At its December 8-9 meeting, MedPAC considered future funding for hospitals and physicians along with other sectors in healthcare. The 17-member commission will vote on its recommendations at its meeting January 12-13 after staff makes some changes based on commissioner feedback and then submit its official recommendations to Congress in March for FY2024.
Re: hospitals, MedPAC staffers presented the following:
- General acute hospital closures equaled the number of openings in 2021-2022: 11 in 2021, 16 in 2022.
- Hospitals excess capacity has decreased slightly since 2017: 38% to 35%.
- In Medicare FFS, inpatient utilization (stays/1000 FFS enrollees) decreased from 252/1000 to 208/1000 between 2017-2021; hospital outpatient utilization (visits/FFS beneficiary) stayed the same (5.2/enrollee/year) though dipping to 4.4 in 2020 (peak of the pandemic).
- The marginal profit for Medicare FFS enrollees was 8% in 2021 noting that “the rapid response to the coronavirus pandemic has demonstrated that many hospitals can substantially lower their costs in response to declining volume over a matter or months”.
- From 2019 to 2021, risk adjusted hospital mortality increased slightly, readmission rates improved and patient experience scores stayed high though “the share of patients rating their hospital highly declined slightly”
- “Access to capital: hospital access strengthened including all payer margin in 2021” The all-payer margin not including relief funds was 7.2% in 2021 (and 8.7% including PRF)—up from 1.9% and 5.3% in 2020.
- Inpatient payments/stay increased 10.3% and outpatient payments per beneficiary increased 16.5%. “Payments grew faster than costs” due to Medicare payment changes including suspension of the 2% sequestration cut.
- “Relatively efficient hospitals (15%) Medicare payments were near costs in 2021.”
The MedPAC report advised that attention to hospital funding be targeted: “Avoid implementing across the board payment rate increases to support a subset of hospitals with specific needs”
Re: physicians, the MedPAC staff presentation highlights include:
- Median physician compensation from all payers for all physicians increased 3% per year from 2017-2021.
- Median compensation in 2021 was $315,000: $264,000 for primary care, $450,000-$484,000 for specialists reflecting the historic under-pricing of E&M office and outpatient visits.
- It also noted “no consistent relationship between physician compensation and practice ownership (hospital owned or physician owned).”
- The MedPAC staff concluded “most input indicators suggest payment rates have been adequate but rising input costs are a concern.”
The lag indicators used by MedPAC to evaluate Medicare utilization and payments for physician and hospital services are accurate. However, they’re of decreasing relevance to the future of Medicare’s formula for paying providers.
Appropriately, in its December report, the marginal impact of operating costs are considered: for hospitals and medical practices, direct costs for staffing (wages), supplies and technology increased more than Medicare adjustments. Since hospitals employ half of the physician workforce, it’s a double hit.
But the lingering impact of inflation, higher borrowing costs and uneven competitive landscape are inadequately considered. Per Pitchbook, private equity has more than $60 billion on hand today to invest in provider services Disruptors and investors are making big bets that the roles played by mid-levels and pharmacists will expand. And insurers are their narrowing networks and paying providers less to hit profitability targets.
Before MedPAC conveys its recommendations to Congress, it should revisit its assumptions and modernize its methodology to reflect realities of the marketplace. Lag indicators in healthcare are decreasingly valid and reliable to project its future. The assumption that the “market” will absorb Medicare underpayments is unrealistic and shortsighted.
