Today's News and Commentary

About the public’s health

WHO reveals delayed pick for H3N2 flu vaccine strain: The WHO delayed by about a month its 2019-20 recommendations for flu vaccine coverage to make sure the chosen strains accurately predicted what would be prevalent. The recommended components were issued yesterday. While hopefully more accurate, the wait will cause a delay in manufacturing- so expect availability a bit later than this season’s vaccines.

Read the story

The Missing Diversity in Human Genetic Studies: Genetic analyses are being used as guides to research and treatments for many different conditions. This study found a lack of diversity in the sampling. For example about 78% of genome-wide association studies were done on populations of European origin.

Read the research (Subscription may be required)

Poll: More Americans say too little spending on health: Perhaps you read that headline twice? In a poll by The AP-NORC Center for Public Affairs Research and General Social Survey staffs, 70% of Americans said we should spend more on “improving and protecting the nation's health.” For comparison, only 52% said we should spend more for law enforcement and infrastructure (highways and bridges).

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Blue states threaten to drop family planning program over Trump abortion rule: Title X programs provide significant federal funding to states for birth control and reproductive health services for low-income women. But new regulations will pull that funding if centers receiving the money provide or refer out for abortion services. According to the article, “of 23 states, including the District of Columbia, suing over the policy changes, only four told POLITICO they plan to stay in the program, citing concerns about giving up those federal dollars even with strings attached.”

Read the article

A Reason to Be Skeptical of the Workplace Wellness Industry: This research concluded that a comprehensive workplace wellness program didn’t “change employees’ behavior or health care costs in the first year. Employees who took part didn’t become healthier or more productive, and were not more likely to go to the gym or run in a local race. Total health care costs didn’t drop, either.” This study was published in the prestigious Scientific American. I am really surprised it got into print. As someone who has been following workplace wellness programs for many years, I found the following problems with the study: 1) It was based one program in Illinois. Outcomes vary by type of organization and geography. 2) Outcomes vary by specific type of intervention (like exercise, tobacco cessation, etc.); so if overall results, such as costs, are reported, less successful programs can cancel more successful ones, making the entire program seem worthless. 3) Perhaps most importantly, the study was for one year (which the authors noted). Uptake of programs, change in corporate culture that foster them and resultant health effects can take longer.

Read the research and decide on the validity of findings for yourself

About pharma

Bayer is taking collaboration with health care start-ups to the next level: Bayer is now consolidating some of its disparate initiatives in IT into one focus on digital health. Since its launch into this area in 2013, Bayer has supported over 149 digital health companies. The program is called G4A.

Read the article

UPS eyes in-home health services with U.S. vaccine project: In yet another cross-industry activity, UPS is planning to provide at-home flu shots this fall in a venture with Merck. Nurses will go to the homes to administer the vaccines.

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Drug Company Protections Are Latest Stumbling Block for Nafta Rewrite:As previously reported, the United States-Mexico-Canada Agreement provides for 10 years of protection for biologics before biosimilars can be introduced. Now House Democrats are threatening to hold up approval of the treaty, claiming this protection is excessive and will continue to contribute to high pharma prices.

Read the article (From the NY Times but appears to be open access)

About devices

A smart toilet seat to detect heart failure?: Engineers at Rochester Institute of Technology have begun preclinical studies using a toilet seat that measures blood pressure, heart rate, oxygenation and cardiac output. The aim is to detect early heart failure in at-risk patients.

Read the story

About insurance

Maryland legislators OK plan to use tax returns to help residents with insurance enrollment: “Seven out of 10 people who are uninsured and qualify for help file Maryland income tax returns.” To take advantage of this finding, the Maryland legislature approved a program to allow people to sign up for insurance on their tax forms. Some states have also proposed allowing signups when renewing drivers licenses.

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The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities: Based on a survey of 62 inpatient psychiatric facilities, the National Association for Behavioral Healthcare (NABH) estimated that compliance with three regulatory requirements “impose $1.7 billion in compliance costs each year nationwide. Put another way, these burdens represent 4.8 percent of an average facility’s annual revenue for all inpatient psychiatric services from all sources.” [Emphases in original.] Read the report and form your own opinion if the costs are worthwhile given the protections the rules require.

Read the study

What Characterizes the Marketplaces with One or Two Insurers? An Update: This research from the Urban Institute updates their 2017 report on ACA marketplaces with only one or two plans. Bottom line is that the number of such plans is lower than last year but still not as low as 2017. However, like all other statements about the ACA, geographic differences are pronounced.

Read the research

VA is gearing up for a massive shift of health care to the private sector. But Democrats are fighting back: This article updates a previous post about Democratic opposition to Republican implementation of private options for veterans who have access problems to care. It is a nice summary of the different stakeholders and their stances on the issue.

Read the article (From the Washington Post but appears to be open access)

Today's News and Commentary

About Healthcare IT

9 top Internet of Things trends for 2019: Interesting list from a healthcare IT trade publication. It has some good thoughts about current and future trends in this area. Worth at least a quick read.

Read the annotated list

Geisinger program improves internal communication between doctors: This system has an internal communications program called Ask-A-Doc. Primary care physicians can ask specialists questions through this e-channel to get faster answers and avoid unnecessary referrals. According to an internal study of nearly 22,000 physician consultations, “the Ask-A-Doc program significantly reduced turnaround time between primary and specialty doctors to 6.5 hours vs. traditional referrals, which range from weeks to months.” In addition to reducing turnaround time, the program reduced costs 20% in its second month, largely due to lower ER visits and a 74% drop in specialty visits.

Read the article
Read more about how the process works

Disconnected: a survey of users and nonusers of telehealth and their use of primary care: This research looked at who is using telehealth services. The conclusion was: “ …users of live video visits were educated, employed, and largely urban based. Compared with nonusers, they were less likely to have a primary care USC [ usual source of care], and many unsuccessfully sought to obtain in-person care.” Having the availability of telehealth is laudable, but not as a substitute for having an ongoing primary care physician relationship.

Read the research

Data Note: Public’s Experiences With Electronic Health Records: This research from the Kaiser Family Foundation has a number of interesting findings (you should look at the whole report). One interesting result was that only about 45% of respondents thought EHRs improved the quality of care or physician interaction. Overall, 54% are concerned about unauthorized access, but results vary by age- younger respondents are more trusting.

Read the report

About the public’s health

A prospective study of tea drinking temperature and risk of esophageal squamous cell carcinoma: This scientific research was the most cited in the media today. It also has the most immediate practical implication. Bottom line: To avoid increasing your risk of esophageal squamous cell carcinoma (by 90%), make sure your hot drinks are below 60 degrees Celsius (140 degrees Fahrenheit). For comparison, those of you who prepare coffee by French press method know the initial brewing temperature is 200 degrees Fahrenheit.

Read the research (May need subscription)
In case you cannot access the research read this story

New Zealand to Ban Military-Style Semiautomatic Guns, Jacinda Ardern Says: While not medical, this announcement was really the biggest public health story today and showed tremendous courage and leadership. US implications are, unfortunately, obvious.

Read the article (from NY Times but appears open access)

About insurance

Community Factors and Hospital Readmission Rates: Medicare penalizes hospitals with excessive readmission rates. But to be helpful, payments must be based on factors over which hospitals have control. This research quantifies the effect of social determinants on the penalties. Researchers studied cases of heart attack, congestive heart failure and pneumonia. They found that for those conditions alone, adjusting for such factors as  poverty, disability and living in a disadvantaged neighborhood accounted for $35 million in penalties for safety net and affluent hospitals. Overall, “Fifty‐eight percent of national variation in hospital readmission rates was explained by the county in which the hospital was located.”

Read the research (Subscription may be required)
If you cannot get access to the research, read this article

The risk of death from this cancer went down in Kentucky after Medicaid expansion: Simple message: Medicaid expansion increased colon cancer screening and decreased mortality. For example: “In Appalachian Kentucky, where cancer rates are the highest in the state, colon cancer screenings went up 43 percent and the risk of death declined by … 27 percent.” Another case to show that insurance coverage matters in quality of care.

Read the story

Today's News and Commentary

About insurance

Where Do U.S. Health Reform Proposals Fall on the Medicare-for-All Continuum?: With all the Medicare-for-all stories in the news I am reposting the Commonwealth Fund site that allows you to compare the spectrum of proposals.

Check the website

Following Medicare’s ACO Program Overhaul, Most ACOs Stay—But Physician-Led ACOs Leave At A Higher Rate: This analysis looks at what types of organizations are dropping out of the ACO program. As the title indicates, physician-led organizations have a higher exit rate than those led by hospitals. The article speculates on the reasons but my take has always been that lack of adequate financing and expertise with risk-taking have consistently plagued these physician ventures.

Read the article

 Mercer’s National Survey of Employer-Sponsored Health Plans-2018: Some of the findings in this annual survey are not surprising- specialty pharmaceutical are a major driver of costs (see pharma articles below). But what employers are doing or not doing about rising costs is puzzling. For example, while 80% offer telemedicine options, only 18% offer a high performance network and 25% steer employees to centers of excellence for transplants. Employers need to get serious about their quality concerns before employees will consider narrower networks.

Read the survey highlights (Free signup required; do not use Safari- the signup form does not load)

A spinal surgery, a $101,000 bill, and a new law to prevent more surprises: One of the hot issues in insurance is surprise bills- patients receiving large bills from providers they thought were in-network with their insurers or from ERs when they did not have time to check provider status. Sarah Cliff at Vox has reported extensively on those ER bills. Here, she reports on NY state’s new law mandating arbitration for such circumstances. It could become a national prototype.

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Health Plans For State Employees Use Medicare's Hammer On Hospital Bills: I have always wondered why many states and private insurers continue to pay hospitals according to non-benchmarked rates. Finally, some states are taking action by using Medicare rates as a reference point. For example, in North Carolina the state Treasurer  plans to “start paying most hospitals Medicare rates plus 82 percent — a figure he says would provide for a modest profit margin while saving the state more than $258 million annually.” This is a great article that could portend shifts in payment methods.

