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About health insurance

The High Cost of Avoidable Hospital Emergency Department Visits: This study by United Health Group found that “the average cost of treating common primary care treatable conditions at a hospital ED is $2,032…, 12 times higher than visiting a physician office ($167) and 10 times higher than traveling to an urgent care center ($193) to treat those same conditions. In other words, visiting either a physician’s office or an urgent care facility instead of a hospital would save an average of more than $1,800 per visit – creating a $32 billion annual savings opportunity systemwide.” The main extra cost is the hospitals’ facility charge.

Politicians Tackle Surprise Bills, but Not the Biggest Source of Them: Ambulances: 51% of out-of- network surprise bills are from ambulance services; yet these charges are not addressed by current legislative proposals.


About the public’s health

U.S. Global Health Legislation Tracker: “This tracker provides a listing of global health-related legislation introduced in the 116th Congress. Currently, there are more than 30 pieces of legislation related to global health. They address topics ranging from global health security to neglected tropical diseases (NTDs) and reproductive health.” This site is a great source for keeping up with public policy proposals in Congress.

Recent trends in the age at diagnosis of colorectal cancer in the US National Cancer Data Base, 2004‐2015: “The proportion of persons diagnosed with CRC at an age younger than 50 years in the United States has continued to increase over the past decade, and younger adults present with more advanced disease. These data should be considered in the ongoing discussion of screening guidelines.” Should guidelines be revised to lower the first age of screening?

Use of Antibiotics Without a Prescription in the U.S. Population: A Scoping Review: One of the causes of bacterial resistance is use of unprescribed antibiotics. These drugs can be obtained over the counter in some foreign countries, “saving pills” from a previous prescription, or “borrowing” from others. This article reviews this often overlooked problem.

Firearm Ownership and Domestic Versus Nondomestic Homicide in the U.S.: The anti-gun lobby wants more controls on firearms in order to reduce homicides. But is such ownership correlated with these deaths? Yes and no. According to these researchers: “State-level firearm ownership rates are related to rates of domestic but not nondomestic firearm homicide.”

Mortality Trends by Race and Ethnicity Among Adults Aged 25 and over: United States, 2000–2017: The CDC released this report today. Hispanics fared best in all age categories (see the charts for quick information). The over-65 age group had declining mortality rates. From 2012-2017, the 25-44 age group had increasing mortality rates. In all categories, the rates were highest for non-Hispanic blacks.

A Unified Welfare Analysis of Government Policies: This paper is from two Harvard economists working with the National Bureaus of Economic Research and is to be presented at a conference there on Thursday. The authors looked at which public policies paid back their investments. No surprise that the answer was childhood-related programs; the reason is the time over which to recoup the spending is longer than in older persons. For example, for every dollar spent on children’s health programs, the system recoups about $1.47. For adult health programs every dollar spent loses an additional sixty cents. Obviously the issues of equity are not considered.

About healthcare quality and safety

Adverse Events in Long-term Care Residents Transitioning From Hospital Back to Nursing Home: Transitions in processes create frequent opportunities for errors. In transition from hospital back to long term care facilities patients in this study experienced a 40% chance of an adverse event. “…pressure ulcers, skin tears, and falls with injury representing the most common types of events in this category. Health care–acquired infections… and adverse drug events… were the next most common…Most were preventable or ameliorable.” The authors call for better information transmission between sites. But person-to-person communication, and even provider continuity, would be better.

About healthcare IT

Groups host congressional briefing to support lifting patient ID ban: As almost every other country has discovered, you cannot have completely useful interoperability of medical information without the ability to link individual patient data. That linkage requires unique patient identifiers. The identifiers were part of the original HIPAA legislation but, subsequently, Section 510 of a Labor-HHS Appropriations bill prohibited federal spending to set up them up. Professional IT groups are now lobbying to reinstate this unique designation.

Health system boards don't do enough IT oversight, report shows: A new study by Black Book Research finds some significant problems with health system boards' knowledge about healthcare IT. For example: “4% of survey respondents said they have direct technology experience relevant to the healthcare industry, and nearly eight in 10 said they don’t get enough feedback or actual data regarding the technology challenges their health system faces… 88% said they had no knowledge of healthcare cybersecurity risks, with just 7% claiming they were ‘somewhat knowledgeable’ of the risks.” Clearly some education and/or board recruiting improvements need to be made immediately.

Anthem launching new app offering personalized health information, texting with doctors: Usually patient-physician communication is driven by the software at the provider site. This app is interesting because it is payer- sponsored. The platform is from K Health, a company that built its platform by using anonymized electronic health records of over 2 million patients from Maccabi Health Services in Israel from the past 20 years. That data, which includes 2 billion health events, was used to train artificial intelligence algorithms to recognize symptoms and diagnoses…” Humana announced a communication app with primary care physicians in April.

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Federal judge upholds Trump's expansion of non-ObamaCare plans: Washington U.S. District Judge Richard Leon ruled that expansion health plans (that is, non-ACA compliant health insurance) can be offered. They do not have to meet the coverage requirements of ACA plans so they can be sold at a cheaper price. To what extent these offerings will further fragment the healthcare insurance market remains to be seen. If experience is any guide, healthier people will flock to them, making the exchange offerings more expensive. The federal government will end up picking up the tab for the higher costs through premium subsidies.

Colorado’s reinsurance bill drops marketplace health insurance: The Colorado legislature passed a law last session that set up a reinsurance scheme for ACA health plans operating in the state. The money comes from the federal government that would go to financial assistance. Since insurance companies have limits on their liability, the premiums have decreased. Other states have also looked at this program, which requires HHS approval. Depending on the individual states, this financial arrangement could be cheaper for the federal government and individuals than straight premium subsidies.

With lessons from hospitality and tech, Forward expands primary care footprint on East Coast: This article looks at the “latest” in concierge medicine, a high tech approach to primary care. While physician and lab fees are part of the monthly charge, patients will need traditional insurance if they really get sick.

About pharma

Incenting Competition to Reduce Drug Spending:The Biosimilar Opportunity : This in-depth report looks at potential cost-savings from current and expanded use of biosimilars: “… the current biosimilar market share is annually creating $253.8 million in savings… Greater savings are possible if the share of biosimilars were higher. Should biosimilars grow to 25 percent, 50 percent, or 75 percent of the market, annual total health care spending would be $2.5 billion, $4.8 billion, and $7.2 billion lower respectively than the baseline scenario. Over 10 years, these savings would become $24.7 billion, $48.0 billion, and $71.7 billion respectively. It should be noted that these savings only count the nine biologic drug classes where approved biosimilars already exist. Even greater savings will be realized if biosimilars were approved for more drug classes.”

Biosimilars were supposed to save us. Can they even save themselves?: On the same theme as the above study, this article keys on patent protections preventing biosimilars from getting to market. Also, discounts in this country start at about 15% below reference drugs- a figure the latter can easily match. In Europe, biologics have shorter patents and can be discounted as much as 80%. The savings outside the U.S. are therefore more substantial. Time to reexamine the regulations for this market?

Lyrica generics roll: Pfizer blockbuster finally hits patent cliff: On Friday, the FDA approved 10 generics for Pfizer’s blockbuster drug Lyrica. With that many competitors, prices are expected to drop by about 75%.

Mounting battle between Amazon's PillPack and Surescripts over access to patient data: Amazon’s PillPack has been cut off from patient medication histories by Surescripts, which is owned by competitors CVS Health and pharmacy benefit manager (PBM) Express Scripts. This action comes, as previously reported, during an FTC investigation of Surescripts for alleged antitrust. PillPack is suing so the fight is not yet over.

About healthcare IT

Anti-extremism software to be used to tackle vaccine disinformation: “Technology used to counter violent messages online from Islamic State and the far right is being adapted to counter the spread of ‘anti-vax’ conspiracy theories.”

Philips Future Health Index 2019 finds US among leaders in EMR use and AI spend, but overall digital health technology adoption mixed: The title is a bit misleading. Much of this wide-ranging report covers American healthcare IT issues such as interoperability, desire for privacy and telemedicine. One part of the report compares the U.S. with other countries. In comparing the percentage of U.S. healthcare professionals who currently use digital health technology or mobile health apps (76%) against many other countries, we do not do so well; for example, Russia is at 81%, Saudi Arabia is at 85% and China tops out at 94%. Clearly we have a long way to go.

