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R1 RCM to buy VisitPay for $300M



R1 RCM to buy VisitPay for 0M

Revenue cycle management company R1 RCM on Tuesday announced plans to acquire VisitPay, a privately held company that sells patient billing tools.

Chicago-based R1 will pay roughly $300 million in cash for Boise, Idaho-based VisitPay, funded with a combination of cash from its balance sheet and debt.

The acquisition provides a tax benefit valued at approximately $40 million, according to R1.

R1’s continued investment in technology is one of the “driving forces” behind the decision to buy VisitPay, said Joe Flanagan, president and chief executive officer of R1, on a call with investment analysts Tuesday, as well as R1’s continued investment in building a patient experience platform.

R1 last year acquired SCI Solutions, a developer of scheduling and other patient engagement tools, for roughly $190 million in cash.

“The next logical capability to bring in-house is the technology to modernize the consumer payments ecosystem in healthcare,” Flanagan said. R1 plans to launch its new patient experience toolset, which combines patient billing and payment tools from VisitPay with the company’s existing online registration and scheduling tools, at HIMSS21 in August.

Flanagan said he expects VisitPay to contribute $41 million to $42 million in revenue in 2022.

VisitPay, which counts Intermountain Healthcare, Geisinger Health and Carilion Clinic among its customers, sells cloud-based payment tools to healthcare organizations that patients use to pay bills, including digital tools that consolidate billing statements and machine learning and analytics tools that recommend personalized payment options to patients.

Payment data that VisitPay has collected over the past decade will also help support R1’s artificial intelligence and automation roadmap, Flanagan said. Flanagan said R1’s technology and automation efforts, which use robotic process automation, machine learning and natural language processing, are a way the company works to differentiate itself from other RCM vendors in the market.

R1 expects to complete the VisitPay acquisition in 2021’s third quarter.

R1 posted $342.6 million in revenue for 2021’s first quarter, up 6.9% year-over-year, according to financial results released Tuesday, including $286.1 million in revenue from net operating fees and $29 million in revenue from incentive fees. Net operating fees growth was chiefly driven by revenue from new customers, R1 Chief Financial Officer Rachel Wilson said on Tuesday’s call.

Also on Tuesday, R1 announced a 10-year expansion of its contract with St. Louis-based Ascension, under which Ascension will also deploy patient experience tools from R1 across its acute-care and ambulatory sites. Ascension has been outsourcing revenue cycle services to R1 over the past few years.

R1 reported $36.8 million in operating income for the first quarter, up 13.6% year-over-year, and $25.8 million in net income, up 41.8% year-over-year.

R1’s stock dropped to $24.29 on Tuesday morning, down from $27.17 when markets closed Monday. The company stock was $23.77 at noon Eastern Daylight Time on Tuesday.

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Congress eyes private equity-owned nursing homes after COVID-19 deaths



Congress eyes private equity-owned nursing homes after COVID-19  deaths

Congress is renewing its scrutiny of the nursing home industry, arguing there is a lack of transparency around the ownership and finances of chains, especially those owned by private equity.

About 40% of COVID-19 deaths in the U.S. occurred in nursing homes, partly due to the nature of congregate settings that make it hard to control the spread of infections. But Democrats want more information about the roles private equity and chain ownership of nursing homes plays in patient outcomes, pointing to studies that show more deaths and worse care in facilities owned by investors.

“We need better information about nursing home ownership and strong enforcement of nursing home quality standards,” Sen. Elizabeth Warren (D-Mass.), a critic of private equity, told Modern Healthcare. “This is why I intend to re-open my investigation of private equity-owned nursing homes so we can make progress on these issues.”

The scrutiny of private equity investment in nursing homes is not new but little has changed since Congress investigated the issue 10 years ago.

A paper published in February by the National Bureau of Economic Research, which hasn’t been peer reviewed, found Medicare patients were 10% more likely to die at private-equity owned nursing homes in the first 90 days, due to lower staffing levels, higher use of antipsychotic drugs and other reasons.

Experts hope the COVID-19 pandemic and its effect on residents will drive Congress to address the issue but they say it’s hard to hold people accountable without more information about who owns nursing homes and how profitable they actually are, two things some experts say private equity owners and chains can hide under the current laws.

A proposal by Ways & Means Committee Chairman Richard Neal (D-Mass.), which will be reintroduced this year, would significantly increase the amount of information investors in the healthcare industry have to report to the IRS.

