Tagged Health Industry

Hospital Sepsis Protocols Can Increase Survival Chances, Study Finds

Many doctors have been skeptical about proposed regulations for screening and treating the life-threatening complication that afflicts tens of thousands of Americans.

Stat: Doctors Have Resisted Guidelines To Treat Sepsis. New Study Suggests Those Guidelines Save Lives
Even in the face of increased pressure from regulators, many doctors have failed to fully embrace early screening and treatment protocols for sepsis, an infection-related complication that afflicts tens of thousands of Americans every year and that can be life-threatening. Skeptics have argued that there haven’t been any comprehensive studies to support the notion that the protocols can actually save lives. On Sunday, however, the New England Journal of Medicine published a large study that could make doctors reconsider — and help hospitals address head-on one of the most common dangers their patients face. (Tedeschi, 5/21)

USA Today: ‘Rory’s Regulations’ On Sepsis Require Hospital Checklists, Save Lives, Report Shows
New York regulations named after a 12-year-old victim of sepsis increased the chance of survival from the potentially deadly condition, a study out Sunday shows. “Rory’s Regulations,” named for the late Rory Staunton of New York City, requires hospitals to quickly perform a checklist of safety measures when people show up at hospitals with sepsis.  A report in the New England Journal of Medicine Sunday found the faster hospitals completed the checklist of care and administered antibiotics, the lower the risk of death in hospitals from sepsis. With each additional hour it took, the risk of death increased 4%. (O’Donnell, 5/21)

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

Georgia Appears To Dodge A Bullet As Blue Cross Doesn’t Signal Plans To Pull Back Operations

In its initial filings with the state, the company says it will continue to sell individual policies in all 159 counties. In other news, a New Hampshire paper reports indications that premiums could go up significantly and California Healthline examines which companies are enticing customers on that exchange.

Atlanta Journal-Constitution: Blue Cross Blue Shield May Stay In Georgia Obamacare Market
Blue Cross Blue Shield of Georgia, the only remaining company to serve all 159 counties in the state, has filed its annual plans for next year’s insurance market exchange under the Affordable Care Act. In its initial filing, it filed plans for the entire state, said spokeswoman Debbie Diamond. The decision can still change. Negotiations between insurers and the state will continue for several months. (Hart, 5/19)

NH Union Leader: Obamacare Rate Could See Big Spike In NH Next Year 
Some Obamacare exchange premiums could increase an average of 44 percent next year in New Hampshire due in large part to Medicaid expansion and the opioid and mental health crises, according to a document obtained by the New Hampshire Union Leader. The document — stamped “Confidential” and marked “Draft Only” and “not for distribution” — hints that New Hampshire soon could be hit with health-care premium increases it has not experienced since Obamacare coverage started in January 2014. Provided by a government official, the document appears to be written by an insurance carrier to explain the expected double-digit increase. (Hayward, 5/20)

California Healthline: Blue Shield Has Highest Share Of Enrollees In Covered California
Blue Shield of California has the largest number of enrollees in the Covered California health insurance exchange, widening its lead over rivals Anthem Blue Cross and Kaiser Permanente, according to recently released data. The data, from Covered California, show that Blue Shield had 389,480 enrollees in the exchange as of December 2016, about 31 percent of the market. Anthem was next with 310,690 members, for a 25 percent share. Kaiser Permanente was third with 297,030 exchange enrollees, or 24 percent. Health Net and Molina Healthcare were fourth and fifth, respectively. (Terhune and Bazar, 5/22)

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

New York State Wants Its Prescription Drug Money Back — Or Else

New York Medicaid regulators aim to use the threat of imposing increased scrutiny of prescription drugs — such as eyeing their relative effectiveness and their profit margins — to coax additional discounts from drugmakers.

The rules, signed into law in mid-April as part of the state’s budget, don’t go as far as the surcharge that Democratic Gov. Andrew Cuomo originally sought to control the “skyrocketing costs of prescription drugs,” but they retain elements guaranteed to get under a pharmaceutical executive’s skin.

For example, those who don’t agree to voluntarily rebate or pass money back to the state when Medicaid drug spending rises fast could face multiple layers of reviews regarding profit margins and how well their drugs work.

The rules are the latest response to growing dissatisfaction about drug costs from the public, lawmakers and those who run programs like Medicaid, the state-federal health insurance program for low-income people.

“It clearly is going to put more pressure on manufacturers to address prices if they want to stay in business in New York,” said Jack Hoadley, a health policy analyst at Georgetown University who studies Medicaid.

The new law also is part of a growing inclination among states to take on prescription drug costs themselves rather than waiting for a response from Congress or the federal government.

