Tagged Health Industry

Viewpoints: Effectiveness Should Guide Doctors’ Prescribing; Climate Change And Medicine

A selection of opinions on health care from around the country.

Stat: Drug Effectiveness Should Influence What Doctors Prescribe
Physicians and payers have called for more outcomes-based drug pricing arrangements. These tie reimbursements to innovation and the value the drug provides, such as how well a drug reduces hemoglobin A1c (a measure of blood sugar) among people with diabetes, or alleviates skin plaques among people with psoriasis, or reduces fracture rates among those with osteoporosis, to name a few examples. Yet the execution of such programs is limited to a handful of agreements between payers and drug makers, each one unique to the parties involved. (Larry Blandford, 4/27)

The Des Moines Register: Saving Medicines, Saving Money, Saving Lives
After the rough, recently-concluded legislative session, you might need a reason to feel good about our state’s priorities. Fortunately, if you were tuned in to NPR’s Morning Edition on Thursday, you would have gotten a strong dose of Iowa pride. Iowa, it turns out, is the envy of the nation for a unique lifesaving, cost-saving and environmentally friendly approach to providing no-cost medicines to people in need. It’s based on reclaiming and redistributing unused prescription drugs through a drug donor repository. (Rekha Basu, 4/27)

The New England Journal Of Medicine: Preventive Medicine For The Planet And Its Peoples
For many Americans, the effects of climate change seem distant: island nations will sink beneath rising seas, areas of the Middle East will become uninhabitable because of extreme heat. But though the worst effects will be felt by poorer people in poorer countries that are less resilient to droughts, floods, and heat, climate change already affects the health of vulnerable U.S. populations, and U.S. health professionals see these effects. (David J. Hunter, Howard Frumkin and Ashish Jha, 4/27)

Cincinnati Enquirer: How The Trump Administration Is Fighting The Opioid Epidemic
One of the most exciting lines of work we get to support at the U.S. Department of Health and Human Services is the development of new drugs to combat deadly diseases. America’s scientists are constantly pushing the boundaries of what is possible, solving or ameliorating conditions we once thought incurable. So it is both heartening and heartbreaking that one of our top priorities in that work is now fighting a disease that is largely of our own making: opioid addiction. (Secretary of Health and Human Services Tom Price, 4/27)

The Washington Post: If Abortions Become Illegal, Here’s How The Government Will Prosecute Women Who Have Them
You’ve heard the stories of the coat hanger and the back alley, those bloody days before Roe v. Wade. Sen. Patrick Leahy told one recently at the Supreme Court confirmation hearings for Judge Neil Gorsuch. As a state prosecutor in 1968, three years before the court struck down state abortion bans, cops woke him up in the middle of the night, because “a young co-ed nearly died from bleeding from a botched abortion.” The senator from Vermont’s drift was clear: If confirmed, Gorsuch could cast a vote, or several, to bring back those horrors (if not the archaic phrase “co-ed”). (Irin Carmon, 4/28)

The New England Journal Of Medicine: Bridging The Data-Sharing Divide — Seeing The Devil In The Details, Not The Other Camp
The movement toward sharing data from clinical trials has divided the scientific community, and the battle lines were evident at a recent summit sponsored by the Journal. On one side stand many clinical trialists, whose lifeblood — randomized, controlled trials (RCTs) — may be threatened by data sharing. On the other side stand data scientists — many of them hailing from the genetics community, whose sharing of data markedly accelerated progress in that field. (Lisa Rosenbaum, 4/26)

The New England Journal Of Medicine: Learning What We Didn’t Know — The SPRINT Data Analysis Challenge
On January 28, 2016, the International Committee of Medical Journal Editors (ICMJE) posted for public comment a proposed plan on sharing clinical trial data. The response was starkly divided: data analysts called for immediate and open access to all clinical trial data; clinical trialists were convinced that investigators should hold data closely. Trialists argued that they would have no incentive to conduct trials if they weren’t given the opportunity to publish all their findings, while data analysts countered that data obtained under federally funded programs belonged to the public and should be available for examination. Ideally, at the center of the debate are patients who participate in clinical trials, often at great risk to themselves, who expect researchers and analysts to use the data in a responsible way to advance medicine. Although much subjective input was obtained, few respondents offered concrete examples on which to base directive action. (Nancy S. Burns and Pamela W. Miller, 4/26)

Tampa Bay Times: Adverse Childhood Experiences Can Have Long-Term Health Consequences 
Lungs expand, and every muscle sits on the verge of action. This describes the stress response, a normal reaction to a normal emotion. But when a child experiences strong, frequent or prolonged adversity, without adequate adult support, it’s referred to as toxic stress, and there can be long-term health consequences. (Zach Spoehr-Labutta, 4/27)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Research Roundup: Price Transparency; Cost Of Not Expanding Medicaid; Coverage In Rural Areas

Each week, KHN compiles a selection of recently released health policy studies and briefs.

JAMA Internal Medicine: Effect Of A Price Transparency Intervention In The Electronic Health Record On Clinician Ordering Of Inpatient Laboratory Tests
Question: Does increasing price transparency for inpatient laboratory tests in the electronic health record at the time of order entry influence clinician ordering behavior? Finding: In this year-long randomized clinical trial including 98 529 patients at 3 hospitals, displaying Medicare allowable fees in the electronic health record at the time of order entry did not lead to a significant change in overall clinician ordering behavior. Meaning: These findings suggest that price transparency alone may not lead to significant changes in clinician behavior, and future price transparency interventions may need to be better targeted, framed, or combined with other approaches. (Sedrak et al., 4/21)

Urban Institute/Robert Wood Johnson Foundation: The Cost Of Not Expanding Medicaid
Nineteen states have not expanded Medicaid eligibility under the Patient Protection and Affordable Care Act (ACA). We estimate that from 2018 through 2027, expansion in these states would increase nominal state costs and federal spending by $59.9 billion and $427.5 billion, respectively, if enrollment is moderate and by $62.9 billion and $487.0 billion if enrollment is high. Each state dollar would thus draw down between $7.14 and $7.75 in net federal funding. (Dorn and Buettgens, 4/27)

Kaiser Family Foundation: The Role Of Medicaid In Rural America
This brief describes Medicaid’s role for 52 million nonelderly children and adults living in the most rural areas in the United States and discusses how expansions or reductions in Medicaid could affect rural areas. … Although private insurance accounts for the largest share of health coverage in rural areas, nonelderly individuals in rural areas are less likely to have private coverage compared to those in urban and other areas (61% vs. 64% and 66%, respectively). Medicaid helps fill this gap in private coverage, covering nearly one in four (24%) nonelderly individuals in rural areas. Further, in many states, Medicaid coverage rates are higher in rural areas than in urban or other areas of the state. (Foutz, Artiga and Garfield, 4/25)

JAMA Internal Medicine: Association Of Donor Age And Sex With Survival Of Patients Receiving Transfusions
In this binational cohort study, which included 968 264 patients who received transfusions, there was no association between age and/or sex of blood donors and survival of patients. Even among the patients who received multiple units of blood from very young or very old donors, absolute mortality differences compared with patients who received no such units of blood were consistently below 0.5%. (Edgren et al., 4/24)

Urban Institute: Shared Decisions In Cancer Care: Is Medicare Providing A Model?
Medicare’s Oncology Care Model (OCM) is designed to incentivize providers to reduce unnecessary spending, improve care, and involve patients more closely in decisions about the use of chemotherapy. The model includes a 13-point care plan recommended by the Institute of Medicine (IOM) that represents a significant step toward making patients partners in their own care; in particular, it aims the volume of OCM episodes by reducing overly aggressive use of chemotherapy and underuse of hospice services among patients who are close to death. However, IOM recommendations since 1999 and recent medical literature suggest that a formal shared decision-making process (SDM) remains vitally important. This paper discusses the rationale for and barriers to adopting a more formal SDM. (Millenson and Berenson, 4/23)

Preventing Chronic Disease/CDC: Quit Methods Used by US Adult Cigarette Smokers, 2014–2016
To quantify the prevalence of 10 quit methods commonly used by adult cigarette smokers, we used data from a nationally representative longitudinal (2014–2016) online survey of US adult cigarette smokers (n = 15,943). Overall, 74.7% of adult current cigarette smokers used multiple quit methods during their most recent quit attempt. Giving up cigarettes all at once (65.3%) and reducing the number of cigarettes smoked (62.0%) were the most prevalent methods. Substituting some cigarettes with e-cigarettes was used by a greater percentage of smokers than the nicotine patch, nicotine gum, or other cessation aids approved by the US Food and Drug Administration. (Caraballo et al., 4/13)

Morbidity and Mortality Weekly Report/CDC: Trends In Repeat Births And Use Of Postpartum Contraception Among Teens — United States, 2004–2015
From 2004 to 2015, the number and percentage of teen births that were repeat births decreased 53.8% and 16.9%, respectively; in 2015, the percentage of teen births that were repeat births varied by state from 10.6% to 21.4%. Among teens with a recent live birth, use of the most effective contraceptive methods postpartum increased substantially, from 5.3% in 2004 to 25.3% in 2013; however, in 2013, approximately one in three teens with a recent live birth reported using a least effective contraceptive method or no method postpartum. (Dee et al., 4/27)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Texas Lawmakers Take Aim At Insurers And Drug Coverage Practices; Fla. House Poised To Approve Trauma Center Deregulation Bill

Media outlets report on news from Texas, Florida, Minnesota, California, Georgia, Massachusetts and Maryland.

Houston Chronicle: Lawmakers Take Aim At Insurance Plan Changes To Patients’ Medications
Health insurers are under pressure from Texas legislators to halt a practice that allows them to change the terms of coverage for prescription drugs with a pair of bills in the House and Senate that would extend earlier protections. Patient advocacy groups and doctor and nurse associations long have been opposed to the practice known as “non-medical switching,” which allows insurers to drop medications from their plans, raise co-pays, or add other restrictions and requirements, typically for financial, as opposed to medical, reasons. (Canaves, 4/27)

Tampa Bay Times: Watered-Down Deregulation Of Trauma Care On Tap In Florida House 
The Florida House is expected to pass watered-down legislation meant to increase the number of trauma centers in the state on Friday. Trauma centers, which handle the worst, most time-sensitive injuries like gunshot wounds and violent car crashes, are limited under state law based on the need in each part of the state. State Rep. Jay Trumbull, R-Panama City, had proposed to get rid of limits statewide. (Auslen, 4/28)

Pioneer Press: Minnesota Measles Outbreak Grows To 29 Cases, Spreads To Stearns County
A measles outbreak that began last month in Hennepin County has grown to 29 confirmed cases and has spread to Stearns County, according to the Minnesota Department of Health. The outbreak’s victims have all been children age 5 and younger, and only one is known to have been vaccinated against measles, the MDH said. Twenty-five have been unvaccinated Somali-Minnesotan children, while the vaccination status and ethnicity of the others is not yet known. Twenty-eight of the cases are located in Hennepin County, while one is in Stearns County. (Woltman, 4/27)

The Star Tribune: 5 More Cases Of Measles Include First Outside Hennepin County 
State health officials reported five more cases of measles Thursday, including one in Stearns County that marked the first time the current outbreak has spread beyond Hennepin County. A total of 29 children have now been sickened since the end of March, making it the largest measles outbreak in Minnesota since 1990. (Howatt, 4/27)

Sacramento Bee: Doctor Shortage At CA State Prison Sacramento Hurts Care 
A summary of the unidentified inmate’s death is included in the latest report by a state inspector general calling attention to “inadequate” health services at a prison with a difficult population of 2,400 inmates that sits next door to Folsom State Prison. The new report, released in late March by the state Office of Inspector General, faulted a “critical shortage” of doctors at the prison and a “seemingly unprecedented ability to recruit and retain” primary care providers. (Ashton, 4/27)

Boston Globe: UMass Boston Nursing Program Faces Uncertain Future 
The nursing school at the University of Massachusetts Boston, one of the campus’s most successful programs, faces an uncertain future because of a logistical snafu caused by the myriad construction projects underway at the same time. The program is housed in a building set to be demolished in the next few years, but the Baker administration has nixed a plan to fund a replacement building, leaving the nursing program looking for a new home. (Krantz, 4/28)

California Healthline: California Proposes Stringent Cap On Toxic Chemical In Drinking Water
California regulators are proposing a strict limit on a toxic man-made chemical that has contaminated water supplies throughout the state, particularly in its vast agricultural heartland. California would be the second state, after Hawaii, to establish a threshold for the former pesticide ingredient and industrial solvent known as TCP (1,2,3-trichloropropane) in drinking water. The chemical compound, identified in California as a human carcinogen, is no longer in wide use but has leached over the years into many wells and reservoirs in California and other states. (O’Neill, 4/27)

Miami Herald: Partners Of Florida Medical Marijuana Grower Fight In Court Over Pending Sale 
A lucrative deal that would place a private Fort Lauderdale equity firm at the center of Florida’s fast-growing medical marijuana market is at risk of collapsing amid allegations of “ransom demands” and a corporate coup inside a state-licensed pot dispensary. According to the details of a lawsuit brought by politically connected Panhandle developer Jay Odom against his partners, the shareholders of the Chestnut Hill Tree Farm cannabis nursery in Alachua have splintered over the pending sale of the company’s assets to a new operator. (Smiley, 4/27)

The Baltimore Sun: Keswick Campus To Get Center For Healthy Living 
Keswick, which provides long-term care and other services to seniors, plans to open a Center for Health Living housed on its campus in Baltimore’s Roland Park-Hampden area.The center will connect older adults in the community to health and wellness services that can help them stay fit and in their own homes. Keswick residents and community members will have access to programs focused on socialization, education, arts, lifelong learning and exercise. There will also be information on chronic disease and care management. The center, spanning more than 10,000 square feet, is currently being designed and will be located inside Keswick’s Bauernschmidt Building. (Cohn, 4/27)

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Buyouts Offered To 1,600 Brigham and Women’s Hospital Workers To Control Costs

The move to reduce 9 percent of the prestigious teaching facility’s workforce signals that few health institutions are immune from the current climate of economic uncertainty. Meanwhile, other hospital news is reported out of California, Kansas, Pennsylvania, Maryland, Colorado and Wisconsin.