Read the article

About pharma

Sage Therapeutics' Zulresso becomes first treatment for post-partum depression approved in US: This story may have the most media coverage today. The title explains what it is about. Good news is not only that it works, but works quickly—over days instead of the weeks with older medication. Bad news is
“the list price for the drug [will] be $7450 per vial, resulting in a projected average cost of $34 000 per patient before discounts” not counting the costs of the hospital stay required to administer the drug. The company is working on an oral version.

Read the announcement

 Soaring cost of new specialty drugs the next front in war over high prescription prices: While the article is recent, the news is very old. Specialty pharmaceuticals have been the cost driver in this sector for years. The impact of biosimilars has yet to be realized.

Read the article

Long-term Effects of Metformin on Diabetes Prevention: Identification of Subgroups That Benefited Most in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study: In patients at high risk for developing diabetes, such as those who had gestational diabetes or elevated HbA1c, those taking 850 mg metformin twice daily significantly lowered the rate of subsequent disease. Unlike many short term studies, this one was conducted over 15 years.
This treatment could become a standard and dramatically increase metformin prescriptions. The good news is that the medication is inexpensive and generic.

Read the research

About devices

FDA approves 6 MRI-safe pacemakers from Biotronik: One of the latest developments in pacemakers is making them able to be used with MRIs. Interesting principle- we are modifying older technology so it can be used with newer technology.

Read the announcement

Reports of Breast Implant Illnesses Prompt Federal Review: This title could have been from the last decade or two, instead of yesterday’s NY Times. Read the article for an update of this problem.

Read the article (From NY Times but appears to be open access)

About the public’s health

Spinach, strawberries and kale top annual report on the most pesticide-tainted produce: This article makes a great case for buying organically grown produce, especially for certain items. The subtitle on the article is: “Annual analysis finds almost 70 percent of U.S. fruits and vegetables have pesticide residues.”

Read the article

San Francisco proposes restricting vape sales. One official would like Juul's headquarters 'gone yesterday': I recently wrote about India’s health ministry trying to block Juul from that country. Now San Francisco is doing the same thing. Hopefully it is a trend.

Read the article

WHO expert panel paves way for strong international governance on human genome editing:
The WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing is starting its work to, among other things, develop a directory of genome editing activities, issue ethical guidelines and create more transparency about genome editing.

Read the article

Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study: It has long been known that diet matters for healthy living. But how do we quantify the benefits? This research was done to answer that question. You will need to read the article for the diet and methodology, but, in short, the outcome was that: “Over a lifetime, the F&V [fruit and vegetable] incentive would prevent 1.93 million cardiovascular disease (CVD) events and 0.35 million CVD deaths and save $40 billion in healthcare costs. The healthy food incentive would prevent 3.28 million CVD cases, 0.62 million CVD deaths, and 0.12 million diabetes cases and save $100 billion in healthcare costs.” Depending on the specifics of the intervention, the costs were in the range of $10-20,000 per Quality Adjusted Life Year (QALY). The article makes a good case for implementing the program.

Read the research

Today's News and Commentary

About insurance

CMS grants Maryland a Medicaid waiver: This announcement is interesting for a few reasons. First, it provides an example of what a CMS document looks like that grants a waiver to a state for specific Medicaid programs. Second, unlike broad waivers allowing managed care plans to substitute for traditional Medicaid, this one provides for specific services eligible to receive federal matching funds. The programs covered in this waiver are: a Diabetes Prevention Program (DPP); expanded medically managed intensive inpatient services; an adult dental pilot program; an  Assistance in Community Integration Services (ACIS) pilot program with an annual enrollment cap; and “modification of the family planning program effective… so that women of child bearing age who have a family income at or below 200 percent of the FPL and who are not otherwise eligible for Medicaid, CHIP, or Medicare, but had Medicaid pregnancy coverage, will be eligible for the HealthChoice family planning program for 12 months immediately following the 2-month post-partum period.” The third part of interest is the last benefit- family planning- especially given current federal attitudes toward this topic. (This service does NOT include abortions).

Read the CMS letter

Medicaid work requirements could cost hospitals up to $4.1B in revenue in 2019—report: Yesterday’s blog noted how many people in Arkansas could be off the Medicaid rolls with a work linkage. This Commonwealth Fund report estimated that, nationally, lost Medicaid payments due to work ineligibility would cost hospitals $4.1 billion in revenue.

Read the article
Read the original report

When medicines are unaffordable, here’s how patients cut costs: This article is a nice summary of strategies patients use to cut costs for expensive prescriptions. It also has some instructive graphics how these methods have changed. One piece of good news is that these behaviors declined starting in 2014, when the ACA started.

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Payer Roundup—Amazon now accepting consumers’ FSA, HSA: Interesting development. The title is self-explanatory.

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VA’s Private Care Program Headed for Tech Trouble, Review Finds: The VA system is gearing up to provide private options to certain beneficiaries. But this study showed the IT solutions for this insurance option is largely flawed.

Read the article

Today's News and Commentary

About pharma

Amgen Announces New Four-Year Outcomes Study To Examine Long-Term Effects Of Repatha (evolocumab) In High-Risk Cardiovascular Disease (CVD) Patients Without Prior Heart Attack Or Stroke: Repatha is in the newest class of cholesterol lowering drugs. It is also, by far, the most expensive class. In addition to cost, longer term effects are not known. This study will look at patients who receive this drug for at least four years. This research is very much needed to more accurately assess the cost benefit of this medication.

Read the announcement

Amgen and Jay Leno Partner to Sound the Alarm on High Cholesterol and its Link to Heart Attack and Stroke in Patients Most at Risk: In a related story, Amgen chose Jay Leno to promote its cholesterol lowering campaign.

Read the announcement

About the public’s health

Exclusive: India's health ministry calls for blocking Juul's entry into country - document: Reuters obtained a copy of a letter from India’s health ministry to the prime minister with the recommendation that Juul not be allowed into the country. The company was planning to set up a subsidiary there later this year. India has a significant prevalence of tobacco-related illnesses. Finally some government is taking real steps to help.

Read the article

Daily low-dose aspirin no longer recommended as heart attack preventative for older adults:Recent research shows that older, healthy people do not benefit from taking low dose aspirin. This weekend, these findings were incorporated into recommendations by the American College of Cardiology and American Heart Association at their annual meeting. By the way, the preferred American term is preventive not preventative.

Read the article

Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018: Much of what happens in medicine is experience-based only- meaning that good clinical studies have not been done to support treatments. Notwithstanding the previous article, this study reviewed evidence-based recommendations in cardiology. It’s conclusion is that:
“In this systematic review of 51 current guideline documents that included 6329 recommendations, 8.5% of recommendations in ACC/AHA [American College of Cardiology/American Heart Association] and 14.3% of recommendations in ESC [European Society of Cardiology]   were classified as level of evidence A (supported by evidence from multiple RCTs), compared with 11.5% of recommendations in a systematic review of ACC/AHA guidelines conducted in 2009.”

In other words, more recommendations with fewer being evidence-based.

Read the research (Subscription required but abstract is available)

Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality: Another controversy is about whether eggs are bad for you. Older recommendations warned against egg consumption because of the cholesterol. Then recommendations said eggs were OK. Now this study appears to swing the pendulum back. The associations between egg consumption and cardiovascular and all-cause mortality were found to be monotonic- that is, the higher the consumption, the higher the mortality rates. The effect appears to be due to cholesterol consumption. Those who like egg whites need not worry.

Read the abstract (Full article requires subscription)
Read the NY Times article about the research

Age, Period, and Cohort Trends in Mood Disorder Indicators and Suicide- Related Outcomes in a Nationally Representative Dataset, 2005–2017:Tell your kids to get off their phones, take a break from social media and get more sleep. This research concluded that: “Cultural trends contributing to an increase in mood disorders and suicidal thoughts and behaviors since the mid-2000s, including the rise of electronic communication and digital media and declines in sleep duration, may have had a larger impact on younger people…”

Read the research
Read the general interest story on this topic

Twenty-Year Trends in Outcomes for Older Adults With Acute Myocardial Infarction in the United States: Now some good news. From 1995-2014, hospitalizations for heart attacks dropped 38% and 30 day mortality after the attack was reduced by more than a third to 12 %- an all-time low.

Read the research

About healthcare IT

Death By 1,000 Clicks: Where Electronic Health Records Went Wrong: READ THIS ARTICLE! It is a great summary of the problems with EHRs- some of which have been life-threatening or fatal. Most of the big players are mentioned as being part of the problem.

Read the article

Electronic Health Record Adoption and Nurse Reports of Usability and Quality of Care: The Role of Work Environment: As the authors point out, little is known about how the work environment affects perceptions of usability of IT systems. In short, they found that: “…independent of EHR adoption level—the hospital work environment plays a significant role in how nurses evaluate EHR usability and whether EHRs have their intended effects on improving quality and safety of care.” How the IT implementation process is carried out is undoubtedly due to management practices and the work environment it creates. One wonders, for example, if processes were improved before IT “solutions” were installed.

Read the research

About insurance

“Direct Enrollment” in Marketplace Coverage Lacks Protections for Consumers, Exposes Them to Harm: Online enrollment in an ACA exchange plan can help people find out the federally compliant coverage which might benefit them the most. Late last year the federal government allowed individuals to directly enroll in plans without ever accessing the federal marketplace. This article explains the problems that have and can occur with this new enrollment mechanism.

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Agency: 13K didn’t meet Arkansas’ Medicaid work requirement: Last month 13,000 Arkansas Medicaid beneficiaries lost coverage because they did not meet work requirements; an additional 6400 are expected to be added to that total by next month. In the meantime Ohio is going ahead with work requirements. As previously reported, the next step will be up to the courts to decide if federal waivers that allow work requirements are legal according to Medicaid law.

