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BackPage Online, June 2023

BackPage Online, June 2023 THE BACKLETTER Vol. 38, No. 6, June 2023 The Soaring Price of Medical Practices—as Big Investors Swoop In Hospitals and healthcare systems have been buying up US primary care medical practices for years. At relatively modest prices—hundreds of dollars per patient. The main motivations appear to have been the allure of triage in primary care practices leading to the capture of patients for high-profit specialty services. However, recent years have seen a massive upswing in the prices of primary care practices as major corporations and deep-pocketed private equity firms have attempted to buy into a high-revenue, high-profit market. And this does not bode well for the US healthcare system—particularly for patients and healthcare providers. “Now, suddenly, the likes of Amazon, CVS Health, Walgreens, Walmart, UnitedHealth, and Humana are vying to acquire and build primary care practices targeted at serving the US’s seniors. So far, we estimate they have committed $50 billion, and the competition has driven prices north of $50,000 per patient. When the US finally grasps what is going on, how this competition was triggered in the first place, and what the long-term consequences will be, none of us will like it,” according to an article by Paul Branstad and Claude Maechling at Health Affairs Forefront. Here is a link to the entire article and the less than happy news it brings: https://www.healthaffairs.org/content/forefront/explaining-corporate-america-s-aggressive-investment-primary-care Space Exploration and the Study of Back Pain Space exploration has turned out to be an excellent laboratory in which to study the nature and prognosis of back problems in a micro- gravity environment. And the multiple interactive risks that astronauts and other space travelers experience. And these risks often lead to protracted back pain. “Among the potential risks of flying, low back pain (LBP) has a high incidence among astronauts and military pilots, and it is often associated with intervertebral disc degeneration events. The mechanisms of degeneration determine the loss of structural and functional integrity and are accompanied by the aberrant production of pro-inflammatory mediators that exacerbate the degenerative envi - ronment, contributing to the onset of pain,” according to Giovanni Marfia and colleagues. Here is a link to their open access review on this topic at Frontiers in Physiology: https://pubmed.ncbi.nlm.nih.gov/36998982/ The First Guideline on Using Cannabis as a Treatment for Musculoskeletal Pain Alan Bell and a group of Canadian researchers have published one of the first “evidence-based” guideline on the use of cannabis as a treat - ment for musculoskeletal pain. Some argue that the evidence in this area isn’t conclusive enough to support evidence-based guidelines. And some argue that none of the RCTs to date prove that cannabis has a defined role in the treatment of chronic pain. However, Bell et al. took a rather liberal and upbeat view of the evidence in this area. “Research typically demonstrates moderate benet o fi f cannabis-based medicines (CBM) in chronic pain management. There is also evidence for efficacy of CBM in the management of comorbidities, including sleep problems, anxiety, appetite suppression, and for managing symptoms in some chronic conditions associated with pain including HIV, multiple sclerosis, fibromyalgia, and arthritis.” Because of the uncertainty over this evidence base, it will be important to wait a few years to see how the evidence in this area ultimately shakes out. In the meantime, here is a link to the guideline: https://www.liebertpub.com/doi/10.1089/can.2021.0156 The BackLetter e1 Vol. 38, No. 6, June 2023 BBLv38n6-Online.indd 1 BBLv38n6-Online.indd 1 5/2/2023 9:43:39 AM 5/2/2023 9:43:39 AM http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png BackLetter Wolters Kluwer Health

BackPage Online, June 2023

BackLetter , Volume 38 (6) – Jun 1, 2023
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Publisher
Wolters Kluwer Health
Copyright
© 2023 Wolters Kluwer Health, Inc. All rights reserved.
ISSN
0894-7376
eISSN
2161-5179
DOI
10.1097/01.back.0000937412.37846.04
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Abstract

THE BACKLETTER Vol. 38, No. 6, June 2023 The Soaring Price of Medical Practices—as Big Investors Swoop In Hospitals and healthcare systems have been buying up US primary care medical practices for years. At relatively modest prices—hundreds of dollars per patient. The main motivations appear to have been the allure of triage in primary care practices leading to the capture of patients for high-profit specialty services. However, recent years have seen a massive upswing in the prices of primary care practices as major corporations and deep-pocketed private equity firms have attempted to buy into a high-revenue, high-profit market. And this does not bode well for the US healthcare system—particularly for patients and healthcare providers. “Now, suddenly, the likes of Amazon, CVS Health, Walgreens, Walmart, UnitedHealth, and Humana are vying to acquire and build primary care practices targeted at serving the US’s seniors. So far, we estimate they have committed $50 billion, and the competition has driven prices north of $50,000 per patient. When the US finally grasps what is going on, how this competition was triggered in the first place, and what the long-term consequences will be, none of us will like it,” according to an article by Paul Branstad and Claude Maechling at Health Affairs Forefront. Here is a link to the entire article and the less than happy news it brings: https://www.healthaffairs.org/content/forefront/explaining-corporate-america-s-aggressive-investment-primary-care Space Exploration and the Study of Back Pain Space exploration has turned out to be an excellent laboratory in which to study the nature and prognosis of back problems in a micro- gravity environment. And the multiple interactive risks that astronauts and other space travelers experience. And these risks often lead to protracted back pain. “Among the potential risks of flying, low back pain (LBP) has a high incidence among astronauts and military pilots, and it is often associated with intervertebral disc degeneration events. The mechanisms of degeneration determine the loss of structural and functional integrity and are accompanied by the aberrant production of pro-inflammatory mediators that exacerbate the degenerative envi - ronment, contributing to the onset of pain,” according to Giovanni Marfia and colleagues. Here is a link to their open access review on this topic at Frontiers in Physiology: https://pubmed.ncbi.nlm.nih.gov/36998982/ The First Guideline on Using Cannabis as a Treatment for Musculoskeletal Pain Alan Bell and a group of Canadian researchers have published one of the first “evidence-based” guideline on the use of cannabis as a treat - ment for musculoskeletal pain. Some argue that the evidence in this area isn’t conclusive enough to support evidence-based guidelines. And some argue that none of the RCTs to date prove that cannabis has a defined role in the treatment of chronic pain. However, Bell et al. took a rather liberal and upbeat view of the evidence in this area. “Research typically demonstrates moderate benet o fi f cannabis-based medicines (CBM) in chronic pain management. There is also evidence for efficacy of CBM in the management of comorbidities, including sleep problems, anxiety, appetite suppression, and for managing symptoms in some chronic conditions associated with pain including HIV, multiple sclerosis, fibromyalgia, and arthritis.” Because of the uncertainty over this evidence base, it will be important to wait a few years to see how the evidence in this area ultimately shakes out. In the meantime, here is a link to the guideline: https://www.liebertpub.com/doi/10.1089/can.2021.0156 The BackLetter e1 Vol. 38, No. 6, June 2023 BBLv38n6-Online.indd 1 BBLv38n6-Online.indd 1 5/2/2023 9:43:39 AM 5/2/2023 9:43:39 AM

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BackLetter – Wolters Kluwer Health

Published: Jun 1, 2023

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