Boston Globe: Brigham Hospital Offers Voluntary Buyouts To 1,600 Workers
Brigham and Women’s Hospital, one of Boston’s largest employers, said Thursday that it is offering voluntary buyouts to 1,600 workers to rein in costs, a sign of financial stress in one of the region’s bedrock business sectors. The hospital is profitable, Brigham officials said, but is being squeezed as payments from insurers and the government flatten while labor and other costs grow. (Dayal McCluskey, 4/27)

Los Angeles Times: Under Fire From Hospitals, Legislator Drops Measure Requiring Reports Of Superbug Deaths
After complaints from California hospitals and physicians, a state legislator has stripped his bill of a measure that would have required doctors to record deadly infections on death certificates. The California Hospital Assn. and the California Medical Assn. wrote letters saying they opposed the plan by state Sen. Jerry Hill (D-San Mateo). The measure would have required physicians to include drug-resistant bacterial infections on the death certificate if in their opinion it helped cause a person’s death. (Petersen, 4/27)

KCUR: Kansas Lawmakers Balk At Brownback’s $24M Plan For Gun Security At State Hospitals 
Lawmakers signaled Thursday that they could exempt Kansas psychiatric hospitals from a law requiring them to allow concealed handguns. Gov. Sam Brownback has requested an additional $24 million in spending over the next two budget years on upgrades needed to provide security at state mental health hospitals and facilities for people with developmental disabilities. A state law taking effect July 1 will allow people to carry concealed guns into any public building that is not secured by armed guards and mental detectors. (Mclean and Wingerter, 4/27)

The Baltimore Sun: Hopkins Adds Pennsylvania Hospital To Research Network 
Allegheny Health Network in Pennsylvania has joined a research network run by Johns Hopkins that aims to accelerate the pace that new treatments are discovered. The network developed by the Johns Hopkins Institute for Clinical and Translational Research connects researchers from academic institutions with those who work in community settings to collaborate on research and share findings. (McDaniels, 4/27)

The Philadelphia Inquirer: Jefferson And National Jewish Health Form New Respiratory Institute In Philly
Jefferson Health and Denver-based National Jewish Health, a leading respiratory hospital, on Thursday announced the creation of a new respiratory institute in Philadelphia. The Jane and Leonard Korman Respiratory Institute will adopt the centralized, streamlined care model used at National Jewish Health. Patients will see specialists and receive tests during one visit, rather than making multiple trips to various locations, said Gregory Kane. chair of Jefferson’s department of medicine. (McCullough, 4/27)

State House News Service: Partners HealthCare, Brigham Hospital Pay $10M In Medical Research Fraud Case 
Partners HealthCare and Brigham and Women’s Hospital have agreed to pay $10 million to settle a medical research fraud case involving three doctors who are no longer affiliated with the companies. The U.S. attorney’s office in Boston announced Thursday that the settlement resolves allegations that a Brigham and Women’s stem cell research lab run by Dr. Piero Anversa fraudulently obtained grant funding from the National Institutes of Health by using improper protocols, inaccurately characterized cardiac stem cells, recklessly kept records, and fabricated data and images included in applications. (Norton, 4/27)

Milwaukee Journal Sentinel: Kenosha’s United Hospital System To Become Froedtert South
Froedtert Health and United Hospital System in Kenosha would work more closely together and United Hospital System would operate under the Froedtert & the Medical College of Wisconsin brand name in a tentative agreement announced Thursday. The two health systems would not merge under the proposed agreement but would share a system for electronic health records and the same protocols for quality. (Boulton, 4/27)

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Bones From 3D Printers And Other Developments Bring Us Step Closer To Making Sci-Fi A Reality

Bloomberg looks at companies pushing the boundaries of medical development, and what that means for the future of diseases. In other public health news: calorie counts, peer reviews, police and mental illness, infertility treatments and more.

Bloomberg: We’re Getting Closer To Mass Production Of Bones, Organs, And Implants
Medical researchers have been able to create certain kinds of living cells with 3D printers for more than a decade. Now a few companies are getting closer to mass production of higher-order tissues (bone, cartilage, organs) and other individually tailored items, including implants. This kind of precision medicine, treating patients based on their genes, environment, and lifestyle, could herald the end of long organ donor lists and solve other problems, too. (Popescu, 4/27)

The Washington Post: Wait For Calorie Count On Burgers, Pizza May Get Longer
Consumers hoping to consistently find out how many calories are in that burger and fries may have to wait — again. New government rules to help people find out how many calories are in their restaurant meals are set to go into effect next week after years of delays. But they could be pushed back again if grocery stores, convenience stores and pizza delivery chains get their way. (Jalonick, 4/28)

Stat: Phony Peer Review: The More We Look, The More We Find
An unknown number of published studies have a hidden flaw: The “peers” who supposedly vouched for their publication are phonies. And the closer publishers look, it seems, the more rotten studies they find. Now, in the biggest haul to date, publisher Springer has announced that it’s retracting 107 papers from a single journal over concerns that authors had cheated the peer review process — some perhaps unintentionally. (Marcus and Oransky, 4/28)

Austin American-Statesman: A Question Of Restraint: When Policing The Mentally Ill Turns Deadly
[Tom] Klessig is one of at least 33 people with histories of mental illness who died after being restrained by police in Texas over the past decade, according to a first-of-its-kind investigation by the American-Statesman of in-custody deaths. Six of those people wielded weapons; the rest were unarmed, records with the Texas Attorney General indicate. Because the reports that law enforcement agencies must file on in-custody deaths do not track information about the decedent’s mental health, the numbers are likely an undercount of those with a psychiatric disorder who die in police custody. (Ball and Schwartz, 4/27)

The New York Times: Baby-Making By Lottery At A Manhattan Clinic
John Zhang, a well-known specialist in reproductive medicine who runs the New Hope Fertility Center out of a vast and science-fiction-looking office on Columbus Circle, believes he has played a singular role in the fiscal health of New York City. Patients come to him from around the world, from the Middle East, from Kenya, from Nigeria, Spain and China. Perhaps especially from China. (Bellafante, 4/27)

Kaiser Health News: ‘Center Of Excellence’ Designation Doesn’t Rule Out Complications Of Bariatric Surgery
Getting bariatric surgery at a “center of excellence” doesn’t mean that patients can be assured that they will avoid serious complications from the weight-loss procedure at the facility, according to a recent study. Even though facilities that have been accredited as centers of excellence must all meet minimum standards, including performing at least 125 bariatric surgeries annually, the risk of serious problems varied widely among centers, the study found. (Andrews, 4/28)

The Plain Dealer: Cleveland Clinic Research Shows Link Between Gut Bacteria, Meat-Heavy Diets, And Risk Of Blood Clots
Cleveland Clinic researchers have established another connection between heart disease and foods, the bacteria in the intestine that digest them, and the substances these bacteria end up creating during digestion. Choline, naturally found in red meat and egg yolks, but in this case administered in a supplement — increased the production of a gut bacteria byproduct called trimethylamine N-oxide, or TMAO, a chemical the group had previously found to be a strong predictor of heart disease risk. (Zeltner, 4/27)

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Biotech Firm Sees Option For Home Addiction Treatment Similar To Giving Insulin For Diabetes

Brady Granier, the CEO of California-based BioCorRx, says that he hopes to develop a low-dose, injectable-form of naltrexone that uses a small needle so that people could administer it at home. Also, another company, Aware Recovery Care, is providing in-home addiction therapy in some areas of the country.

Stat: Company Hopes To Make Addiction Treatment For Home Use
A California-based addiction treatment company hopes to change the way patients struggling with substance abuse disorder receive a popular form of medication-assisted treatment. If approved, patients could self-administer naltrexone, an opioid antagonist, in the comfort of their own homes — like insulin, but for recovering addicts. The promise of this advancement has some addiction experts excited about a product that could reduce the stigma surrounding recovery. Others, though, remain wary of moving such treatment out of a doctor’s office and away from wraparound services seen as essential for staying clean. (Blau, 4/28)

Kaiser Health News: Try This At Home: Program Brings Drug Addiction Treatment To Patients
Hannah Berkowitz is 20 years old. When she was a senior in high school, her life flew off the rails. She was abusing drugs. She was suicidal. She moved into a therapeutic boarding school to get sober, but she could stay sober only while she was on campus during the week. “I’d come home and try to stay sober really hard — really, really hard,” said Berkowitz, who had trouble staying away from old friends and bad habits. … But Berkowitz did have luck. She had private health insurance and lived in Connecticut, where a startup company, Aware Recovery Care, had begun treating clients in the very environment where Hannah struggled to stay sober: her home. (Rodolico, 4/28)

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Key Florida Lawmaker Says State, Federal Cuts To Medicaid Will Reach $650 Million

But state Sen. Anitere Flores says the effect on hospitals may be mitigated by other federal funding that is expected. News outlets also report on Medicaid news in Wisconsin, Mississippi and Minnesota.

Tampa Bay Times: Florida Medicaid Cuts Will Hit $650 Million, Senate Chair Says 
As part of a broad budget deal, House and Senate leaders have agreed to roughly $650 million in cuts to hospital payments through Medicaid. Sen. Anitere Flores, R-Miami, the Senate’s health care budget chairwoman, confirmed that the state would cut its share of Medicaid payments by $250 million in the upcoming budget, which reduces federal matching dollars by more than $400 million. That’s more than was proposed by either the House or Senate in their original budgets. (Auslen, 4/27)

Madison (Wis.) Capital Times: Madison Disability Advocates Speak Out Against Proposed Medicaid Changes
[Anna] Moffit and other disability advocates in Madison say that restructuring Medicaid could lead to drastic cuts to crucial programs that help individuals with intellectual and developmental disabilities thrive and contribute to their communities. … The way Medicaid is currently set up, the federal government pays 60 percent of Wisconsin’s Medicaid costs. There’s no limit in this system; the more the state spends, the more the federal government supplements that spending. But the proposed American Health Care Act (AHCA) would put a cap on federal funds. (Speckhard, 4/27)

Wisconsin State Journal: Medicaid, Health Care System Confronting High Cost Of Specialty Drugs
Spending on specialty drugs for cancer, hepatitis and other conditions in Wisconsin’s Medicaid program is up 40 percent the past four years, a trend that could continue as more specialty drugs are approved, a state administrator said Thursday. Medicaid spending on prescription drugs overall is relatively flat, largely because drug companies are required to give Medicaid programs rebates, said Rachel Currans-Henry, director of Medicaid benefits management for the state Department of Health Services. But the rebates could be in jeopardy under Medicaid block grants being considered as part of federal health care reform, Currans-Henry said. (Wahlberg, 4/27)

Jackson (Miss.) Clarion-Ledger: Watchdog: Miss. Made $21M Medicaid Mistake, Owes Refund
The state Division of Medicaid could face an unwelcome expenditure, following a federal audit’s findings that the agency, in error, claimed $21.2 million in unallowable reimbursements from the U.S. Department of Health and Human Services over a three-year period. The report released by the Office of Inspector General last month recommends the state refund that amount to the federal government. (Harris, 4/27)

Minnesota Public Radio: Medica Slashes Jobs As It Quits Most Medicaid Business 
Health insurer Medica is cutting about 110 jobs and not filling about 140 more vacant positions because of its decision to get out of Minnesota’s Medicaid program serving children and families, the company announced Thursday. Late last year, Medica said it would no longer manage the care for more than 300,000 MinnesotaCare and other Medicaid customers effective May 1. (Zdechlik, 4/27)

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Trump’s FDA Pick, Scott Gottlieb, Clears Committee And Heads To Full Senate Vote

Democrats have voiced concerns about Gottlieb’s ties to the industry, but the nominee has had a fairly smooth confirmation process thus far.