Public health: “We have to have the authorities to be more nimble. We cannot compel data to come to CDC… I think people anticipate that we have access to data that we’re somehow not transmitting or being transparent about.” CDC Director Rochelle Walensky at the Milken Institute Future of Health Summit on December 7, 2022 https://milkeninstitute.org/events/future-of-health-summit-2022
“Public health is often neglected… Creating a National Public Health Institute can help to overcome that chronic neglect.” Tom Friedan, former CDC Director What’s a National Public Health Institute to Do? Health Affairs December 7, 2022 www.healthaffairs.org/content/forefront/s-national-public-health-institute-do
Food as Medicine, Food Insecurity: “The FDA’s food program has] “been under-supported, under-resourced… Maybe the commissioners have all been medical people, so not so interested in that.” FDA Commissioner Robert Califf Milken Institute December 7
Weight Management, Obesity: “More than 650 million adults are obese and 13% of the 8 billion world’s population (including over 340 million ages 5-18) is obese—that sums us to over 1 billion people…We now have a breakthrough class of drugs that can achieve profound weight loss equivalent to bariatric surgery… That, in itself, is remarkable. Revolutionary….Other than Viagra and Botox, I’ve seen no other medication so quickly become part of modern culture’s social vernacular.…we cannot miss that this represents one of the most important, biggest medical breakthroughs in history.” Eric Topol The New Obesity Breakthrough Drugs: I’m not using the term breakthrough lightly December 10, 2022 Ground Truth https://erictopol.substack.com/p/the-new-obesity-breakthrough-drugs
Market Economics, Investing: “Private capital is much more valuable today than it was last year or five years ago. That’s going to create some really, really interesting buying opportunities.” Joseph Y. Bae, co-CEO of KKR, in a panel at the 2022 US Financial Services Conference in New York December 6, 2022 Cityhttps://event.webcasts.com/starthere.jsp?ei=1584213
Clinical Innovation: “We’re not focused just on technology, but a strategic understanding of how to redesign and enhance care delivery, and all that goes into it. Now we have a dedicated, focused, multidisciplinary team who wakes up every day thinking about this.” The Exec: HCA Healthcare’s Michael Schlosser Takes on Innovation and Transformation Health Leaders December 6, 2022 /www.healthleadersmedia.com/innovation/exec-hca-healthcares-michael-schlosser-takes-innovation-and-transformation
Value-based care: “Overall, the percentage of all payments in category 3 or 4 APMs has grown steadily…up from 23% in 2015 to approximately 41% in 2020. A subset of the latter, only 6.7% of all payments was population-based (that is, these payments included no fee-for-service payment at all).
Savings attributable to Accountable Care Organizations range from just under 1% to just over 6% of per person spending. Researching accountable care organization savings can be challenging, because it is difficult to establish a “true counterfactual,” or what would have happened without an ACO, in order to compare outcomes.”
Value-Based Payment as A Tool to Address Excess US Health Spending Health Affairs December 1, 2022 www.healthaffairs.org/do/10.1377/hpb20221014.526546/full
Federal Agency Reports
CMS: Marketplace coverage up: The CMS said Wednesday that 5.5 million signed up for coverage through the healthcare marketplace this year (vs. 4.6 million in 2021) including 1.2 million people new to the exchanges and 4.3 million returning. to the exchanges. www.com.gov
CMS Proposal: streamlining payer authorization requirements: CMS issued a new rule meant to streamline prior authorization by requiring payers to…
- implement an electronic prior authorization process and respond to requests more quickly
- provide doctors their rationale for denied requests
- build and maintain standardized application programming interfaces (APIs) to automate the process for providers to determine whether prior authorization is needed
- identify any documentation requirements and facilitate the exchange of requests and decisions electronically
CMS Proposes Rule to Expand Access to Health Information and Improve the Prior Authorization Process CMS December 6, 2022 www.cms.gov/newsroom/press-releases/cms-proposes-rule-expand-access-health-information-and-improve-prior-authorization-process
White House Office of National Drug Control Policy and National Highway Traffic Safety Report: There were 181,806 nonfatal opioid overdoses recorded in the United States in the past year, and it takes 9.8 minutes on average for emergency medical services to reach someone who’s overdosing. https://www.whitehouse.gov/ondcp
USDA: Study: Food Insecurity Associated with Poor Sleep Quality, Quantity: Food insecurity was linked with poor sleep quality and quantity in adults 18 years and older, per the metanalysis. Moderate or severe food insecurity increased from 8.3% in 2014 to 25.9% in 2020.
