Former COO sues Friday Health Plan

Plus: AI may be better at predicting breast cancer outcomes than the BCSC

Jun 09, 2023

Good morning and happy Friday. This is the Friday Pulse Check, a weekly newsletter featuring some of the most important headlines in the healthcare world from your friends at Fulcrum Strategies and FLATLINING.net.

In the news:

As Friday Health Plan folds, former COO sues

Former Friday Health Plan Chief Operating Officer David Pinkert is suing the failing company for a severance package he claims he didn’t receive. According to the lawsuit, his contract had a severance clause that entitled him to his $300,000 salary and other benefits. He alleges that in February, the health plan told him he wouldn’t be getting his check “due to liquidity concerns of the company at this time.” Friday Health Plan announced on 1 June that they would be shutting down operations over the course of the year as several states pause their enrollment or begin to regulate their finances. Read more in Becker’s Payor Issues.

Growing number of hospital-based physicians going part-time

It is no secret that burn-out rates have spiked 25% among physicians over the last few years, particularly since the start of the COVID-19 pandemic. It is also not surprising that physicians feel unappreciated as the federal government (and thus Current Year Medicare-based commercial fee schedules) keeps cutting reimbursement. Going part-time or “travel based” is difficult for physicians because they need to fulfill the licensing and credentialing requirements in each state. Is it worth it? Read more from NewsNation.

AI potentially better at predicting breast cancer risks than BCSC

A study published this week in Radiology showed that artificial intelligence was able to better predict breast cancer risks than the Breast Cancer Surveillance Consortium (BCSC) clinical risk score, a widely used formula to calculate a woman’s risk for breast cancer. In the study, thousands of mammograms were studied and risk scores were made by five different AI algorithms. In all five instances, the risk scores were more accurate than the BCSC. Read more from CBS News.

The FLATLINING Podcast

The Affordable Care Act is having its day in court, again. The 5th Circuit Court of Appeals heard arguments on Tuesday about the legality of employers being required to pay for preventative care. Previously, Judge Reed O’Connor, who has previously ruled that the entire ACA was unconstitutional, ruled that employers should not have to pay for preventative care such as HIV testing and treatment because it may violate a business person’s religious beliefs. Additionally, he ruled that the Preventative Services Task Force has no ability to dictate what should or shouldn’t be covered because the group isn’t appointed by Congress.

Either way the 5th Circuit rule, this case will likely make its way to the Supreme Court. Previously, SCOTUS has ruled that the Affordable Care Act is, in fact, constitutional.

Ron and I also discussed several drug-related stories. First, pharmaceutical giant Merck (MRK 0.00%↑) is suing the federal government over the price negotiation provisions in the Inflation Reduction Act. Then, Johnson and Johnson’s (JNJ 0.00%↑) COVID-19 vaccine lost its emergency use authorization. We discussed whether or not it matters.

Listen to this episode

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Ukraine

After the Kakhovka Dam collapse this week, there is a new public health emergency lurking in the flood waters. The waters have swept up chemicals, fertilizer, and what President Volodymyr Zelensky has called “anthrax burial” sites. Additionally, previously buried mines may have been swept up and moved from their marked position. All of it is currently making its way toward the Black Sea. Read more from NBC News via Microsoft Start.

Final Thought

Bedside manners are important. Perhaps one of the worst examples of bad bedside manners was depicted in the popular TV show House.

UCLA Health in Los Angeles is looking to do somewhat of the opposite of that. Dr. Henry I. Miller wrote in RealClear Health this week about a program the system is using to make patients feel more comfortable, especially for end-of-life care. You should read about the 3 Wishes Program if you need a pick-me-up this week. Read more in RealClear Health.

Have a good weekend,

Matthew