Today's News

About the public’s health:

Changing Epidemiology of Herpes Zoster After Vaccine Adoption in the U.S.: This study looked at the effect of varicella vaccine introduction in 1996 in the US. Two questions required answers: 1. Did the vaccine reduce childhood chicken pox and 2. Did this reduction in childhood disease lead to fewer cases of shingles in older adults? The answer to the first question is: “Among children, the incidence of herpes zoster declined in all age groups by 70% to 80%.” The answer to the second question is mixed: “Among adults age 35 and older, herpes zoster [shingles] incidence increased steadily through ages 50-55 without any clear accelerations or decelerations, whereas the rise in shingles incidence for older individuals has slowed since adoption of the herpes zoster vaccine program.” The takeaway is that we need research looking at the long-term effects of vaccines in adults- prevention in children is good, but what about their lifelong protection against those diseases?

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Patient Attitudes Toward Individualized Recommendations to Stop Low-Value Colorectal Cancer Screening:
In this research, Veterans Administration patients were asked: “If you personally had serious health problems that were likely to shorten your life and your doctor did not think screening would be of much benefit based on the calculator, how comfortable would you be with not getting any more screening colonoscopies?” The overall results were that: “many veterans have strong preferences against screening cessation even when given detailed information about why the benefit may be low.” The article details factors that positively and negatively affect the probability of agreement with the statement. Two caveats must be considered. One is demographics: those surveyed were overwhelmingly white males. Perhaps more importantly is the insurance status of this population. Because this study was in the VA system, the costs were largely covered. These types of studies need a price sensitivity component to be truly worthwhile.

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BD Completes Molecular Portfolio For GI Infection With New Viral Panel: While this article could have been classified as tech news, the public health implications convinced me to place it here. The FDA approved this device that can, in 3.5 hours, distinguish among five viruses that cause gastroenteritis (norovirus, rotavirus, adenovirus, human astrovirus and sapovirus). Rapid identification of the cause of outbreaks can help containment efforts. The cost of this device is not clear or whether it can be used at the point of care (like a pediatrician’s office).

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Fight Against Superbugs at an Inflection Point in Science and Innovation: Drug resistant bacteria pose an ever-increasing public health problem. This article is a nice summary of what the FDA is doing to help address this issue- ranging from expedited approvals to supervision of safety for newly introduced medications. It is based on a talk that FDA Commissioner Dr. Scott Gottlieb gave at the Pew Charitable Trusts.

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About quality:

Hospital readmission reduction program linked to heart failure, pneumonia deaths: Starting in 2012, CMS penalized hospitals for higher than expected Medicare readmissions for pneumonia, heart failure (HF) and acute myocardial infarction (AMI- heart attack). Readmission for these and other conditions added to the list resulted in $2billion in penalties to date. But what were the health outcomes of this program? This study seeks to answer this question by analyzing the effect of the Hospital Readmissions Reduction Program (HRRP) on 30 day post-discharge mortality for the original three illnesses.. Briefly, the research showed: “Among Medicare beneficiaries, the HRRP was significantly associated with an increase in 30-day postdischarge mortality after hospitalization for HF and pneumonia, but not for AMI.” As far as site of care, the “overall increase in mortality among patients with HF and pneumonia was mainly related to outcomes among patients who were not readmitted but died within 30 days of discharge. “ The increased rates were small (less than 0.5%) but statistically significant. These findings should still cause concern because we don’t always understand the unintended consequences of seemingly logical legislation to lower costs or improve quality. The results are also disturbing because the exact reasons for these findings are not known.

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About pharma:

A Chinese alternative medicine empire is under fire after doctors say it gave jujube tea to a 4-year old cancer patient: Regulation of drugs in the category called: “alternative and complementary medications” has been problematic for the FDA. The operative question is “When is a substance a drug” and not, for example, a nutritional supplement? Some other countries (like Singapore) regulate what is sometimes called Traditional Chinese Medicine- by and large, the FDA does not regulate them. This article highlights what happens when loosely regulated companies can market their products to the public.

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Federal judge says HHS overstepped authority in cutting 340B payments: The 340B program allows hospitals and other entities with poorer populations (such as those who are uninsured or on Medicaid) to buy pharmaceuticals from the manufacturer at a discount over prevailing true wholesale rates and charge payers their full retail prices. The “profit” here is from enhanced cost reductions not increased pricing. Since last year, the federal government has been trying to reduce payments to providers participating in the 340B program. Today, saying that HHS overstepped its authority, a federal judge issued an injunction stopping these cuts.

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About insurance:

Tracking Medicaid Expansion: As the year closes, it is worthwhile to track where things stand with respect to Medicaid. In addition to new expansion states (such as Virginia and Maine), there are now six states with job requirements and another ten pending approval.

See the map of what is happening nationally

The Hidden System That Explains How Your Doctor Makes Referrals: This article is from the front page of today’s Wall Street Journal print edition. It explains how, once a hospital buys a physician’s practice, it keeps track of where referral services go, i.e., if they stay in-system or not. This is an excellent explanation of contractual issues, pressures and cost differences between office procedures and the much more expensive facility-based services.

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