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Improving the Structure of Disproportionate Share Hospital [DSH] Allotment Reductions: The federal government has been planning across the board reductions in their subsidies to hospitals that serve disproportionately large Medicaid and uninsured populations. Instead of this indiscriminate approach, MedPAC is recommending that the reductions: are phased in more gradually over a longer period of time; apply first to places with unspent funding; and, are distributed “in a way that gradually improves the relationship between DSH allotments and the number of non-elderly, low-income individuals in a state.”

Read the report

MedPAC Releases Report to Congress on Medicare Payment Policy: Separately, MedPAC issued this press release summarizing payment recommendations for the coming year. It covers a wide range of programs so is hard to succinctly summarize. However, the most radical recommendation is consolidation of the The Hospital Inpatient Quality Reporting Program (IQRP), the Hospital Readmissions Reduction Program (HRRP), the Hospital-Acquired Condition Reduction Program (HACRP), and the Hospital Value-Based Purchasing (VBP) Program into one quality program based on methodology the Commission developed last year- called the he hospital value incentive program, or HVIP.

Read the press release

Today's News and Commentary

About insurance

Judge Vows To Rule On Medicaid Work Requirements By End Of March: The National Health Law Program and other plaintiffs have sued the federal government over its granting of Medicaid waivers that allow states to tie the program’s health benefits to work requirements. The rulings to date have supported the plaintiffs- the reasoning is that the work requirements do not further the health care goals of Medicaid. U.S. District Judge James Boasberg will rule about the specific work requirement in Arkansas. He is the same judge who blocked Kentucky’s waiver last year.

Read the article

Good Ideas Must Be Evaluated: Speaking of waivers, CMS Administrator Verma announced a new set of tools to helps states get and maintain their Medicaid waivers. These waivers would include those with a tie to work requirements (at least until now).

Read the announcement
Read about the Evaluation Resources

Out-of-Network Emergency Physicians Increase Health Care Prices for Consumers by $6 Billion Each Year: This study by UnitedHealthGroup found that:

“Inflated charges by out of network (OON) emergency physicians treating patients at in-network EDs totaled an estimated $6 billion.
OON emergency physicians charged an average of $538 (150 percent) more per ED visit than in-network emergency physicians were paid ($898 vs. $360).
Over one-quarter of visits to in-network EDs resulted in OON physician charges (12 million out of 44 million).”

Since patients often do not have a choice where they go in an emergency, these charges are the worst kind of monopolistic prices. Is it time for nationally- imposed rates- at least for emergency departments?

Read the study

Azar calls out ‘absurdity' in Medicare wage index: The Medicare wage index is an important component in deciding how much hospitals and physicians are paid for their costs of doing business. The formula is a complex blend of like-jobs and does not specifically look at healthcare employees. It is long overdue for reform.

Read the article (Modern Healthcare but appears to be open access)

Measuring progress in improving prior authorization [PA]: In January of last year the AMA issued a report that documented the burden on physicians of prior authorizations. It then called on insurance companies for certain measures to alleviate this problem. The report says there has not been progress in this area. Among the findings: “A strong majority (88% and 86%, respectively) of physicians report that the number of PAs required for prescription medications and medical services has increased over the last five years.” Further, phone and fax reminders by far the most-used methods of obtaining approvals. Time for the insurance industry to come into this century- that is, if they really want to do so.

Read the research

About the public’s health

Poll shows emerging ideological divide over childhood vaccinations: In a poll asking about federal mandates for childhood vaccines, 61 percent of registered voters were in favor and 39 percent were opposed. But the breakdown is strongly along political ideology: Seventy percent of liberal voters said they favor an immunization requirement compared to 54 percent of conservatives; sixty one percent of moderates were in favor.
Do we really need to make the public’s health about politics?

Read the analysis and survey results

Early Release of Selected Estimates Based on Data From January-September 2018 National Health Interview Survey: This CDC survey is a treasure trove of information ranging from access to insurance to health behaviors. Overall, the percentage of people who reported excellent or very good health was 66.3, statistically unchanged from the previous year.

Read the report

About pharma

Updated CMS drug dashboards show prescription price hikes sustained by Medicaid, Medicare: If you thought the federal government was on top of its own pharmaceutical prices, read this article. From 2013-2017, Medicaid prescription drug spending rose by nearly 15% and average spending per unit dose under Medicare Parts B and D rose 10.6% and 10%, respectivelyThese figures come from the
CMS Drug Spending website.

Read the article

Interim report from the Advisory Council on the Implementation of National Pharmacare: This report is from out northern neighbor. It states, in part, that: “Canada’s spending on prescription drugs is unsustainable…In fact, drug spending is now the second largest category of spending in Canadian health care, surpassing spending on physician services – only hospitals cost more. Canadians pay among the highest prices and spend more on prescription drugs than citizens of almost every other country in the world.”  We will have to see how they will address the same problem we have.

Read the brief

About quality

Variation in Surgical Outcomes Across Networks of the Highest-Rated US Hospitals:Popular press surveys are a common source of information for the public to help them make healthcare decisions. This study uses the 2018 US News & World Report Honor Roll hospitals to assess variations in select surgical outcomes of care among hospitals that were parts of the same systems. No surprise, there was a wide variation. The paper calls for systems to more closely monitor member hospitals but what I take away is that system rankings cannot be used as a proxy for individual institutional care- another case of caveat emptor in healthcare.

Read the research (Subscription required by abstract is accessible)

Today's News and Commentary

About pharma

“Inactive” ingredients in oral medications: If you’ve noticed the labels on back of pill bottles that list active and inactive ingredients, most likely you’ve ignored the latter list. This research may make you think twice about doing that: “A majority of medications contain ingredients that could cause adverse reactions, underscoring the need to maximize the tolerability and safety of medications and their inactive ingredients.”

Read the research (Subscription required)

Reducing the burden of tuberculosis treatment-Drug delivery system would allow patients to switch from daily to monthly doses: One reason chronic medications fail is patient compliance. A new device from MIT is a wire on which “beads” of antibiotics are strung and is placed in the stomach. The beads dissolve over a month after which the wire is removed and another “dose” is placed.

Read about this fascinating medication delivery system

Senate Bill Would Address ‘Patent Thicket’ Critics Say Stymies Biosimilars: A bipartisan Senate bill would require pharma companies to disclose all applicable patents that are being used to protect their biologic drugs. The aim is to help generic companies understand sooner what these protections are so they can develop biosimilars sooner.

Read the announcement

Effect of Potential Policy Change to Part D Generic Tiering on Patient Cost Sharing and Part D Plan Costs: Medicare Part D plans are allowed to place generic drugs in a “non-preferred” tier in their formularies. As a result, CMS is considering requiring these plans to place generics in the lowest tier. A study by Avalere calculated that if this tier change occurrs in 2019, it could save Medicare beneficiaries $4.1 billion. This one is a “no brainer;” only question is what is taking CMS so long to make the change (other than lobbyists)?

Read the study

Cutbacks by some doctors halved new opioid prescriptions over 5 years: The campaign to reduce opioid prescriptions is working. “The rate of first-time opioid prescriptions declined 54 percent between 2012 and 2017 in the U.S., largely because many doctors stopped prescribing the painkillers.” Further, for those who are receiving opioids, the prescriptions are have a shorter duration.

Read the article

 About the public’s health

U.N. warns of millions of premature deaths by 2050 due to environmental damage: Adding to yesterday’s environmental warning, this 740-page UN report was “compiled over six years by 250 scientists from 70 nations.” It concluded that human activities causing pollution could be devastating from both health and economic standpoints. The harm from air pollution alone (vehicle emissions, industrial waste, as well as burning fuels such as wood, coal and kerosene for cooking, heating and lighting) “was resulting in around 7 million deaths annually…costing around $5 trillion in welfare losses.” Additional costs in life and wealth occur from other sources, like water pollution. And yet, we have climate change/pollution deniers…

Read about the study

About insurance

State-Run Reinsurance Programs Reduce ACA Premiums by 19.9% on Average: Seven states decided to offer their own reinsurance programs for ACA Exchange plans. Yesterday, Avalere released a study that such programs reduced premiums by 6% to 43.4%.

Read about these programs and other benefits

Key Democrat announces investigation into 'junk' healthcare plans backed by Trump: Yesterday, House Committee on Energy and Commerce Chairman Frank Pallone, D-N.J., announced an investigation into short term health insurance plans- what they are calling “junk plans.” The concern is that, although the premiums are less costly than ACA Exchange plans the benefits may be much worse and the out of pocket expenses may be much higher in the long run.

Read the announcement

Today's News and Commentary

About quality and safety

Claims Data Signals & Solutions to Reduce Risks and Improve Patient Safety: This study (prepared by medical liability insurer Coverys) offers reasons for malpractice suits against primary care physicians. By far the single greatest cause was diagnostic error, accounting for 46% of the claims and 68% of indemnity payments. About half of the diagnostic errors were cancer-related. The study also has suggestions for mitigating these risks.

Read the report

2019 Top 10 Patient Safety Concerns: This report from the ECRI provides a list of top patient safety concerns. Following on the above article, the #1 concern is “Diagnostic Stewardship and Test Result Management Using EHRs.”

Read the report

Patient Outcomes After Hospital Discharge to Home With Home Health Care vs to a Skilled Nursing Facility: All things equal, which is better, discharging to home or a skilled nursing facility? After adjustment for proximity of the two options, the authors of the study found that: “Among Medicare beneficiaries eligible for postacute care at home or in a skilled nursing facility, discharge to home with home health care was associated with higher rates of readmission, no detectable differences in mortality or functional outcomes, and lower Medicare payments.”

Read the research (Subscription required, but abstract is available)

About health insurance

The Impact of Medicare-X Choice on Coverage, Healthcare Use and Hospitals: The American Hospital Association and Federation of American Hospitals issued a report on the effect Medicare buy-in would have on healthcare costs and hospital finances. Among the conclusions: “Nationally, healthcare spending would be reduced by $1.2 trillion (7%) over the 10-year period from 2024 to 2033, with spending for hospital services being cut by $774 billion -accounting for almost two-thirds of the total spending reduction.”

Since Medicare payment rates are a lot lower than commercial plans, and since these rates would affect hospitals the most, the findings are not surprising.