Do protections for people with disabilities apply online? Domino’s asks high court: This article is not, strictly speaking about healthcare but the implications for the field are obvious. Domino’s Pizza is being sued by a blind customer because the website does not offer ordering options for his disability. The overall question being raised is in the article’s title.

About the public’s health

Oral health: This link is for a special issue of The Lancet on important trends in oral health- a topic that is often ignored in public health.

Trump administration pauses new rule limiting abortion referrals: The rule prohibiting abortion referrals for all organizations receiving Title X funds has been paused. Affected groups now have up to 2 months to comply.

About healthcare quality and safety: The American College of Surgeons, along with 50 stakeholder organizations (the ACS Coalition for Quality in Geriatric Surgery Project) launched The American College of Surgeons (ACS) Geriatric Surgery Verification (GSV) Program. The GSV consists of “30 new surgical standards designed to systematically improve surgical care and outcomes for the aging adult population.” Included are assessments of social issues, such as a patient’s caregiver situation.

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About the public’s health

Calories Purchased by Hospital Employees After Implementation of a Cafeteria Traffic Light–Labeling and Choice Architecture Program: In their main cafeteria, the Massachusetts General Hospital installed “‘traffic light’ food labels (in which green indicates healthy, yellow indicates less healthy, and red indicates least healthy) and choice architecture (product placement)…” These signals resulted in a reduction of 47 kcal per day and estimated a 2.0-kg weight loss over 3 years. This reduction was sustained and assumes no other dietary or activity changes. This program is really simple and much easier (and faster) than having people read labels.

Natural environments and craving: The mediating role of negative affect: This small, but intriguing study from the UK’s University of Plymouth shows that exposure to nature (fields, tress, etc.) reduces cravings for such items as unhealthful snacks, alcohol, or tobacco.

Association between coffee consumption and overall risk of being diagnosed with or dying from cancer among >300 000 UK Biobank participants in a large-scale Mendelian randomization study: Breath easier when you have that cup of coffee. Based on observational data as well as literature review (through a meta-analysis) the researchers found that “summary data on various cancers do not support a strong causal relationship between coffee and risk of breast, ovarian, lung or prostate cancer, upon correction for multiple testing.”

About healthcare professionals

Investing in Primary Care: A State-Level Analysis: All studies from around the world show the advantages of a primary care system; yet the US has had a very specialty-focus. This difference is highlighted by the facts that on average, “the United States spends 5%-7% on primary care as a percentage of total health care spending. By comparison, Organisation for Economic Co-operation and Development (OECD) countries average 14% spending on primary care.” This research study of primary care investment by state found an association “between increased primary care spend and fewer emergency department visits, total hospitalizations, and hospitalizations for ambulatory care-sensitive conditions.” While a causal relationship was not asserted, the results were consistent with other research studies about primary care’s benefits.

About healthcare quality and safety

Association Between State-Mandated Protocolized Sepsis Care and In-hospital Mortality Among Adults With Sepsis: Clinical protocols usually come from medical organizations or accreditation groups. In 2013 New York State mandated the use of protocols for sepsis recognition and treatment. “By the 10th quarter after implementation of the regulations, the adjusted absolute mortality was 3.2% lower than expected in New York State relative to the control states.” The authors caution about applying the program to other states.

CMS updates Medicaid and CHIP Scorecard with new data: For the second year, CMS released scorecards for Medicaid and CHIP, this time with new data. This article provides an overview of the scorecard while the CMS site provides more details. Unfortunately, like much health data, the findings are a bit old.

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis: “Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6% (95% confidence interval 5% to 7%). A pooled proportion of 12% (9% to 15%) of preventable patient harm was severe or led to death. Incidents related to drugs (25%, 95% confidence interval 16% to 34%) and other treatments (24%, 21% to 30%) accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties (intensive care or surgery; regression coefficient b=0.07, 95% confidence interval 0.04 to 0.10).”

About pharma

Canada warns U.S. against drug import plans, citing shortage concerns: It might not be so easy to get medications from Canada. To save money on prescription drugs, some states (like Florida) have passed laws enabling their purchase from Canada. Canada has warned the US that if the volume is large enough to affect Canadian supplies, the exports will be cut.

Roche doomsday is here: Long-feared Herceptin, Avastin biosims bust into U.S. market: Good news for consumers, bad news for Roche. “Amgen and Allergan Thursday launched U.S. biosimilars of both HER2-positive breast cancer med Herceptin and colorectal cancer treatment Avastin, threatening a combined $5.9 billion in U.S. sales in 2018.” The prices will be 15% lower than the reference biologics, which is consistent for biosimilars.

Novartis, aiming to clean up its rep, sets aside $700M for kickback settlement: This amount should settle a decade-long federal bribery charge from a whistleblower suit. Novartis was accused of bribing physicians to prescribe their medications. “Among some of the most eyepopping claims in the suit were Novartis sales execs treating doctors to $10,000 dinners at expensive New York seafood restaurants and wild nights out at Hooters. In one instance, Novartis held one of its speaker events aboard a fishing boat, allegedly without any educational material in tow.”

About health insurance

Aetna-CVS merger to go back before judge; 5 states support approval: In a continuation of scrutiny of this merger, next Wednesday “lawyers from California, Florida, Hawaii, Mississippi, and Washington will appear before U.S. District Judge Richard J. Leon in Washington, D.C., … to defend a Justice Department-brokered settlement as an ‘effective and appropriate remedy’ for potentially anti-competitive effects stemming from the tie-up.”

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House votes to get rid of ACA's controversial 'Cadillac' tax on high-cost plans: As predicted a few days ago, the House voted to repeal the tax on costly health plans. Now large firms will be able to provide rich health benefits that are fully tax deductible for them and tax exempt for employees. I expect the Senate to vote to pass the measure.

House lawmakers add arbitration to surprise billing measure: The House Energy and Commerce Committee “unanimously advanced the No Surprises Act as part of a major package that reauthorizes funding for community health centers and delays implementation of cuts to disproportionate share hospitals. The legislation, which now heads to the full House, bans balance billing and requires insurers to pay the median in-network rate for out-of-network surprise bills.” A last minute addition was an arbitration provision if the provider does not accept the insurance company payment.

Health Care Spending, Utilization, and Quality 8 Years into Global Payment: A pilot project of Blue Cross in Massachusetts set spending goals for physicians through population-based global budgets and . quality payments. “During the first 8 years after its introduction, the BCBS population-based payment model was associated with slower growth in medical spending on claims, resulting in savings that over time began to exceed incentive payments. Unadjusted measures of quality under this model were higher than or similar to average regional and national quality measures.” While these results were just published today, the trial ended in 2016. Further, there is nothing new in these findings, as similar results have long been known for capitated arrangements.

About healthcare quality and safety

Today, the Leapfrog Group released: Safety In Numbers: The Leapfrog Group’s Report on High-Risk Surgeries Performed at American Hospitals. Of the eight high-risk procedures assessed, “open abdominal aortic aneurysm repair and esophageal resection for cancer are the two procedures where the fewest hospitals met the volume standard for patient safety (less than 3% fully meeting for each). The procedure for which hospitals were most likely to meet the safety standard was bariatric surgery for weight loss (38%).”

About healthcare professionals

Medscape Residents Salary & Debt Report 2019: Some major findings:
—Over the past 2 years, average resident salaries have increase 3% to $61,200.
—Medical genetics topped the list at $67,500 and at the bottom was family medicine ($10,000 lower). Of course salaries increase each year and are greatest in the longest residencies.
—41% of residents said future earnings were extremely or very important to their specialty choice, while only 8% said it had no influence.
—22% had no debt while 24% had more than $300,000 in debt.

About healthcare IT

Exploring the Digital Divide: Age and Race Disparities in Use of an Inpatient Portal: This research found that there was “lower use of the inpatient portal among African American and older patients, relative to White and younger patients, respectively.” Authors concluded the “findings suggest that the availability of the technology alone may be insufficient to overcome barriers to use and that additional intervention may be needed to close the digital divide.”

About the public’s health

Disease X: Which Plague Is Coming Next?: Ebola, SARS, MERS, Zika…These are infections diseases which have sprung up relatively recently. What is next? This article is a nice summary of the answer to this question.