Mazloomi SN, Talebi S, Kazemi M, et al. Food insecurity is associated with the sleep quality and quantity in adults: a systematic review and meta-analysis. Public Health Nutrition Published online November 23, 2022. doi:10.1017/s1368980022002488
MedPAC considers proposals to increase physician pay: ‘Medicare needs to pay physicians more’ per the Medicare Payment Advisory Commission (MedPAC). MedPAC is discussing two proposals:
- The first proposal would raise Medicare’s physician payments by half of whatever the percentage increase is in the annual Medicare Economic Index (MEI), which tracks changes over time in physician practice costs and earning levels.
- The second proposal is to increase pay by 15% to primary care physicians who treat low-income patients, and by 5% to non-primary care physicians who treat those patients.
PE acquires FL multispecialty group: The 85-physician multispecialty physician group Medical Specialists of the Palm Beaches has secured a private equity investment from Ascend Capital Partners. A total of 245 private equity transactions took place in the third quarter of 2022, up 12% year over year per Irving Levin Associates. Private equity was behind 70% of about 461 physician medical group deals in 2021–145% higher than those in 2020 but less than 2019 peak of 80% .Ophthalmology and dental practices saw the most transaction volume in 2021.
Medical Specialists of the Palm Beaches www.mspbhealth.com
Wall Street Journal analysis: hospital relief funding formula flawed: “Some large health systems — including nonprofits — posted profits from patient care during periods they received government aid. Some systems were financially healthy enough that they could direct money into investment funds, while others spent money to expand facilities and campuses.” Per the WSJ analysis of 3,684 nonprofit and government-owned hospitals:
- 1,257 hospitals that got federal pandemic aid were profitable when they got the funding totaling $16.7 billion in aid though collectively reporting $53.6 billion in profits.
- For 783 hospitals, $10 billion in aid helped swing their losses to profits.
- 1,644 hospitals, which received $35 billion in federal pandemic aid, reported a loss of $129.1 billion during the period, not counting the added funds.
Evans et al Billions in Covid Aid Went to Hospitals That Didn’t Need It Wall Street Journal December 4, 2022www.wsj.com/articles/billions-in-covid-aid-went-to-hospitals-that-didnt-need-it
Investor-owned hospital system profitability pre- and post-pandemic: Researchers evaluated the financial performance of the three largest for-profit health systems in the country—HCA Healthcare (“HCA”), Tenet Healthcare Corporation (“Tenet”), and Community Health Systems (CHS)—which collectively accounted for about 8% of community hospital beds in the US in 2020. Findings:
- “Operating margins among all three large health systems were positive and exceeded pre-pandemic levels for the majority of the pandemic, including most recently in the third quarter of 2022.
- HCA and Tenet had positive operating margins throughout the pandemic, and CHS had positive operating margins in all but two quarters of the pandemic (with one of those quarters being at the very beginning of the pandemic).
- For all three systems, operating margins have exceeded pre-pandemic (2019) levels for most of the pandemic (9 out of 11 quarters), including the last quarter of our analysis (the third quarter of 2022), despite recent decreases in operating margins.
- Stock prices increased and then decreased during the pandemic; HCA and Tenet stock prices have increased overall since January 2020 while CHS stock prices have decreased. Stock prices increased dramatically during the first 1.5 to 2 years of the pandemic.
- As of November 8, 2022, HCA and Tenet stock prices have increased overall relative to January 2020 (by 44.6% and 12.6%, respectively).3 CHS stock prices have decreased by 11.5% since January 2020, though CHS has also experienced longstanding financial challenges that predate the pandemic.
- As of December 2, 2022, the majority of market analysts followed by MarketWatch were bullish on HCA and Tenet stock (with 18 buy, 3 overweight, and 5 hold recommendations for HCA stock and 14 buy, 2 overweight, and 4 hold recommendations for Tenet stock) and neutral about CHS stock (with 8 hold and 4 buy recommendations); none of the analysts rated these stocks as “sell” or “underweight.”
