Today's News and Commentary

About health insurance

Share of Americans With Health Insurance Declined in 2018 (NY Times- subscription may be required): “About 27.5 million people, or 8.5 percent of the population, lacked health insurance for all of 2018, up from 7.9 percent the year before, the Census Bureau reported Tuesday. It was the first increase since the Affordable Care Act passed in 2010, and experts said it was at least partly the result of the Trump administration’s efforts to undermine that law.
The growth in the ranks of the uninsured was particularly striking because the economy was doing well. The same report showed the share of Americans living in poverty fell to 11.8 percent, the lowest level since 2001.”

‘UVA has ruined us’: Health system sues thousands of patients, seizing paychecks and putting liens on homes: In a related story, the University of Virginia hospital appears to be more aggressive than peer organizations in its debt collection efforts, leading to financial ruin for many patients.

Gearing up for Medicare’s imaging decision support requirements: Appropriateness of radiologic diagnostic services is coming to CMS payment decisions. As a result of Medicare’s Appropriate Use Criteria Program, which launches January 1, the financial responsibility for noncompliance with the diagnostic imaging requirements will fall on providers of those tests.  
“…2020 will be an educational and testing year for the program. Then, beginning Jan. 1, 2021, the Centers for Medicare and Medicaid Services will stop reimbursing radiologists and other providers who perform imaging for certain outpatient advanced diagnostic imaging claims if the ordering professional did not consult a qualified clinical decision support (CDS) mechanism, incorporating evidence-based appropriateness criteria.” This pre-authorization check has been in use for many years in the private sector.

States Pass Record Number Of Laws To Reel In Drug Prices: “Among the new measures are those that authorize importing prescription drugs, screen for excessive price increases by drug companies and establish oversight boards to set the prices states will pay for drugs.” This week Speaker Pelosi is expected to release a drug price control plan at the federal level.

About the public’s health

Global patterns and trends in colorectal cancer incidence in young adults: We often think about colon cancer as an “over 50” disease. However, while not a universal finding, this research found that colorectal cancer “increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis.” We have identified certain carcinogenic substances, like nitrosamines, but what else is responsible? In a related article, Meat Intake and Cancer Risk : Prospective Analysis in UK Biobank, “Higher intakes of red and processed meat were associated with a higher risk of colorectal cancer.”

California governor signs vaccine bills he demanded: As previously reported, California was legislating very tough vaccine exemption laws. Yesterday, California Gov. Gavin Newsom signed bills “to crack down on doctors who write fraudulent medical exemptions for school children’s vaccinations.”

Is setting a deadline for eradicating malaria a good idea? Scientists are divided: Good discussion question. Shall we set deadlines, and if so how high should they be set relative to the “ideal” goals? What do we do if we miss the deadline? The Healthy People initiatives in the US (See Chapter 9 of the text) and previous WHO Millenial Development Goals provide examples.

Millions of diabetes patients are missing out on Medicare's nutrition help: An estimated 15 million traditional “Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit, but the federal health insurance program for people 65 and older and some people with disabilities paid for only about 100,000 recipients to get the counseling in 2017, the latest year billing data are available. The data do not include the 20 million enrollees in private Medicare Advantage plans.” What programs can we implement to increase access to needed dietary counseling?

Potential Effects of Regionalized Maternity Care on U.S. Hospitals: “Though only 2.41% of deliveries occurred at hospitals with an inappropriate level of maternal care, a substantial fraction of women at risk for maternal morbidity delivered at hospitals potentially unequipped with resources to manage their needs. Promoting triage of high-risk patients to hospitals optimized to provide risk-appropriate care may improve maternal outcomes with minimal effect on most deliveries.” This article points out that appropriate specialized services need some coordination to be accessible. How do we accomplish this task using private sector and/or governmental interventions? For an article commenting on this original research, see this one from Reuters.

About healthcare IT

Telemedicine CEO pleads guilty to role in $424M Medicare fraud scheme: If there are more ways to bill, there will be more opportunity for fraud. The Department of Justice said “ that the involved medical device companies paid kickbacks and bribes to physicians at telemedicine companies in exchange for referrals for back, shoulder, wrist and knee braces that were not medically necessary.
All told, more than $1.7 billion was billed to Medicare under the scheme, with $900 million paid out.”

UCSF, Cornell working on Android health record app to rival Apple: “UC San Francisco and Cornell Tech are leading a project to create an open-source platform to enable Android phone users to access and share their health records on par with Apple's mobile health records feature.
The project, called CommonHealth, will use data interoperability standards, including HL7 Fast Healthcare Interoperability Resources (FHIR)…”