Today's News and Commentary

About pharma

Medicare Spending on 22 Drugs Jumped 500% From 2013-2017: Recent postings have cited proposed Congressional action on increased drug costs for all payers. This article’s title should prompt the question- what took them so long to catch on?

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Prevalence and Nondisclosure of Complementary and Alternative Medicine [CAM} Use in Patients With Cancer and Cancer Survivors in the United States: Cancer patients often get desperate and use untested medicines. However, these CAMs can harmfully interact with standard care. This study quantified the problem: “In this comprehensive national study, 1023 of 3118 (33.3%) participants with a history of cancer reported CAM use in the past year, 288 (29.3%) of whom did not disclose use of CAM to their physician.”

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Medicare Aims to Expand Coverage of Cancer Care. But Is It Enough?: In the next few weeks, Medicare will announce its decision on coverage for CAR T therapy for cancer treatments. These therapies are individualized for each patient and are thus extremely expensive. The guidelines will be watched closely by the private sector as all payers are struggling with costs for individualized care.

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Maryland, Massachusetts statehouses press drug-pricing bills as feds founder: Instead of waiting for federal action, some states are trying to control drug prices on their own. California was mentioned in a previous post. This article reviews what two other states, MD and MA, are doing.

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AMA teams up with biotech incubator to connect physicians with startups: Very often tech companies come up with solutions to medical problems without clinician input. This project provides a different approach: “The AMA and Sling Health, a student-run biotechnology incubator, launched the clinical problem database on the AMA's Physician Innovation Network, an online forum that connects physicians and health technology companies looking for clinician feedback.”

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About health insurance

Democratic proposals to overhaul health care: A 2020 primer: As the baseball saying goes- you can’t tell the players without a program. This article summarizes which Democrats favor which healthcare proposals.

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Sutter Health agrees to pay $30M to settle accusations of inflated MA 'risk scores': Medicare Advantage contracts have payments that are adjusted by severity of illness of the beneficiary. These adjustments are driven by diagnosis codes. Sutter agreed to settle charges that it incorrectly used codes that paid more.

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About healthcare IT

Clinical decision support for high-cost imaging: A randomized clinical trial: “There is widespread concern over the health risks and healthcare costs from potentially inappropriate high-cost imaging. As a result, the Centers for Medicare and Medicaid Services (CMS) will soon require high-cost imaging orders to be accompanied by Clinical Decision Support (CDS): software that provides appropriateness information at the time orders are placed via a best practice alert for targeted (i.e. likely inappropriate) imaging orders…We find that CDS reduced targeted imaging orders by a statistically significant 6%, however there was no statistically significant change in the total number of high-cost scans or of low-cost scans. The results suggest that the impending CMS mandate requiring healthcare systems to adopt CDS may modestly increase the appropriateness of high-cost imaging.” This study raises the question of whether there are other measures that would have more impact on the high cost of imaging.

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12 healthcare areas where AI will result in near-term breakthroughs: This article provides a nice summary of the areas in healthcare where artificial intelligence could be helpful in the near future. Despite technical feasibility, we will need to see how these technologies are regulated to assess their availability.

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About healthcare quality

Differential Safety Between Top-Ranked Cancer Hospitals and Their Affiliates for Complex Cancer Surgery: Branding is a form of a promise of consistency- hopefully high quality consistency. This research found that when high quality cancer treatment hospitals co-brand their care with affiliates it is not a guarantee of the same level of quality. This finding also raises transparency issues.

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