Read the full report

UnitedHealthcare Will Expand a Drug Discount Program Aimed at Lowering Consumer Costs: United’s pharmaceutical benefits management (PBM) subsidiary (OptumRx) announced that it will require all new employer-sponsored plans to pass along drug company rebates to their members. This action is in line with Medicare Part D proposals being floated by CMS.

Read the story (From the NY Times but appears to be open access)

Pharmacy benefit managers next up to testify in US Senate hearings on drug pricing: Speaking of drug prices, on the heels of recent Congressional testimony by big pharma execs, PBMs are set to appear on April 3.

Read the story

HHS Secretary Azar defends proposed cuts to Medicare hospital payments: Part of the President’s budget calls for reduction in hospital payments. This article reviews both what Democrats say the budget does and what Secretary Azar says will happen. You can see a recording of his defense and make up your own mind.

Read the article and see his defense

About the public’s health

FDA rolls out vaping policy to make it harder for minors to buy flavored products: Outgoing FDA Commissioner Scott Gottlieb continued his assault on tobacco products- this time issuing proposed rules for controlling flavored tobacco products delivered by electronic devices (vaping). The rules would limit sales of fruity and kid-friendly vaping products to stores that bar minors or have separate adult-only sections; online sellers would have to enhance their age verification processes and cut bulk sales.

Read the article
Read the FDA Draft Guidance

Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions: This research concludes that: “The annual excess mortality rate from ambient air pollution in Europe is 790 000…Between 40% and 80% are due to cardiovascular events, which dominate health outcomes… We estimate that air pollution reduces the mean life expectancy in Europe by about 2.2 years with an annual, attributable per capita mortality rate in Europe of 133/100 000 per year.” To put these numbers in perspective, the mortality rates are higher than tobacco use. Seems like air pollution has become the #1 public health problem.

Read the research

Today's News and Commentary

BREAKING NEWS:

National Cancer Institute director Ned Sharpless to become acting FDA head
Read the announcement

About pharma

FDA approves Pfizer's biosimilar to Roche's Herceptin: Biosimilar drugs are coming into increased use. They are expected to lower costs by about 20% (far less than non-organic medications). This biosimilar will have a big impact on costs because of the frequency with which it is used.

Read the announcement

MAP4K4 Inhibition Promotes Survival of Human Stem Cell-Derived Cardiomyocytes and Reduces Infarct Size In Vivo: Interesting molecular science article. Briefly, these investigators found that a certain gene produces a toxic protein when heart cells are stressed (like in a heart attack). Blocking expression of the gene can save heart cells and lead to a greater functional status after healing. Though the research was in a mouse model it has great promise for future human trials.

Read the research

FDA launches Request to Connect website:According to the website, the form : ” is intended for use by individual patients, caregivers, advocates, patient groups, and health professionals to encourage understanding and participation in FDA's regulatory work. This form is not for use by industry stakeholders. Requests may be related to a drug, biologic, device or a combination thereof.”

Request information from the FDA


About insurance

The Many Varieties of Universal Coverage: Confused about all the new proposals for health reform- especially those calling themselves “Medicare for all?” This interactive graphic from the Commonwealth Fund provides a really good explanation about these plans.

Read the article

10 critical facts about the TPE program: This article is a really good summary about the Targeted Probe and Educate program- CMS’ audit procedure. Originally designed to help providers reduce rejected claims, it is really a sampling of bills and the medical records to back them up. This process can be conducted annually even if no problems are uncovered. If there are problems…well, read the article.

Read the article

About the public’s health

Trump proposes big cuts to health programs for poor, elderly and disabled: The White House budget is out and it has a number of healthcare provisions- ranging from the opioid crisis to controlling drug costs to Medicaid funding. The overarching message is: “The 2020 Budget requests $87.1 billion for HHS, a 12-percent decrease from the 2019 estimated level. The Budget proposes $1,248.8 billion in net mandatory health savings, reducing longer-term deficits.” This article is a nice summary of these proposed changes.

Read the article
Read the budget statement (Start on page 39)

Performance of human papillomavirus testing on self-collected versus clinician-collected samples for the detection of cervical intraepithelial neoplasia of grade 2 or worse: a randomised, paired screen-positive, non-inferiority trial: Human papilloma virus (HPV) is responsible for cervical cancer.; so screening for HPV has been replacing Pap smears in some settings. This study showed that self- obtained specimens were as good as clinician-obtained specimens in picking up higher grades of cancerous changes in women infected with HPV. While these self-obtained specimens are not a replacement for medical care, they would be very helpful in screening programs in places where such care is not readily available.

Read the research

Health Literacy and Income Mediate Racial/Ethnic Asthma Disparities: Many factors account for health disparities. This study “suggests racial/ethnic differences in several asthma outcomes are largely due to effects of health literacy and income. Interventions to improve racial/ethnic asthma disparities should target health literacy and income barriers.”

Read the research

VA Secretary Robert Wilkie announces precision medicine testing initiative with Sanford Health: Veterans will have a no-cost option to obtain genetic testing so their healthcare can be tailored to those results. “Veterans will access the test at their local VA facility, and Sanford Health will process the tests at its South Dakota-based Imagenetics facility.” Why Sanford? Because that’s where former VA Secretary Shulkin landed after he was fired.

Read the story

About healthcare IT

How to ensure business associate agreements protect all parties: As mentioned yesterday, significant IT breaches are coming through business associates. This article is a reminder of and a good summary about the importance of business associate agreements and their part in security.

Read the article

With lessons learned from computers, a new platform could help boost production of lifesaving biological therapies: What happens in a cell when a manufactured sequence of DNA is introduced, for examples, to help the cell produce immunity to infection or manufacture a protein missing in its host? Microsoft announced a partnership with Princeton University and two British biotech companies to develop a platform to more rapidly answer such questions. According to the company: “Microsoft’s Azure cloud infrastructure and machine learning tools can quickly analyze experimental data and improve models that predict how cells will react when a particular sequence of DNA is introduced. That could help users zero in on the best conditions for engineering a lifesaving drug, or bacteria that fix dyes onto textiles through a non-toxic process.” The venture is called Station B.

Read the announcement

Today's News and Commentary

About devices

Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial: This research could change the way glaucoma is treated. Traditionally, a patient administers medicated drops to the eyes when there is a buildup of pressure (glaucoma). This study concludes that a single laser treatment does just as well as a lifetime of medication. It goes so far to conclude that: “Selective laser trabeculoplasty should be offered as a first-line treatment for open angle glaucoma and ocular hypertension, supporting a change in clinical practice.”

Read the research

Senators Introduce Bipartisan Bill to Repeal Device Tax: “Sens. Pat Toomey (R-Penn.) and Amy Klobuchar (D-Minn.) have introduced legislation that would end the nationwide medical device tax. The 2.3 percent medical device excise tax — a tax paid whenever a purchase is made — became active in 2013. In July 2018, the House voted to permanently repeal the tax, with 283 members of Congress voicing their support for revocation.” With this tax gone and others on hold- where will the money come from to fund the ACA?

Read the announcement

About the public’s health

Chile’s sugary food fight echoes around the world:Taxing unhealthy products is the best way to lower consumption. The soft drink industry in this country has successfully fought against such measures for sugary drinks- claiming that the taxes infringe on people’s choice about what to eat. Five years ago, Chile imposed an 18% tax on sugared drinks. Two years ago the government targeted kid-friendly marketing of such products. “A new law limits cartoon food packaging, stops schools selling unhealthy foods, restricts TV adverts, bans promotional toys and mandates large black cigarette-style warning labels on foods high in salt, saturated fat, sugar and calories.” The result? “New labels have cut the likelihood of people choosing sugary breakfast cereals by 11 per cent and sugary juices by almost 24 per cent… Monthly consumption of targeted sugary drinks fell by almost 22 per cent after the tax started in 2014.” These changes were implemented because of the same health problems we face in America- obesity and diabetes. Where is our government’s political will to stand up to these lobbies in the interest of the public’s health?

Read this story (Subscription required- Financial Times )

About healthcare IT

Doctor on Video Screen Told a Man He Was Near Death, Leaving Relatives Aghast: A machine was rolled into the critically ill patient’s room where a physician on the devices’ screen asked him and his family about end of life measures. This story is about the lack of human touch with telemedicine.

Read the story (From the NY Times but appears to be open access)

Taking the Best Care of Our Members: Oscar 2018: In contrast to the above telemedicine article, health plan Oscar’s members have a very high use of telemedicine and other online services, and they appreciate the experience. This information is from their annual report so the data is self-reported.

Read the report

Apps step up to the plate with diet and DNA-tailored advice: This article discusses two apps. The first is a customized diet using the “nudge” behavioral motivation. The second is grocery store-based. The customer provides a saliva sample that is analyzed within 15 minutes. The results are used to provide a customized diet based on the individual’s DNA results.

Read the article (Subscription required- Financial Times )

Data breach may have exposed the personal, medical information of 600,000 in Michigan: While data breaches are, unfortunately, no longer big news, this one (and another, smaller, one at Rush Medical Center in Chicago last week) highlight that business associates are increasingly to blame.

Read the story

Medical Devices; Obstetrical and Gynecological Devices; Classification of the Software Application for Contraception: Since this announcement is about software I put in in then IT section. The FDA has changed software apps for contraception from Class III to Class II devices. The reasoning is that: “We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.” It is interesting to follow the FDA’s reasoning as it tries to understand and regulate healthcare apps.

Read the final rule


About pharma
Patients and Insurers Accuse Genentech of Exploiting Cancer Patients: The class action lawsuit accuses the Roche subsidiary of Genentech of furnishing vials with more medication than can be used in a single treatment. The extra cannot be used because the potency expires. The problem is that patients/insurers are charged for the full amount of the drug. These practices especially apply to the commonly used (and expensive) drugs Rituxan (rituximab) and Avastin (bevacizumab).
Read the story

About insurance

Anthem Won’t Mimic UnitedHealth’s Doctor Buying Binge: Many hospitals and insurance companies are buying doctor practices. Anthem, however says it would rather develop partnership arrangements. Sounds like it’s back to the 1980s and 90s with IPA and network models.

