Today's News and Commentary

About devices

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

Read the research

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

Read the announcement

About the public’s health

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

Read this story (Subscription required- Financial Times )

About healthcare IT

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

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

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

Read the report

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

Read the article (Subscription required- Financial Times )

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

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

Read the final rule

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

About insurance

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

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

Read the story

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

For details, read the research report

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

Read the summary article

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

Read the MedPAC discussion