Today's News and Commentary

CVS plans to expand HealthHubs to 1,500 stores by 2021: As previously reported, CVS has rolled out HealthHubs in select markets to try a concept that is different from a traditional drug store. A HealthHub is a place where patients can not only fill their prescriptions, but do supervised exercise, receive acute care and even buy Aetna insurance. But don’t expect a wide selection of greeting cards or alcoholic beverages; the space for those items has been cut back for health programs. As the headline says, CVS announced it is expanding HealthHubs to 1500 stores by 2021.

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PwC’s 22nd Annual Global CEO Survey: Lots to read in this CEO survey but the overall takeaway is that “Optimism for global economic growth has plummeted over the past year.”

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About the public’s health

Low-Value Diagnostic Imaging Use in the Pediatric Emergency Department [ED] in the United States and Canada: Canadian EDs order fewer pediatric diagnostic imagining tests than their US counterparts; the outcomes are no different. Time to look at adherence to guidelines and tying compliance to liability protection.

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FDA confirms PFAS chemicals are in the US food supply: “PFAS is a family of nearly 5,000 synthetic chemicals that are extremely persistent in the environment and in our bodies… sometimes called forever chemicals. These chemicals all share signature elemental bonds of fluorine and carbon, which are extremely strong and difficult to break down in the environment or in our bodies.” A disturbing report because it is very hard to avoid these substances.

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Taking Stock of Dietary Supplements' Harmful Effects on Children, Adolescents, and Young Adults: This story was very popular with the news media today. The research concluded: “Consumption of dietary supplements sold for weight loss, muscle building, and energy involved increased risks for severe medical events compared with vitamins. Proactive enforcement of regulations is needed to reduce access and consumption among children, adolescents, and young adults.”

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Coffee not as bad for heart and circulatory system as previously thought: And now, another conflicting piece of research about coffee consumption. Yesterday I reported a study that 6 cups of coffee per day seemed to be the cutoff for deleterious cardiovascular effects. This British study indicates that even much larger amounts have no lasting effects on blood vessels. Now the rest is up to your judgment.

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Survey: Housing, food, isolation major barriers to health: Another survey that emphasizes the importances of social factors to health. For example:

—”Americans view social needs as equally important to their health as medical care, with 89% of respondents saying safe and stable housing is very or extremely important to health and 80% saying reliable transportation is very or extremely important.”
—”The vast majority of Americans want their medical providers to ask about social needs, with 97% of respondents saying their providers should ask about social needs during medical visits. “

—”…68% of Americans surveyed reported they experienced at least one unmet social need in the past year. More than a quarter of those surveyed said that an unmet social need was a barrier to health, with 21% prioritizing paying for food or rent over seeing a doctor or getting a medication.”

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'It’s a miracle': Helsinki's radical solution to homelessness: A response to the above article might be that the costs of addressing such problems are prohibitive. This program in Helsinki provides housing for all who need it when they need it. It is communal living and each tenant “has a contract, pays rent and (if they need to) applies for housing benefit.” This policy has “made Finland the only EU country where homelessness is falling.” And the cost? “ Finland has spent €250m creating new homes and hiring 300 extra support workers. But a recent study showed the savings in emergency healthcare, social services and the justice system totalled as much as €15,000 a year for every homeless person in properly supported housing.”

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Trump administration imposes new restrictions on fetal tissue research: Breaking news: “The administration is discontinuing funding of all ‘intramural’ fetal tissue research within the National Institutes of Health.” Further, “The Department of Health and Human Services terminated the years-long contract to a laboratory at the University of California at San Francisco, ending its only source of funding. Officials said in a statement they were ‘not sufficiently assured that contract included the appropriate protections applicable to fetal tissue research or met all other procurement requirements.’” These changes will impede progress on such diseases as AIDS and Zika infections.

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7 complex words you shouldn’t include on your consent form: Given the low level of health literacy, this article provides recommendations for simpler language on consent forms.

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Effects of red meat, white meat, and nonmeat protein sources on atherogenic lipoprotein measures in the context of low compared with high saturated fat intake: a randomized controlled trial: Bottom line- doesn’t matter if you eat red or “white” meat, the effect on your lipid (fat) profile is the same.

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About insurance

Newsom Proposes Penalty To Fund Health Insurance Subsidies: California’s governor is proposing a penalty on those who do not have health insurance in order to help those who make too much to qualify for Medicaid or ACA plan premium subsidies.

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10 Years[2008-2017] of Emergency Room Spending for the Commercially Insured: This study was presented by Health Care Cost Institute researchers on Monday at AcademyHealth's 2019 Annual Research Meeting. The analysis revealed that: “Overall ER Use did not change over the 10 years, but the mix of CPT codes billed did.” The higher intensity codes grew much faster than the lower intensity ones. Prices also went up disproportionately. USA Today also picked up this story with the headline: “Average cost of hospital ER visit surges 176% in a decade…”

Read the research summary (It has great graphics)

Hospitals can't challenge Medicare payment methodology, court rules: As previously reported, the Supreme Court ruled the federal government cannot cut Disproportionate Share Hospital (DSH) payments because there was no comment period as the law requires. In a separate ruling, the U.S. Court of Appeals for the D.C. Circuit just ruled that hospitals cannot challenge the methodology of the payments. In other related news, there seems to be bipartisan support for some changes in the formula for these payments. Attention to the issue is also important because the savings from eliminating the DSH payments was going to fund other federally sponsored health programs.

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About healthcare IT

2018 Data Breach Investigations Report: This article is the annual Verizon report that covers many industries, including healthcare (see page 33). Some of the highlights:

—Ransomware accounts for 85% of all malware in Healthcare.

— Most threats (56%) come from inside the organization

—Most motives are financial (75%)

—Most of the compromised data is medical (79%) not payment (4%)

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Quest, LabCorp report billing data breach compromising nearly 20M patients: Speaking of breaches, these were huge.

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Here's what former national coordinators, health IT groups had to say on ONC's information blocking rules: Six former national coordinators for health IT support the ONC’s rules for information blocking and timeline for implementation. Their joint letter is in contrast with strong opposition by user groups that have argued the guidelines are vague and the timeline is too short.

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About pharma

Pfizer had clues its blockbuster drug could prevent Alzheimer’s. Why didn’t it tell the world?: This article is a good case study on the workings of the pharma industry. At the heart of the answer to the headline’s question may be that Enbrel (the drug in question) is going generic soon and the research costs of a study to prove the drug’s effectiveness will never be recouped.

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

ASCO19: Round-up for day four and five… 

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