Consistency hasn’t been in the cards—or on our bingo card, as it were—for healthcare companies lately. Instead, the financial shakeout for companies was vastly different across the healthcare spectrum (depending on the area you’re looking at), but it’s a safe bet that just about everyone has been struggling with similar issues.

Patient volume was top of mind for executives during recent earnings calls at health systems like HCA Healthcare and Tenet Healthcare, especially as executives struggled to keep enough staff to meet returning demand for elective procedures.

The outlook was better than expected for most pharmaceutical companies, according to Mohit Bansal, managing director for biopharma equity research at Wells Fargo, but analysts are paying close attention to a couple drugs with patents that are expiring soon. Those drugs will soon face new competition, potentially causing a steep decline in sales for some drugmakers.

The potential for a “tripledemic” of Covid, RSV, and the flu is also of concern for many healthcare companies moving into the winter months.

Patient volumes: There were pushes and pulls (one phrase that didn’t make the bingo card!) that continued to make it hard for hospitals to predict future patient volumes, or how many patients are getting care. For example, even as demand is increasing for elective procedures, hospital staffing shortages are limiting how many surgeries can actually be done, orthopedic device maker Stryker reported.

Strong pharma results: This quarter’s pharmaceutical earnings were overall better than expected, Bansal said. He gave the to Merck, thanks to its Keytruda sales. The cancer drug brought in $5.4 billion last quarter, accounting for a whopping 36% of the company’s revenue for that period. But, Keytruda’s patent is expiring in 2028, and everyone is waiting to see what Merck pulls out of its hat to replace it. Keep reading here.—MA, MS

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At the end of September, California made it possible for doctors who spread Covid-19 mis- and disinformation to their patients to face punishment. Passed in response to a nationwide rise in misinformation that’s been linked to unnecessary Covid deaths, the law classifies “the dissemination of misinformation or disinformation” about Covid as a form of unprofessional conduct, which can be investigated and potentially punished by state medical boards.

“The spread of misinformation and disinformation about Covid-19 vaccines has weakened public confidence and placed lives at serious risk,” the law states.

It only applies to discussions directly between a doctor and a patient “under their direct care” and “does not apply to any speech outside of discussions directly related to Covid-19 treatment,” Gov. Gavin Newsom wrote in a letter to the California State Assembly. It doesn’t apply to posts on social media.

But, according to Katrine Wallace, an epidemiologist and an adjunct assistant professor at the University of Illinois Chicago School of Public Health, that’s exactly where most of the misinformation is being spread. And a small number of people may be responsible for a lot of the misinformation circulating.

Nearly two-thirds of anti-vaccine posts on Facebook and Twitter made between Feb. 1, 2021, and March 16, 2021—more than 812,000 messages—were tracked back to just 12 people, according to a study by the Center for Countering Digital Hate, a nonprofit aimed at countering online hate and misinformation.

“It’s not a doctor-patient relationship…where the harm is happening,” Wallace said. “It’s a social media mass-spreading of misinformation.”

Arthur Caplan, a professor of bioethics at NYU Grossman School of Medicine, said he doesn’t think the California law will do much to counter medical misinformation because state medical boards “don’t have the resources to really do anything.” They are often “underfunded, understaffed, and under-resourced,” he said. Keep reading here.—MA

Paying providers for their services may seem simple on the surface, but it’s actually extremely complex. Enter two of the most commonly heard phrases in healthcare: “fee-for-service” and “value-based care,” two models insurers use to decide how much to pay providers.

Under a fee-for-service model, providers are paid for each individual service they perform, like a blood test or an X-ray, according to Jennifer Clawson, partner and director of value-based health systems at Boston Consulting Group. A service is provided, and the doctor gets a fixed fee for providing it. Simple enough.

The value-based care model is a bit more complicated, as there are many types of value-based payments. What makes them “value-based” is that payers take patient outcomes into consideration, aka they consider the relative value.

“The core of value-based care is ultimately, ‘How do I get a better outcome for less money?’” said Sam Hendler, managing director at private equity firm Thomas H. Lee Partners.

One type of value-based payment is called a bundled payment, Clawson said. Say you have a heart condition and need to get a stent put in. There are usually several providers involved in that process, e.g., a primary care doctor, cardiac surgeon, and anesthesiologist. An insurer gives the health system a set amount of money to cover everyone involved in the procedure, and the health system decides how to divvy it up.

Another type of value-based payment is called capitation, and there’s multiple types of capitation payments. It’s sort of like a bundled payment, but instead of insurers paying a set amount per procedure, they’re paying a set amount to cover an entire population of patients with a specific disease, like diabetes.

When it comes to the US healthcare system adopting value-based payment models, Hendler says we’re only “in the second inning.”—MA

Today’s top healthcare reads.

Stat: Nearly 30% of households in America comprise one person, compared to 13% in 1960. (the New York Times)

Quote: “I didn’t feel represented, and I felt that so much of my family’s history just didn’t feel like it was considered.”—Eden Teng, a Cambodian American therapist, on a growing number of mental health professionals of color who are offering a new framework to their non-white patients (NPR)

Read: Native tribes in the Pacific Northwest are catching and consuming fish that can result in “a disproportionate risk of toxic exposure.” (ProPublica)

Catch up on the top Healthcare Brew stories you may have missed:

• Walgreens is building the ‘pharmacy of the future’
• Billionaire investor Mark Cuban says his eponymous online drug company isn’t collecting customer data
• Fewer people are likely to get Botox during a recession, and that’s bad news for AbbVie