Association of Genetic and Environmental Factors With Autism in a 5-Country Cohort: Many environmental causes (including, erroneously, vaccinations) have been hypothesized as the cause of autism. This multi-country study shows that the heritability of autism is 80%, “indicating that the variation…is mostly owing to inherited genetic influences…”

Provisional Drug Overdose Death Counts: According to CDC provisional data, about 68,500 Americans died of a drug overdose in 2018, a 5% drop from the previous year. The decrease is the first time the number has fallen since 1999.

Latin America’s war on obesity could be a model for U.S.: Obesity is a major problem in Latin America. Countries in the region face the same obstacles as the U.S. in addressing this problem- including hard lobbying by business groups that would be affected by public health laws. This article is a nice summary of their successful efforts. For example, in" “July 2012, the Chilean Senate approved the law of food labeling and advertising, which went into effect in 2016 with comprehensive food-regulation policy in three, increasingly stringent phases. Spearheaded by Guido Girardi, a physician and senator, the law included front-of-package warnings, restrictions on marketing unhealthful foods directly to children, and limits on what foods could be sold in schools and day-care facilities.”

About healthcare technology

CVS Health Announces Start of Clinical Trial for New Home Hemodialysis Device: CVS announced it will initiate a clinical trial on up to 70 patients to test the safety and effectiveness of the at-home HemoCare Hemodialysis System. Because typical hemodialysis is accomplished during regular, scheduled hours in a facility, times are limited. CVS hopes that this home system will not only make treatment more convenient for patients but also allow them to have longer (or more frequent) sessions- thus improving clearance of blood toxins.

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CBO: Senate surprise billing legislation would save feds $7B over next decade: The Senate Health, Education, Labor and Pensions Committee asked the Congressional Budget Office for estimates on the financial impact of its proposal to address surprise medical bills and high pharmaceutical costs. The CBO reported that the law would lower federal expenses by $7 billion over the next decade. A closer look (Table 1) reveals that that savings do not start until 2025. By 2028 the net federal budget savings reaches about $4.5 billion.

Democratic chair: Medicare negotiating drug prices not moving before August: On the House side, it appears that drug price legislation will not happen before the August recess.

New CMS resources help states waive ACA requirements: The ACA has provisions to grant states waivers (Section 1332) to adopt alternative schemes to provide health insurance. “Most states have gotten or are seeking the Section 1332 waivers to establish a reinsurance program to fully or partially reimburse insurers that are covering claims for high-risk beneficiaires. This reduces the price of premiums in those states.” CMS has just issued guidelines to make the waiver process easier. The question that arises is what happens to insurance markets as the number of products increase and enrollees segment themselves among these plans by financial and health status criteria?

Trump Administration Moves to Shift Patients’ Chronic Illness Costs to Insurers: In order to have a Health Savings Accounts (HSAs), participants must also have a high deductible health plan. These plans require large out of pocket payments before the insurance becomes responsible. The Internal Revenue Service and the Treasury Department just issued a guidance for high-deductible health plans that allows insurance companies to pay for such chronic disease items as glucose monitors and blood pressure cuffs without first satisfying the deductible. This type of allowance has been discussed before with respect to total coverage of chronic medications to ensure compliance.

Insurers Running Medicare Advantage Plans Overbill Taxpayers By Billions As Feds Struggle To Stop It: Payments to Medicare Advantage plans include adjustments for the severity of illnesses of covered persons. CMS clams that over the past three years these plans have overbilled Medicare $30 billion. The controversy over this issue is whether plans are documenting better or exaggerating patient findings. We will see which is true when the government seeks to recoup the money it claims plans owe.

Early Effects of an Accountable Care Organization Model for Underserved Areas: In its first year, the Accountable Care Organization Investment Model "was associated with a differential reduction in total Medicare spending of $28.21 per beneficiary per month relative to the comparison group, which amounted to an aggregate decrease of $131.0 million…” After accounting for “$82.4 million in CMS spending, the aggregate net reduction was $48.6 million, which corresponded to a net reduction of $10.46 per beneficiary per month. Decreases in the number of hospitalizations and use of institutional post-acute care contributed to the observed reduction in overall spending.”

Health Insurance Index Report for the 2019 Open Enrollment Period: This report from eHealth found that, for unsubsidized enrollees in exchange plans, the average premiums for two-person families broke $1,000 per month for the first time and the total “combined annual premiums plus deductible for a four-person family now tops $25,000.” The good news is that for 2019 the “average individual deductible decreased 6%…” and the “average family deductible decreased 8%…”

About the public’s health

Unintentional Injury Death Rates in Rural and Urban Areas: United States, 1999–2017: We pay much attention to diagnosis and treatment of diseases such as cancers and heart attacks; however, according to the CDC, unintentional injury is a leading cause of death in the United States. In this category are traffic accidents, unintentional drug overdoses, and falls. In this July report, the CDC says that from” 1999 through 2017, the age-adjusted unintentional injury death rate increased 40%.” Clearly more attention needs to be directed at this category of deaths.

Planned Parenthood ousts leader after less than a year: Normally a job change is not big news. However, this ouster was caused by the Monday start of the rule prohibiting federally funded family planning clinics from providing referrals for abortions. Apparently former president Leana Wen, MD wanted to approach the issue as a medical one while the organization saw it as a political fight. In related stories, two Planned Parenthood clinics (in Illinois and Maine) said they would refuse federal funding so they could continue to provide abortion services.

76 billion opioid pills: Newly released federal data unmasks the epidemic: This Washington Post story details the magnitude of opioids that have been flooding the market and the role played by pharma companies and the manufacturers which supply them. This information comes from the public release of data from the Drug Enforcement Administration. The question now is not about who produced and promoted what drugs, but why the DEA was sitting on data that clearly showed an epidemic in the making.

Trump to order drive for improved flu vaccine: Now some good news. After years of questioning the safety of vaccines, President Trump “is readying an executive order that would direct HHS to overhaul the development of flu vaccine and encourage more Americans to get vaccinated.”

Incentives for smoking cessation: The best way to get people to stop smoking is to raise cigarette taxes. But does paying them to stop also work? This Cochrane Collaborative article concludes that: “Six months or more after the beginning of the trial, people receiving rewards were more likely to have stopped smoking than those in the control groups.” The amount did not matter.

New York City Hopes to Ease Strain on Its Emergency Rooms: NY City has announced an expanded primary care system called NYC Care. It is expected to serve 300,000 patients and reduce ER usage by providing a regular source of care.

About pharma

Johnson & Johnson lifts annual revenue guidance as Q2 drugs sales top estimates, led by Darzalex, Imbruvica, Tremfya: Despite the pending liability suits over opioids and asbestos in baby powder, and pressures from generics, J&J continues to be profitable. This is article provides a good look at the importance of a diversified product line.

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A look at how providers could fare in CMS' new primary care payment models: As previously reported, starting in January 2020 CMS will start a demonstration project to incentivize primary care physicians to accept risk arrangements with quality bonuses. This scheme is separate from the ACO program. This article is a nice summary of what the primary care payment models will look like.

Problems Remain for Ensuring That All High Risk Medicaid Providers Undergo Criminal Background Checks: The Office of the Inspector General of HHS surveyed states’ compliance with measures to assure “high risk” individuals were appropriately screened before being allowed to participate in the Medicaid program. The OIG “found flaws with States' implementation of fingerprint based criminal background checks for high risk Medicaid providers. Eighteen States missed the deadline for implementation that CMS had set, and 13 of those 18 States had still not implemented these checks as of January 1, 2019.” Recommendations are included in the report.

About healthcare IT

Surescripts files motion to dismiss FTC's antitrust case: Recall that in April the FTC filed suit against Surescripts for monopolizing the e-prescribing market. This article provides an update on that story.

About pharma

Advocates frustrated over pace of drug price reform: Despite all the talk in Congress (by both parties) about addressing high drug prices, nothing has been done; and the August recess is fast approaching. This article is a nice summary of what is (or is not) happening.

How pharma, under attack from all sides, keeps winning in Washington: This article provides a different spin than the one above by focusing on the role of the pharma lobby.

Limited Information Exists on the Effects of Synchronizing Medication Refills: “Medication synchronization is a process whereby a pharmacist aligns the refill dates of two or more of a patient’s medications to a single day.” The GAO was mandated to do a survey about this issue and found scant data. Some findings support increased drug adherence. But there are problems with this process. A major one is that patients stagger their filling of prescriptions because they need to spread out the costs. Perhaps the problem could be solved with a utility-like payment method that “smooths” payments rather than requiring a periodic lump sum. For example, instead of paying the out-of-pocket costs of several 90-day supplies of medications all at once, the patient could be billed equal amounts each month for 3 months.