The Washington Post: Trump Nominee To Head FDA Clears Key Panel, Moves To Full Senate For Vote
The Senate health committee voted 14-9 Thursday to approve physician Scott Gottlieb to be the next commissioner of the Food and Drug Administration, sending the nomination to the full Senate. All 12 Republicans on the committee voted in favor of Gottlieb, a former venture capitalist who served as an FDA deputy commissioner during the George W. Bush administration. Two Democrats, Michael F. Bennet of Colorado and Sheldon Whitehouse of Rhode Island, also voted yes. (McGinley and Bernstein, 4/27)

Stat: Senate Committee Votes To Advance Scott Gottlieb’s Nomination To Lead FDA
The vote was originally scheduled for Wednesday, but Senator Patty Murray of Washington, the committee’s ranking Democrat, asked for a 24-hour postponement after receiving responses to paperwork relating to Gottlieb’s financial holdings less than an hour before the vote was to take place. Murray had previously complained of Gottlieb’s slow pace in responding to committee members’ questions for the record — a separate set of written clarifying questions they submitted after Gottlieb’s first hearing before the committee. (Facher, 4/27)

CQ Roll Call: Health Panel Approves FDA Nominee For Senate Floor
Gottlieb was an FDA official during the George W. Bush administration. Since leaving the agency, he has worked for numerous pharmaceutical companies and biotechnology startups with interests in FDA policies and approvals. He has promised to resign from and divest from companies he currently works for or has a financial stake in, and said he will recuse himself from decisions involving any companies he’s been tied to for a year after confirmation. The Office of Government Ethics signed off on his nomination. (Siddons, 4/27)

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Viewpoints: Reducing Harm Reduces Overdose Deaths; Trump Undermines Women’s Access To Health Care

A selection of opinions on health care from around the country.

Chicago Tribune: A Bold Remedy For Overdose Deaths
Adddiction to opioids is hazardous to your health. This may sound like an obvious and inescapable reality. If your chief priority is staying cool, the thinking goes, you don’t move to Phoenix. If you really want to stay alive, you don’t use heroin. But humans have created innumerable places in Phoenix where it’s possible to minimize personal contact with searing heat. Humans have also created places where it’s possible to inject opioids at relatively low risk. (Steve Chapman, 4/26)

Alaska Dispatch News: Medicaid Helps Alaska Fight Opioid Addiction
Medicaid expansion under the Affordable Care Act has been working in Alaska. Since implemented in 2015, more than 30,000 Alaskans previously shut out from routine and necessary care are now eligible to receive it. Not only does expansion make treatment possible for lower income Alaskans suffering with addiction, it makes it possible earlier in their illness, when treatment is typically less expensive, more effective and has the most potential to prevent the kinds of harm that can accompany addiction, such as homelessness, incarceration, or even death. (Tom Chard, 4/26)

Roll Call: A Disturbing Trend Against Women’s Health
Despite the fact that most Americans want their leaders focused on creating jobs and boosting the economy, in his first 100 days in office, President Donald Trump has spent significant time and effort attacking women’s access to critical health care services and it is clear that women should expect even more harmful policies in the future. (Rep. Carolyn B. Maloney (D-N.Y.), 4/27)

USA Today: Democrats’ Foolish Abortion Orthodoxy
The contest for mayor of Omaha seems an unlikely place for a fight to break out among Democrats over the issue of abortion rights. For one thing, mayors have very little influence on abortion policies. Such matters are most commonly debated in state legislatures and the U.S. Congress or mulled over by the U.S. Supreme Court. Nonetheless, the Democrats, with their penchant for finding issues to battle over, have been feuding over whether to support the Democratic candidate for mayor of Obama, Heath Mello, who, as a practicing Catholic, opposes abortion. He has also pledged not to use his office to obstruct the access of women to reproductive health care. Nonetheless, pro-choice group NARAL Pro-Choice America and the news website Daily Kos have called upon Senator Bernie Sanders and Democratic National Committee chair Tom Perez to withdraw their support of Mello. This is left-wing sectarianism at its most suicidal and an inauspicious sign for the hope of the party to regain the many offices it has lost. (Ross K. Baker, 4/27)

Bloomberg: Pelosi Makes Shrewd Case For Pro-Life Democrats
Democrats have made health care a moral issue, based on a compelling argument, passionately held, that everyone deserves access to care by virtue of being human. That’s one context to keep in mind as the party’s powerful pro-choice contingent attempts to transform a morally contentious issue, abortion, into a health-care issue that — unlike the party’s approach to health care generally — is stripped of moral content. (Francis Wilkinson, 4/26)

Chicago Tribune: Tax Dollars And Abortions: When Politics And Scare Tactics Roil A Difficult Debate
You can’t count on the Illinois General Assembly to pass a balanced budget. But you can count on lawmakers to pass heater bills that are sure to show up in campaign materials during the next election cycle. And so on Tuesday, House lawmakers passed a bill that would significantly shift long-standing state policy on taxpayer funding of abortions. The bill, now headed to the Senate, would include abortions as covered procedures in the health plans of Medicaid recipients and state workers. (4/26)

The New York Times: Spreading Plan C To End Pregnancy
After lunch on a Saturday in late January at her home in Los Angeles, Francine Coeytaux, 63, an abortion rights activist, retrieved a Priority Mail envelope from her office and announced to her guests, a group of young women she had recruited to her cause, the results of a recent experiment. “A couple weeks ago, we Googled ‘abortion pills’ and tried ordering from a few of the sites that came up,” she said. (Patrick Adams, 4/27)

JAMA: Navigating Transitions And Charting New Paths
A career in medicine creates an identity and a defining sense of purpose in life. I love being a physician and relish the planned and unexpected challenges and opportunities that have unfolded over time—which for many years seemed endless. But I also observed early in my career what can happen if one doesn’t anticipate transitions, especially in midlife and beyond. While I have come to know this as a physician, I have learned it is also true for individuals in other walks of life, as choices, options, and opportunities become altered and sometimes appear constrained and truncated by physical and cognitive changes or because one has become burned out and needs a change of direction or new path to pursue. (Philip A Pizzo, 4/25)

JAMA: Single IRBs in Multisite Trials: Questions Posed by the New NIH Policy
On June 21, 2016, the US government announced changes that are arguably the most significant of the last quarter century concerning the protection of human research participants—a requirement for use of central or single institutional review boards (IRBs) in multisite National Institutes of Health (NIH)–funded research. Specifically, the NIH announced a new policy (effective September 25, 2017) to mandate that nonexempt multisite research with humans funded by the NIH be reviewed by a single IRB. (Robert Klitzman, Ekaterina Pivovarova and Charles W. Lidz, 4/26)

The Des Moines Register: The Strange Iowa Political Trip For Medical Marijuana
Two state senators, one Republican and one Democratic: One voted in favor of the medical cannabis bill that passed in the final hours of the legislative session, one voted against it. Both are unhappy. In a legislative session that tended to defy prediction, perhaps it shouldn’t be surprising that medical marijuana was the issue that kept lawmakers up all night as they tried to adjourn. It created odd, bipartisan political alliances as well as conflicts among lawmakers who support medical marijuana. (Kathie Obradovich, 4/26)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Contemplating Health System Reform: Trump Could Save Obamacare; Anthem’s Earnings Alter The Narrative

Opinion writers offer their thoughts on what is happening with efforts to repeal and replace the health law as well as other steps that could result in meaningful health care change.

The New York Times: How Trump Could Save Obamacare, And Help Himself
In this case, improving the Affordable Care Act would not only be good policy for millions of Americans but would also be farsighted politics for Mr. Trump. The obvious obstacles are his repeated claim that the law is a “disaster” and internal Republican Party dynamics. But his endorsement of the House Republican bill last month ended in one of the biggest embarrassments of his first 100 days. And the new attempt this week to revive the effort might have a similar fate. So he shouldn’t let his past criticisms preclude him from pivoting from “repeal and replace” to “repair and rebrand.” A rebranded Affordable Care Act would be consistent with the vision Mr. Trump offered during the campaign. Then, he promised that everyone would be “beautifully covered,” with “much lower deductibles,” and “taken care of much better than they’re taken care of now.” He said he wouldn’t cut Medicaid and would provide coverage for those who can’t afford care.(Nanacy-Ann and Phil Schiliro, 4/27)

Bloomberg: Anthem Shakes Up The Obamacare Narrative 
At a time of extreme uncertainty in the health-insurance market, Anthem Inc. just posted its best quarterly earnings since 2013. The company’s first-quarter results, announced Wednesday morning, beat analyst expectations on just about every measure, driven by growth in its Medicare and Medicaid businesses and a lot of new and healthier-than-expected patients enrolled via the Affordable Care Act’s individual exchanges. Anthem says it intends to stay in the exchanges in 2018 — something I (mea culpa) previously thought unlikely — though that is based on a risky assumption Congress will fund payments to insurers that lower costs for people insured under the ACA. (Max Nisen, 4/26)

USA Today: Both Parties Can Win If We Cut Health Care Costs
Largely absent from the current health-care debate in Washington is one astonishing number: We waste fully one-third of our medical care dollars, about $1 trillion out of $3 trillion annually, according to a paper by Donald Berwick and Andrew Hackbarth that was published in The Journal of the American Medical Association. After practicing medicine for almost 40 years, including 20 in health policy, I’ve become convinced that to achieve adequate, affordable health care for all Americans, the cost of care must be reduced. (Arthur Garson Jr., 4/26)

RealClear Health: How Congress Can Get Health Reform Right
When the One Nation Health Coalition launched we argued that Congress has a once-in-a-generation opportunity to get health reform right. That is still the case. Congress can get this done. And they must get it done. As Congress returns this week they have the opportunity to restart the work of reform. The task has been challenging because the issue is so complex. But there has also been movement on key issues. For instance, giving states flexibility and letting the market define essential health benefits can give patients more choices at a lower cost. (Dave Hoppe and David Wilson, 4/27)

JAMA Forum: Where Does The Health Insurance Premium Dollar Go?
In early March, America’s Health Insurance Plans (AHIP), the national association of private US health insurers, released an interesting report that presents, for insured patients younger than 65 years, financial statistics for 2014 of commercial and nonprofit health insurance companies. According to the report, “Where Does Your Premium Dollar Go?,” an average of 79.7 cents per premium dollar is spent by insurers on health care proper and 17.8 cents on the insurers’ “operating costs,” leaving only 2.7 cents per premium dollar as profits. (Uwe Reinhardt, 4/25)

RealClear Health: The Path To Health Care Reform Starts With Health Savings Accounts
Congress left Washington last week without passing a plan to repeal and replace Obamacare. They are now back with an amendment to the failed American Health Care Act. A growing number of Americans aren’t waiting for lawmakers to figure out how to make health insurance more accessible and affordable. They’re reclaiming control of their health care dollars from their insurers and assuming responsibility for spending that money themselves. (Sally Satel, 4/27)

Arizona Republic: Try Actually Legislating For A Change
Take the issue of health care. Few doubt that the individual health insurance market is in serious trouble under Obamacare. Yet Republicans can’t agree on the extent to which they want to repeal Obamacare or what they want to replace it. Democrats get to criticize Republicans for wanting to repeal Obamacare, but face no pressure, and have no incentive, to advance serious proposals to fix it. (Robert Robb, 4/26)

Louisville Courier-Journal: Fix Health And Pension Plans For Retired Miners
Time is running out for retired coal miners and their dependents, again. If Congress fails to act this week, the beleaguered miners and dependents will be without health insurance, something that came perilously close to happening in December 2016. Sen. Mitch McConnell engineered a short-term deal then, kicking the can down the road until the end of April. (4/26)

Cincinnati Enquirer: Don’t Take Away Subsidies That Make Health Care Affordable
House Republicans are suing to stop the federal government from paying subsidies that substantially cut the deductibles and out-of-pocket costs of 7 million low-wage Americans with Obamacare silver plans. President Trump, who promised to cover all Americans, threatens to join them in attacking these life-saving subsidies. As a volunteer Certified Application Counselor in Cincinnati, I meet many working people who are able to get the care they need because of the cost-sharing these Republicans want to end. (Aariel Miller, 4/26)

Seattle Times: The Affordable Care Act Has Been Good For Washington State
Enrollment data released last week shows a record number of people bought health insurance through Washington’s insurance marketplace, Washington Healthplanfinder, during the open enrollment period that ended Jan. 31. Washington has more than 38,000 new people buying insurance through the exchange this year and an additional 60,000 getting free insurance through Washington Apple Health. Under the Affordable Care Act, nearly 2 million people in Washington state and tens of millions more across the country have health insurance coverage. (4/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Grand Jury Indicts Doctors In Genital Mutilation Case; Doctors’ Salaries In Baltimore Some Of Lowest In Country

Media outlets report on news from Michigan, Kansas, Maryland, Minnesota, Missouri, Iowa and Illinois.

