💌🏥 Golden Age of Older Rectums
 Happy Sunday, Welcome back to the Sunday Hospitalogy and Huddle crossover send. If you missed it, Jared wrote a deep dive last week on what he wants mental health care to look like in 2032. Many thanks to those who replied to Jared on Twitter with their thoughts on the topic! Huddle up:
 Subscribe to Healthcare Huddle to get the industry news, insights, and analysis you need every Sunday from current medical student, Jared Dashevsky.  BUSINESS “The Golden Age of Older Rectums”Private equity-backed firms are buying out gastroenterology practices left and right. There are no signs of slowing down. As one investment manager said:
The Deets
GI Alliance is on an acquisition spree, having acquired seven GI groups since January. GI Alliance mainly acquires practices in the south, where they already have a prominent presence. In Austin, for example, they have 16 locations. #Trending Think about it... the population is aging. The number of adults 65 and older is expected to double within 20 years to 80 million. And the newest USPTF guidelines recommend colonoscopy starting at 45 (versus 50). Suffice it to say: there will be a lot of people needing a lot of colonoscopies. My Thoughts
 From the doctor’s perspective, running an independent gastroenterology practice is becoming ever-so challenging. Reimbursements are declining, payers are consolidating, hospital competition is increasing and administrative burden is exhausting. As a result, the business components of running such a practice are cumbersome to manage efficiently. So, PE firms—or PE-backed firms—may be attractive to physician groups struggling with day-to-day business operations. The PE firm manages the business of things; the physician manages the medicine of things. It’s nice. But, there are downsides, now that the physician is operating under a profit-motivated business. As for patients, they’re always left out of the conversation despite being the “end-user” who’s left paying the costs of care. Robust data is lacking on patient outcomes under PE-backed health care—but data from PE-backed nursing homes suggests outcomes aren’t the best. Patients may be left paying hefty bills for the same amount—or less—care they would’ve received somewhere else not PE-backed. For example, one patient reported paying $1,100 for a colonoscopy (3x more than what she paid in a different state) at a PE-backed GI practice. Again, PE firms are profit-focused. There’s inherently nothing wrong with this and it makes sense PE firms are after GI practices, given their lucrative colonoscopy reimbursements. These firms are just following the money. As for my overall assessment of PE in healthcare, I agree with Dr. Diane Meier in her response to a JAMA article on private equity and healthcare:
Madden's Musing: I've touched on the increased employment of physicians nationwide - almost 75% of physicians are employed by a corporate interest or hospital these days. Employment by a larger group or hospital increases the chances for care collaboration but decreases the independence & referral patterns of those physicians. Private equity players see the writing on the wall for the future of healthcare. With Medicare beneficiaries increasing every day, there will be a growing need and expansion in demand utilization for GI (as mentioned above), ophthalmology, post-acute care, and plenty of other services that aging seniors will require.  HOSPITALOGY THIS WEEK Hospitalogy's Week AheadThere's been a lot of chatter lately about the parallels between fintech & health tech, which fascinates me considering most of the people I've spoken to seem to agree that healthcare is ~10 years behind the financial industry. This week I (Blake) will be doing a cool little crossover send with fellow Workweek creator, Nicole Casperson, on the current problems with the financial side of healthcare, and the massive opportunities healthcare-focused fintech companies have to implement solutions. Of course, Tuesday's 8am send will cover all of the relevant healthcare business news from the week - digital health layoffs, Steward's major deal with CareMax, and more. See ya Tuesday morning at 8am ET & Thursdays at 12pm ET as always, Hospitalogy fam.  INSURANCE Fast-track Too Fast?Medicare Part B premiums will remain the highest they’ve ever been for the rest of 2022. CMS made efforts to reduce Part B premiums in response to the drama surrounding Biogen’s Alzheimer’s Disease drug Aduhelm, but operational and legal barriers prevented such efforts from succeeding. Biogen’s Timeline
My Thoughts The accelerated approval program fast-tracks drugs that meet unfulfilled needs for hard-to-treat diseases like cancer and Alzheimer’s. These drugs get to the market faster than if they followed the regular approval route. As a result, the accelerated approval program is becoming increasingly popular. Last year, over 20% of the 50 new drugs approved came from this program.  The fast track works by allowing the drug’s approval to be based on surrogate endpoints. These are endpoints that, by proxy, are likely to show the drug works clinically, avoiding the need for clinical results right away (but you still have to run a confirmatory trial after approval to show the drug actually has clinical benefits). For Aduhlem, the decrease in amyloid-beta plaque was a surrogate for improved cognitive function. The amyloid-beta plaque alone is not itself a measure of clinical benefit. But, studies actually showed that there was minimal cognitive benefit. The FDA ended up granting Biogen nine years to run confirmatory trials that their drug works in the clinical setting. Nine years is a long time for a drug to be on the market without confirmatory results showing that the drug works clinically. The timeline needs to be shortened to raise the standards of the fast-track program. At the end of the day, it’s not the doctor taking the drug—it’s the patient. Patients deserve to know that what they’re taking is safe and clinically effective. While the fast-track program needs to be more exclusive, it’ll be difficult for the FDA to add stricter requirements for the program. From my experience researching healthcare, once stakeholders get a taste of something sweet (fast-track approval with long confirmatory trial timelines), it’s extremely difficult to take that sweetness away, whether due to operational barriers or hard-core lobbying (which Pharma does well at). Lastly, Eli Lilly’s Alzheimer’s drug donanemab functions similarly to Aduhelm. Lilly will also apply for fast track approval, given the reduction in amyloid-beta plaques (surrogate endpoint). I think it’s highly likely the FDA will approve it, given it approved Aduhlem. It’s the surrogate endpoint that matters in these cases, according to the “rules,” not if there’s a clinical benefit (yet). Either way, the precedent for how the FDA approves these fast-tracked drugs needs to be updated.  OUTSIDE THE HUDDLE
 HUDDLE HITS
  HEALTHCARE JOBS Here are some jobs that I’m curating for the healthcare industry. Use this link to submit your role to be featured if you’re looking to hire. Digital Health PR + Comms, HermesPR Fast-growing boutique PR agency HermesPR is looking for someone to fill their PR and communications role. All entry levels! Candidates must have transferable experience in public relations or communications to be considered. Digital health or tech PR experience is required. Customer Success Operations Manager, WHOOP As a Customer Success Operations Manager at WHOOP you will partner with the Customer Success Team and Support to define CS objectives and measure customer experience. A large part of this role will be to develop a scalable operational foundation through system enhancements which enable the team to be more effective in their role. Social Media Manager, Mindbloom If you’re extremely passionate about psychedelic therapies, consider applying for this position. As social media manager you will grow Mindbloom’s social media presence, develop editorial strategy, create content and build community.  THE WEEK AHEAD
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