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1 in 5 employers may face the ACA's 'Cadillac' tax on high-cost health plans: Health benefits are deductible expenses for employers and tax free benefits for employees. If these benefits expand in place of higher salaries (which are taxable), the government loses more money. Further, such a system discourages prudent purchasing of insurance. In this setting, the ACA mandated a so-called “Cadillac tax” ( a 40% excise tax) on an employer health plan when its cost surpasses $11,200 for an individual and $30,100 for a family. Both major political parties do not like this provision. One reason is it was not indexed to inflation or even geared to rising healthcare costs, thus causing the burden to fall on the middle class. The start date for this tax has been delayed but is now set to go into effect in 2022. If it proceeds as planned, this new study estimates that about 21% of “employers offering health plans will have at least one plan affected.” The House is expected to vote this week on a full repeal of this tax.

Biden reveals healthcare plan piggybacking on ACA: Add one more variation…Biden proposes that a Medicare-like system be offered with Medicaid benefits. This option would be offered for those who would qualify for Medicaid if their states had signed on for the expansion.

CMS Proposing Bundled Payment Model for Radiation Oncology: The title speaks for itself. This proposal has been months in the making. "Participation would be mandatory for certain geographic areas during the model's projected five-year timeline…” and prospective payments will be linked to quality metrics.

U.S. appeals court blocks Trump administration birth control exemptions: “A federal appeals court on Friday blocked the Trump administration from enforcing new rules allowing employers to obtain exemptions from an Obamacare requirement they provide health insurance that covers women’s birth control.”

About healthcare quality

Quality Payment Program Releases 2017 Physician Compare Data and Sees Increases in Clinician Participation Rates and Success for 2018: CMS Administrator Seema Verma announced that the number of Qualified Practitioners participating in the Advanced APM programs for quality reporting “nearly doubled in 2018 from the previous year, increasing from 99,076 to 183,306 clinicians…Additionally, nearly 90% of clinicians in small practices participated in 2018, which was an increase from 81% in 2017.” Any recent economic and clinical benefits still need to be assessed.

CMS to delay star ratings update pending expert panel review: This February, CMS started to look at changes in the quality assessment methodology that underpins the star reports for hospitals. After receiving more than 800 comments from a solicitation, CMS decided to delay its summer report and instead look at revisions in the program.

Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers: The authors of this study looked at malpractice claims and found that '“ vascular events, infections, and cancers… account for about three-fourths of serious misdiagnosis-related harms.” They concluded that initial programs to improve diagnoses should be targeted at these conditions.

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Court rules Trump administration can go ahead with Title X 'gag rule':By a 7-4 vote, the U.S. Court of Appeals for the 9th Circuit upheld the June 20 ruling by a three-judge panel that allows the government to withhold Title X funds from clinics that provide abortion referrals.

Trends in prevalence of protective levels of hepatitis B surface antibody among adults aged 18–49 years with risk factors for hepatitis B virus infection—United States, 2003–2014: Fewer than a third of high risk adults had been immunized for hepatitis B by 2014. Clearly more needs to be done to increase this coverage. (The number today is perhaps higher given the requirement for vaccine coverage under the ACA. Recall the insurance exchanges started in 2014.) This problem is the perfect example for the need for more social marketing.

Health plans ramp up new IT efforts:This article is not just about IT. The main theme is how Social Determinants of Health are being addressed by insurers. The lead example is a food market in a bus that brings healthy food into a “food desert” in Minneapolis-St. Paul.

About pharma

Failure to Launch: Patent Abuse Blocks Access to Biosimilars for America’s Patients: This Whitepaper from the trade group “Biosimilars Council” details the impediments to biosimilars getting to market. The study claims that these obstacles, including patent abuse by branded products, have cost the public $7.6 billion.

Speaking of generics, the FDA tentatively approved Mylan's generic Eliquis. As this class of drugs goes generic, prices will come down; however the number of indications have increased.

About healthcare quality

Association of residency work hour reform with long term quality and costs of care of US physicians: observational study: Work hour reforms for residents started in 2003 because of problems in care attributed to fatigue. Since then the question has been raised about the quality of care these physicians will deliver after training, viz., will the reduced hours produce less qualified practitioners? The answer, at least for internists, is “no difference.” The bottom line: “ Exposure of internists to work hour reforms during their residency was not associated with post-training differences in patient mortality, readmissions, or costs of care.”

About health insurance

CMS Proposes Elimination of RAPs, $250 Million Medicare Payment Increase: CMS is proposing a number of changes in home care payments, including a new home infusion benefit. Overall, these changes “would increase Medicare payments to home health agencies by 1.3% — or about $250 million.”

CMS proposes new approach to monitoring protections for Medicaid beneficiaries: Current Medicaid rules require states to report data on access to that program every three years. But the rule only applies to fee for service Medicaid. Since the majority of Medicaid recipients are enrolled in managed care plans. the rules need to be changed. Further, CMS plans to change the type of evaluation to more of an outcomes-driven approach.

About healthcare IT

GE anesthesia/respiratory devices have cyber vulnerabilities: This story highlights another recent example of the vulnerability of healthcare “peripherals” too hacking.

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About pharma

White House kills major drug pricing proposal: Remember the President’s proposals to lower individuals’ drug costs by re-channeling rebates? Nevermind. Now Congressional focus will be on prices pharma companies charge.

About healthcare IT

FCC approves $100M rural telehealth program: “The proposed pilot program would offer an 85 percent discount on connectivity for telehealth services powered by broadband internet access. The virtual care services would connect patients directly to their physicians through audio and video technology.” The question is whether there is adequate connectivity in places that need it.

Amazon's Alexa will now give Brits health advice: Want to ask Alexa about your symptoms or how to treat your illness? You can in the UK. It appears the concerns there are only about privacy. In this country we would also have liability concerns.

About healthcare quality

Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study: Does the threat of penalties improve care? The answer with respect to hospital acquired conditions is: “No.” In fact financially penalizing hospitals could make it more difficult to deliver care to needy populations. The research concluded: “Penalization was not associated with significant changes in rates of hospital acquired conditions, 30 day readmission, or 30 day mortality, and does not appear to drive meaningful clinical improvements.”

About the public’s health

Sugary drink consumption and risk of cancer: results from NutriNet-Santé prospective cohort:  “In this large prospective study, the consumption of sugary drinks was positively associated with the risk of overall cancer and breast cancer. 100% fruit juices were also positively associated with the risk of overall cancer. These results need replication in other large scale prospective studies. They suggest that sugary drinks, which are widely consumed in Western countries, might represent a modifiable risk factor for cancer prevention.”

About health insurance

Appeals court appears likely to call for lower court to settle unanswered questions on ACA lawsuit, experts say: More legal experts have weighed in on what might happen as the appeals court rules on the ACA. The most recent comments are that the court will send the suit back to a lower court to decide which parts of the law can exist without the individual mandate.

Rifts Emerge Over Congressional Move to Curb Surprise Medical Bills: While bipartisan support for addressing surprise medical bills still exists, the implementation details are causing some disagreements. For example, if you take the patient out of the equation, who is responsible for the difference between what the insurance company pays and what the provider is asking?

California gov signs health care bill extending coverage to some undocumented residents: “Democratic Gov. Gavin Newsom on Tuesday signed SB-104, which extends health care benefits to individuals 19 to 25 years of age, regardless of their immigration status.”



Today's News and Commentary

About the public’s health

HyperFoods: Machine intelligent mapping of cancer-beating molecules in foods: Which foods are more likely to help prevent cancers? The authors used a network-based machine learning method to find answers. The bottom line? “… plant-based foods such as tea, carrot, celery, orange, grape, coriander, cabbage and dill contain the largest number of molecules with high anti-cancer likeness through exerting influence on molecular networks in a similar fashion to existing therapeutics.” However, among the authors other cautions is the warning that “concentrations of bioactive molecules are not taken into account and it is unclear they would be present in sufficient enough concentration to exert their beneficial biological activity.”