The Washington Post: Detroit-Area Doctors Indicted In ‘Brutal’ Genital Mutilation Case
In what is believed to be the first case of its kind in the United States, a grand jury issued a federal indictment Wednesday against two Detroit-area doctors and a medical officer manager for scheming to perform female genital mutilation. The doctors — Jumana Nagarwala and Fakhruddin Attar — along with Attar’s wife, Farida Attar, were charged with performing female genital mutilation on minor girls at Fakhruddin Attar’s medical office in Livonia, Mich. Until Wednesday, only Nagarwala, 44, was charged with performing the procedure; the others were merely charged as conspirators in the case. (Schmidt, 4/27)

The Baltimore Sun: New Survey Says Baltimore Doctors’ Salaries Among Lowest In The Country 
Baltimore area doctors earn on average some of the lowest salaries in the country, according to a new survey by Doximity, a social network of health care professionals. The compensation report found that on average physicians earned $281,005 a year. Only doctors in two others metropolitan areas reported lower salaries. The the average salary was $267,598 in the Durham, NC area and $272,398 in Ann Arbor, MI and surrounding areas. (McDaniels, 4/26)

KCUR: A New Uber-Style App Helps Riders With Disabilities In Kansas City
The Kansas City Area Transportation Authority is launching an app next week to help people with disabilities get a ride. The launch follows a year of development and two months of trials in a partnership with the company Transdev. Anyone can use the RideKC Freedom app, but it’s specially designed for the more than 300,000 people with disabilities who use the KCATA’s subsidized paratransit services. CEO Robbie Makinen says the Uber-style app is an innovation for the public transit agency. (Wood, 4/27)

St. Louis Public Radio: Cases Of Syphilis Transmittin In Pregnancy Rise In Missouri 
The St. Louis region has long grappled with high rates of sexually transmitted infections, but an uptick in syphilis among women of child-bearing age is drawing the concern of public health officials. In Missouri, 10 cases of congenital syphilis — when the infection is transmitted in the womb — were reported last year. (Bouscaren, 4/26)

Iowa Public Radio: Iowa’s Gonorrhea Infection Rate Up 75 Percent Since 2013 
Reported cases of gonorrhea infections in Iowa are up 75 percent in the last three years, according to preliminary data from the Iowa Department of Public Health. The department says while Iowa’s overall infection rate isn’t unusual, the sudden increase in infections from 2013 is unique. IDPH STD program manager George Walton says part of the reason for this increase is that providers are conducting more comprehensive testing, which has identified cases that would have otherwise gone undetected. (Boden, 4/26)

New Orleans Times-Picayune: Peoples Health To Cut 42 Positions In ‘Organizational Changes’
Peoples Health, a Metairie-based Medicare Advantage Plan provider, is eliminating 42 positions as part of what it’s calling “organizational changes.” The company did not detail the types of employees who would be affected. Its reduction falls below the state labor department’s threshold of 50 layoffs, which would require it to provide more details. The company reports having 60,000 beneficiaries in southeast Louisiana who receive Medicare-supported services from affiliated physicians and health care providers. The leadership of Peoples Health wasn’t immediately available for an interview, but their communications director issued a statement in response to questions about the job cuts. (LaRose, 4/26)

Chicago Sun Times: Family Members Get Prison Time For Running Health Fraud Scheme 
A Wheeling chiropractor and two of his relatives have been sentenced to prison time for bilking insurance carriers out of more than $10.8 million. Dr. Vladimir Gordin Jr., 46; his father Vladimir Gordin Sr., 70; and his brother Alexsander Gordin, 34, pleaded guilty earlier this year to healthcare fraud, according to a statement from the U.S. Attorney’s office. The trio operated Gordin Medical Center S.C., a chiropractic group at 350 E. Dundee Rd. in Wheeling, according to prosecutors. They billed insurance carriers for services that were either never performed or were medically unnecessary. (4/26)

The Star Tribune: Chaska Nursing Home Ruled Negligent After Resident Fell Into 155-Degree Water, Died 
An elderly resident at a Chaska nursing home suffered severe burns and died after falling into a tub of scalding laundry water, according to a state Health Department report that faults the home’s staff for leaving a laundry door open and unattended… State Health Department investigators concluded that the operators of Auburn Manor were negligent when the 90-year-old resident, known to wander throughout the facility, ended up on her back in a few inches of 155-degree waste water on Dec. 31. (Walsh, 4/26)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Rural Doctors’ Training May Be In Jeopardy

In nearly two years as a medical resident in Meridian, Mississippi, Dr. John Thames has treated car-wreck victims, people with chest pains and malnourished infants. Patients have arrived with lacerations, with burns, or in a disoriented fog after discontinuing their psychiatric medications.

Thames, a small-town Mississippi native, said the East Central Mississippi HealthNet Rural Family Medicine Residency Program has been “exactly what I was looking for.”

Unlike the vast majority of doctors, Thames sought a residency in a rural clinic instead of in a teaching hospital because his ambition is to practice in the sort of place where he grew up, where doctors are scarce. He wants to be able to handle anything that comes through the door, from infections to gunshot wounds to a woman who might deliver a baby any second.

But budget decisions in faraway Washington, D.C., may make it more difficult for Thames and other doctors who want to practice in small towns or underserved cities.

Under the Teaching Health Center Graduate Medical Education program, which is part of the Affordable Care Act, the federal government dispenses grants to community health centers to train medical residents. The goal of the program is to address the shortage of primary care physicians in rural and poor urban areas.

But under current law, the federal government will stop funding the program, which serves nearly 750 primary care residents in 27 states and Washington, D.C., at the end of September. Without congressional action, it might be shut down.

“The program is absolutely doing what it is designed to do, which is to put doctors in underserved areas like ours,” said Darrick Nelson, the director of Hidalgo Medical Services’ teaching health center program, which is training six residents in Lordsburg, New Mexico.

The teaching health centers have received bipartisan support in the past. But supporters worry that because the program is new, relatively small, and not as well-known as other federally funded doctor training programs, it might fall through the federal budgetary cracks.

“The greatest threat to the teaching health centers is the dysfunction in Washington,” said Dan Hawkins, a vice president at the National Association of Community Health Centers, a research and advocacy group.

Earlier Cuts

Bipartisan support didn’t protect the program from earlier cuts. In 2010, Congress allocated $230 million over five years, or about $46 million a year. But when it approved a two-year extension in 2015, it reduced funding to about $43 million a year. That reduction was enough to cause some of the teaching health centers to train fewer residents. Some have closed.

Studies have found that most physicians end up practicing close to where they did their residencies. But most teaching hospitals are located in urban centers, far from rural regions with acute doctor shortages. Poor urban neighborhoods also have difficulty attracting physicians.

The American Association of Teaching Health Centers, a nonprofit advocacy group, said the ACA residency program is having the intended result. According to the organization, 55 percent of teaching health center graduates practice in underserved areas, compared to 26 percent of those who graduate from hospital-based residencies.

“The program is doing exactly what we wanted it to do,” said John Sealey, director of medical education for Authority Health in Detroit. More than 60 percent of residents who graduated from teaching health centers in Detroit go on to practice in medically underserved areas, many of them in Michigan, he said.

Progress in Montana

RiverStone Health, a health care provider in Billings, Montana, was a teaching health center even before the federal program began. RiverStone started training residents in 1998, after partnering with two local hospitals.

“The state was completely reliant on recruiting from other areas, which was clearly not working as well as it should,” said Roxanne Fahrenwald, a RiverStone vice president. Fifty-one out of 56 Montana counties have shortages of primary care doctors, according to the federal government.

With the federal money awarded to it under the ACA, RiverStone has been able to add one medical resident a year to its program, bringing its number of residents to 24. About 70 percent of RiverStone graduates have remained in the state.

Supporters also argue that teaching health centers expose residents to the types of ailments and health disparities, such as higher rates of obesity, diabetes and heart disease, that they are likely to encounter if they practice primary care in underserved areas.

“In a community health center, most of the patients are going to present with conditions or ailments more common to a primary care practice, whereas those in the hospital will be sicker, with more acute needs,” said Shawn Martin, a vice president at the American Academy of Family Physicians.

The residents in teaching health centers do spend some of their time training in hospitals. They must complete hospital rotations in surgery, inpatient care, obstetrics and gynecology.

But health center residents also see what many hospital residents never do. In Washington, D.C., for example, medical residents at Unity Health Care Inc. often work in jails, homeless shelters and HIV/AIDS clinics.

Those receiving care at such sites would bear the brunt of the impact if federal money for the health center residency program disappears.

“I’m very nervous,” said Eleni O’Donovan, director of the teaching health center program at Unity. “The program is not sustainable without that funding.”

Categories: Health Industry, Public Health, The Health Law

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Widespread Hype Gives False Hope To Many Cancer Patients

After Michael Uvanni’s older brother, James, was diagnosed with a deadly form of skin cancer, it seemed as if everyone told the family what they wanted to hear: Have hope. You can beat this, and we are here to help.

The brothers met with doctors at a half-dozen of the country’s best hospitals, all with impressive credentials that inspired confidence.

Michael Uvanni was in awe when he visited the University of Texas MD Anderson Cancer Center in Houston, one of world’s most respected cancer hospitals. It was like seeing the Grand Canyon, said Uvanni, 66, of Rome, N.Y. “You never get used to the size and scope.”

Even the MD Anderson logo on buses and buildings — with “Cancer” crossed out in red, above the words “Making cancer history” — made the family’s battle seem winnable.

“I thought they were going to save him,” said Uvanni, an interior designer.

Patients and families are bombarded with the news that the country is winning the war against cancer. The news media hypes research results to attract readers. Drug companies promise “a chance to live longer” to boost sales. Hospitals woo paying customers with ads that appeal to patients’ fears and hopes.

“I’m starting to hear more and more that we are better than I think we really are,” said Dr. Otis Brawley, chief medical officer at the American Cancer Society. “We’re starting to believe our own bullshit.”

The consequences are real — and they can be deadly. Patients and their families have bought into treatments that either don’t work, cost a fortune or cause life-threatening side effects.

“We have a lot of patients who spend their families into bankruptcy getting a hyped therapy that [many] know is worthless,” Brawley said. Some choose a medicine that “has a lot of hype around it and unfortunately lose their chance for a cure.”

Although scientists have made important strides in recent years, and many early-stage cancers can now be cured, most of those with advanced cancer eventually die of their disease.

For Uvanni, hope gave way to crushing disappointment when his brother’s health declined and he died from metastatic melanoma in 2014.

“You get your hopes up, and then you are dropped off the edge of a cliff,” said Uvanni. “That’s the worst thing in the world.”

Caregivers like Uvanni can suffer prolonged grief and guilt if their loved ones are riddled with side effects and don’t survive as long as the family expected, noted Holly Prigerson, co-director of the Center for Research on End-of-Life Care at Weill Cornell Medical College.

For decades, researchers have rolled out new cancer therapies with great fanfare, announcing that science has at last found a key to ending one of the world’s great plagues, said Dr. Vinay Prasad, an assistant professor of medicine at Oregon Health & Science University. When such efforts fail to live up to expectations, the cancer world simply moves on to the next big idea.

Hyping early scientific results — based on lab tests or animal studies — can attract investors that allow researchers to continue their work. Positive results can lead biotech firms to be bought out by larger drug companies.

“It’s in the interest of almost every stakeholder in the health system to be optimistic about these therapies,” said Dr. Walid Gellad, co-director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh.

Uvanni says his brother may have gotten more time from the many drugs he tried during his illness but that his quality of life was mostly terrible. (Mike Roy for KHN)

Of course, there is plenty of money to be made.

The U.S. spent nearly $88 billion treating cancer in 2014, with patients paying nearly $4 billion out-of-pocket, according to the American Cancer Society Cancer Action Network. Spending on cancer, a disease that most afflicts the aging, is predicted to soar as people live longer.

“While many people are trying to make patients’ lives healthier and longer and better, there are others that are exploiting their vulnerability,” said Dr. Leonard Saltz, chief of the gastrointestinal oncology service at New York’s Memorial Sloan Kettering Cancer Center.

Others argue that the excitement about cancer research is justified. A spokeswoman for the Pharmaceutical Research and Manufacturers of America, an industry group, said cancer patients have good reason for optimism.

“We continue to see great strides in identifying the genetic mutations and related factors that can drive the seemingly random formation of abnormal cells in cancer,” spokeswoman Holly Campbell said in a statement. “In the last decade, we’ve seen a number of scientific advances transform the landscape of many cancers.”

Promises To Cure Abound

Even the country’s top scientists sometimes get carried away.

In 1998, Nobel laureate James Watson — who co-discovered the structure of DNA — told The New York Times that scientists would “cure cancer in two years” using drugs that block tumor blood supplies. At that time, the drugs had succeeded only in mice.

In 2003, the director of the National Cancer Institute, Dr. Andrew von Eschenbach, announced a goal of “eliminating suffering and death due to cancer by 2015” by better understanding tumor genetics.

Last year, when President Barack Obama announced the Cancer Moonshot, which aims to accelerate and better coordinate research, he said, “Let’s make America the country that cures cancer once and for all.”

In a recent interview, von Eschenbach acknowledged he didn’t communicate his goal well.

“We all fall into that trap,” said von Eschenbach, now a senior fellow at the Milken Institute, a health and public policy think tank. “We’re offering what we have, but making it appear that it’s more than what it is.”

It’s easy to see how patients’ hopes are raised, said Timothy Turnham, former executive director at the Melanoma Research Foundation, an advocacy group. Researchers are frequently overly enthusiastic about early discoveries that have little chance of leading to a new drug.

“There is a disconnect between what researchers think is statistically significant and what is really significant for patients,” Turnham said. “Patients hear ‘progress,’ and they think that means they’re going to be cured.”

A Marketing Blitz

Uvanni said his brother’s experience was nothing like the sunny images in TV commercials, in which smiling cancer patients hug their grandchildren, hike in the mountains and lead dance classes.