Read the story

Iowa court: Medicaid can cover sex reassignment surgery: The Iowa Supreme Court upheld a lower court’s ruling that “the state cannot deny two transgender women Medicaid coverage for sex reassignment surgery.” Not too long ago, two conditions were specifically excluded from virtually all health insurance policies- cosmetic surgery and sexual reassignment surgery. We have come a long way.

Read the story

Child Enrollment in Public Health Programs Fell by 600K Last Year: Good news or bad news? We don’t know. Some explain that this finding is due to higher employment, and thus private coverage through parents’ employers . Other worry about an increase in the number of uninsured. The truth may depend on circumstance in each state.

For details, read the research report

Study: High-deductible health plans aren't making members better healthcare consumers: This article reviews two studies in the March issue of Health Affairs (subscription access only). One looks at consumer behavior for those with a High Deductible Health Plan (HDHP). These plans are supposed to make patients more cost-conscious since the first dollar payments for care are coming from their own savings. However, the study found that only about 40% “were saving for future healthcare costs. Other behaviors were even less common: just a quarter of those surveyed had spoken with a doctor about price, and about 14% had compared prices.” Other studies on HDHP members have shown higher rates of cost-seeking behavior but the figures are certainly more than plans with higher out of pocket coverage. The second study raises another concern with these plans- delay of care; in this case for breast cancer diagnosis and treatment.

Read the summary article

Evaluating an episode-based payment system for post-acute care: One of the most costly and variable expenses for Medicare is post-acute care. To get a better handle on these costs, MedPAC is discussing changing the payment basis for these episodes of care.

Read the MedPAC discussion

Today's News and Commentary

About the public’s health

Grape or grain but never the twain? A randomized controlled multiarm matched-triplet crossover trial of beer and wine: To start your weekend…Now research has proven it doesn’t matter if you drink wine before beer, or vice versa- as long as you drink responsibly.

Read the research (if you need to be convinced)

About insurance

Why Consumers ChooseShort-Term Health Insurance: This survey by eHealth delves into who buys short term policies, why they make this choice and how they use their benefits. It is an interesting read, One big surprise is that people ages 55-64 are more likely to buy these policies than those in younger age groups. The reason is premium affordability- which is a tradeoff for coverage.

Read the survey results

Trump Administration Weighs Publicizing Secret Rates Hospitals and Doctors Negotiate With Insurers: As of January 1, hospitals are required to disclose their “list prices.” But these figures are meaningless because the vast majority of payments are according to contractual rates (or mandates in the cases of Medicare and Medicaid). The next step in federal calls for hospital price transparency is to have them reveal their contractual pricing with insurance companies. Still, individuals will be left to figure out what they will owe given the terms of their insurance policies. What is really needed is a calculator for patients with specific insurance policies to know what they will end up paying if they get care from a specific provider.

Read the article (Wall St Journal but appears to be open access)

About pharma

Two Medicare payment strategies to improve price competition and value for Part B drugs: Reference pricing and binding arbitration: MedPAC has joined the call to look for ways to reduce Part B drug spending by calling for its Commissioners to comment about reference pricing and binding arbitration at its full meeting the month.

Read the meeting brief

EMA Shuts Down London Office for Move to Amsterdam: In advance of the impending Brexit, the European Medicines Agency has completed its planned London office closing and is opening in Amsterdam.

Read the announcement

Johnson & Johnson, ViiV report positive data for once-monthly injectable HIV regimen combining Edurant, cabotegravir: HIV treatments have been complex cocktails of drugs, initially requiring multiple daily doses. If this regimen proves successful it would be a truly disruptive innovation. This treatment would not only be more convenient but also enhance monitoring of non-compliant patients.

Read the article

New target for chronic pain relief confirmed by scientists-Scientists observe drug target that can reduce pain when activated: New research from the University of Hiroshima gives hope for a novel pain control mechanism." “Previous research had shown that activating a type of cell receptor (REV-ERBs) that sends chemical signals inside the cell to block the production of certain genes regulates pain-causing and inflammatory molecules inside the body.” Turning on this gene in mice lowered pain. It is not clear if therapies would be stand-alone or used to reduce use of other drugs.

Read the research

Statement from FDA Commissioner Scott Gottlieb, M.D., on FDA's steps on naming of biological medicines to balance competition and safety for patients receiving these products: The FDA is trying to balance the need for information about which drugs are biosimilars against an implication that they are inferior to the original branded medication. This announcement explains changes in how medications will be named to accomplish both purposes.

Read the announcement

About devices

Hidden FDA Reports Detail Harm Caused By Scores Of Medical Devices: READ THIS STORY. The essence of the report is that: “The FDA has built and expanded a vast and hidden repository of reports on device-related injuries and malfunctions, a Kaiser Health News investigation shows. Since 2016, at least 1.1 million incidents have flowed into the internal “alternative summary reporting” repository, instead of being described individually in the widely scrutinized public database known as MAUDE, which medical experts trust to identify problems that could put patients in jeopardy.”

Read the story

Today's News and Commentary

About pharma

Good News: Opioid Prescribing Fell. The Bad? Pain Patients Suffer, Doctors Say: The pendulum seems to be swinging back. First we did not treat pain adequately. Then came the call to treat pain control as a “vital sign,” which led to over treatment and the opioid epidemic. Now that we are beginning to control opioid overuse, physicians are saying our zeal is causing under-treatment.

Read the article (NY Times but appears to be open-access)

J&J prices ketamine-like depression treatment at $590-$885 for two doses: To amend a previous story, J&J has announced the price for its new anti-depression drug Spravato.

Read the announcement

Office of Generic Drugs- 2018 Annual Report: While this report was issued about a week ago, it is noteworthy to recall the accomplishments on the heels of Commissioner Gottlieb’s resignation. Among the milestones are approval or tentative approval of 1,021 Abbreviated New Drug Applications (ANDAs) and publication of more than 250 new or revised guidances, product- specific guidances (PSGs), and manuals of policies and procedures (MAPPs) for stakeholders.

Read the report

Louisiana's 'Netflix' deal for hepatitis C drugs wins bids from AbbVie, Gilead and Merck: As previously reported, Louisiana was considering a “subscription price” for pharmaceuticals as a way to control costs- like Netflix. Now the state has moved forward and is accepting bids for drugs that treat hepatitis C.

Read the article

About healthcare IT

6 top challenges to successful data integration: This short explanation is a good summary of barriers to data integration. For example: “Each organization has a unique set of APIs, and 47 percent of survey respondents pointed to integrating all these sources as their most challenging task.”

Read the article

Lawmakers voice concerns about VA’s plans for Cerner EHR: The integration of VA and DoD information systems as well as upgrading for both will take another 10 years and $16.1 billion. Congress is now concerned about that timeline and cost. Further, with new VA initiatives to expand care options in the private sector, it appears the new system may not be interoperable with non-governmental provider sites.

Read the article

2019 CIO Survey Report: This survey was conducted by Grant Thornton and the results were sorted by industry sector. One key finding for the healthcare/life science sector was that the top problem for Chief Information Officers is conflicting priorities among stakeholders. This finding is no surprise, particularly in hospitals systems where different departments not only have different information needs but their financial metrics are different and can come into conflict.

Read the report

About the public’s health

Federal judge in Boston sets timeline for FDA to produce graphic cigarette warnings:”A federal judge in Boston has ordered the US Food and Drug Administration to create mandated colorful graphic health warnings on cigarette packs and advertising products by mid-March of next year.” If you ever find yourself in a Canadian airport and go to a duty-free shop that sells cigarettes you will see what these packages might look like.

Read the article

Even with measles outbreaks across the US, at least 20 states have proposed anti-vaccination bills: Given population mobility, we need a national immunization policy that will protect the whole country. Think about federal regulation of interstate commerce as an example.

Read the article

Industry Voices—Six keys to focusing on social determinants with the biggest economic impact: This article provides a short, useful list of best cost-effective strategies for implementation of programs to address the social determinants of health.

Read the article

WHO unveils sweeping reforms in drive towards “triple billion” targets: In order to accomplish its five year strategic “triple billion plan,” the WHO announced a major reorganization. The strategy calls for: “one billion more people benefitting from universal health coverage (UHC); one billion more people better protected from health emergencies; and one billion more people enjoying better health and well-being.” The four pillar structure will deal with Programmes, Emergencies, External Relations and Governance, and Business Operations. All will be supported by the Division of the Chief Scientist at WHO Headquarters in Geneva “to strengthen WHO’s core scientific work and ensure the quality and consistency of WHO’s norms and standards.”

Read the announcement

About insurance

The Atul Gawande health care company finally has a name: Haven: The health care company formed in January, 2018 by Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. finally has a name and website. It is called Haven and it will focus on “improving access to primary care, lowering prescription drug costs, and making insurance benefits easier to understand.” While initially focusing on the 1.2 million employees of its founders, the venture is expected to expand its practices more widely once it gets going (and is successful).

Read the story

Why judge’s ruling against UnitedHealth could be turning point for mental health parity: U.S. Chief Magistrate  Joseph C. Spero of the U.S. District Court in Northern California ruled that United Behavioral Health (UnitedHealth’s behavioral health subsidiary) unlawfully used internal policies to discriminate against patients with these needs order to cut costs. Federal law mandates that behavioral health benefits are on parity with other benefits. The decision in this class action suit is expected to be appealed.

Read the story

Trump Administration Looks to Jump Start Interstate Health-Insurance Sales: The Trump administration has discussed this initiative before. Somehow it has the idea that if cross-state products were offered it would lower insurance costs. I think the policy makers forgot that healthcare is delivered locally and costs reflect that fact. A policy sold in Oregon (where costs are relatively cheap) will not cost less if the customer lives and receives health services in the expensive Miami area.

