Today's News and Commentary

About the public’s health

Association of Racial Bias With Burnout Among Resident Physicians: Physician burnout has been blamed for clinical errors and personnel shortages due to early retirement. This article explains another problem resulting from burnout- racial bias among resident physicians. The authors speculate that burnout may thus be contributing to healthcare disparities.

Juul went into a ninth-grade classroom and called its device 'totally safe,' teens testify:This story was reported in a number of media outlets. At the same time Juul has been promoting its programs to restrict its products to potential underage users, according to these stories it paid schools to do presentations on the safety of vaping. The stories are really disturbing.

Yale Employees Test Their Workplace Wellness Program In The Courts: Yale instituted a workplace wellness program to reduce healthcare costs. Participation is “voluntary,” but non compliance will trigger a financial penalty deducted from paychecks. Employees have filed a class action lawsuit against this program. Perhaps Yale should have increased costs for health benefits for all and provided reductions for those who participated in healthy activities?

About healthcare quality and safety

Modernizing the HCAHPS Survey: The Federation of American Hospitals conducted a survey about the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) that is administered to Medicare patients after hospital care. The organization points out a number of problems with the current version: Response rates are falling; the survey could do better to provide patients with comparable data; the topics need to be updated (for example to include questions related to efficiency and team-work of the care team); more research is needed on additional factors that influence patient experience; and  health literacy level needs to be made more appropriate for the surveyed population.

The top recommendations were: Add a digital mode of delivery to patients; shorten the survey; make revisions “in light of today’s shift to value-based care, changes in health care delivery, improvements in technology, and evolving patient priorities; reframe the care transitions and discharge planning sections of the HCAHPS survey; and periodically re-evaluate the HCAHPS survey.”

About pharma

Medicare Spending on Drugs and Biologics Not Recommended for Coverage by International Health Technology Assessment Agencies (From the Journal of General Internal Medicine- subscription required): Unlike other countries, the US does not have a central technology evaluation entity that looks at cost-effectiveness. This research compares FDA-approved drugs with those from Australia, Canada, and England, which do have cost-effectiveness review. Medicare spending from 2011-2016 was then calculated for the drugs that were used in this country but not approved in the other three. The results were: “Medicare spending totaled $3.7B, $17.8B, and $2.1B on drugs and biologics not recommended nor covered in only Australia, Canada, and England, respectively… $2.8B on those not recommended nor covered by any two countries, and $0 by all three countries. Between 2011 and 2015, Medicare beneficiaries filled 43.4M prescriptions for the not recommended nor covered drugs and biologics, spending $2.8B out-of-pocket …” The recommendation to apply cost-benefit standards seems obvious but it is currently illegal here.

Trump gives boost to state drug import plans: As previously reported, several states (Vermont, Florida, Colorado and Maine) passed laws allowing foreign drug importation to lower costs. But this action is illegal unless it gets federal approval. Now HHS Secretary Azar has changed his stance on this issue and will support ordering drugs, mainly from Canada.

FDA Agrees to Accept Inspections for All 28 EU Member States: One of the objections to drug importation is the spotty oversight of manufacturing in other countries. The US has been working with other nations to deem their supervisory authorities acceptable for imported drugs. Now, the “FDA has agreed to recognize inspections by all 28 EU member states under the U.S.-EU's mutual recognition agreement (MRA) for GMP [Good Manufacturing Practices] inspections.”

Senate panel advances bipartisan bill to lower drug prices amid GOP blowbackThis bipartisan bill is the one Senators Grassley and Widen have been crafting. One of the controversial parts of the bill is provision that limits drug price increases for Medicare Part D; drug companies would have to repay revenue if their prices rise faster than inflation. Many Republicans see this measure as a free market constraint. Democrats are crafting their own bills which may go even further than this one. Further, the industry trade group, Pharmaceutical Research and Manufacturers of America (PhRMA), has continued to lobby against this Senate bill. In any case, nothing further will be done before the August recess.