US life expectancy has been declining. Here’s why: “A baby born in the U.S. in 2017 is expected to live to be 78.6 years old, which is down from 78.7 from the year before.” The CDC targeted three causes for this decline: rise in drug overdoses; increase in liver disease; and rise in the suicide rate.

About pharma

Novartis to sell epinephrine shot in U.S. pharmacies amid EpiPen shortage: Novartis will make its generic pre-filled epinephrine shots immediately available in local pharmacies across the United States. This announcement comes because of a shortage of Mylan’s EpiPen due to manufacturing problems. It is nice to see the market working.

Tax-Funded Drug Research Should Spell Cheaper Drugs: Advocates(Free trial available): How should we handle drug (and other) discoveries that are made using federal research funds? Should the government have an equity share in the product? Should the prices be lower? Right now there is no financial recognition. This article addresses the questions above.

Germany Joins U.S.-EU Inspection Partnership: This article is a reminder that the FDA does not have the resources to examine all foreign plants for Good Manufacturing Practices (GMPs) and is increasingly relying on other countries to police their own facilities.

Congress Seeks GAO Review of Foreign Drug Inspection Program: This article addresses the same issue as the one above.

Score! 'Good Pharma' ranking finds uptick in new drug data sharing and clinical trial transparency: Now some good news. According to findings from the Good Pharma Scorecard biennial ranking, Big Pharma is sharing more data than ever before. 95% of patient trials are “now providing public results within six months of FDA approval. If the time period is extended to 12 months, that improves to 100% for the new drugs reviewed after approval in 2015.”

About health insurance

U.S. appeals court signals sympathy to bid to strike down Obamacare: Lots of speculation on the outcome of the ACA appeals hearing yesterday. Two of the three judges were Republican appointees (which should not make a difference, but does). Observers said their questions indicated they might rule against the appellants, who are mostly attorneys general from Blue states. A decision will not be forthcoming for weeks and is likely to reach the Supreme Court regardless of outcome. This article is a nice summary of the history leading up to this trial. Here is another good source of information from the Washington Post.

Buyer beware: When religion, politics, health care and money collide:Some people are buying into what they think are insurance plans but are really faith-based medical cost sharing schemes. This article is a good example of what can (and does) go wrong when coverage is required.

Anesthesiologist indicted for alleged role in $7M telemedicine fraud case: Find an innovative healthcare technology and someone will use it to defraud payers. In this case, starting in January 2015 the anesthesiologist in the headline “and other medical providers purported to practice telemedicine pursuant to agreements with unnamed companies in exchange for kickbacks paid for each purported telemedicine encounter, according to the indictment.” The alleged fraudulent payments totaled $7 million.

Covered California says consumers will see lowest-ever premium hike for individual policies: “Covered California announced Tuesday morning that it expects an average premium increase of 0.8 percent for 2020 in the state’s individual marketplace, the lowest such rate change since the health insurance exchange started business in 2013. 
Peter V. Lee, the executive director of Covered California, attributed the low rate change to bills passed by the California Legislature and signed into law by Gov. Gavin Newsom over the past six months. 
The legislation includes a so-called individual mandate that will impose a state tax penalty on any California resident who does not maintain health insurance coverage and offers state subsidies that will help an estimated 922,000 residents pay for insurance.”

About healthcare quality

HHS Quality Summit (QS) Fact Sheet: HHS announced that it will convene a summit of “key industry stakeholders and government leaders to discuss how current quality programs administered by HHS can be further evaluated, adapted, and streamlined to deliver better outcomes for American patients.” The announcement is a bit vague but appears to be geared to streamlining all the disparate quality criteria.

Today's News and Commentary

About pharma

U.S. judge strikes down Trump administration rule requiring drug prices in TV ads: This story is today’s top news. U.S. District Judge Amit Mehta in Washington ruled in favor of pharma companies Merck & Co Inc, Eli Lilly and Co and Amgen in their suit to stop the requirement for posting drug prices in ads. The judge ruled that HHS overstepped its authority in imposing this requirement and that it was up to Congress to make such a decision. Given the climate of pharma-cost bashing, Congress may pass such a measure with significant bipartisan support.

Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map: Many vitamins and dietary supplements are touted as effective preventives for cardiovascular disease. This extensive literature review, published online today, provides more insight. Other than lowering your salt intake, all other measures are, at best, unproved.

In summary:

“There was moderate-certainty evidence that reduced salt intake decreased the risk for all-cause mortality in normotensive participants… and cardiovascular mortality in hypertensive participants.”

“ Low-certainty evidence showed that omega-3 long-chain polyunsaturated fatty acid (LC-PUFA) was associated with reduced risk for myocardial infarction…and coronary heart disease…”

“Folic acid was associated with lower risk for stroke (… low certainty), whereas calcium plus vitamin D increased the risk for stroke (… moderate certainty).”

”Other nutritional supplements, such as vitamin B6, vitamin A, multivitamins, antioxidants, and iron and dietary interventions, such as reduced fat intake, had no significant effect on mortality or cardiovascular disease outcomes (very low– to moderate-certainty evidence).”

Financial Implications of 12-Month Dispensing of Oral Contraceptive Pills in the Veterans Affairs Health Care System: The arguments against dispensing a 12 month supply of oral contraceptives are financial and clinical. Less frequent renewals will require more frequent patient copays, thus reducing payer costs. Some physicians also use more frequent prescription as a way to bring patients to the office to check for side effects and deliver other preventive services. This VA study found the 12 month dispensing to be cost-effective. The one caution is that the VA population is rather stable, while the privately insured population tends to change insurance plans at a significant rate. Private insurers may be willing to pay for longer prescriptions but probably not those that exceed the contract year.

About the public’s health

Duration of Antibiotic Therapy: Shorter Is Better(Subscription required for full article): One way to reduce antibiotic resistance is to shorten the course of treatment. This article provides a review of the evidence for shorter course of therapy. For example, for community acquired pneumonia 8 randomized controlled trials “have shown that 3- to 5-day courses of antibiotic therapy are at least as effective as 7- to 14-day courses…”

2019: Vulnerabilities in Hospice Care: This site provides links to two reports by the HHS Inspector General detailing the quality of care findings for Medicare-covered hospices. In short: “the majority of U.S. hospices that participated in Medicare had one or more deficiencies in the quality of care they provided to their patients.”

About healthcare IT

Security, control of data seen as key barriers to cloud adoption by pharma: This article explains why the pharma industry does not think cloud-based data storage is safe, and therefore will not use it.

About health insurance

Trump aims to shake up kidney care market: The federal government spends more than $100 billion per year on the End Stage Renal Dialysis Program, its only disease-specific insurance. Tomorrow the Trump administration will announce plans to change payment methods to encourage more home dialysis as well as earlier detection and treatment of kidney disease.

Today's News and Commentary

Welcome back after the long July 4 “weekend”

In the new format below, the article link will be in the story’s title

About pharma

Fast-Track Drug Approval, Designed for Emergencies, Is Now Routine: This article was in the print edition of the Wall Street Journal this weekend. It is a great piece about the balance between quick drug approval to help people who need treatment and the possibilities of harm from unanticipated side effects.

Only 2% of genomic material available for research comes from Africa; 54gene wants to change that: The headline is self-explanatory. The article highlights the opportunities for drug discoveries by conducting more research on highly diverse African genomes.

Exclusive: Five couples lined up for CRISPR babies to avoid deafness: Five Russian couples with hereditary deafness have applied to the country’s authorities to have children who will be genetically modified to correct the defect.

About the public’s health

Fight over vaccine exemptions hits state legislatures: This article is a nice summary of the issues around state requirements for vaccination versus personal liberties. The one key factor is that the individual risk of vaccination is negligible while the public risk of non-vaccination is considerable.

Smoke-free and tobacco-free colleges and universities in the United States: Restaurants and public places have adopted tobacco-free environments. According to this research: “In 2017, just 16.7% of accredited, degree-granting institutions in the USA had 100% smoke-free or 100% tobacco-free protections. Despite progress, more efforts can ensure that students and staff benefit from comprehensive 100% smoke-free and 100% tobacco-free protections at US colleges and universities.”