Read the article (Wall St Journal but appears to be open access)

Today's News and Commentary

About pharma

Today’s top story is the resignation of FDA Commissioner Scott Gottlieb, MD. Regardless of political affiliation, most healthcare experts agree he was a bright spot in the current administration. Dr. Gottlieb has been praised for, among other actions, promotion of expedited generic approvals and fighting tobacco use- especially flavored cigarettes. He has been commuting between the DC area and his family in Connecticut and cites family time as his reason for leaving. A replacement has not been named.

The Real Price of Medications- A survey of variations in prescription drug prices:This report by the U.S. PIRG Education Fund found huge variations in drug prices among pharmacies. (As examples, see the graphic in the article.) Patients should not assume that they are getting best prices if they are go to a pharmacy contracted with their health plan.

Read the report

FDA Approves Esketamine Nasal Spray For Hard-To-Treat Depression: I previously reported that an FDA committee approved Esketamine for treatment of depression. Now the drug has been approved by the full FDA for use in very controlled circumstances under physician supervision. Its potential is to rapidly treat depression when other medications have failed or in addition to other medications.

Read the story

The Orphan Drug Act Revisited: This opinion piece is a thoughtful review of why we have the Orphan Drug Act and why it needs to be changed. Briefly, rare diseases, which were the intended targets of the drugs developed under this law, were defined by organ system. With increasing knowledge of genetic and molecular mechanisms of disease, many commonalities are being identified- making rarity no longer a reliable criterion for granting orphan status.

Read the article (From JAMA but appears to be open access)

About the public’s health

Dietary Reference Intakes for Sodium and Potassium (2019)-National Academy of Sciences Engineering Medicine): Sodium intake guidelines have been controversial for many years. People sensitive to sodium can get or worsen high blood pressure and heart failure. So what is a reasonable intake if you do not know if you will be adversely harmed? This study recommends 2300 mg/day or less. To put this number into perspective, the average US consumption is 3400mg/day. The report also calls on commercial food companies to lower sodium content in their products; most dietary salt comes from prepared food not from added salt at home.

Read the full study (Free signup required)

Staph infections can kill-More prevention in healthcare & communities needed: The CDC issued this report noting that staph infections (particularly MRSA) are still the cause of significant mortality. Recommendations for control are cited.

Read the announcement

Unconventional natural gas development and hospitalizations: evidence from Pennsylvania, United States, 2003–2014: This research found that long term exposure to fracking was associated with higher rates of genital and urinary problems ( like urinary tract infections, kidney infections, and kidney stones) and skin conditions( such as cellulitis and abscesses). The greater the density of drilling, the higher the incidence. Add these findings to other environmental concerns for this drilling technique.

Read the research

About insurance

How Affordable are 2019 ACA Premiums for Middle-Income People?: Subsidies for ACA exchange premiums are for those who make up to 400% of the federal poverty level. But what about those above that figure? Premiums can vary dramatically by age group and location. Research by the Kaiser Family Foundation found that: “while there seems to be a consensus that individual market premiums are out of reach for some middle-class people ineligible for ACA subsidies, there is little consensus around what to do about it.”

Read the research

Medicare Advantage insurers to CMS: Rethink expanding use of encounter data in risk adjustment: Among other factors, CMS adjusts Medicare Advantage payments based on the severity of illness of the beneficiaries. About 25% of this risk adjustment is based on claims data and CMS want to increase the contribution to 50%. Insurers are pushing back, citing inaccuracies and gaps in such sources.
One wonders how insurers are making accurate payments if the claims data is so poor.

Read the story

About healthcare IT

UPMC files federal trademark registration for cloud solution: UPMC has developed what it calls its “healthcare operating system (hcOS).” It is described as a three layer cake: “We ingest the data out of clinical systems as the base layer and get it into the cloud…The middle layer is a set of tools or processing that can handle things like governance, security, identity management, privacy, harmonization and indexing on top of the data. And, the third layer is natural language processing and artificial intelligence.” It is built using the Health Level 7 Fast Healthcare Interoperability Resources (FHIR) standard. For those into IT terminology this product is a PaaS (platform as a service).

Read the article

Today's News and Commentary

About healthcare IT

UPMC cuts hospital readmission rates with ML [Machine Learning] algorithm: Interesting article on the use of ML to effectively decrease readmissions by identifying at-risk patients. The results: “…the ML algorithm identifies patients at highest risk of re-hospitalization within seven and 30 days of discharge. To date, re-hospitalizations have been reduced by about 50 percent.” The article has a dashboard graphic that illustrates important features of the algorithm.

Read the article

Microsoft built a bot to match patients to clinical trials: Microsoft's lab in Israel has developed user-friendly software to match patients with clinical trials. Patients can enter their information and the app will ask further questions if needed. The business model is for drug companies to buy the product to help them recruit patients for their studies.

Read the article

Amazon gives AI to Harvard hospital for efficiency gains: Beth Israel Deaconess Medical Center in Boston already uses Amazon’s cloud service to store its data. Now Amazon is giving the medical center a grant to develop Artificial Intelligence to help with some routine functions, like more efficient operating room scheduling.

Read the article

‘Wired into the walls’: Voice-recognition system promises to automate data entry during office visits: One of the most burdensome tasks facing medical professionals is documentation of the patient visit. Some practitioners use “medical scribes.” The device described in this article is made by Nuance, the parent company of Dragon dictation software. Patient-physician conversations are transcribed live and aided by a locator when movement of either occurs. Having personally used Dragon for medical dictation, I can attest to its accuracy once it learns your voice and to spell technical terms. However, the transcription will still need to be reviewed since substitutions do occur.

Read the article

IQVIA debuts research platform to de-ID links between genomic and clinical data: One problem in gathering data for research is protection of patient confidentiality. IQVIA has developed a platform that de-identifies patient data while preserving clinical and genetic data.

Read how this task is accomplished

What Your Doctor Isn’t Allowed to Tell You:
Despite the promise of healthcare IT, systems do make mistakes that create errors in care. The theme of this article is: “Badly designed electronic records can be hazardous to your health, but a gag clause protects the makers.The problem is that some EHR vendors have such overwhelming market power that they insert gag clauses into their contracts with hospitals, ostensibly to protect their intellectual property.” The author calls for banning these gag clauses in order to help healthcare providers freely exchange information about functionality.

Read the article (From the Wall Street Journal, but appears to have open access)

How Banner Health Network is managing interoperability with 30-plus EHRs: Interoperability continues to be a problem, especially within healthcare systems that are expected to have freely flowing information. Phoenix-area Banner Health Network is successfully using software to link internally disparate EMRs.

Read the story

About hospitals

IBM Watson Health Announces 100 Top Hospitals:2019 Study Finds Top-Performing U.S. Hospitals Provide Better Care at Lower Cost and Higher Profit Margins than Peers Evaluated in the Study: This “top” list was formerly the Truven Health Analytics 100 Top Hospitals. Each “top hospital” ranking has its own methodology. Read this list and see if you agree with its evaluation.

Read the rankings

Speech: Remarks by Administrator Seema Verma at the Federation of American Hospitals 2019 Public Policy Conference: This speech was delivered yesterday. While Verma covered many topics (the full address is included in the link), the one part on which the media is focusing is the “Stark” laws. The laws in question (named after the now-retired Fortney “Pete” Stark, D-CA) were directed at hospitals providing financial incentives to physicians in return for referrals. With increasing prevalence of bundling and cooperative relationships like ACOs, the federal government is realizing that the laws need to be changed or “safe harbors” for the relationships need to be more clearly defined.

Read the address

About the public’s health

New funding models for health urgently needed, experts warn: The G20 Health and Development Partnership — a coalition of business, academic and non-governmental organisations- issued a report today that says disease and antimicrobial resistance pose a bigger threat to the world’s economy than global warming. Governments need to take responsibility for these problems and new methods of financing must be implemented.

Read a summary article
Read the full report

Big Pharma Gave Money To Patient Advocacy Groups Opposing Medicare Changes: For-profit entities, especially “big pharma” are influencing the lobbying efforts of nonprofits by making large donations. The Kaiser Family Foundation has a website called Pre$cription For Power that is a resource for such information.

Read the article

About insurance

Paying Patients To Switch: Impact Of A Rewards Program On Choice Of Providers, Prices, And Utilization: We know that patients who have to pay more out of pocket use fewer services. This study is the “other side of the coin.” Patients who used lower-cost, preferred providers got money back for doing so. The results: “For 131 elective services, patients who received care from a designated lower-price provider received a check ranging from $25 to $500, depending on the provider’s price and service. In the first twelve months of the program we found a 2.1 percent reduction in prices paid for services targeted by the rewards program. The reductions in price resulted in savings of $2.3 million, or roughly $8 per person, per year. These effects were primarily seen in magnetic resonance imaging and ultrasounds, with no observed price reduction among surgical procedures.”

Read the research (Subscription required)
Read an open access summary

Today's News and Commentary

About pharma

BREAKING NEWS

Drugmaker Lilly to Launch a Half-Price, Generic Version of Its Top-Selling Insulin: While Congress presses pharma companies to lower costs, and specifically allow importation of generic insulin, Lilly announced this morning that it would launch the generic Insulin Lispro at half the price of the Humalog branded version. This article is one of many published in the past few hours on this topic. Expect widespread print coverage tomorrow.

Read the announcement

Marketplace Pulse: Cost-Sharing for Drugs Rises Sharply at Higher Tiers: One way insurance companies have been able to maintain profitability is by increasingly shifting costs to patients (and providers). This study from the Robert Wood Johnson Foundation documents this shift for pharmaceuticals. Among the study’s findings: “The median co-insurance is 40 percent, not insignificant when the average monthly cost of a specialty drug can exceed $5,000. In the small group market, less than one-third of silver plans have this design, and the median co-insurance is somewhat lower at 30 percent.” The article has some helpful graphics to demonstrate the market conditions.

Read the research

Drug Companies and Doctors Battle Over the Future of Fecal Transplants: A side effect of antibiotic use can be diarrhea due to overgrowth of the bacterium C. Difficile in the intestine. Traditional treatments have been use of additional, different antibiotics. In the past few years, researchers found that delivery of normal fecal bacteria to the colon works as well as the antibiotics and has the advantage of repopulating the flora. Now that the latter therapy has proved itself, the FDA is facing the question of how to regulate it. Is it a drug, a device, or something else?

