Today's News and Commentary

About the public’s health

Culpeper Literacy Council helps spread health literacy to seniors: Health illiteracy is major barrier to understanding and obtaining necessary care. This article is about a local program in Culpeper Virginia that is successfully addressing this problem. “The Culpeper Literacy Council partnered with the Culpeper Wellness Foundation to help teach seniors at the Culpeper Senior Center health literacy.” The program also “helps train medical professionals to identify behaviors or language barriers for someone lacking health literacy…”
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Judge upholds New York City's mandatory measles vaccination order: Brooklyn Judge Lawrence Knipel “ruled against a group of parents who challenged New York City’s recently imposed mandatory measles vaccination order, rejecting their arguments that the city’s public health authority exceeded its authority… The judge rejected the parents’ contention that the vaccination order was excessive or coercive, noting that it does not call for forcibly administering the vaccine to those who refuse it.” Failure to be vaccinated carries a fine.

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As the scope of corporate well-being programs continues to expand, large employers expected to spend an average of $3.6million in 2019: This research from the 10th annual Health and Well-Being Survey from Fidelity Investments and the National Business Group on Health provides the spending amounts and types of corporate wellness programs. Check Wednesday’s blog for the entry about the lack of their effectiveness.

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Senator McConnell, a Tobacco Ally, Supports Raising Age to Buy Cigarettes: While I usually do not comment on proposed legislation, this one is noteworthy. Senate Majority Leader McConnell has come out in favor of increasing the smoking and vaping age to 21.

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

Medicine’s racist past makes many African-Americans wary of giving blood — but sickle cell patients have urgent need: African-Americans have good reasons for not trusting the US healthcare system. Most prominent is the Tuskegee study that watched AA men deteriorate and die from treatable syphilis infections so researchers could watch the natural course of the disease (which had been know for centuries). This “human interest” story makes the point that distrust is also affecting AA’s willingness to donate blood at a time when many in their communities need transfusions to treat sickle cell disease.

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Nanoethics: It’s time for big thinking about nanomedicine: Newer technologies raise ethical issues about their use. The April issue of the AMA Journal of Ethics is devoted to such issues around nanotechnology’s applications in medicine. The link below will take you to some of the articles that appear to have open access.

Connect to the ethics articles

About pharma

Human Gain-of-Function MC4R Variants Show Signaling Bias and Protect against Obesity:
Researchers from the University of Cambridge studied 500,000 people and found 61 variants in the Melanocortin-4 Receptor gene. This gene regulates how satisfied someone feels after eating, called postprandial satiety. In fact, it can also regulate appetite. Some variants cause people to be less satisfied- so they eat more. Other variants are what the authors call “protective,” since less interest in eating leads to lower rates of obesity, Type 2 diabetes and cardiovascular disease. I am sure you see where this research is going. Perhaps we can replace bariatric surgery with genetic modification in the not too distant future.

Read the abstract
Read about the findings in the NY Times

Drug Companies Reaped Billions from New US Tax Law: This Oxfam study was published April 9 but just came to my attention. Like many other US corporations, Johnson & Johnson, Pfizer, Merck and Abbott Laboratories used much of their billions of dollars in tax savings for stock buybacks and dividend payments rather than R&D investments.

Read the report

FDA Sends Warning Letters on Dietary Supplements: The FDA is cracking down on manufacturers of dietary supplements whose products do not meet its guidelines. The agency has a website where such products are listed; the problem is getting people to know about and use this resource.

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

About health insurance

Health Insurance Coverage for People Under Age 65: Definitions and Estimates for 2015 to 2018: The Congressional Budget Office issued this study reporting, among other things, that between 2017 and 2018 1.1 million more people were uninsured.

Read the study

Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020: CMS has issued its final rules for 2020 concerning benefits and payment parameters for ACA health plans. (It is scheduled for publication in the Federal Register on 04/25/2019.)
It is a very long document that included initial recommendations, comments, response to comments and final rules. Among the changes in the final rule:

  1. If a drug has an appropriate, generic equivalent, discount coupons can no longer be applied towards an enrollee's maximum out-of-pocket costs. This measure was directed against pharma companies using this tactic to raise prices for insurers.

  2. Reduces user fees for plans sold on the exchanges by 0.5%. CMS hopes these savings will be passed along to its customers. Presumably, part of these fees were used to promote the plans to the public. Since the Trump administration has cut back on this activity, it is only fair the plans do not have to pay for it.

  3. Refines the adjusters for payments by risk category. The categories used in this adjustment for each plan level (bronze, silver, etc.) include age, sex, diagnosis, enrollment duration and prescription use. The final rule also calls for enforcement of the accuracy of this information. (Diagnosis code accuracy has been particularly problematic.)

  4. CMS expresses support to reduce high silver level premiums (silver loading) that were the result of elimination of cost sharing reductions (CSRs). CMS is open to reinstitution of the CSRs but nothing definitive will be done until, at soonest, 2021.

Read the final rule

About healthcare IT

Trends in Healthcare Payments  Ninth Annual Report: 2018:  Healthcare payments company Instamed issued its 2018 report. The findings are not very encouraging. For example, 90% of providers still ”leverage paper and manual processes for collections” and 53% of payers are still sending checks to providers. In the face of these inefficiencies, “80% of patients reported that ‘convenience factors’ would be enough to make them switch providers.”

Read the report (Free signup to download pdf)

Hospitals’ Use of Electronic Health Records Data, 2015-2017:This report is from the Office of the National Coordinator…dated April 2019. The first problem is much government data is at least a year out of date (I have seen some agencies still using charts from 2016). The overall message here is that statistically significant improvements in many areas of hospital IT use occurred between 2015 and 2016, but improvements stagnated in 2017. A bright spot is that in 2017, 94 percent of hospitals used their EHR data to perform hospital processes that inform clinical practice (the same percentage as in 2016).

.Read the report