They concluded: “our results indicate that the largest for-profit systems have had operating margins that exceed pre-pandemic levels.”
Study: rural hospital emergency designation: The Consolidated Appropriations Act of 2021 introduced the rural emergency hospital (REH) designation to preserve emergency and outpatient services in areas unable to sustain full-service hospitals. An REH must maintain a 24-hour emergency department but will not provide inpatient care. Hospitals that convert into REHs starting in 2023 will receive a 5% add-on to Medicare outpatient prospective payment rates and a new facility payment.
Researchers analyzed 2019 Medicare Cost Reports to distinguish REH-eligible hospitals, defined as critical access or rural hospitals with 50 or fewer beds, from noneligible rural hospitals. Findings:
- There were 1569 REH-eligible and 368 noneligible rural hospitals. Eligible hospitals were located in counties with fewer hospital beds per 100 square miles compared with noneligible hospitals (4.0 vs 12.4). Eligible hospitals had more emergency physicians per 1000 patient-days (0.16 vs 0.07), but fewer county-level primary care physicians per 100 000 population (55.8 vs 62.1), and were located in counties with a lower percentage of Black population (5.9% vs 11.1%;) compared with noneligible hospitals.
- Eligible hospitals had lower operating (−1.0% vs 3.5%) and total margins (1.9% vs 4.9%); than noneligible hospitals. Outpatient payments composed a larger share of total Medicare payments at eligible vs noneligible hospitals (65.9% vs 41.6%)). Eligible hospitals were less likely than noneligible hospitals to provide certain emergency services, including orthopedic (52.7% vs 92.2%) and obstetric care (41.0% vs 94.0%) outpatient psychiatric (21.3% vs 29.5%;) and substance use disorder care (4.1% vs 16.0%), and several telehealth services.
Chatterjee et al Characteristics of Hospitals Eligible for Rural Emergency Hospital Designation JAMA Health Forum. December 9, 2022;3(12):e224613. doi:10.1001/jamahealthforum.2022.4613
Bed capacity in Children’s Hospitals shrinking: “The dire shortage of pediatric hospital beds plaguing the nation this fall is a byproduct of financial decisions made by hospitals over the past decade, as they shuttered children’s wards, which often operate in the red, and expanded the number of beds available for more profitable endeavors like joint replacements and cancer care.
The current surge in dangerous respiratory illnesses among children is yet another example of how covid-19 has upended the health care system. The lockdowns and isolation that marked the first years of the pandemic left kids largely unexposed — and still vulnerable — to viruses other than covid for two winters, and doctors are now essentially treating multiple years’ worth of respiratory ailments.
Hospital Financial Decisions Play a Role in the Critical Shortage of Pediatric Beds for RSV Patients Kaiser Healthcare News December 9, 2022 https://khn.org/news/article/hospital-financial-decisions-pediatric-bed-shortage
Morning Consult: trust in healthcare system resilient: Shares of U.S. adults who report having “some” or “a lot of” trust in the following institutions based on a representative sample of 2,210 U.S. adults, with an unweighted margin of error of plus or minus 2 percentage points. (January 2021 vs. December 3, 2022)
- Healthcare System: 65% vs. 62% (-3%)
- Public Education System: 62% vs. 56% (-6%)
- Corporate America: 40% vs. 41% (+1%)
- Silicon Valley: 38% vs. 38% (NC)
- Wall Street: 39% vs. 37% (-2%)
- News Media: 42% vs. 43% (+1%)
- US Government: 48% vs. 45% (-3%)
- Congress 43% vs. 41% (-2%)
- Supreme Court: 62% vs. 48% (-14%)
Average Trust in U.S. Institutions Ticks Slightly up in November Morning Consult December 8, 2022 https://morningconsult.com/tracking-trust-in-institutions
Wolters Kluher survey: consumers receptive to bigger role for pharmacists in primary care: The Pharmacy Next: Health Consumer Medication Trends survey included 1,006 U.S. adults, 18 and older conducted online between September 19-26, 2022. Highlights:
- Looking ahead five years, 61% envision most primary care services being provided at pharmacies, retail clinics and/or pharmacy clinics instead of going to a PCP:70% Millennials, anticipate a move to new care settings. 66% Gen Z, 65% Gen X and 43% Boomers
- At least half of Americans see potential savings on medical expenses as an incentive to look beyond solely physician-credentialed providers
- To staff these new settings, consumers would trust pharmacists (56%), nurse practitioners (55%) and physician assistants (50%) to provide healthcare and prescriptions if it meant lower costs.