With nursing homes in particular — an already fragmented section of the healthcare industry — complex ownership structures make it hard for policymakers and families to know which facilities are owned by private equity investors or how profitable they are.

“Examining the role of private equity in the healthcare system remains a top priority for the committee, especially in light of the last year, and we are actively accessing options for action here,” said a Ways & Means Committee aide.

A version of the Neal bill introduced last year would require private equity firms with controlling interests in medical services providers file annual information returns with the IRS detailing real estate and payments to related parties, debts, acquisitions and more, and for that information to be made public.

“I think one of the biggest problems with private equity investment in healthcare is it’s impossible to measure the impact,” said Eileen O’Grady, research and campaign coordinator at the Private Equity Stakeholder Project, which receives funding from unions and other not-for-profits. “All we have are these anecdotal stories. It’s very much the tip of the iceberg. What increased transparency does is allow regulators and lawmakers to have a more accurate picture of the landscape and help design policy that ensures these predatory practices can’t continue.”

While nursing homes have caught the attention of Congress, private equity investments in healthcare have also spread to home health, behavioral health, urgent care and other sectors of the industry.

All would be effected by the Neal bill, which would discourage investment in the health sector, opponents argue.

“This legislation includes burdensome regulations that would chill private sector investment, innovation, and growth in the healthcare space and ultimately threaten access to quality care,” said a spokesperson for the American Investment Council.

There are more than 15,000 nursing homes in the U.S., about 70% of which are for-profit.

About 10% are owned by private equity investors, according to the American Health Care Association, a trade group representing for-profit nursing homes, but other experts say that number doesn’t tell the full story.

Skilled nursing facilities only have to report direct or indirect ownership down to 5% to the Medicare Provider Enrollment, Chain and Ownership System (PECOS) database.

“They could own 4.5% but still have a lot of control over the administration over the home,” said one senior Democratic aide. “It’s kind of staggering how much we don’t know.”

The information that is filed to PECOS is not audited by CMS for accuracy or completeness, or made available to the public, according to a Health Affairs brief published in February.

President Joe Biden on the campaign trail vowed to require HHS Office of Inspector General audit nursing home cost reports and PECOS ownership data. Experts have recommended HHS work with CMS, HHS OIG, the Department of Justice and the CDC to analyze PECOS data for accuracy and completeness.

“The monetary and enforcement authorities are pretty robust at the federal levels between DOJ, HHS and CMS but they don’t tend to work together. They tend work in silos,” said Anne Montgomery, director of eldercare improvement at Altarum and co-author of the Health Affairs article.

The data could then be used to determine the impacts of ownership on patient care and discipline bad actors with a history of problems.

CMS didn’t respond to a request for comment. HHS Secretary Xavier Becerra told Sen. Warren in February, in response to written questions about private equity ownership of nursing homes, “nursing homes’ first obligation should be to their patients, no matter what kind of ownership arrangements they have.”

Organizations that receive Medicare or Medicaid reimbursements are also required to file annual cost reports but those also don’t present a full picture on whether a nursing home or chain is profitable, experts say.

Nursing home operators have to report revenues and expenses during a particular time period, but experts say profits can be “hidden” in related-third parties to make it appear that a facility is losing money.

Experts say for-profit chains — sometimes owned by private-equity firms — can pull out profits from a nursing home by contracting with a related-party it also owns, like a staffing agency. Sometimes those related parties charge the nursing homes inflated rates, “siphoning” profits from the facility, an expert told the Ways & Means Committee last month. While charges to related-parties must be reported on cost reports, those parties don’t have to file reports with CMS.

Lawmakers and experts have questioned private equity’s strategy of buying nursing homes in an apparent attempt to profit off its real estate by selling it to related third-parties and leasing it back to the operators at high rents.

“They’re able to pull so much money out of nursing homes through related party organizations and they don’t have to report on those,” said Charlene Harrington, a professor emerita of nursing and sociology at the University of California at San Francisco who studies nursing homes and co-authored the Health Affairs brief.

The brief recommends cost report requirements be amended to require nursing homes provide consolidated financial reports including data from operating entities, and all organizations and entities related by common ownership or control.

As nursing homes beg Congress for more money, and claim Medicaid and Medicare reimbursement rates are too low to cover the cost of the services they provide, experts say these complex ownership structures make it impossible to know how profitable some of these facilities actually are.