A TV commercial for the Bristol-Myers Squibb drug Opdivo projects the words “a chance to live longer” on the side of skyscrapers, as a captivated crowd looks on. In much smaller type, a footnote reveals that lung cancer patients taking Opdivo lived just 3.2 months longer than others.

(Screenshot of Opdivo TV Commercial)

(Screenshot of Opdivo TV Commercial)

A TV ad for Merck’s Keytruda features reassuring images of a smiling, healthy patient hugging her family — not fighting for breath or struggling to walk. Although the commercial notes that the people in the ad are portrayed by actors, the commercial claims the drug provides “a chance for a longer life. It’s Tru.”

“Your heart sinks when you see those ads,” Uvanni said. Seeing the family depicted in the ad, he said “makes you wonder if they’re going down the same path that we did.”

The Keytruda ad notes that 71 percent of patients given the drug were alive “at the time of patient follow-up,” compared with 58 percent of those who received chemotherapy. The ad doesn’t mention that the “time of follow-up” was 11 months.

(Screenshot of Keytruda TV Commercial)

“It’s not false; it’s just incomplete,” said pharmacist Harold DeMonaco, a visiting scientist at the Massachusetts Institute of Technology in Boston. “They don’t give patients or the patients’ family enough information to make a reasonable decision.”

In an interview, Merck senior vice president Jill DeSimone said that the company aims to be responsible with its advertising, noting that the Keytruda ad reminds patients to talk to their doctors. “The physician is the ultimate decider on treatment,” DeSimone said.

In a statement, Bristol-Myers’ senior vice president Teresa Bitetti said that Opdivo ads play “an important role in educating patients about new treatment options and fostering informed conversations between patients and their doctors.”

Hospitals also have drawn criticism for overstating their success in treating cancer. In 1996, Cancer Treatment Centers of America, a for-profit chain, settled allegations from the Federal Trade Commission that “they made false and unsubstantiated claims in advertising and promoting their cancer treatments.”

The company’s current commercials — dozens of which are featured on their website — boast of offering “genomic testing” and “precision cancer treatment.”

The commercials don’t tell patients that these tests — which aim to pair cancer patients with drugs that target the specific mutations in their tumors — are rarely successful, Prasad said. In clinical trials, these tests have matched only 6.4 percent of patients with a drug, according to Prasad’s 2016 article in Nature. Because these drugs only manage to shrink a fraction of tumors, Prasad estimates that just 1.5 percent of patients actually benefit from precision oncology.

In a statement, Cancer Treatment Centers of America said, “We use national media to help educate cancer patients and their families about the latest diagnostic tools and treatment options. … All of our advertising undergoes meticulous review for clinical accuracy as well as legal approval to ensure we tell our story in an informative and responsible manner, and in compliance with federal guidelines.”

Spending on ads for hospitals that treat cancer soared 220 percent from $54 million in 2005 to $173 million in 2014, according to a 2016 article in JAMA Internal Medicine. Ads for Cancer Treatment Centers of America accounted for nearly 60 percent of all total cancer center advertising.

Targeting Melanoma

For more than a decade, the Food and Drug Administration approved no new treatments for metastatic melanoma. Patients typically died within a year of diagnosis.

Since 2011, however, the FDA has approved 11 new treatments, including several immunotherapies, which aim to harness the immune system to fight cancer. Last year, doctors leading a clinical trial announced that the median survival of patients taking the drug Keytruda had grown to two years. Forty percent of patients were alive three years later, according to the clinical trial, presented at the American Society of Clinical Oncology.

Researchers have tested immunotherapies against a variety of tumors, leading to approvals in lung cancer, kidney cancer, bladder cancer and others.

Such success has led doctors to label cancer immunotherapy as a “game changer.” N­­ewspapers and magazines call it a “breakthrough.” And hospitals laud them as “a miracle in the making.”

Yet these treatments — which were initially assumed to be gentler than chemotherapy — can provoke fatal immune system attacks on the lungs, kidneys, heart and other organs.

And there are no approved immunotherapies for tumors of the breast, colon, prostate and pancreas.

Only about 10 percent of all cancer patients can expect to benefit from immunotherapy, Prasad said.

Uvanni’s brother — who tried immunotherapy, as well as a number of other approved and experimental treatments — survived 3½ years after his diagnosis. That might lead many oncologists to describe his story as a success.

Uvanni sees no reason to celebrate. He wanted more than short-term survival for his brother.

“I thought we were going to have a treatment where we’d at least have a good block of quality time,” Uvanni said.

But treatments meant to control the cancer only made him sick. Some caused flu-like symptoms, with fever, chills and shakes. Others left him nauseated, unable to eat or move his bowels. Others caused dangerous infections that sent him to the emergency room.

“I hope that if something like that happens to me,” Uvanni said, “I would be strong enough to say no to treatment.”

Categories: Cost and Quality, Health Industry, Mental Health, Pharmaceuticals

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Thoughts On How Trump Could Shift His Health Care Focus; Safeguarding People With Pre-Existing Conditions

Editorial pages across the country include ideas about how the Trump administration and GOP lawmakers should shift their repeal and replace efforts as well as other reflections on the health care system.

Bloomberg: A Better Goal For Trump On Health Care
Rather than renew their failed effort to repeal and replace Obamacare, President Donald Trump and congressional Republicans should move on to another aspect of health care: the need to contain costs and improve value. Such a shift would allow them to be far more productive. For many if not most Americans, cost trends and value matter more than what’s happening on the individual insurance exchanges. Progress on this front would raise people’s take-home pay and improve the nation’s long-term fiscal balance, while also constraining the growth in premiums for those who buy insurance on the exchanges. (Peter R. Orszag, 4/25)

RealClear Health: First, Do No Harm to Patients With Pre-Existing Conditions
The recent U.S. House decision to pull the first iteration of the American Health Care Act (AHCA) off the floor doesn’t necessarily mean efforts to reform health care are at an end. As members of Congress work to develop legislation that will change the current health care system, they must develop policy that ensures people with pre-existing conditions will receive coverage without additional costs in premiums, deductibles or coinsurance for their pre-existing condition. (John Meigs Jr., 4/26)

The Washington Post: Even In Trump’s Base, His Path Forward On Health Care Is Awfully Unpopular
On the campaign trail, Donald Trump’s proposal on health care was nebulously perfect. Obamacare — that is, the Affordable Care Act — would be gone, he told his cheering supporters, replaced by something cheaper, better and more expansive that wouldn’t be burdened by the hated word “Obama.” When it came time to deliver on that promise, very early in his administration, the bill that was offered up was somewhat distant from that target. (Philip Bump, 4/25)

The Washington Post: This New Poll Shows Trump May Be Making Obamacare More Popular, Not Less
President Trump had hoped to celebrate his 100-day mark by boasting of his success in obliterating his loser predecessor’s signature domestic accomplishment — and in replacing it (naturally, since Trump is a winner) with something that delivers more and better health care for less money. Instead, one of his chief 100-day accomplishments may be that he’s in the process of making Obamacare more popular. A new Post-ABC News poll finds that 61 percent of Americans now favor keeping and improving the Affordable Care Act, while only 37 percent favor repealing and replacing it. Crucially, it also finds that huge majorities reject the ideas at the core of the latest version of the GOP replacement that Trump is championing. (Greg Sargent, 4/25)

The Tennessean: In Health Care, Price Is Not The Only Factor
A Tennessean article this year highlighted the efforts of a Nashville-based company to promote health care price transparency. … Consumer empowerment in health care requires reliable price information. Online price comparison websites will be a critical building block in harnessing free market forces to control health-care spending. (Rick Abramson, 4/25)

The Washington Post: Apparently Repealing Obamacare Could Violate International Law
We’ve already seen that repealing Obamacare is politically perilous. Now there’s a new complication: It may also violate international law. The United Nations has contacted the Trump administration as part of an investigation into whether repealing the Affordable Care Act without an adequate substitute for the millions who would lose health coverage would be a violation of several international conventions that bind the United States. It turns out that the notion that “health care is a right” is more than just a Democratic talking point. (Dana Milbank, 4/25)

Modern Healthcare: How Much Charity Care Do Not-For-Profit Hospitals Provide?
In March, it was discovered that the Mayo Clinic’s CEO, John Noseworthy, had asked staff to “prioritize . . . commercially insured patients” over those covered by Medicare or Medicaid. Observers described the message as being in poor taste but surprising only because someone publicly discussed the policy—not that hospitals were trying to bring better-paying patients through their doors, even when those hospitals are not-for-profit organizations that receive tax exemptions in return for providing community benefits. (Elizabeth Whitman, 4/24)

Milwaukee Journal Sentinel: Gov. Scott Walker’s Proposal Is Detrimental To The Health Of Wisconsin
Gov. Scott Walker, in response to Health and Human Services Secretary Tom Price’s request for states to “innovate” their Medicaid programs, has laid out a proposal that would decrease access to health care for our most vulnerable, humiliate and marginalize those with addiction, and increase government bureaucracy. The core elements of the proposal include charging premiums, co-payments for unnecessary ER visits, work requirements for non-disabled adults, maximum enrollment periods, and, most sensationally, drug testing of Medicaid recipients. (Rebecca Bernstein, 4/25)

Vox: Is Singapore’s “Miracle” Health Care System The Answer For America?
Here’s what Singapore’s conservative admirers get right: Singapore really is the only truly universal health insurance system in the world based on the idea that patients, not insurers, should bear the costs of routine care. But Singapore isn’t a free market utopia. Quite the opposite, really. It’s a largely state-run health care system where the government designed the insurance products with a healthy appreciation for free market principles — the kind of policy Milton Friedman might have crafted if he’d been a socialist. Unlike in America, where the government’s main role is in managing insurance programs, Singapore’s government controls and pays for much of the medical system itself — hospitals are overwhelmingly public, a large portion of doctors work directly for the state, patients can only use their Medisave accounts to purchase preapproved drugs, and the government subsidizes many medical bills directly. (Ezra Klein, 4/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives: Importing Drugs Isn’t The ‘Nuclear Option’ The Industry Paints It To Be

Read recent commentaries about drug-cost issues.

The New York Times: How To Stop Drug Price Gouging
If Mr. Trump wishes to show he’s serious about his populist promise, the place to start is by declaring war on the price gougers. The key power is found in the “import relief” law — an important yet unused provision of the Medicare Modernization Act of 2003 that empowers the Food and Drug Administration to allow drug imports whenever they are deemed safe and capable of saving Americans money. The savings in the price-gouging cases would be significant. Daraprim, the antiparasitic drug whose price was raised by Mr. Shkreli to nearly $750 per pill, sells for a little more than $2 overseas. The cancer drug Cosmegen is priced at $1,400 or more per injection here, as opposed to about $20 to $30 overseas. The remedy is simple: The government can create a means for pharmacies to get supplies from trusted nations overseas at much lower prices. Doing this would not only save Americans a lot of money but also deflate the incentive to engage in abusive pricing in the first place. (Tim Wu, 4/20)

RealClear Health: Does Crime Pay When It Comes To Fake Drugs?
The purpose of penalties such as fines and jail time is to address and correct perpetrators’ bad behaviors, whilst signaling to others that illicit behavior will not be tolerated – “crime will not pay.” However, when it comes to the business of counterfeit prescription medications, law enforcement falls far short as an effective deterrent. (Steve Pociask, 4/26)

Bloomberg: Express Scripts’ Anthem Loss Goes Deeper Than Numbers
In losing Anthem Inc. as a client, Express Scripts Holding Co. is surrendering more than just its biggest customer and 18 percent of its revenue. Its very identity is now at risk. The PBM on Monday night said it expected to lose Anthem’s business at the end of 2019 after a long, bitter pricing dispute. Through Monday’s trading, Express Scripts shares had fallen more than 20 percent since the Anthem squabble began in December 2015 — so this news was somewhat priced into the stock.  (Max Nisen, 4/25)

CNN: How To Cut The Price Of Prescription Drugs
Reducing the cost of medical care, rather than health insurance, is so often underemphasized or even absent from discussions of reforming the health care system. And yet lowering costs of medical care is essential for broadening access to care, reducing insurance premiums and ultimately ensuring better health. (Atlas, 4/20)

Bloomberg: Generic Drug Woes Aren’t Going Away 
Cardinal Health Inc. on Tuesday announced a $6.1 billion deal for a Medtronic PLC medical supplies unit. But this deal was overshadowed by the gruesome earnings forecast Cardinal released at the same time. The company warned 2017 earnings will be at the low end of its already lowered guidance and said 2018 would miss Wall Street expectations. Cardinal shares fell 12 percent on Tuesday.That’s bad news for the drug distributor and its peers McKesson Corp. and AmerisourceBergen Corp. as they enter earnings season. It also confirms a multi-year price crunch in generic and specialty drugs may not be going anywhere soon — just as the market for such assets appears to be getting hot. Buyer beware.  (Max Nisen, 4/19)

East Bay Times: Pass Bill To Sunshine Prescription Drugs Prices
Pharmaceutical companies need an intervention to address their addiction to prescription drug price gouging. Californians should demand that Big Pharma be more transparent about drug-pricing habits and put an end to pharmaceutical industry practices that state Sen. Ed Hernandez says “literally rape the American people at the expense of the taxpayer.” (4/24)

The Oregonian: Oregon Must Address Drug Costs And Transparency
The rising cost of prescription drugs in Oregon should worry us all. I often hear from neighbors and constituents about the real challenges of out-of-pocket costs for prescription medicines. Given that the clock usually resets for a patient’s insurance deductible responsibility in January, this time of year can be especially difficult for Oregon families who depend on expensive prescription drug treatments. (Bill Kennemer, 4/21)

Bloomberg: An Alcon Sale Will Take A Bargain Price
Novartis AG’s consideration of a spinoff or sale of its Alcon eye-care business just got serious; Bloomberg News reported Thursday the company has hired Bank of America to review its options. It’s eminently reasonable for the company to consider it, as my colleague Chris Hughes and I wrote when the company aired the notion in January. The declining business has become more trouble than it’s worth. And Novartis could use the money to supplement its growing generics business, or to bolster its all-important pharma division as its best-selling medicine Gleevec faces generic competition. (Max Nisen, 4/20)

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This Lawyer Is Tired Of Pharma Getting Richer And Americans Paying The Price — So He’s Suing

News outlets report on stories related to pharmaceutical pricing.