- 72%% would be open to having medications prescribed by a specially-trained pharmacist instead of a doctor.
- 97% of Americans say a pharmacist should have responsibility for informing them about the safety and/or effectiveness of their medications.
- 64% say prices for their medications have gone up over the past few years; 44% admit to choosing not to fill a prescription because of the cost.
- US survey signals big shifts in primary care to pharmacy and clinic settings as consumers seek lower medication and healthcare costs December 7, 2022 www.wolterskluwer.com/en/news/us-survey-signals-big-shifts-in-primary-care-to-pharmacy-and-clinic-settings
Pitchbook: PE investments in healthcare services changing: “We estimate that US PE firms currently have $62.0 billion in dry powder available to deploy in healthcare services, which translates to roughly $150 billion in cumulative company enterprise value…
Historically, hospitals have also been the leading consolidators of independent physician practices in the US. As of January 2022, hospitals and health systems employed 341,200 physicians nationally—an 18.3% increase since January 2020. However, corporate entities, which include PE-backed platforms, publicly traded provider groups, and payviders, are now consolidating at a faster rate than hospitals. In January 2022, they employed 142,900 physicians, a 39.4% increase from January 2020.
While PE investment in these established provider categories is still going strong, PE firms have become more sophisticated healthcare services investors—not only entering new provider categories but also seeking out opportunities wherein scale and capital availability provide second-order advantages in improving patient care and returns. “
Pitchbook Healthcare Services Report November 2022 www.pitchbook.com
Mercer: US employers expect increase of 5.4% in 2023: The average per-employee cost of employer-sponsored health insurance rose by 3.2% this year vs. 6.3% in 2021. This year’s total health benefit cost per worker hit $15,013 on average, with small organizations (50-499 employees) reporting slightly higher costs than large organizations (500 or more employees).
“While this year’s increase may seem like a return to normal trend, it is far below general inflation, which is averaging about 8% for 2022. Typically, health benefit cost growth runs higher than general inflation. According to Sunit Patel, Chief Health Actuary at Mercer, 2022 is an anomaly because employer health plan sponsors haven’t felt the full impact of inflation yet. For now, most employers are prioritizing enhancing benefits to attract and retain workers over cost-cutting; enhancements range from adding perks to improving healthcare affordability Mental health remains a top concern of employers and employees – and virtual mental healthcare is proving key to improving access to services.”
National Survey of Employer-Sponsored Health Plans Mercer December 8, 2022 www.mercer.us/what-we-do/health-and-benefits/strategy-and-transformation/mercer-national-survey-benefit-trends
Study: outcome comparison for AMI between MA and Medicare FFS: Researchers analyzed data for Medicare beneficiaries with acute myocardial infarction (MI) from 2009-2018, to determine how outcomes and treatment processes differ for patients enrolled in Medicare Advantage as compared with traditional Medicare. Findings:
“Enrollment in Medicare Advantage, compared with traditional Medicare, was associated with modestly lower rates of 30-day mortality following acute MI in 2009, and the difference was no longer statistically significant by 2018.”