Read the article

The Side Effects of Million-Dollar Drugs: The article focuses on Luxturna, a gene therapy for a form of blindness affecting about 2000 people in the US. The article also summarizes the gene therapy efforts for other conditions and the extraordinary costs of this type of therapy.

Read the article (Subscription required)
Read a recent industry-sponsored summary about this topic

About the public’s health

Sugary drink tax tied to drop in soda consumption: Despite efforts at behavioral therapy and education programs, the best way to discourage unhealthy consumption is to tax the offending product. This method has worked very well with respect to tobacco. Lately, despite vigorous industry opposition, it has proven effective in lowering consumption of sugary drinks. Last year’s imposition and repeal of such a tax in Cook County, IL is evidence of the political difficulties of such a measure.

Read the article

About devices

FDA Seeks to Build Risk-Benefit Database for Robotically-Assisted Surgical Devices: On the heels of last week’s announcement that robotic surgeries are not always better than their traditional counterparts, the FDA has made this announcement.

Read the artcle

Mammalian Near-Infrared Image Vision through Injectable and Self-Powered Retinal Nanoantennae: This article is fascinating- it explains research using nanoparticles injected into mouse eyes that bind to receptors and enable the animals to see the infrared spectrum. If the concept proves valid in humans, it can help colorblindness. Imagine other implications as well.

Read the research

About healthcare IT

Moody's: Hospitals among industries with highest risk of exposure to cyberthreats: The bond-rating firm, Moody’s, is concerned about any financial liability companies and sectors may have that will affect credit status. This recent report cites hospitals as having among the highest threats to cybersecurity. One reason for this vulnerability is the need for interoperability.

Read the article (The original study requires a paid subscription)

About insurance

U.S. seeks to cut dialysis costs with more home care versus clinics: Medicare’s End Stage Renal Dialysis Program costs about $114 billion annually. Many patients have their treatments in dialysis centers when care can be provided with equal effectiveness and lower cost at home. CMS is now interested in increasing earlier treatments, home care options and access to transplantation in order to lower overall costs.

Read the article

Reducing Individual Market Premiums to Expand Access to Coverage and Care: In its March 2019 Issue Brief, the BCBS Association describes the high cost of individual policies on the ACA exchanges. Three solutions are explained to address this problem:
1. Revise federal assistance to help more people afford coverage
2. Enact policies to lower costs and remove financial barriers to accessing care
3. Improve outreach to encourage people to obtain and maintain insurance
If these measure seem familiar…remember when cereal assistance helped with out of pocket expenses and “navigators” helped people understand and signup for plans?

Read the Issue Brief

About healthcare quality

Medicare Trims Payments To 800 Hospitals, Citing Patient Safety Incidents: “Eight hundred hospitals will be paid less by Medicare this year because of high rates of infections and patient injuries, federal records show.
The number is the highest since the federal government five years ago launched the Hospital Acquired Conditions (HAC) Reduction Program, created by the Affordable Care Act. Under the program, 1,756 hospitals have been penalized at least once… This year, 110 hospitals are being punished for the fifth straight time.”

Read the article
Check if “your” hospital is on this list

About hospitals and health systems

Updated Physician Practice Acquisition Study: National and Regional Changes in Physician Employment 2012-2018: The trend for hospital-employed physicians has grown rapidly, but in the past year seems to have leveled off. This is a very interesting study of you want to “look at the numbers.”

Read the report

Today's News and Commentary

About healthcare quality

I’m a Journalist. Apparently, I’m Also One of America’s “Top Doctors.”: Today’s news starts with an amusing article by Marshall Allen, a non-physician healthcare reporter for ProPublica, who was named one of America’s “Top Doctors.” The story looks into the for-profit world of “best” lists for physicians in healthcare. Not in the article, but how accurate is that Yelp rating?

Read the story

CMS has just released its hospital star (quality) rankings-updating 2017 evaluations. You can look up specific hospitals on the “hospital compare” website. A number of hospitals and organizations have complained that these ranking do not adjust for severity of illness or social factors. One article that analyzed these concerns was from the Chicago Tribune, which detailed the drop in quality scores for a number of academic institutions in the Chicago area. In reply to critics, CMS asked for comments about the process.

About pharma

FDA warns Canadian drug distributor about sending ‘unsafe’ drugs to U.S.: In looking for less expensive medications, not all sources from abroad are safe and effective. According to the article: “The FDA urged U.S. consumers ‘not to use any medicines from CanaRx,’ which supplies drugs to employees of about 500 cities and counties, and private-sector employers seeking discounts on drug prices.”

Read the article
Read the FDA letter

Bill would allow lower priced insulin to be imported: Despite the above concerns, “ U.S. Rep. Peter Welch of Vermont introduced legislation on Thursday that would allow for the importation of low cost insulin from Canada and other countries for people with diabetes.”

Read the article

About healthcare insurance

GOP senator: Legislation combating surprise medical bills could come in March: The latest Congressional initiative to address surprise medical bills could be introduced this month.

Read the article

H.R.1398 - To delay the reimposition of the annual fee on health insurance providers until after 2021: One of the sources of funding for the ACA is a tax (fee) on healthcare insurers. Congress delayed this source of funding hoping that if insurers did not have to pay the tax they would lower premiums. There is now a bipartisan bill that would further delay reimposition of this tax.

Read the bill
Read an article about the proposal

How Much Will Medicare for All Cost?: As previously reported, the “Medicare for all” proposal does not have a definitive funding source (or price tag). The Committee for a Responsible Federal Budget writes that similar proposals would cost $28-32 trillion dollars over a decade. This interesting article also provides estimates from different sources about the cost for such plans. Where will we get the money?

Read the article

About devices

Guardant’s blood test outperforms standard tissue biopsy in landmark NSCLC study: One of the latest impactful technologies is so-called “liquid biopsies,” where blood is analyzed for cancer. This article reports that, by several measures, this new tool is better than the standard tissue biopsy.

Read the article

Genetic test to detect antimicrobial resistance developed:
Antibiotic resistance is traditionally determined by growing the bacterium and placing a disc containing an antibiotic amid the growing culture. Lab techs then observe whether the disc kills the bacteria. A rapid test for assessing resistance has now been developed that relies on detecting the genes responsible for resistance. The new test is not only accurate but much faster than the older method (10 minutes versus days).

Read the article

FDA warns against using surgical robots for breast cancer surgery: Just because it is new doesn’t mean it is better. The FDA is warning that the use of robotic surgery for breast and other cancer surgeries does give as good results as more traditional methods.

Read the article

About the public’s health

Hawaii Tops U.S. in Wellbeing for Record 7th Time: The new Gallup poll is out and again Hawaii is on top.

Read the poll results

Today's News and Commentary

After yesterday, today was a light healthcare news day.

About insurance

Azar touts funding HSAs with Obamacare subsidies: HHS Secretary Azar gave a talk about the options opening up for health insurance. They include: funding Health Savings Accounts (HSAs) with ACA premium subsidies for those enrolling in the individual market; expanding plan coverage (such as for essential medications) before patients need to use HSA money; eliminating rebates to the PBMs in the Medicare Part D market; and expanding “association health plans.”

Read the article
Read another article covering a different slant on the speech

Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–September 2018: The National Center for Health Statistics released its most recent health insurance coverage report.The overall findings: “In the first 9 months of 2018, 29.7 million persons of all ages (9.2%) were uninsured at the time of interview—not significantly different from 2017, but 18.9 million fewer persons than in 2010.” The coverage varied by age: of adults aged 18–64, 13.0% were uninsured; among children aged 0–17 years, 4.9% were uninsured.

Read the report

Claims Denials and Appeals in ACA Marketplace Plans: This study by the Kaiser family foundation found that: “across issuers with complete data, 19% of in-network claims were denied by issuers in 2017, with denial rates for specific issuers varying significantly around this average, from less than 1% to more than 40%. We also find that consumers rarely appeal claims denials to their issuers, and when they do, issuers typically uphold their original decision. Healthcare.gov consumers appealed less than one-half of one percent of denied claims, and issuers overturned 14% of appealed denials.” Claims denials also varied by state. For example, in Kentucky the rate was 40.7% while in Oregon it was 7.6%. The research speculates on the possible reasons for these denials but is not clear.

Read the research

Today's News and Commentary

About pharma

The big news from yesterday was the testimony of drug execs about why prices are high and what can be done about the problem. In short, they said prices were high because of R&D costs. When confronted with the fact that prices are lower in other countries, they said those countries have price controls. When asked if they would lower prices if the rebate system were changed they gave a qualified yes. But, of course, they said blame should be placed on Pharmaceutical Benefit Managers (so-called middle men) and insurance companies who demand the rebates. In sum, nothing new and we will see if anything but posturing will come from this meeting. Of the many articles summarizing exactly what happened, I think the two below are best.

The Health 202: Congress could have been tougher on drug executives
Big Pharma grilled on the Hill: International pricing, AbbVie CEO's bonus and bye-bye rebates

GOP lawmaker says panel to investigate drug company gaming of patent system: On a related issue is this announcement about looking at patent gaming to prolong profitability. For example, Abbvie has more than 100 patents on its top seller Humira.

Read the announcement

About devices

FDA, CDC, and CMS launch task force to help facilitate rapid availability of diagnostic tests during public health emergencies: The title explains the content of the announcement. This launch presents an outstanding opportunity for medical diagnostic companies to create useful and profitable products.

Read the announcement

About insurance

U.S. House Democrats introduce sweeping 'Medicare for All' bill: House of Representative “Progressives” have offered their version of “Medicare for All.” Unlike some of the buy-in proposals making Medicare available for all, this one would create a true single payer system. Two features make this bill improbable for both passage and success: a 2 year implementation timeline and, according to the article, it “does not include new or increased taxes or other additional revenues to pay for the healthcare overhaul.” Lead sponsor Pramila Jayapal said possible ways to pay for the bill include “a tax on millionaires and billionaires, employer premiums and closing tax loopholes for the wealthy.” Does she think that is anywhere near enough money when the current Medicare system has less than 10 years solvency left?