Stat: Meet The Lawyer Trying To Pry Drug Pricing Secrets Out Of Big Pharma
Class action attorney Steve Berman is coming after a drug industry he says is “gouging” the American consumer. And his suits have the potential to crack the lid on the black box of drug pricing, shedding light on a secretive process that has sparked an escalating blame game between drug makers and the many middlemen in the US health care system. Berman sees the drug pricing system as a Rube Goldberg machine for extracting money from patients: Pharma sets a high price for a given medication, and then promises a big, undisclosed rebate to the pharmacy benefits managers who control which drugs get covered by insurers. (Garde, 4/20)

The Wall Street Journal: Corporate Feud Exposes Big Profits On Drug Sales
The rising pressure on drug pricing has shifted to the companies that were supposed to guard against rampant increases.A dispute between two of the most important companies in the health-care industry, Express Scripts Holding Co., the largest pharmacy benefit manager, and health insurance giant Anthem Inc., has shown in stark terms how profitable some relationships have become. That will give more ammunition to critics of the system. (Grant, 4/25)

CNBC: In The Debate Over Rising Drug Prices, Both Drugmakers And PBMs Claim Innocence
The battle over rising drug prices has become a full-blown he-said-she-said. Drug companies have pointed the finger at middlemen in the health-care system, saying they not only benefit from rising drug prices but contribute to their increases. Those middlemen — namely, pharmacy benefits managers (or PBMs) — have said the only parties responsible for drugs’ list prices are the manufacturers. So who’s right? (Tirrell, 4/19)

Stat: Supreme Court To Review Biosimilar Battle Between Amgen And Sandoz
A hotly anticipated hearing takes place at the US Supreme Court on Wednesday about biosimilars and the eventual decision is expected to have widespread implications for health care costs. At issue are some of the complex procedures found in the Biologics Price Competition and Innovation Act that are supposed to determine when lower-cost biosimilar medicines, which are highly identical versions of expensive biologics, can be launched. And one brand-name drug maker, Amgen, is squabbling with Sandoz, a generic company, over competing interpretations of two provisions. (Silverman, 4/25)

Bloomberg: Biotech M&A Falls Off As Trump Dashes Hopes Of A New Pharma Boom
Pharmaceutical and biotech acquisitions totaled $44 billion last quarter, down 13 percent from a year earlier, and 35 percent below the first quarter of 2015, according to data compiled by Bloomberg. And exchange-traded funds, a good indicator of investors’ appetite in a sector because they typically track an index, are seeing about half as much trading volume in health care as three years ago, data show.Part of the reason is that President Donald Trump dashed hopes for a new biotech boom. Once thought friendlier to the industry than his Democratic campaign opponent, he’s since attacked drugmakers and vowed to force down their prices. (Hopkins, 4/21)

FierceHealthcare: Drug Prices Still A Major Concern For Healthcare Leaders
Rising drug prices remain a top concern for health system leaders, according to a new survey.Premier, Inc.’s spring Economic Outlook Survey polled 91 people representing a variety of roles in U.S. health systems, including physicians, C-suite members and supply chain management professionals.Almost every respondent agreed that increasing pharmaceutical prices pose a significant challenge to their operations. In addition, more than 90% said they would likely experience continued drug shortages over the next three years. (Minemayer, 4/25)

Stat: Gene Therapy 1.0 Is A Flop, But Biotech Isn’t Worried
The Western world’s first gene therapy is soon to become but a footnote in biotech history, doomed by minuscule demand and a colossal price. But its failure has hardly dampened the enthusiasm of the scientists and biotech companies betting that gene therapy’s best days are ahead. The therapy, made by the Dutch biotech UniQure, treats a one-in-a-million rare disease called familial lipoprotein lipase deficiency and has been used exactly once since winning European approval in 2012, the company said. That’s in part because it costs about $1 million for a one-time dose, a price that made it nearly impossible to get insurance coverage, as MIT Technology Review reported last year. (Garde, 4/21)

Bloomberg: Top White House Officials To Meet With Biotech Executives And Researchers 
Almost a dozen top administration officials, including the vice president and two Trump family members, are scheduled to meet next month with drug companies and government scientific researchers at the White House, according to an agenda obtained by Bloomberg. Vice President Mike Pence, President Donald Trump’s daughter Ivanka Trump and his son-in-law Jared Kushner will attend the May 8 summit, along with the head of the U.S. National Institutes of Health, executives from Celgene Corp. and Regeneron Pharmaceuticals Inc., and leaders of top research universities and hospitals. (Hopkins, 4/21)

Stat: Roche Faces Investigation Into Charges It Wrongly Thwarted Rivals
The Competition Commission of India has ordered an investigation into charges that Roche tried to block a more affordable biosimilar version of its Herceptin breast cancer drug. Although the agency did not issue a final opinion, its order suggested that Roche moved to eliminate competition after reviewing communications the drug maker sent to the Drugs Controller General of India and the National Pharmaceutical Pricing Authority, as well as doctors and hospitals. (Silverman, 4/25)

Kaiser Health News: A Spoonful Of Kids’ Medicine Makes The Profits Go Up
When prescribing medications, caring for children poses a particular challenge. They’re not just little adults. Their still-developing brains and bodies metabolize drugs differently, and what works for grown-ups can yield radically different — and sometimes dangerous — results in kids. (Luthra, 4/24)

Stat: Bristol-Myers Shuffles Management And Its Chief Strategy Officer Is Leaving
Following setbacks with an important cancer drug, Bristol-Myers Squibb reorganized some key managerial slots last week and, as part of the shuffling, chief strategy officer Emmanuel Blin will leave in June, according to a memo written by chief executive officer Giovanni Caforio. The drug maker is integrating all commercial functions into one organization and Murdo Gordon, who is the chief commercial officer, will expand his responsibilities to include both worldwide oncology commercial activities and specialty drugs. (Silverman, 4/24)

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State Highlights: Examining Minn. Measles Outbreak; Arizona Lawmakers Continue Efforts On Workers’ Comp Coverage For First Responders

Media outlets report on news from Minnesota, Arizona, Illinois, North Carolina, Ohio, Texas, California, Maryland, Pennsylvania and Massachusetts.

Arizona Republic: Arizona Firefighters Call For Expansion Of Health-Care Coverage
Arizona firefighters gathered outside the state Capitol on Tuesday to call for an expansion of health-care coverage to treat conditions that could arise later in life. Firefighters have been working with Arizona legislators for several months to pass House Bill 2161 and House Bill 2410, both of which would expand workers’ compensation insurance coverage for first responders. (Dantuono, 4/25)

The Star Tribune: Minn. Ruling On Abuse At Group Home Likely To Be Far-Reaching One 
Four years ago, a woman with severe mental illness poured a pot of boiling water over Michael Sorenson as he sat in his wheelchair at a Bloomington group home, leaving him with burns covering 35 percent of his body. This week the Minnesota Court of Appeals ruled that the group home operator cannot claim legal immunity under a 1967 state law and shield itself from more than $1 million in potential civil damages. (Serres, 4/25)

San Francisco Chronicle: Novato Oxygen Equipment Supplier Pays $11.4 Million In Settlement 
A major supplier of home oxygen equipment has agreed to pay $11.4 million to settle accusations that it profiteered by filing false reimbursement claims with the government and arranging kickbacks with sleep-testing clinics, federal officials said Tuesday. Justice Department and health care officials announced the settlement with Pacific Pulmonary Services, which is based in Novato and has more than 100 outlets in 20 states. (Egelko, 4/25)

Morning Consult: HHS Settles With Mobile Health Company Over Records
A mobile health company has reached a $2.5 million settlement with the Department of Health and Human Services, in the first case of its kind involving the protection of health records. CardioNet, a Malvern, Pa.-based subsidiary of BioTelemetry that operates a mobile monitoring system for patients diagnosed with cardiac arrhythmia, will pay the settlement for not properly securing sensitive patient data and for possibly violating federal privacy laws. (Reid, 4/24)

WBUR: ‘Trauma Teams’ To Help Boston Residents In Higher Crime Areas Cope In Wake Of Violence
The city of Boston will deploy “trauma response and recovery teams” to several neighborhoods in the aftermath of violent incidents, as part of a new program announced Tuesday. The teams will connect residents in Roxbury, Dorchester, Jamaica Plain, East Boston and Mattapan who have been victims of or exposed to violence — like homicides, shootings or stabbings — with mental health services and ongoing support. (Creamer, 4/25)

The Associated Press: Texas Advocates Push Longshot Pot Bills With Veterans, Moms
Medical marijuana advocates in Texas are promoting support from more conservative sources to push longshot legislation that would ease pot laws in a state that’s lagging behind much of the rest of the country on medical marijuana. Conservative Christian mothers of autistic children and veterans suffering post-traumatic stress disorder rallied outside the state Capitol on Tuesday, entreating the Republican-majority Legislature to advance two bills legalizing medicinal cannabis, one by San Antonio Democratic Sen. Jose Menendez and one by Rep. Eddie Lucio III, a Brownsville Democrat. (4/25)

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‘Biobag’ That Replicates Womb Could Help Improve Survival Rates For Babies Born Early

“This is an old idea,” Dr. Alan Flake, the study’s leader, said. “People pursued it for about 60 years experimentally but we were able to do what others haven’t been able to do and some of that is related to technology.”

USA Today: ‘Biobag’ System Mimics Womb, Could Provide Hope For Premature Babies
Pediatric researchers in Philadelphia have developed a system mimicking the environment in a mother’s womb that could provide new hope for survival and illness prevention in premature babies. The research team at the Children’s Hospital of Philadelphia call the system the “biobag.” It consists of a container made of inert plastic and electrolyte fluid that serves as substitute amniotic fluid. It also contains a device  that allows the baby’s heart to pump blood via the umbilical cord and acts in place of the placenta, continually exchanging oxygen and carbon dioxide. (Eversley, 4/25)

NPR: Artificial Womb Shows Promise In Animal Study
So far the device has only been tested on fetal lambs. A study published Tuesday involving eight animals found the device appears effective at enabling very premature fetuses to develop normally for about a month. “We’ve been extremely successful in replacing the conditions in the womb in our lamb model,” says Alan Flake, a fetal surgeon at Children’s Hospital of Philadelphia who led the study published in the journal Nature Communications. (Stein, 4/25)

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Severe Shortage Of Home Health Workers Robs Thousands Of Proper Care

Acute shortages of home health aides and nursing assistants are cropping up across the country, threatening care for people with serious disabilities and vulnerable older adults.

In Minnesota and Wisconsin, nursing homes have denied admission to thousands of patients over the past year because they lack essential staff, according to local long-term care associations.

In New York, patients living in rural areas have been injured, soiled themselves and gone without meals because paid caregivers aren’t available, according to testimony provided to the state Assembly’s health committee in February.

In Illinois, the independence of people with severe developmental disabilities is being compromised, as agencies experience staff shortages of up to 30 percent, according to a court monitor overseeing a federal consent decree.

Renzo Viscardi (center), pictured with his parents Anthony Viscardi and Cheryl Dougan, relies on round-the-clock care from home health aides. (Courtesy of Cheryl Dougan)

The emerging crisis is driven by low wages — around $10 an hour, mostly funded by state Medicaid programs — and a shrinking pool of workers willing to perform this physically and emotionally demanding work: helping people get in and out of bed, go to the bathroom, shower, eat, participate in activities, and often dealing with challenging behaviors.

It portends even worse difficulties to come, as America’s senior citizen population swells to 88 million people in 2050, up from 48 million currently, and requires more assistance with chronic health conditions and disabilities, experts warn.

“If we don’t turn this around, things are only going to get worse” said Dr. David Gifford, senior vice president of quality and regulatory affairs for the American Health Care Association, which represents nursing homes across the U.S.

“For me, as a parent, the instability of this system is terrifying,” said Cheryl Dougan of Bethlehem, Pa., whose profoundly disabled son, Renzo, suffered cardiac arrest nearly 19 years ago at age 14 and receives round-the-clock care from paid caregivers.