“We really don’t know whether rates are too low because without transparency, we have no idea where the money is going. We just know it’s not going for the care,” Harrington said.

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Meat Production Is Polluting the Air You Breathe



Meat Production Is Polluting the Air You Breathe

By Amy Norton
HealthDay Reporter

TUESDAY, May 11, 2021 (HealthDay News) — Steaks and burgers could be killing thousands of Americans each year, but in a way most people wouldn’t expect — via air pollution.

That’s the conclusion of a new study estimating that airborne particles generated by food production kill nearly 16,000 Americans each year. Pollution related to animal products — most notably beef — accounts for 80% of those deaths.

“What we eat affects not only our own health, but the health of others,” said researcher Jason Hill, a professor of bioproducts and biosystems engineering at the University of Minnesota in St. Paul.

Farming generates pollutants in numerous ways, but Hill’s team focused specifically on its role in fine-particle pollution — tiny substances suspended in the air that can be inhaled deeply into the lungs.

That can be especially dangerous for people with existing heart or lung conditions, and the World Health Organization says exposure to dirty air kills roughly 7 million people worldwide each year.


Farming activities like plowing fields, fertilizing crops and spreading and storing manure all help generate fine-particle pollution.

Growing plant foods creates some pollutants, but not at the level of animal products. There’s not only the livestock themselves — think manure — but the crops grown to feed them, Hill said.

Raising cattle requires the most resources and churns out the most pollution.

Accordingly, the study found, air pollution related to red-meat production caused the most harm: Per serving, its impact on deaths was seven times that of poultry, 10 times that of nuts and seeds, and at least 15 times that of other plant foods.

“Red meat has such a large impact that reducing our intake of that alone could make a big difference,” Hill said.

Gidon Eshel, a researcher not involved in the study, agreed.

Beef production “exerts, by far, the most environmental and health consequences,” said Eshel, a research professor at Bard College in Annandale-on-Hudson, N.Y.

It’s been well known that agriculture contributes to air pollution, Eshel said, and that air pollution contributes to deaths.

But the new findings, he said, show “crisply and numerically” how the nation’s collective diet contributes to deaths in the population.


The study — published May 10 in the Proceedings of the National Academy of Sciences — was partly funded by the U.S. Environmental Protection Agency (EPA) and U.S. Department of Agriculture.

It drew on EPA emissions data to gauge the impact of different farming activities on U.S. counties’ air quality. The researchers then used statistical models to estimate the effects of fine-particle pollution, from various agriculture sources, on annual deaths nationwide.

The verdict: Agriculture generates enough dirty air to kill about 18,000 Americans each year. Specifically, ammonia from livestock waste and fertilizer was a major culprit, the researchers said.

Of those deaths, the vast majority — almost 16,000 — were related to food production, mainly meat, poultry and dairy.

To take a more positive view, Hill’s team also estimated the impact of potential solutions.

They found that certain farming measures — such as improving fertilizer application — could prevent some deaths.

But changes to the American diet would reap far greater benefits: If veganism and vegetarianism swept the nation, most of the described deaths could be avoided, the researchers found.


However, Hill stressed, “you don’t have to become an absolutist.”

His team projected that “flexitarian” eating would prevent a large number of deaths, too. That refers to diets that are largely plant-based but allow some animal products in moderation.

Given the large effects of red meat, Hill noted, even declaring “meatless Mondays” could make a difference.

But would there be ill health effects from eschewing animal protein?

Eshel said there’s “not a shred of evidence” that people need animal protein to be healthy — but a “mountain of evidence” supporting the benefits of plant-based diets.

In a 2019 study, Eshel estimated that if all Americans traded in meat for plant alternatives, it would make a big dent in greenhouse gas emissions, and use of crop lands and nitrogen fertilizers.

And with sources like soy and buckwheat supplying protein, the study found, there would be no skimping on nutrients, either.

But Eshel also acknowledged that a national embracing of veganism is unlikely. He said that “jettisoning” beef, and replacing it with healthy plant foods, would be a good step in itself.


More information

The Academy of Nutrition and Dietetics has advice on building healthy vegetarian diets.