Landon et al Association of Medicare Advantage vs Traditional Medicare with 30-Day Mortality Among Patients With Acute Myocardial Infarction JAMA December 6, 2022;328(21):2126-2135. doi:10.1001/jama.2022.20982
Modern Healthcare analysis: insurtech executive compensation (on paper) higher than traditional insurers: Modern Healthcare’s Caroline Hudson reported the comparison:
Insurtech CEO comp primarily based on stock awards:
- Clover Health awarded CEO Vivek Garipalli with $389.6 million in total compensation. Clover Health shares closed at $1.13 on Friday, a 93% plunge from its $15.30 initial public offering.
- Oscar Health awarded CEO Mario Schlosser with $60.8 million in total compensation, also largely based on stock awards. The company announced last month that it would exit almost all Medicare Advantage markets next year. Oscar Health closed at $2.68 Friday, a 94% decline since its shares debuted in March 2021.
- Bright Health Group’s compensation package for CEO Mike Mikan last year was $180.8 million, about 99% of which were stock and option awards. Bright Health recently raised $175 million to curb its financial losses, which exceeded $430 million in the third quarter. Bright Health shares closed Friday at 82 cents, 95% lower than its $18 IPO in June 2021.
Legacy insurers which also include stock awards:
- Guidewell Mutual Holding, the holding company for Florida Blue, awarded CEO Patrick Geraghty $24.6 million in total compensation, including a $1.3 million base salary, a $4.8 million bonus and $18.5 million in other compensation, which typically includes additional executive benefits. His compensation grew 11.5% from 2020.
- Centene CEO Michael Neidorff, who died in April, received $20.64 million in total compensation last year, including a $1.8 million base salary and $12.8 million in stock awards. Neidorff’s compensation declined 17.3% from the prior year.
- Molina Healthcare CEO Joseph Zubretsky: $120 million in total compensation; 12.1% increase; includes $1.5 million in base salary and $15 million in stock awards.
- Cigna CEO David Cordani: $19.9 million in total compensation; 0.3% decrease; includes $1.5 million in base salary and $11.8 million in stock awards.
- Anthem CEO Gail Boudreaux: $19.4 million in total compensation; 13.1% increase; $1.6 million in base salary and $9.9 million in stock awards
- UnitedHealth Group CEO Andrew Witty: $18.4 million in total compensation; 43.4% increase; includes $1.5 million in base salary and $10.8 million in stock awards.
- Humana CEO Bruce Broussard: $16.5 million in total compensation; 0.2% increase; includes $1.4 million in base salary and $9.8 million in stock awards.
Insurtech CEOs compensated more than their legacy insurer peers Modern Healthcare December 10, 2022www.modernhealthcare.com/executive-compensation/bright-health-clover-health-ceos-led-insurance-compensation-2021
Shelby Livingston Inside the stunning unraveling of Bright Health, a health-insurance upstart that rocketed to an $11.2 billion valuation and then cratered as it grew too fast Business Insider Dec 5, 2022, 5:00 AM/www.businessinsider.com/what-happened-to-bright-health-health-insurer-grew-too-fast-2022
CA becomes 4th state to increase regulation of healthcare deals: California health care entities can expect increased scrutiny of future mergers, acquisitions, and other transactions following the passage of the California Health Care Quality and Affordability Act (HCQAA). Effective April 1, 2024, a newly minted regulatory agency will review certain California health care deals for their impact on market competition and health care prices prior to closing. Any health care entity considering a significant transaction in California should seek legal advice before attempting to navigate this new, complex, and potentially costly regulatory regime. This change in California follows recent steps taken in a number of other states to regulate health care transactions, including Oregon, Nevada and Massachusetts.