Rising Demand, Stagnant Wages

For years, experts have predicted that demand for services from a rapidly aging population would outstrip the capacity of the “direct care” workforce: personal care aides, home health aides and nursing assistants.

The U.S. Bureau of Labor Statistics estimates an additional 1.1 million workers of this kind will be needed by 2024 — a 26 percent increase over 2014. Yet, the population of potential workers who tend to fill these jobs, overwhelmingly women ages 25 to 64, will increase at a much slower rate.

After the recession of 2008-09, positions in Medicaid-funded home health agencies, nursing homes and community service agencies were relatively easy to fill for several years. But the improving economy has led workers to pursue other higher-paying alternatives, in retail services for example, and turnover rates have soared.

At the same time, wages for nursing assistants, home health aides and personal care aides have stagnated, making recruitment difficult. The average hourly rate nationally is $10.11 — a few cents lower than a decade ago, according to PHI, an organization that studies the direct-care workforce. There is a push on now in a handful of states to raise the minimum to $15 an hour.

Even for-profit franchises that offer services such as light housekeeping and companionship to seniors who pay out-of-pocket are having problems with staffing.

“All the experienced workers are already placed with families. They’re off the market,” said Carrie Bianco, owner of Always Best Care Senior Services, which is based in Torrance, Calif., with franchises in 30 states.

Finding new employees was so difficult that Bianco started her own 14-week training program for caregivers nine months ago. To attract recruits, she ran ads targeting women who had left the workforce or been close to their grandparents. In exchange for free tuition, graduates must agree to start working for her agency.

“There’s much more competition now — a lot of franchises have opened and people will approach our workers outside our building or in the lobby and ask if they want to come work for them,” said Karen Kulp, president of Home Care Associates of Philadelphia.

Hardest to cover in Kulp’s area are people with disabilities or older adults who live at some distance from the city center and need only one to two hours of help a day.  Workers prefer longer shifts and less time traveling between clients, so they gravitate to other opportunities and “these people are not necessarily getting service,” she said.

It isn’t possible to document exactly how common these problems are nationally. Neither states nor the federal government routinely collect information about staff vacancy rates in home care agencies or nursing homes, turnover rates or people going without services.

“If we really want to understand what’s needed to address workforce shortages, we need better data,” said Robert Espinoza, vice president of policy at PHI.

Hard Times In Wisconsin

Some of the best data available come from Wisconsin, where long-term care facilities and agencies serving seniors and people with disabilities have surveyed their members over the past year.

The findings are startling. One of seven caregiving positions in Wisconsin nursing homes and group homes remained unfilled, one survey discovered; 70 percent of administrators reported a lack of qualified job applicants. As a result, 18 percent of long-term facilities in Wisconsin have had to limit resident admissions, declining care for more than 5,300 vulnerable residents.

“The words ‘unprecedented’ and ‘desperate’ come to mind,” said John Sauer, president and chief executive of LeadingAge Wisconsin, which represents not-for-profit long-term care institutions. “In my 28 years in the business, this is the most challenging workforce situation I’ve seen.”

Sauer and others blame inadequate payments from Medicaid — which funds about two-thirds of nursing homes’ business — for the bind. In rural areas, especially, operators are at the breaking point.

“We are very seriously considering closing our nursing facility so it doesn’t drive the whole corporation out of business,” said Greg Loeser, chief executive of Iola Living Assistance, which offers skilled nursing, assisted living and independent living services in a rural area about 70 miles west of Green Bay.

Like other short-staffed operators, he’s had to ask employees to work overtime and use agency staff, increasing labor costs substantially. A nearby state veterans home, the largest in Wisconsin, pays higher wages, making it hard for him to find employees. Last year, Iola’s losses on Medicaid-funded residents skyrocketed to $631,000 — an “unsustainable amount,” Loeser said.

Wisconsin Gov. Scott Walker has proposed a 2 percent Medicaid increase for long-term care facilities and personal care agencies for each of the next two years, but that won’t be enough to make a substantial difference, Loeser and other experts say.

The situation is equally grim for Wisconsin agencies that send personal care workers into people’s homes. According to a separate survey in 2016, 85 percent of agencies said they didn’t have enough staff to cover all shifts, and 43 percent reported not filling shifts at least seven times a month.

Barbara Vedder, 67, of Madison, paralyzed from her chest down since a spinal cord injury in 1981, has witnessed the impact firsthand. Currently, she qualifies for 8.75 hours of help a day, while her husband tends to her in the evening.

“It’s getting much, much, much more difficult to find willing, capable people to help me,” she said. “It’s a revolving door: People come for a couple of months, maybe, then they find a better job or they get pregnant or they move out of state. It’s an endless state of not knowing what’s going to happen next — will somebody be around to help me tomorrow? Next month?”

When caregivers don’t show up or shifts are cut back or canceled, “I don’t get proper cleaning around my catheter or in my groin area,” Vedder continued. “I’ll skip a meal or wait later several hours to take a pill. I won’t get my range-of-motion exercises, or my wheelchair cushion might slip out of place and I’ll start getting sore. Basically, I start losing my health.”

Debra Ramacher is executive director of Wisconsin Family Ties, an organization for families of children with emotional, behavioral and mental disorders. Her daughter Maya, 20, pictured in 2015, has cerebral palsy, epilepsy and other significant disabilities. (Courtesy of the Ramacher family)

Debra Ramacher and her husband have been unable to find paid caregivers since June 2015 for daughter Maya, 20, and son Michael, 19, both of whom have cerebral palsy, epilepsy and other significant disabilities. The family lives in New Richmond in western Wisconsin, about 45 minutes from the Minneapolis-St. Paul metropolitan area.

“At least three agencies told me they’ve stopped trying to hire personal care aides. They can’t find anybody and it costs them money to advertise,” said Ramacher, executive director of Wisconsin Family Ties, an organization for families with children with emotional, behavioral and mental disorders.

“It’s incredibly stressful on all of us, living with this kind of uncertainty,” she said.

Every few months, Ramacher tries to find caregivers on her own by putting ads up on Craigslist, in local newspapers and on job boards.

“We get a few bites,” she said. “Most recently, two people came and interviewed. One never got back to us; the other got a better job that paid more.”

In the meantime, she and her husband are being paid by Medicaid to look after Maya and Michael.

“We don’t want to be the caregivers; we want to have our own life,” Ramacher said. “But we don’t have any option.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Cost and Quality, Health Industry, Medicaid

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Viewpoints: The Health Implications Of Trump’s Immigration Policy; Medicine And Science Benefit From Diversity

A selection of opinions on health care from around the country.

Stat: Trump Should Consider The Health Consequences Of Immigration Policy
We asked this question: Could removing the uncertainty around deportation reduce psychological distress among undocumented immigrants? To answer it, we analyzed data from the US National Health Interview Study, comparing mental health outcomes before and after DACA was signed among non-citizen Latinos and Latinas who met the age eligibility criteria for DACA and among those who did not. Our findings, recently published in Lancet Public Health, were striking. Implementation of the DACA program reduced rates of moderate to severe psychological distress among eligible individuals by nearly 40 percent. This is a remarkable finding, considering that DACA did not grant amnesty for these individuals. (Atheendar S. Venkataramani, Sachin Shah and Alexander Tsai, 4/24)

Stat: In Science And Medicine, Diversity Shouldn’t Be Optional
The debate about whether to advocate for diversity within the March for Science is emblematic of the burdens placed on women and minorities in the scientific workforce at large. We are expected to advocate on behalf of a community that simultaneously makes us feel undervalued and requires us to continually prove our existence. For example, both women and minorities are less likely to be granted funding from the National Institutes for Health, whose budget is expected to be hard hit by the Trump administration. (Altaf Saadi, 4/24)

Miami Herald: Let’s Work Across Borders To Fight Mosquito-Borne Disease
Diseases don’t stop at borders. On World Malaria Day, we take note that mosquito-borne diseases pose serious threats around the world. Without continued leadership from the United States, diseases like Zika and malaria will weaken public health throughout the Americas, including in the United States. The United States has been a leader in advancing global health, but recent policy recommendations will erode efforts to combat these threats. As a public health physician, former policymaker, and president of a comprehensive research university, I find these shifts of growing concern. (Julio Frenk, 4/24)

Bloomberg: Stepping Up The Fight Against Opioid Addiction
Efforts to control the epidemic abound, such as new national prescribing guidelines for doctors, more state drug courts and increased access to addiction treatment. But opioids are extraordinarily addictive, and the pattern of abuse is shifting: Many people who became hooked on prescription opioids go on to use heroin, or worse, illicit fentanyl, which is many times as potent. Fentanyl overdose, which can occur almost instantaneously when the drug is taken, is mainly what’s driving the death rate skyward. (4/24)

Milwaukee Journal Sentinel: Crack Down On Violent Crime
Thanks to state Sen. Leah Vukmir and state Rep. Joe Sanfelippo, legislation providing greater consequences to young offenders has been introduced in the Legislature… Quite frankly, why should a young person be in possession of a firearm unless out hunting with his or her family? (Mark Borkowski, 4/24)

The Des Moines Register: Lawmakers Rightly Dismiss Medical Board Members
Republicans had healthy majorities in the Iowa Legislature this year. Democrats could do little to stop the majority party from busting unions for public employees, expanding gun laws, underfunding schools, approving unprecedented restrictions on abortion, and wreacking other havoc on this state that will be felt for years to come. Democrats did, however, score one victory last week. With urging from Sen. Janet Petersen, D-Des Moines, they rightly refused to reconfirm two of Gov. Terry Branstad’s appointments to the Iowa Board of Medicine. (4/24)

St. Louis Post-Dispatch: Democrats Form Circular Firing Squad Over Abortion Rights
An election campaign for, of all things, mayor of Omaha, Neb., is focusing attention on a major problem for the national Democratic Party. Republicans should be delighted. Democrats should be worried. At issue: How ideologically pure must Democratic candidates be? Specifically, can a candidate be opposed to abortion rights and still expect support from the national party? Or should the party’s principal focus be economic populism with everything else — abortion, guns, immigration, gay rights, etc. — subject to the “agree to disagree” rule? (4/23)

The Washington Post: Washington’s VA Hospital Is Sick. What About The Rest Of The Country?
It did not take long for the inspector general of the Department of Veterans Affairs to figure out there was something seriously wrong with conditions at the VA medical center in the District. He also quickly determined that senior VA officials had long been aware of some of the problems and so could not be trusted to fix them. That the inspector general issued a rare, urgent warning about the risks posed to patients underscores the deep-seated issues still confronting the department entrusted with taking care of the men and women who have fought for their country. (4/24)

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Thoughts On The Obamacare Repeal’s Direction; Whether It Can Survive Another Challenge; And Budget Brinkmanship

Editorial writers offer perspectives on these and other health policy and system issues.

The Wall Street Journal: ObamaCare Repeal Needs A Direction
Before you start a journey, it helps to know where you are going. That’s obvious advice—but instructive as Republicans consider next steps in the effort to repeal ObamaCare. Before getting lost in arcane Senate rules, technical modifications to the existing law, or Congressional Budget Office scores, conservatives must define for themselves and the American people what they are actually trying to accomplish. (Bobby Jindal, 4/24)

RealClear Health: Can Obamacare Survive Another Round In The Congressional Boxing Ring?
The Affordable Care Act (ACA) has survived its biggest challenge to date with the failed attempt to repeal and replace by the GOP. But will it survive in the long run? Republican comments and President Trump’s many tweets would suggest the law is still doomed. It is hard to predict what will happen, but let’s examine some themes we are seeing so far to try to gain some insight. (Shawn Yates, 4/25)

The Wall Street Journal: Medicaid And Mr. Monopoly
When progressives think of Republicans, the image that likely comes to mind is Mr. Monopoly, the top-hatted fellow from the popular board game. It helps that his original name was Rich Uncle Pennybags. In what will be a busy week in Washington, circumstances are ripening for a revival of the Mr. Monopoly caricature. The Republican House hopes to take another whack at ObamaCare reform, a large chunk of which is Medicaid. As if this were not enough to handle, Donald Trump promises a “big announcement” Wednesday about his tax plan, which will likely include cuts in the corporate tax rate. (William McGurn, 4/24)

The Washington Post: Downside To Holding Obamacare Hostage To Pay For Trump’s Wall? Obamacare Is More Popular.
In theory — as stipulated by President Trump countless times on the campaign trail and as reiterated by him on Twitter over the weekend — the construction of a large wall on the United States’ southern border will be paid for by the nation of Mexico. At no point in time has Trump offered a politically feasible explanation for how that payment will occur; in a tweet Sunday, he was more nebulous than normal. (Philip Bump, 4/24)

Chicago Tribune: Trump’s Warning To Democrats About Obamacare Could Be A Bluff … Or An Opportunity
Juust when Americans thought the Obamacare repeal effort was dead and buried, President Donald Trump has exhumed it. The president says he wants a deal on health care even as he vowed Friday to unveil a massive tax cut for Americans — another enormously complicated mission. The White House is pushing for a vote on a new Obamacare replacement bill in the coming days. The trouble is, Trump hasn’t publicly demonstrated an ability to add or subtract provisions, or assemble a bipartisan coalition, to make a good deal happen. (4/21)

Los Angeles Times: This One Unbelievably Expensive Iowa Patient Makes The Case For Single-Payer Healthcare
Back in mid-2016, Iowa customers of Wellmark Blue Cross Blue Shield, the dominant company in the state’s individual insurance market, got a shock: Premium increases of 38% to 43% were in store for many of them for this year. Three weeks ago they got a bigger shock: Wellmark was pulling out of Iowa’s individual market entirely, leaving the state with one company selling individual policies. Wellmark placed some of the blame on congressional Republicans’ failure to come up with a coherent repeal plan for the Affordable Care Act, leaving plans for 2018 in legislative limbo. With Wellmark’s departure, Iowa’s individual market may be down to a single insurer next year. (Michael Hiltzik, 4/24)

Chicago Tribune: How Our Health Care System Falls Short Compared With Those In Other Countries
I was four months pregnant, living in London, when American friends began to openly express their concern about why I wasn’t moving back home to Los Angeles before the birth. “Doesn’t it worry you to be so far away from your community?” one asked. “Don’t you want to have an American baby?” asked another. I can’t be sure what motivated these questions, but I suspect their fears were less about the emotional impact of giving birth overseas, as opposed to an unspoken anxiety about my baby’s safety and my own under socialized medicine. (Lauren Marks, 4/23)

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State Highlights: Worries Surround Rural Health Training, Finances In Miss., Ga.; N.H. Health Execs Fret Over Mental Health Access Issues

Media outlets report on news from Mississippi, Georgia, New Hampshire, California, Tennessee, Florida, Minnesota, Texas, Ohio, Utah, Pennsylvania and Connecticut.