Natural history of prediabetes in older adults from a population‐based longitudinal study: One of the screens done in older adults is for pre-diabetes, i.e., an abnormal blood sugar level that doesn’t quite meet criteria for the disease. This 12 year-long Swedish research study looked at 918 individuals who had prediabetes. During that time, 22% reverted to normal, 13% developed diabetes and 23% died. The exact causes of death are not specified. The takeaway here is that prediabetes does not always progress to the disease and normal sugars can be achieved. The modifiable factors to achieve this goal are lowering systolic blood pressure and promoting weight loss. Providing this data to patients with prediabetes may give them hope so that can engage in healthy lifestyles and comply with treatment recommendations.

National and State Estimates of Lost Earnings From Cancer Deaths in the United States: “A total of 8 739 939 person-years of life were lost to cancer death in persons aged 16 to 84 years in the United States in 2015, translating to lost earnings of $94.4 billion (95% CI, $91.7 billion-$97.3 billion). For individual cancer sites, lost earnings were highest for lung cancer ($21.3 billion), followed by colorectal ($9.4 billion), female breast ($6.2 billion), and pancreatic ($6.1 billion) cancer.” Large state-by-state differences also occur.

2019 Review of Physician and Advanced Practitioner Recruiting Incentives: This recent report by physician search firm Merritt Hawkins has a number of important public health findings. Among them:

—”For the 13th consecutive year, family physicians topped the list of Merritt Hawkins’ 20 most requested recruiting assignments, underscoring the continued robust demand for primary care physicians.”

—”The use of quality/value-based physician compensation is rising. 56% of physician production bonus formulas tracked in the 2019 Review feature quality-based metrics, up from 42% the previous year.” Such figures often fail to note how much of the compensation is value-based.

—”Employment rather than independent practice remains the dominant physician recruiting model. Over 90% of Merritt Hawkins’ search assignments feature employed practice settings, while less than 10% feature independent practice.” This finding may be based on the fact that hospitals and other large employers can afford expensive search companies.

The survey also lists salary trends by specialty. Guess where the primary care physicians fall?

About healthcare IT

6 ways smaller health systems are falling behind in cybersecurity: CHIME-KLAS survey: “While large healthcare organizations are successfully adopting best practices for cybersecurity, smaller health systems and hospitals are falling behind as budget constraints and a lack of qualified talent hinder progress…” As large systems try to implement interoperability solutions, linkages with smaller organizations which are not as “cybersecure” may pose a threat. There needs to be a systemic solution to the security issue, not just an institution-by-institution implementation.

Global EHR market hits $31B but faces usability, interoperability challenges: This article summarizes a proprietary research study. “The market for EHRs, which includes revenues for EHR systems, computerized provider order entry systems, and directly related services, such as installation, training, servicing, and consulting, grew 6% from $29.7 billion the previous year…” Read the article for more details.

About health insurance

ObamaCare repeal lawsuit faces major court test: Tomorrow the 5th Circuit Court of Appeals in New Orleans “will hear arguments in a lawsuit backed by the Trump administration seeking to overturn the entire 2010 Affordable Care Act (ACA).” The article is a nice summary of the events leading up to this hearing.

Congress has ambitious agenda tackling health care costs: Now that the 4th of July holiday is over, Congress will begin to address a variety of health issues ranging from surprise medical bills to lowering out-of-pocket drug costs. This article is a nice summary of these initiatives.

Study finds 33% of ACOs took on major risk in 2018 as new program starts: This article summarizes recent research in Health Affairs (subscription only access). The survey found that “only 33% of accountable care organizations have at least one contract that takes on greater risk,” up from 28% in 2012. It will be interesting to see how many ACOs stay in the program. Starting July 1, they are allowed up to 3 years in a no-downside risk program. Previously, they could remain in that status for 6 years.

Today's News and Commentary

About health insurance

CMS extends Medicare coverage for ambulatory blood pressure test: Ambulatory blood pressure monitoring (that is blood pressure readings taken outside the doctor’s office ) is the current medical recommendation for following hypertension. CMS has just approved Medicare coverage.

Read the story

Five states seek to join hearing to determine fate of CVS-Aetna merger: As previously reported, federal Judge Richard Leon is reviewing this merger, claiming it was not adequately vetted. Now attorneys general from California, Florida, Hawaii, Mississippi and Washington have repeated a request to speak before the court in favor of the deal.

Read the story

Accuracy Of The Relative Value Scale Update Committee’s Time Estimates And Physician Fee Schedule For Joint Replacement: Physicians’ time is one element that CMS uses to pay for services. This research was based on actual electronic record time stamps rather than self-reported times. The results were that “the fee schedule overestimated the operating time of original hip replacements by 18 percent and original knee replacements by 23 percent. Revision hip replacements were overestimated by 61 percent and knee replacements by 48 percent.” Keep in mind that the payment recommendations come from an AMA committee largely composed of surgical specialists, so reform in payment will be problematic.

Read the abstract

About the public’s health

Facebook to tackle content with misleading health claims: The headline is self-explanatory.

Read the story
Read another version

Exclusive: FDA enforcement actions plummet under Trump: Again, the headline is self-explanatory.

Read the report for more details

Microbiota-Driven Tonic Interferon Signals in Lung Stromal Cells Protect from Influenza Virus Infection:Despite the complex title, this research’s method is important. Because antibiotics do not help treat viral infections like influenza, physicians should avoid using them. Another reason to avoid use is fostering the emergence of drug resistance. This article provides a third reason.
Intestinal bacteria are known to have a number of beneficial effects. One benefit that this research found is that they help attack viral infections. Use of antibiotics that can kill these bacteria may make viral infections worse.

Read the abstract

Today's News and Commentary

About pharma

Pharma shells out $3B to doctors and hospitals—with Roche, Sanofi leading: CMS: This story is a followup to yesterday’s post about patients not paying attention to how much their physicians are paid by pharma companies. Despite the available information, these amounts are increasing. This article provides more detail about totals and who is spending the most.

Read the story

New drug approvals in 2019 - what’s left to come…: This article is just FYI. What new drugs are likely to come to market this year.

Read the story

Study finds sizable delay in use of new antibiotics: Why did hospitals wait about a year to use five new antibiotics? A few reasons are cost (they are very expensive), stewardship (waiting to choose appropriate patients to avoid emergence of resistance), and similarity to existing drugs. Marketers should take note of these reasons.

Read the analysis

More states move to protect patients seeking prescribed meds: One of the most frequently used tools for controlling drug costs is “step therapy.” Patients are required to start with the cheapest and/or most proven first line treatment for their illness. If that treatment fails, a series of excepted “next steps” can be used. This article explains how some states are passing laws against insurers using such policies. It should be noted that step therapies for such conditions as asthma, hypertension and diabetes are accepted and preferred medical treatments. We need to balance government concern for patient care with its practicing medicine.

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Drug prices in 2019 are surging, with hikes at 5 times inflation: This story was all over the media today. The overall message is that for all the talk by Congress about controlling drug costs, more than “3,400 drugs have boosted their prices in the first six months of 2019, an increase of 17% in the number of drug hikes from a year earlier.”

Read the story
Another version from the Wall Street Journal

About the public’s health

10 Medical Myths We Should Stop Believing. Doctors, Too.: This is a “fun” article that is also informative.

Read the article (NY Times, may need subscription)

More states are targeting teen vaping, but health advocates say it’s not enough to curb use: Yesterday many state laws went into effect that banned teen vaping and raised the age for tobacco purchase to 21. But, as the article asks, are those measures enough to curb use of these products?

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

Children who say hand dryers ‘hurt my ears’ are correct: A real-world study examining the loudness of automated hand dryers in public places: Maybe paper towels are healthier. “This study suggests that many hand dryers operate at levels far louder than their manufacturers claim and at levels that are clearly dangerous to children’s hearing.”

Read the research

Implications of Changing Public Charge Immigration Rules for Children Who Need Medical Care: “In October 2018, the Trump administration published a proposed rule change that would increase the chance of an immigrant being deemed a “public charge” and thereby denied legal permanent residency or entry to the United States….A total of 8.3 million children who are currently enrolled in Medicaid and CHIP or receiving SNAP benefits are potentially at risk of disenrollment.”

Read the research

Today's News and Commentary

About pharma

Cue the ‘revolving door’ criticism: Former FDA commissioner Gottlieb joins Pfizer’s board: Since retiring to spend more time with his family, former FDA director Gottlieb joined a VC firm and is now a Pfizer board member. He will also serve on the board's regulatory and compliance committee and its science and technology committee.

Read the story

American Pain Society Goes Belly Up: The Society filed for Chapter 7 bankruptcy in the wake of accusations it was a front for opioid manufacturers.

