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U.S. hospitals are facing another year of rough finances as they cope with sharply higher costs and growing labor tension, Fitch Ratings says, Bloomberg News reported. Fitch has a negative rating on the sector, with a deteriorating outlook, and expects more downgrades than upgrades this year for not-for-profit hospitals with rated debt. The smaller and often-rural facilities that aren’t rated will fare far worse, Kevin Holloran and Mark Pascaris said in a report. There’s not a lot to be optimistic about in the fourth year of a pandemic that pushed hospitals into distress as they shut down profitable procedures and saw expenses, especially labor, soar. The billions in federal aid that buoyed balance sheets has ended, including the $178 billion Provider Relief Fund. "There’s just no more free money coming from the feds and the states," Holloran said during a presentation Wednesday. About three-quarters of hospitals’ expenses are "under intense pressure." Though hospitals are relying less on the travel nurses that filled in for departing and sick nurses during the pandemic, wages for regular staff will be higher for years, he said. Add inflation and higher borrowing costs, and the situation looks even more worrisome. While hospital volumes are rising, "we're struggling with right now the wrong’ kind of volumes," meaning patients sickened in the so-called tripledemic of COVID, flu and RSV that require more care, instead of elective procedures, Holloran said. But "it’s labor, labor, labor" that forms the biggest challenge to hospitals, he said. "The potential for strikes is much more elevated than it used to be." Those tensions have been playing out this week in New York City, where more than 7,000 nurses at two hospitals concluded a three-day strike Thursday that focused on increasing staffing. Nurses say inadequate staffing levels cause them to leave the field, forcing hospitals to pay for more-expensive temporary replacements and ensuring that turnover remains high.

The owner of a former vermiculite mine in northwestern Montana that spread harmful asbestos in and around the town of Libby has offered $18.5 million to settle the last of the state’s claims for environmental damages, Gov. Greg Gianforte announced on Tuesday, the Associated Press reported. The proposed settlement was filed in W.R. Grace & Co.’s bankruptcy case in Delaware for the Libby Asbestos Superfund Site in Lincoln County. Asbestos from a vermiculite mine owned by W.R. Grace beginning in 1963 polluted the area until the mine was shuttered in 1990. Cleanup began in 2000, after media reports spurred federal officials to investigate widespread health problems among area residents. Health officials estimate that several thousand people have been sickened in northwest Montana from exposure to Libby’s asbestos and at least 400 have died. More than 2,600 homes, businesses and other properties were cleaned up at a cost of more than $600 million under the U.S. Environmental Protection Agency’s Superfund program for hazardous sites. W.R. Grace agreed in a 2008 settlement to pay the EPA $250 million for cleanup work.

The health impact in Scott County with a population of 25,000 was catastrophic: 88% of the patients infected with HIV injected Opana ER or a generic with oxymorphone — a highly profitable opioid with a trail of misery formed over decades by the Malvern, Pa., drug firm Endo Pharmaceuticals Inc. Opana ER, the most sought Endo pill, was the “cornerstone” of the company’s pain-management business, the government says, the Philadelphia Inquirer reported. In 2017, two years after the Indiana crisis, the Food and Drug Administration requested that Endo remove the crush-resistant Opana ER pills from the market as drug users were shifting from snorting to injecting oxymorphone. Thousands of government and private organizations have sued Endo for its alleged part in the nation’s opioid epidemic, which government experts say has claimed more than 500,000 lives in America. Michael Carrier, a Rutgers Law professor who has studied pharmaceutical antitrust behavior for 15 years. But oxymorphone is still a big money-maker for Endo, whose patent for the drug makes it the medication’s “gatekeeper,” the government says. The FDA didn’t ban oxymorphone in 2017, and generic pills based on Endo’s original Opana ER formulation are still available for doctors to prescribe for cancer, lower back and other pain. Endo estimated in 2017 that a royalty stream from the oxymorphone ER generic pills over time was worth “close to $265 million” — non-crush-resistant pills that Endo once told the FDA should be taken off the market for safety. Endo controls a critical patent on the generic pills through 2029. Because of patents, Endo earns a percentage of the “monopoly” profits on the generic pills distributed by Impax Laboratories LLC, a 2021 Federal Trade Commission lawsuit says. The FTC, which enforces consumer protection laws, is asking the federal court to find that the agreement between Endo and Impax violates antitrust laws and seeks unspecified monetary damages.

Clovis Oncology Inc. filed for bankruptcy and plans to sell its experimental cancer drug at an auction with Novartis Innovative Therapies making a binding, opening bid worth as much as $681 million, Bloomberg News reported. Novartis has agreed to pay $50 million initially and another $630.75 million in payments if the cancer drug, FAP-2286, wins regulatory approval and later hits certain sale goals, Clovis said in a statement. The agreement will be considered the opening bid of a court-supervised auction, should a judge approve the deal and competing offers come in. For Clovis, which once had a market value of over $3 billion, the opening bid for its pipeline candidate is a far cry from the $5.1 billion that a competitor secured from GSK Plc in 2018. Back then Clovis was riding high on speculation it could secure a similar deal for another cancer drug, Rubraca. But regulatory setbacks and disappointing sales have left the company saddled with debts. The company is also talking to other parties about selling different parts of its business.

U.S. drugmaker Clovis Oncology Inc. on Sunday filed for bankruptcy protection in Delaware, hit by a fall in sales of its cancer drug and challenges in raising additional capital, Reuters reported. Clovis has been struggling to sell its cancer drug Rubraca, the company's only approved drug, as sales were hit in recent years by intensifying competition from rival ovarian cancer treatments, and partly due to declining diagnoses during the pandemic lockdowns. The company has also lined up a debtor-in-possession (DIP) financing facility of up to $75 million to provide it with necessary liquidity, subject to court approval, Clovis said in a press release on Monday. Colorado-based Clovis said it has entered into a stalking horse agreement with Novartis Innovative Therapies AG to sell the license rights to its pipeline clinical candidate FAP-2286 for an upfront payment of $50 million and up to an additional $333.75 million after achieving some development and regulatory milestones. Clovis will also receive $297 million later, when it hits certain sales milestones. Clovis is also actively engaged in discussions with a number of interested parties regarding a potential sale of one or more of its other assets. In a filing at the U.S. Bankruptcy Court for the District of Delaware, Clovis estimated its assets to be in the range of $100 million to $500 million, with liabilities between $500 million and $1 billion.

For 46 million Americans, rural hospitals are a lifeline, yet an increasing number of them are closing. The federal government is trying to resuscitate them with a new program that offers a huge infusion of cash to ease their financial strain. But it comes with a bewildering condition: They must end all inpatient care, the New York Times reported. The program, which invites more than 1,700 small institutions to become federally designated “rural emergency hospitals,” would inject monthly payments amounting to more than $3 million a year into each of their budgets, a game-changing total for many that would not only keep them open but allow them to expand services and staff. In return, they must commit to discharging or transferring their patients to bigger hospitals within 24 hours. The government’s reasoning is simple: Many rural hospitals can no longer afford to offer inpatient care. A rural closure is often preceded by a decline in volume, according to a congressional report, and empty beds can drain the hospital’s ability to provide the outpatient services that the community needs. But the new opportunity is presenting many institutions with an excruciating choice. “On one hand, you have a massive incentive, a ‘Wow!’ kind of deal that feels impossible to turn down,” said Harold Miller, the president of the nonprofit Center for Healthcare Quality and Payment Reform. “But it’s based on this longstanding myth that they’ve been forced to deliver inpatient services — not that their communities need those services to survive.”