SOURCES: Jason Hill, PhD, professor, bioproducts and biosystems engineering, University of Minnesota, St. Paul; Gidon Eshel, PhD, research professor, environmental and urban studies, Bard College, Annandale-on-Hudson, N.Y.; Proceedings of the National Academy of Sciences, online, May 10, 2021

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Poll: Most in US who remain unvaccinated need convincing



Poll: Most in US who remain unvaccinated need convincing

Fewer Americans are reluctant to get a COVID-19 vaccine than just a few months ago, but questions about side effects and how the shots were tested still hold some back, according to a new poll that highlights the challenges at a pivotal moment in the U.S. vaccination campaign.

Just 11% of people who remain unvaccinated say they definitely will get the shot, while 34% say they definitely won’t, according to the poll by The Associated Press-NORC Center for Public Affairs Research.

That leaves a large swath of Americans in the middle who might still roll up their sleeves — including 27% who say they probably will and 27% who say they probably won’t — if someone credible addressed their concerns. That’s where National Institutes of Health immunologist Kizzmekia Corbett comes in.

Corbett helped lead development of the Moderna shot, and she spends hours giving plain-spoken answers to questions from Americans — especially Black Americans like her — to counter misinformation about the three vaccines used in the U.S.

No, COVID-19 vaccines won’t cause infertility: “Whoever started that rumor, shame on you.”

No, the shots’ speedy development doesn’t mean corners were cut: “We worked our butts off for the last six years” hunting vaccines for earlier cousins of COVID-19 — a head start that made the difference, Corbett recently told the AP.

Getting as many people vaccinated as fast as possible is critical to returning the country to normal. More than 150 million people — about 58% of all adults — have received at least one dose, according to the Centers for Disease Control and Prevention.

As that number grows, reluctance is inching down. Overall, the AP-NORC poll found about 1 in 5 American adults say they probably or definitely won’t get vaccinated, compared to about a third in January, when the shots were just rolling out.

Black Americans likewise are becoming more open to the shots, with 26% now saying they definitely or probably won’t get vaccinated compared with 41% in January. That’s similar to the 22% of Hispanic Americans and white Americans the poll found unlikely to get vaccinated. Among Asian Americans, just 9% say they definitely or probably won’t get the shots.

Holdouts are from all over American society — fueling experts’ advice that there is no one-size-fits-all vaccine message and that people need to hear from trusted sources, whether that’s scientists like Corbett or their own doctors. Adults under 45, rural Americans and Republicans are especially likely to say they will avoid vaccination, the poll found. But again, attitudes are changing: 32% of Republicans now say they probably or definitely won’t get vaccinated, down from 44% in January.

About three-fourths of those who say they are unlikely to get vaccinated have little to no confidence that the vaccines were properly tested, and 55% are very concerned about side effects, the poll found. Even among those who say they will probably get vaccinated but have not done so yet, concerns about proper testing are elevated compared with people who have received their shots already.

In forums hosted by colleges, Black pastors, doctors and even basketball great Kareem Abdul-Jabbar, Corbett says the best way to overcome distrust is to put the science in understandable terms for strangers just like she does for family. Later this spring, she’s moving from the NIH to Harvard’s School of Public Health to continue both her vaccine research and that outreach to communities, the school plans to announce on Tuesday.

The vaccines’ speedy development “is historic and it is brag-worthy,” said Corbett, whose NIH team was able to customize a shot that matched the new virus after spending six years developing vaccines against other dangerous coronaviruses such as MERS.

But “really, we should have started the conversations very early about what went into it,” she said, so the public understood that no steps were skipped.

A combination of huge studies and real-world data show the main side effects of the U.S. vaccines are temporary fevers or aches as the immune system revs up. The shots are undergoing unprecedented safety monitoring, which last month led to a temporary pause in Johnson & Johnson vaccinations to determine how to handle an incredibly rare risk of blood clots.

Even after that pause, overall confidence in the vaccines is up slightly compared with a few months ago, with 45% of all adults now very or extremely confident that the shots were properly tested for safety and effectiveness, compared with 39% in an AP-NORC poll in February.

But side effect myths persist. Corbett calls the fertility concern “completely absurd,” and in forum after forum explains why it’s biologically impossible for the vaccines to alter anyone’s DNA.

The repetition is OK: “People need to hear things multiple times,” she said.

Plus, many Americans have some of the same questions scientists are still trying to answer, such as whether or when people might need a booster dose.

“Those are things that even I can’t even answer. But what I can say is that we’re doing everything we can to make sure we can answer it as soon as possible,” Corbett said.

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