California: Health Care M&A Market Heats up as New Regulator Takes a Closer Look National Law Review, December 8, 2022 www.natlawreview.com/article/california-health-care-ma-market-heats-new-regulator-takes-closer-look
Study: Application of value-based drug pricing would reduce spending 11%-37% in US: Background: The National Academy of Medicine recommends basing drug prices on value, tying prices to the magnitude of benefit to preserve incentives for innovation. One way to do this is to set prices to achieve a certain cost-effectiveness threshold. Value-based prices (VBPs) are estimated by the Institute for Clinical and Economic Review (ICER). Researchers evaluated prescription drug cost effectiveness using the ICER methodology. Findings:
- The study sample comprised 73 unique drugs which accounting for $110.4 billion in annual US drug spending, approximately one-fifth of total US drug spending in 2020. Eleven unique drugs had multiple ICER-reported VBPs. Most of the drugs (86.3% and 72.6%, respectively) had observed net prices higher than the VBPs at $100 000 per QALY and $150 000 per QALY thresholds.
- In the base case, applying VBPs at $100 000 per QALY and $150 000 per QALY reduced the median spending per drug by $373 million (IQR, $87 million-$953 million) and $164 million (IQR, –$5 million to $600 million) equating to estimated total annual savings of $11.8 billion (11%) to $40.3 billion (37%) for the 73 drugs. Scenario analyses without price increases produced estimated savings of $38.4 billion (35%) to $57.5 billion (52%).
“To put these $11.8 billion to $40.3 billion base case estimates in perspective, total Medicare Part D spending in 2020 was $89 billion.”.”
Kai Yeung et al Value-Based Pricing of US Prescription Drugs: Estimated Savings Using Reports From the Institute for Clinical and Economic Review JAMA Health Forum December 9, 2022;3(12):e224631. doi:10.1001/jamahealthforum.2022.4631
Amgen bidding for Horizon Therapeutics: California-based Amgen is one of 3 bidders for Horizon Therapeutics in a takeover likely to be valued at well over $20 billion and mark the largest healthcare merger of the year. Horizon develops medicines to treat rare autoimmune and severe inflammatory diseases that are currently sold mostly in the U.S. Its biggest drug, Tepezza, is used to treat thyroid eye disease, an affliction characterized by progressive inflammation and damage to tissues around the eyes.
Acquiring Horizon could add about $4 billion in new revenue for Amgen by 2024, according to Jefferies & Co. Other big life-sciences companies have been inking deals in recent months:
- Johnson & Johnson recently struck a $16.6 billion deal to acquire heart device maker Abiomed Inc. to bolster sales of its medical-gear division, which had been lagging behind those of its pharmaceutical unit.
- Merck & Co. followed with a deal of its own, agreeing to buy blood-cancer biotech Imago BioSciences Inc. for $1.35 billion, ahead of the patent expiration of its cancer immunotherapy Keytruda.
- Pfizer Inc., meanwhile, agreed in August to buy Global Blood Therapeutics Inc. for $5.4 billion, in a deal that would give the big drugmaker a foothold in the treatment of sickle-cell disease.
Amgen in Advanced Talks to Buy Horizon Therapeutics Wall Street Journal December 11, 2022 ww.wsj.com/articles/amgen-in-advanced-talks-to-buy-horizon-therapeutics
Report: advertised wage growth slowing: Per Indeed Wage Tracker’s latest report:
- The Wage Tracker shows US posted wages grew in November at a robust 6.5% year-over-year pace, up from 3.1% in November 2019.
- Nevertheless, year-over-year posted wage growth has declined substantially in recent months, falling from a peak of 9% in March 2022, a signal employer now faces less-steep competition for new hires.
- The deceleration is broad-based, with wage growth in 82% of job sectors lower in November than six months earlier.
- Wages and salaries advertised in job postings have been rising quickest in lower-wage occupational categories, but those sectors are now seeing the biggest declines in growth.
- If posted wage growth continues on its current trajectory, it will return to its pre-pandemic range by the second half of next year, though it will take more time for the trend to appear in overall measures of wage growth.
Growth in US Posted Wages Strong but Slowing Substantially December 8, 2022 www.hiringlab.org/2022/12/08/growth-in-us-posted-wages-is-strong-but-slowing