Read the story

Pfizer gains FDA approval of Zirabev as a biosimilar of Roche's Avastin: The headline is self-explanatory. Generic competition with frequently-used, expensive medications is unfortunately not as common today as once hoped.

Read the story

Evaluating Open Payments: Five years into the requirement for pharma companies to furnish lists of physicians who received payments (or in kind gifts), the program is not fulfilling its promise to make people aware of potential conflicts their physicians may have. The reason? Patients do not look up the information.

Read the study

About the public’s health

Disease Watch: What Global Travelers Should Know In Summer 2019: If you are traveling abroad, you should check the CDC website for updates on local illness and prevention. This article is a nice overview of what is going on in different countries this summer.

Read the article

Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income, 1993-2017: The summary reveals that “there has been a clear lack of progress on health equity during the past 25 years in the United States.” The research looked at illness rather than mortality rates to derive its conclusions. One finding is that the rich are staying healthy while the poorer segment of the population is is getting sicker.

Read the research

U.S. federal court delays adoption of healthcare rule on abortion: “The U.S. Department of Health and Human Services (HHS) and its opponents in a California lawsuit agreed on Friday to delay implementing a rule that would allow medical workers to decline performing abortions or other treatments on moral or religious grounds, according to a federal court filing.” This case was about the “matter of conscience” refusals that would have been allowed pending court rulings.

Read the story

Kentucky law requiring ultrasounds before abortions will stand, federal appeals court says: The courts have usually ruled against some of the more restrictive recent abortion laws. This one is an exception.

Read the story

About hospitals and health systems

Sanford Health, UnityPoint to merge: 5 things to know:These two organizations have about $11 billion in combined revenue. This article is a nice summary of the scope and impact of this latest systems merger.

Read the story

About health insurance

Individual Insurance Market Performance in Early 2019: After 3 consecutive years of 1st quarter decreases in the medical loss ratio, this year it went up to 73% from a low of 68% last year. Except for that exceptional performance last year, this quarter’s results are still lower than any in the past 8 years.

Read the report

About healthcare quality and safety

Never Events Report 2019: In 2017, the Leapfrog Group asked hospitals to add four extra commitments regarding its “Never Event” program. This year’s report (which is is for actions through 2018) shows that addition of those promises resulted in drops in compliance for every category of hospitals. The “good news” is that all hospital categories did better using the old criteria.

Read the report

AHRQ unveils new database of patient safety events reported by PSOs: “The Agency for Healthcare Research and Quality has released its new Network of Patient Safety Databases [NPSD]…, the first public, online resource listing nonidentifiable information on patient safety events gathered by AHRQ-approved Patient Safety Organizations. NPSD data will be used to create dashboards and a chartbook designed to educate providers and others about patient safety events. These resources will include information on incident distribution, near misses, unsafe conditions and ways to reduce patient safety risk and harm across health systems.”

Read the announcement

Today's News and Commentary

About pharma

European Commission Approves Opioid Dependence Implant: The headline says it all. When will it become available in the US?

Read the story

Israeli researchers discover immune mechanism that fights obesity: Fascinating research about lipid-associated macrophages and their immune mechanism role in obesity. The gene for activation of the immune mechanism is also explained. It will be a while before a medication is available that takes advantage of this pathway.

Read the article

Future is in doubt for cheaper versions of biologic drugs: “Last year, the U.S. spent $126 billion on biologic drugs, only 2% of it on biosimilars…” Why haven’t the biosimilars made more of an impact as they have in Europe and elsewhere?

Read the article for an explanation

About the public’s health

Five things found in the FDA’s hidden device database: As previously reported, the FDA recently dismantled its hidden reporting system for malfunctioning medical devices. This article explains five significant public safety issues that this system covered up.

Read the article

Health panel: Millions of US kids should get hepatitis shot: On the heels of yesterday’s HPV recommendation, the Advisory Committee on Immunization Practices recommended hepatitis A shots should be given to older children who weren’t vaccinated earlier, including 14- to 18-year-olds who turned 1 before the recommendation was made” 13 years ago.

Read the announcement

Evaluation of USPSTF Lung Cancer Screening Guidelines Among African American Adult Smokers: It took healthcare organizations many years to get lung cancer screening recommendations “right.” Early attempts did not alter mortality rates and, when more sensitive technology became available, the number of false positives was excessive. Now that the recommendations seem more reasonable, research found that they are too conservative when applied to African American smokers.

Read the research

About health insurance

Out-of-pocket costs increased across all healthcare in 2018: The article reports on a TransUnion Healthcare study reported at this year’s HFMA annual meeting. “Patients experienced out-of-pocket increases as high as 12% for their healthcare costs last year… Specifically, inpatient care costs between 2017 and 2018 went up an average of $573 per person, and outpatient costs went up an average of $119. ED costs went up an average of $40 per person.”

Read about the study

Health Care Gets Heated On Night 2 Of The Democratic Presidential Debate: On the second night of Democratic candidate debates Senators Sanders and Harris said they would abolish private insurance and all participants said they would make health insurance available to all immigrants. The arguments were over how to role out universal insurance availability.

Read a summary

About healthcare IT

The Most Googled Medical Symptoms by State: This study by eligibility.com found that nationally, 89% of patients Google their health symptoms before going to their doctor. But the subject of the search is very state specific. This article provides a map of the US and the most frequent inquiries. Yes, all healthcare is local.

Read the article

Medtronic recalls some insulin pumps as FDA warns they can be hacked: This article is a reminder about the vulnerability of “peripherals” to hacking.

Read the story

Providence St. Joseph Health acquires Epic IT solutions consultant Bluetree: Yet another case of cross-sector linkups in healthcare. “With the addition of Bluetree, the Renton, Washington-based health system now has two of the top EHR solutions companies in the country. It also owns Engage, which has grown to become one of the largest Meditech solution companies in the United States, according to the health system.”

Read the story


Today's News and Commentary

About health insurance

Democrats clash over ‘Medicare for all’ in first debate: Read about and listen to what the first 10 Democratic candidates had to say about healthcare last night. Only Warren and deBlasio favored total abolition of private health insurance.

Read and listen to the opinions

The Medical Hospital Readmission Reduction Program.Does It Do Any Good?: This editorial reviews two research papers analyzing the effect of Medicare’s Hospital Readmission Reduction Program. The “bottom line” is that the methodologies overstated the reductions attributed to the program. However, the mortality rate did decrease after implementation.

Read the paper

Appellate court raises potential new threat to ACA: “The U.S. Court of Appeals for the 5th Circuit, which is scheduled to begin hearing oral arguments about the constitutionality of the law on July 9, said it needed more information as to whether the House and Democratic states had standing to intervene in the lawsuit and whether their interventions were timely.”

Read the story

CMS approves 'Netflix' model for hepatitis C drugs in Louisiana's Medicaid program: As previously reported, Louisiana (and subsequently other states) proposed a prepaid model to cover costs for Hepatitis C drugs for which the state was responsible. The measure required CMS approval which was just granted.

Read the story

Senate Health Committee advances bipartisan package to lower health costs: The previously reported bipartisan bill to lower healthcare costs passed the Senate Health Committee. Senators Sanders, Warren and Paul voted against the measure (all for different reasons). The bill would also raise the age for tobacco use from 18 to 21.

Read the story

About the public’s health

Trump signs pandemic preparedness bill into law: The headline speaks for itself.

Read the announcement

CDC walks back pneumonia vaccine recommendation for seniors: The CDC says administration of Prevnar 13 should not be a blanket recommendation for those over 65 years old. Instead, it should be an individual decision between patient and physician.

Read the story

France loses landmark court case over air pollution: A mother and daughter successfully sued the French government over the adverse health effects of air pollution in the Paris area. I am surprised trial lawyers have not thought about this strategy in this country.

Read the story

CDC panel recommends HPV vaccine for men through age 26 and for some older adults: Citing its effectiveness, the CDC recommends extension of the ages for which HPV vaccination may be appropriate.

Read the story
Also see the Lancet research that underpins the recommendation

Overdose Deaths Likely to Fall for First Time Since 1990: The headline is self-explanatory. It appears the reason for the fall is many different types of state-initiated programs.

