
Welcome to The Donut Hole’s weekly summary. The news doesn’t stop. Lucky for you, we are here to help you take in the week that was in the business of healthcare.
MATCH DAY CONGRATULATIONS!!!
Congratulations to all the med students who matched today! We hope you take the time to celebrate this major accomplishment with friends and family!
Amazon is expanding Amazon Care telehealth service nationally for its employees and other companies
Big, albeit not surprising, news from Amazon this week. The company announced the expansion of its existing Amazon Care program to all 50 states by this summer, and, more significantly, that it will be offering the service to employers later this year. Amazon Care launched as a pilot program two years ago. The original offering paired free virtual urgent care visits with in-home visits for a fee from nurses for testing, blood draws, and vaccinations. The program has since expanded into more of a primary care service with the ability to treat chronic conditions.
Amazon plans to roll out the virtual care part of the program for its employees and other companies nationwide later this year, but the added in-person services will initially be offered only in Washington state and the D.C. metro area. We expect Amazon to quickly add in-person capabilities in additional cities, but the exact pace remains to be seen. Amazon also recently launched Amazon Pharmacy, which is expected to run independently of Amazon Care but would obviously be a convenient place for Amazon Care users to route any prescriptions (Amazon Pharmacy includes home delivery).
Potential Impact on You: The Amazon Care launch is big news for the other large virtual care players in the employer market. Teladoc and AmWell in particular saw significant negative stock price moves. That said, the actual impact Amazon Care will have on the broader healthcare landscape is unclear. In theory, Amazon Care would siphon off meaningful patient volume from primary care practices, impact referral patterns in competitive health system markets, and could serve as a good place to work for providers. Amazon Care will need to reach a much larger footprint before those possibilities become reality, though.
MedPAC Recommends Limiting Post-COVID-19 Telehealth Coverage, More Study
Uh oh, pump the breaks on the telehealth revolution! The Medicare Payment Advisory Commission is telling lawmakers to extend COVID-19 telehealth freedoms for a few years before making any final decisions, likely delaying any robust health system investment investment in virtual-focused care models. MedPAC detailed, “Under the policy option, policymakers should temporarily continue some of the telehealth expansions for a limited duration of time (e.g. one or two years after the Public Health Emergency) to gather more evidence about the impact of telehealth on beneficiary access to care, quality of care, and program spending to inform any permanent changes.” The recommendations also call for renewed safeguards to prevent fraudulent claims and for mandatory in-person visits before ordering expensive durable medical equipment (like oxygen therapy) or expensive diagnostics.
Potential Impact on You: Virtual care is here to stay in some capacity, but the lack of clarity on long term use and reimbursement will likely leave telemedicine relegated to its current niche as a low acuity urgent care solution for at least the next few years for most providers. The continued growth of value-based payment models in Medicare Advantage, Managed Medicaid, and bundled payments offer some promise for an expanded role, but care will likely continue to focus on in-person settings, be it in a traditional care setting or the patient’s home.
SEC charges co-founders of shuttered microbiome startup uBiome with $60 million fraud
Another interesting diagnostics fraud story from Silicon Valley (think Theranos-lite). uBiome was a high-flying microbiome diagnostics start-up that aimed to help patients better understand their risk of disease. The company raised $105M in total from well-known venture capital firms and other investors and reached a peak valuation of $600M in 2018. In April 2019, though, the FBI raided uBiome’s San Francisco headquarters to collect evidence around fraudulent billing practices. The Company filed for bankruptcy six months later.
The details of the maleficence are well documented in this article from May 2019. From the article:
As part of its growth strategy, people close to the company say uBiome would repeatedly nudge patients, such as Harris, to send in multiple samples and bill their insurance each time. The company would also “upgrade” their samples, often without the patient’s knowledge, and then bill again for those. It wasn’t uncommon for an insurance company to be billed two or three times for the same set of tests, the people said. That includes Medicare patients, whose insurance is provided by the government, the people said.
The Medicare issue in particular is what drew the attention of the FBI. The complaint filed in Federal court seeks to bar uBiome’s former CEO and Chief Scientific Officer from serving as officers or directors of a company in the future and force them to pay civil penalties.
Potential Impact on You: Companies like uBiome and Theranos are good reminders that patients may not be able to sift through all the noise to draw the right conclusions around heavily marketed novel diagnostics that lack clinical validity. Particularly in our current era where diagnostics companies can directly target potential users with convincing marketing messages, misinformation can be tough to combat.
If you liked what you saw, please share this post!
If you’re not already a subscriber, sign up now so you don’t miss the next update!