Stateline: Rural Doctors’ Training May Be In Jeopardy
In nearly two years as a medical resident in Meridian, Mississippi, Dr. John Thames has treated car-wreck victims, people with chest pains and malnourished infants. Patients have arrived with lacerations, with burns, or in a disoriented fog after discontinuing their psychiatric medications. Thames, a small-town Mississippi native, said the East Central Mississippi HealthNet Rural Family Medicine Residency Program has been “exactly what I was looking for.” (Ollove, 4/24)

Georgia Health News: Ideas And A Sense Of Urgency Permeate Rural Health Care Symposium
Policymakers, medical professionals and those interested in rural health care converged at a symposium at the University of Georgia School of Law last week to discuss the unique challenges of rural medicine… One of the biggest and most often mentioned challenges facing rural hospitals is their lack of cash on hand, or accessible cash to meet future costs. (Male, 4/24)

NH Times Union: Lack Of Access To Mental Health Services Concerns Health Execs
Executives from six of the state’s largest health care systems wrote to Gov. Chris Sununu on Monday to express their “deep concerns” about access to mental health services in the state, and the backlog of patients in emergency rooms awaiting admission to the state’s psychiatric hospital. “Given the state’s insufficient investments in additional bed capacity at New Hampshire Hospital, our emergency departments have become a boarding place for behavioral health patients in acute crisis,” states the April 24 letter from Dr. Travis Harker, chief medical officer at Granite Health, a collaborative involving Catholic Medical Center, Concord Hospital, LRG Healthcare, Southern NH Health and Wentworth-Douglas Hospital. (Solomon, 4/24)

Los Angeles Times: California Lawmakers Push To Link Public Health Efforts To Climate Programs
California’s fight against climate change would be overhauled under legislation advanced by an Assembly committee on Monday. The legislation, a revised version of a measure introduced earlier this year, would link the state’s efforts against greenhouse gases, which contribute to global warming, and other pollutants, which cause public health problems such as asthma. (Megerian, 4/24)

Sacramento Bee: Mentally Ill Inmates Seek Punitive Damages To Change State Prisons 
In a trial underway in front of U.S. District Court Judge Kimberly J. Mueller, plaintiffs want a jury to find nine corrections department employees liable for malice and oppression to rectify abuses they say their client suffered during a brutal 2012 cell extraction. Along with general damages, the attorneys say a punitive award would send a message to the prison system and its staff on how to carry out the best practices – and avoid the worst – when inmates have full-blown psychotic breakdowns. (Furillo, 4/24)

The Tennessean: Judge Rules In Favor Of Tennessee Clinic In Meningitis Outbreak Case
A federal judge has ruled that the U.S. Food and Drug Administration and a state pharmacy board can be found at fault for the 2012 fungal meningitis outbreak that took the lives of some 77 patients who had been injected with fungus contaminated drugs. In a nine-page ruling issued Monday, U.S. District Judge Rya Zobel concluded that lawyers for a Tennessee pain clinic had presented sufficient evidence in her Boston, Mass. courtroom for the claims that the two agencies acted recklessly to go forward. (Roche, 4/24)

Cleveland Plain Dealer: Akron Mayor Appoints First Health Equity Ambassador 
Akron Mayor Dan Horrigan has appointed Tamiyka Rose to serve as the city’s first health equity ambassador. The new position will advise the mayor and his staff on policy initiatives and lead the city’s efforts to decrease racial and ethnic disparities, specifically premature birth and infant mortality rates. (Becka, 4/24)

The Philadelphia Inquirer/Philly.com: Utah Man Dies In Philly After Double-Lung Transplant He Couldn’t Get At Home For Smoking Pot
A Utah man who was denied a double lung transplant in Salt Lake City because he had smoked marijuana, according to his family, died in Philadelphia on Saturday, several weeks after receiving new organs at the Hospital of the University of Pennsylvania. Riley Hancey, 20, smoked a joint with friends on Thanksgiving, his father, Mark, said in an interview. The next day, the avid skier was stricken with pneumonia. By mid-December he was on life-support in a University of Utah hospital intensive care unit. (Wood, 4/24)

Houston Chronicle: Ambulance Company Owners Convicted In Health Care Fraud Case
A pair of brothers who own a Houston based ambulance company will each spend more than four years in federal prison after their conviction in a a government health fraud case. Kevin Olufemi Davies, 29 and Melvin Olusola Davis, 28, were sentenced for conspiracy to commit health care fraud, conspiracy to commit health care fraud and money laundering, the U.S. Attorney’s Office for the Southern District of Texas announced Monday. They pleaded guilty in December 2016. (Glenn, 4/24)

Reveal: New Bill Would Require Pot Worker Training In Safety And Sexual Harassment 
Marijuana growers in California would be required to train employees about worker safety and sexual harassment under state legislation headed for a hearing tomorrow. Sponsored by the UFCW Western States Council, the Cannabis Workers Protection Bill would require marijuana business owners of all kinds to put at least one employee per year through a 30-hour Cal-OSHA training. (Walter, 4/24)

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Physicians Seek Modifications In Medicare’s New Plans For Payment

The doctors are hoping that in rules expected soon the federal government will ease requirements for small practices to participate in the new Medicare payment options offering higher risk and higher financial reward. Also, some hospitals are asking the federal government to make some bundled-payment programs voluntary.

The Hill: Doctors Look To Price For Tweaks In Medicare Rule
Doctors are hoping Health and Human Services Secretary Tom Price, a fellow physician, will address challenges for small practices in a proposed Medicare rule expected in coming weeks. The White House is reviewing potential 2018 updates to Medicare’s new payment system commonly known as MACRA, a shift in reimbursing physicians to reward them with bonuses for better patient care. (Clason, 4/24)

Modern Healthcare: Hospitals Call On Trump Administration To End Mandatory Bundled Pay Programs
Several hospitals have called on the CMS to turn Obama-era bundled-payment initiatives for cardiac and orthopedic care into voluntary programs, as they don’t have the financial resources to invest in the changes.The CMS last month delayed the effective dates of four new payment models for certain cardiac and orthopedic conditions from July 1 until Oct. 1, 2017, and asked for input on whether they should be delayed even further until Jan. 1, 2018. (Dickson, 4/24)

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Gov. Walker Seeks To Make Wisconsin First State To Impose Drug Testing For Medicaid

Critics are mobilizing against the screening and testing requirement because they say it could unfairly stigmatize the poor and complicate an already difficult application process. News outlets also report on Medicaid news from Arkansas and Ohio.

Boston Globe: Wisconsin Seeks To Mandate Drug Tests For Medicaid Recipients 
Low-income residents seeking government help in Wisconsin often slog through a frustrating, outdated bureaucracy at a run-down state building in Milwaukee, enduring a process that generates complaints about the difficulties of signing up for food assistance, unemployment benefits, and Medicaid. Now, in a first-in-the-nation experiment, Wisconsin Governor Scott Walker plans to raise the bar higher for people seeking Medicaid, with an expansive program of mandatory drug screening, testing, and treatment as a condition of receiving benefits. (Herndon, 4/25)

Arkansas Times: Legislature Set To Tackle Changes To “Arkansas Works” Medicaid Expansion In Special Session
KNWA’s Curt Lanning reports that Rep. DeAnn Vaught, chair of the House Management Committee, sent an email to legislators stating that the legislature will likely immediately reconvene for a special session focusing on health care after adjourning sine die on May 1. The governor is expected to call the special session to get legislative approval of his proposed alterations to the private option (now known as “Arkansas Works”) — the state’s unique version of Medicaid expansion, which uses Medicaid funds to purchase health insurance for low-income Arkansans. (Ramsey, 4/24)

Cleveland Plain Dealer: Ohio Nursing Homes Ask Lawmakers To Delay Medicaid Changes For Long-Term Care Patients 
Ohio’s nursing home lobby is pushing back on proposed budget changes that would make managed care health plans, rather than nursing homes, responsible for overseeing the care of 150,000 Ohioans on Medicaid. Currently, nursing homes and assisted living centers take responsibility for ensuring all aspects of a patient’s care, both in and out of the facility, and bill Medicaid directly for services. (Borchardt, 4/24)

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Perspectives: The GOP’s Intra-Party Scramble Toward A Health-Plan Compromise; And What About Those Subsidies?

Opinion writers take on various aspects of the current debate surrounding the future of the Affordable Care Act and how Republican efforts to repeal and replace it are unfolding.

The Wall Street Journal: A GOP Health-Care Reprieve?
Republicans have put themselves in a deep hole on ObamaCare, both politically and on the health-market merits, but maybe they’ll grab the rescue line now dangling in front of them. A potential compromise among the House’s contentious GOP factions could begin the climb out. (4/21)

USA Today: Don’t Hold Obamacare Subsidies Hostage: Our View
Ever since House Republicans balked at a plan to end health insurance for 24 million Americans by repealing Obamacare, President Trump has been casting around for alternative strategies. One idea is to take another crack at legislation. To that end, Republicans have spent recent days struggling to craft a plan that both hard-line conservatives and more moderate members could support. Another idea is to sabotage President Obama’s signature legislation by blocking funds for cost-sharing subsidies that help lower-income people purchase insurance. (4/23)

USA Today: Scrap Obamacare Subsidies: Opposing View
President Trump has a new bargaining chip in the drive to repeal and replace Obamacare. He recently expressed willingness to end the law’s “cost-sharing reduction” subsidies — which reimburse insurers for covering out-of-pocket costs like deductibles and co-pays for low-income exchange enrollees — in order to bring Democrats back to the negotiating table. That’s exactly what he should do. (Sally C. Pipes, 4/23)

USA Today: GOP Health Plan Is Awful And Americans Know It 
President Trump is in a big rush for House Republicans to repeal the Affordable Care Act by the time he reaches the 100-day mark on Saturday. This revives what for many Americans has been an agonizing process of watching their access to health care become a political football in the worst tradition of Washington deal-making — secretive drafting, rushed votes, multiple closed-door sessions and minimal debate. (Andy Slavitt, 4/24)

Los Angeles Times: How Trump And The GOP Are Plotting To Give Big Health Insurers Exactly What They Want
The nation’s biggest health insurer, UnitedHealth Group, had a pretty good quarter, judging from the preening by its executives during a conference call with Wall Street analysts this week. The company turned a profit of $2.2 billion on revenue of $48.7 billion for the quarter ended March 30. That was partially the result of the company’s bailing out entirely on Affordable Care Act individual insurance exchanges, on which it was losing money. … they weren’t shy about proposing changes to the law that they think will make it better. Interestingly, every change they mentioned would make the ACA work a lot better for UnitedHealth, though not for its customers. (Michael Hiltzik, 4/21)

Arizona Republic: Fix Health Care? Give Us More AHCCCS
Most Arizona counties have just one remaining insurer for the Affordable Care Act. The Arizona Health Care Cost Containment System (AHCCCS) holds the solution to this problem. AHCCCS works and works well, providing health-care services to 1.8 million Arizonans annually. (Victoria Kauzlarich, 4/23)

Columbus Dispatch: ‘Mr. Republican’ Supported Funding For Health Care
A study published April 12 in the journal Health Affairs reported that states such as Ohio that expanded Medicaid to cover the working poor, an option offered by the Affordable Care Act, “did not experience any significant increase in state-funded expenditures, and there is no evidence that (Medicaid) expansion crowded out funding for other state priorities.” That study, by Harvard’s Benjamin D. Sommers and MIT’s Jonathan Gruber, suggests that Ohio’s Medicaid expansion has been a good deal for Ohio and Ohioans. (Thomas Suddes, 4/23)

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