Read the story (Wall Street Journal. This article may require a subscription)

About healthcare IT

Google and the University of Chicago Are Sued Over Data Sharing: “On Wednesday, the University of Chicago, the medical center and Google were sued in a potential class-action lawsuit accusing the hospital of sharing hundreds of thousands of patients’ records with the technology giant without stripping identifiable date stamps or doctor’s notes.”

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

Pressure builds to secure health care data: This article reviews current Congressional efforts to protect patient data as more breeches occur and more types of devices exist as portals for hacking.

Read the story

About pharma

Drug shortages and labor costs: This study by Vizient calculates hospitals’ labor costs to deal with drug shortages as at least $359 million per year, or 8.6 million additional personnel hours.

Read the report

Today's News and Commentary

About health insurance

Policy advisers urge continued Medicare 'squeeze' of hospital pay: This brief report from a Brookings conference quotes policy experts who advocate for lower Medicare hospital payments, claiming that financial stress will result in more efficiency.

Read the story

When Patients Can’t Pay, Many Hospitals Are Suing: This Wall Street Journal article looks into the human side of a research study in JAMA that found nonprofit hospitals more aggressively go after patient balances than do for-profits.

Read the story (requires subscription)

Judge rejects effort to block suit claiming Medi-Cal discriminates against Latinos: A California judge is allowing a lawsuit to proceed that challenges the state’s low Medicaid payments. The claim is not that it hurts hospitals but creates a barrier to care for low-income people, particularly Latinos. The issue of adequacy of Medicaid payments is a national concern. At one time, the federal government had a law mandating adequacy of Medicaid payments (the “Boren Amendment”), but it was repealed long ago.

Read the story

About healthcare IT

Car-award conferrer J.D. Power sets eyes on telehealth business: The rating service famous for its auto satisfaction studies announced it will start grading telehealth businesses. While you have the freedom to buy any car (considering finances), often your telehealth service is linked to your insurer or provider organization. It would still be nice to know how “your” plan stacks up.

Read the story

UnitedHealth buys PatientsLikeMe, which faced Trump administration scrutiny over Chinese investor: “PatientsLikeMe provides an online service that helps patients find people with similar health conditions.” The company needed to find a new owner because of federal restrictions on Chinese investor ownership. This condition-based social network will also be a way for United to track its members behavior. Too much information for the payer?

Read the story

What the U.S. Medical System Can Learn From Estonia: Estonia has had leading healthcare IT systems for a while. This article briefly explains how this interoperable system works. Two key elements are a universal patient identifier and blockchain artcitecture.

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Patients with complex chronic conditions: Health care use and clinical events associated with access to a patient portal: In this study of patients with diabetes and related complications, the authors found that access “to a patient portal can increase engagement in outpatient visits, potentially addressing unmet clinical needs, and reduce downstream health events that lead to emergency and hospital care, particularly among patients with multiple complex conditions.”

Read the research

About the public’s health

Humanwide: A Comprehensive Data Base for Precision Health in Primary Care: This approach to personalized care from Stanford provides “patients with genetic screening, wearable sensors, health assessment, and wellness coaching. We synthesized patient-level biometric, genetic, social, environmental, and behavioral data into the electronic health record for primary care teams’ use in building individual care plans.”

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About pharma

Stem cell treatments are being regulated like pharmaceuticals. Their use has resulted in many complications as well as benefits. Two related articles present the downsides. Yesterday, Florida Judge Ursula Ungaro issued an injunction preventing U.S. Stem Cell Clinic “from selling a scientifically unproven procedure that uses patients’ fat to create a stem cell treatment.” Four people were blinded apparently as the result of such treatments. The other article was a research study looking at competencies of physicians who provide stem cell treatments [subscription required]. The authors found that only “13 companies (19%) that marketed stem cells for nonorthopedic indications had physicians practicing within their scope of training.”

Gov. Mills signs 4 bills to reduce medication prices, including buying from Canada: Maine has joined Florida with a state-initiated program to allow purchase of drugs from Canada. As with Florida, the state must get a federal waiver to legally carry out the program.

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Today's News and Commentary

About health insurance

Trump administration plans to require hospitals to list 'shoppable' prices: Yesterday President Trump issued an executive order to make healthcare prices more transparent. Among its provisions is for HHS to come up with a proposal for providers and insurers to let patients know what their out of pocket expenses will be before treatment. The rules would not start until, at soonest, 90 days. The real impact will not be on patients’ choice of care based on cost, there is ample evidence that such an impact is small. Instead, the “big reveal” will be differences in how much different payers pay providers; in effect, no more confidential pricing agreements.

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For a “deeper dive” read the Washington Post story

Employers’ top health care priority: offer choice and decision support tools to meet employees’ diverse benefit needs: This survey from WillisTowersWatson found that “over the next three years, three-in-four employers (75%) are prioritizing efforts to provide employees with the tools they need to make smart benefit choices and personalize a benefit package that best suits their situation. Today, just over half of employers (55%) provide benefit decision tools.” While customization is apparently good, It does add to the administrative costs. Employees should be able to make that tradeoff as well.

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About pharma

AbbVie buying Allergan for $63 billion: This purchase is today’s biggest business story.

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Today's News and Commentary

About pharma

Key Trump proposal to lower drug prices takes step forward: In October, President Trump floated the idea of linking drug prices to an international index. Last week, Senate Finance Committee Chairman Grassley (R-Iowa) expressed his oppotion to that proposal. On Friday, HHS Secretary Azar sent the White House an indexing plan. We will see if Sen. Grassley changes his mind about the scheme.

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Ingredient CBD Could One Day Become an Antibiotic: The headline speaks for itself. The article indicates promising results.

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The top 10 drug launches of 2019: This article is FYI and has details about each drug.

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About healthcare IT

Medication lists generated by EHRs lack accuracy: Although this study was for ophthalmology, it highlights the need to double check patient information.

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About healthcare quality and safety

MedPAC Seeks Changes to Medicare Advantage, Star Ratings Metrics: CMS rates Medicare Advantage plans using a star system based on the insurer’s service area. MedPAC is recommending the evaluations be based on local market measurements that are “prospectively set” in “five major, assessable domains of healthcare set on a scale from 0 to 10. Each domain contributes 20 percent to the final score…The commission offered the following as major indications of quality: avoidable hospitalizations, avoidable emergency department (ED) visits, readmissions, patient experience, and patient-reported outcomes.” It is up to CMS to accept or reject these recommendations.

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Update on FDA device reporting: As previously reported, the FDA is shutting down its Alternative Summary Reporting program that allowed manufacturers to report product malfunctions and avoid public scrutiny. It is replacing this system with “The National Evaluation System for health Technology (NEST), which uses data from patient registries, Medicare claims, and electronic health records, is meant to provide critical information for assessing the safety and effectiveness of medical devices using real-world evidence.”

Hospital Readmission Rates in Medicare Advantage and Traditional Medicare: A Retrospective Population-Based Analysis: Policy makers are always looking at difference between traditional Medicare and Medicare Advantage to promote a particular viewpoint. This study concluded that: “The HEDIS data underreported hospital admissions for 3 common medical conditions [heart attack, heart failure, and pneumonia] and readmission rates were higher among patients with underreported admissions. Medicare Advantage beneficiaries had higher risk-adjusted 30-day readmission rates than traditional Medicare beneficiaries.” The debate about which system is better will continue as “Medicare for all” proposals are still on the table.

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About health insurance

CMS Defines New Medicaid Integrity Guidelines:Based on a report from its Office of Inspector General (OIG), CMS is claiming that it overpaid states $1 billion because they are not accurately following Medicaid eligibility criteria. This article describes what is happening and what CMS seeks to do.

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Supreme Court agrees to hear insurers' cases seeking billions in ACA risk corridor payments: Risk corder payments were instituted to protect insurers from downside risk in the first few years of the ACA. Many lost money but the government did not pay them. The reason was that the program was legislated to be budget neutral and there weren’t enough profitable plans to come up with money for those losses. Now the Supreme Court has decided to hear a combination of 3 suits claiming $12 billion in lost payments.

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Now Trump says he meant to keep Obamacare. Say what?:In an NBC interview yesterday, President Trump says he saved the ACA despite its flaws and made it as good as it can get. Guess he forgot the failed Republican attempt at repeal in 2017 (remember how angry he got at the late Senator McCain for casting the deciding vote) and the Justice Department’s siding with the Texas court decision on appeal to declare the ACA invalid.

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