Read the article

About hospitals

New Survey Shows Physicians Are Key Revenue Generators for Hospitals: A new survey by Merritt Hawkins finds that, on average, physicians bring in $2,378,727 per year for hospitals. This figure “includes both net inpatient and outpatient revenue derived from hospital admissions, tests, treatments, prescriptions, and procedures performed or ordered by physicians.” Of course there is a large spread. “Full-time cardiovascular surgeons generate an average of $3,697,916 a year…[while] family physicians generate an average of $2,111,931 in net revenue annually for their affiliated hospitals.”

Read the survey results

Today's news and Commentary

About pharma

As mentioned last week, today is the day major pharmaceutical company executives will testify before Congress about price increases. More on this event tomorrow when all the testimony has been given.

FDA Approves More Generic Drugs, but Competition Still Lags: Speaking of increase prices, this study by the Pew Charitable Trusts looked at what happened to generics after Congress passed the Generic Drug User Fee Amendments (GDUFA) in 2012. Some highlights:

  • More drugs were approved than before the law but the speed of approval has not increased.

  • “Costs generally decline most significantly once second and third generics enter the market, but versions after the third generic usually reduce prices less effectively.”

  • “…more than 500 brand drugs still lack competition, even though there are no patent protections or periods of exclusivity that would prevent the approval of competing generic versions.3 These “sole source” products are most at risk for price spikes.”

    This study is a really good review of the generics field.

    Read the research

CRISPR Therapeutics and Vertex Announce Progress in Clinical Development Programs for the Investigational CRISPR/Cas9 Gene-Editing Therapy CTX001: This announcement is an important milestone: the first company-sponsored use of a CRISPR/Cas9 therapy in a clinical trial. This gene-editing technique will be used to treat patients with beta thalassemia and sickle cell disease.

Read the announcement

Antibiotic resistance: using a cultural contexts of health approach to address a global health challenge: This monograph from the WHO presents a fascinating analysis of how addressing cultural factors is essential for attacking healthcare problems- in this case antibiotic resistance. The analysis makes the case for this approach thusly:
”Any attempt to reduce inappropriate uses of antibiotics and reduce the risks of resistance requires systematic understanding of the histories and cultures of medicine uses, structural issues surrounding health and health care, and an appreciation of cultures of risk.”

This approach can be used at the organizational as well as the societal level.
Read the monograph 

French Patients Refusing Generic Drugs to Face Reduced Reimbursement:The point of including this article is that the US has lots of price control mechanisms in place, but the prices themselves are so high these measures are not making a significant impact. French President Macron has just announced a new “health transformation strategy” that will be phased in over the next few years. The purpose is to increase organizational efficiency and reduce costs. Starting next year, patients who refuse generic drugs or substitutions without a valid medical reason will have higher out-of-pocket costs for those prescriptions. This practice is, of course, not new in the US; but since 2013 in France 80 percent of brand-name drugs were substituted for generics.

Read the announcement

About hospitals

A comparison of scheduling, work hours, overtime and work preferences across four cohorts of newly licensed registered nurses: This article reviews the items in the title. The study found that: ”New nurses are predominantly scheduled for 12‐hour shifts and nearly half work weekly overtime, trends that have remained relatively stable over the past ten years.” The concern is overwork leading to errors- a topic addressed by residency rules limiting physician trainees from working more than 80 hour weeks.

Read the study

Hospitals' all-payer margins climb in 2017 even as Medicare margins slump: Bad news and good news from MedPAC. Average hospital margins for Medicare were negative 9.9% in 2017, the lowest in at least a decade. The good news is that aggregate all-payer margins climbed to 7.1% in 2017; by comparison, it was 6.3% in 2010. These data support the contention that private insurance is subsidizing Medicare.

Read the article (Basic subscription required)

About healthcare IT

Assessing the Use of Google Translate for Spanish and Chinese Translations of Emergency Department Discharge Instructions: Hospitals need to deal with an increasing number of patients whose primary language is not English. Yet translators are not always available. How good are online translations, like Google Translate (GT)? Researchers studied “100 sets of patient instructions contained 647 sentences. Overall, 594 (92%) and 522 (81%) sentences were accurately translated into Spanish and Chinese, respectively, by GT.” Not bad. It does raise the question of accuracy for other languages. Also, how critical are the errors in the non-accurate parts of the translation?

Read the research (Subscription required)

Catholic Health merges IT to enable use of social determinant of health data: Catholic Health has incorporated what it calls the “Total Health Roadmap” into its IT capabilities for primary care physicians. This roadmap includes “a range of physical, social and psychological issues, such as availability of food and safe housing, transportation, quality child care, access to behavioral health treatment, and more.” The purpose is to prospectively identify social determinants of health that will affect a patient’s care.

Read the article

Today's News and Commentary

About the public’s health

Trends in Human Papillomavirus Vaccine Types 16 and 18 in Cervical Precancers, 2008–2014: HPV vaccinations are working to reduce incidence and spread of the two most common cancer-causing strains. According to this research: “From 2008–2014, the proportion of HPV16/18-positive CIN2+ declined, with the greatest declines in vaccinated women; declines in unvaccinated women suggest herd protection.”

Read the research

Trump steps up attack on Planned Parenthood: In a rule issued Friday, the Trump administration issued new rules making clinics ineligible for Title X Family Planning funds unless they are physically and financially separate from abortion providers. This ruling hits Planned Parenthood especially hard. Undoubtedly these changes will be challenged in the courts.

Read the article

Chemicals in e-cig flavors could harm respiratory tract: Flavoring chemicals that have been regarded as safe were found to be harmful when inhaled. In recent lab experiments, “diacetyl - a chemical with a butter-like smell - and its ‘chemical cousin’ 2,3-pentanedione” were found to cause genetic damage in the cells that line the respiratory track. This study adds further evidence that e-cigarettes are not safe.

Read the article

These Are the World's Healthiest Nations:The Bloomberg Healthiest Country Index is now out. Spain took the #1 spot from Italy, which is now #2. The US is down one spot at 36- one below Costa Rica and six below Cuba. Health systems, as well as healthy practices like diet, are factors the study cites for these findings.

Read the report

Association of Physician Organization–Affiliated Political Action Committee Contributions With US House of Representatives and Senate Candidates’ Stances on Firearm Regulation: The simple (though disturbing) conclusion of this research is that for the 2016 election: “Physician organization–affiliated PACs included in this study donated more funds to more US House of Representatives and Senate candidates who oppose firearm safety policies than to candidates in support of such policies.” The reasons for PAC donations are complex and include candidate stances on insurance issues and other public health matters. Still, this issue should be high on the priority of the mix of important topics that determine support.

Read the study

About pharma

Roche nears $5-billion deal to acquire Spark Therapeutics: report: In the latest case of pharma M&A, Roche will spend a reported $4.3 billion to purchase gene therapy company Spark Therapeutics.

Read the announcement

GE to sell its biopharma business to Danaher for $21.4B: The above announcement was all over the news today: but in a much even bigger deal, GE is selling its biopharma business as part of a restructuring plan.

Read the article

Novartis gene therapy would be cost effective up to $900,000: U.S. group: The Institute for Clinical and Economic Review (ICER) calculated that Novartis’ gene therapy for muscular dystrophy would be cost effective not only at the target price of $900,000 but also up to $5million. These findings raise many questions about how much is available to spend on healthcare. It is unlikely countries with national budgets for healthcare (everyone but the US) would pay so much. We will need to see how this pricing plays out in the public and private sectors.

Read the article

Senators Introduce Bill to Prevent Using Native American Tribes to Shield Patents: Last year, Allergan cut a deal with the St. Regis Mohawk tribe to protect its patent on Restasis. The legal theory is that native tribes have their own sovereign immunity that gives them special status with respect to patents. Several Republican senators have introduced a bill to take such legal maneuvers off the table.

Read the article

About human resources

Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017: Physician shortages are due to both supply and demand problems. On the supply side, physicians have either been leaving practice or cutting back due to “burnout.” The good news is: “Burnout and satisfaction with work-life integration among US physicians improved between 2014 and 2017, with burnout currently near 2011 levels.” The bad new is physicians are “at increased risk for burnout (odds ratio, 1.39; 95% CI, 1.26-1.54; P<.001) and [are] less likely to be satisfied with work-life integration (odds ratio, 0.77; 95% CI, 0.70-0.85; P<.001) than other working US adults.”

Read the research

Healthcare Executives See a Mixed Outlook: Physicians are the toughest recruits for healthcare organizations but nurses, other healthcare professionals, as well as administrators are also in short supply.

Read the study from JP Morgan

About healthcare IT

Data error exposes patient information: In the latest case of large data breaches, the University of Washington (UW Medicine) announced that a vulnerability in their system exposed Protected Health Information of about 974,000 individual patients.

Read the announcement

Epic Systems Remains Top Overall Software Suite in KLAS Rankings: The annual KLAS rankings are out for software systems. While Epic Systems remains best overall, each category has its own best product.

Read the article
Read the rankings (signup required)

About healthcare quality

Health plan solutions can help improve patient care, but will providers adopt them?: Physicians trust heath plans only a bit more than pharma companies (which have the lowest low scores). Yet plans need their cooperation to improve patient quality outcomes. What can be done?
A recently released Deloitte survey said that compliance and cooperation are fostered if the plans offer providers assistance, like help with care coordination and chronic care management. Also, providers would like certain benefits in return for their participation, including reduced preauthorizations and preferred status in the plan’s network.

Read the study

Factors Associated With High-Quality Guidelines for the Pharmacologic Management of Chronic Diseases in Primary Care: This article points out the need for clinical research to make sure what we do is evidence-based. The authors of this literature review found that clinical practice guidelines (CPGs) in primary care “are of widely variable quality, with less than 25% of included CPGs rated as high quality. “

Read the research