New York’s rules are novel, though, because they are the first to set an annual cap on Medicaid prescription drug spending. The target aims to limit total payments to the sum of medical inflation plus 5 percent, a goal that would have been exceeded in recent years, state officials say.

The law also stands out because — if that target is likely to be exceeded — it explicitly allows regulators to pursue a type of review drugmakers dislike. Such reviews, which are more common in the private sector, use scientific studies and other information to evaluate whether specific medications are overpriced proportionate to their medical benefit.

Drugmakers generally object to such reviews and often dispute their results.

To avoid having their drugs sent for such a review under the law in New York, targeted manufacturers could agree to add additional discounts.

The law “creates an incentive to want to collaborate with us and give us rebates,” said New York State Medicaid Director Jason Helgerson.

Drugmakers had strong objections to the governor’s proposal since its earliest iterations, and Priscilla VanderVeer, a spokeswoman for the industry’s trade lobby, said the group still has “significant concerns” about the price cap and “the chilling effect it could have on New York’s economy,” which she said benefits from 240,000 industry-related jobs.

It’s Not Just New York

States, which pay health costs for millions of employees, prisoners and Medicaid beneficiaries, are particularly sensitive to recent increases in brand and generic drug prices, as well as the introduction of very expensive products, such as treatments for hepatitis C.

New York’s Medicaid program, for example, has seen its drug spending rise on average 8 percent each year over the past three years, after taking into account existing rebates. The program, which uses federal and state funds, serves more than 6 million people. Drugs represent about 5 percent of the cost of the program — with the state paying out $3 billion last year for prescriptions, Medicaid officials said.

Though its law is unique, New York’s efforts are “in keeping with the mood in a number of other states,” said Rachel Sachs, an associate professor at Washington University-St. Louis School of Law who studies intellectual property, health law and food and drug regulation.

For instance:

  • Vermont lawmakers last year adopted legislation that requires drugmakers to provide justification for price increases it determines are driving up spending in state programs, such as Medicaid.
  • Maryland lawmakers in March passed legislation, still awaiting the governor’s signature, that directs Medicaid to notify the attorney general when off-patent or generic drugs experience an “excessive price increase” — and sets financial penalties if the drugmaker can’t justify the hike.
  • In Louisiana, officials have asked whether a rarely used federal law could be tapped to sidestep patents and allow government programs to get lower-cost generic versions of pricey hepatitis C treatments.

A Trigger For Action

Under the New York law, everything plays off an annual spending growth cap.

The new rules are triggered if the combination of price increases and use of drugs is forecast to push spending to exceed that target. First, regulators will ask drugmakers seen as driving that spending to voluntarily offer rebates.

No specific drugs have yet been named, and it isn’t clear how they will be chosen.

“This policy will not affect the vast majority of drugs,” said Helgerson, adding that it will target “the manufacturers that attempt to use periods of patent protection to drive outrageous prices.”

Attorney John Shakow, who represents drug manufacturers, said his clients’ reaction is “mystification and concern,” in part because it is unclear how regulators will select which drugs or manufacturers to pursue for additional rebates.

“It seems prone to abuse, if they want to go after a manufacturer for political reasons or otherwise,” said Shakow, a partner at King & Spalding who specializes in drug price cases. “Laws that are this amorphous and nonspecific and vest so much discretion in regulatory authorities strike us as being ripe for challenge.”

Other laws already require drugmakers nationwide to give Medicaid programs their “best price” — equal to or less than what it is paid by private insurers. Most states, including New York, already seek supplemental rebates, often in exchange for priority placement on lists of which drugs can be dispensed.

But the new law goes further in seeking additional rebates on top of those.

If the targeted drugmakers balk at offering discounts, regulators are granted a range of options that ramp up pressure by requiring those uncomfortable reviews.

Regulators, for example, can refer specific drugs to an evaluation by the state’s Drug Utilization Review Board.

The board would recommend a target rebate. If the state could not get the drugmaker to agree to at least 75 percent of that rebate amount, other sanctions could apply. Prior authorization — meaning a doctor would have to get special permission to prescribe — could be placed on the drug. Advocates fear that could make access to needed medications more of a hurdle for patients.

The state could also require drugmakers to disclose how much was spent on research and marketing, what it charges for the drug in other countries and its average profit margin over a five-year period. Such “transparency” rules are strongly opposed by the drug industry, which says they don’t capture all the costs that go into drug development — and won’t help consumers. With a few exceptions, the industry has successfully fought efforts in various states to pass such legislation.

And, finally, the strongest enforcement mechanism would allow the state to bar some medications entirely, so long as they were not the only drug for a particular condition or treatment. It isn’t clear how that would square with other federal requirements.

If it all works according to plan, the state expects to save $55 million this fiscal year and $85 million the next under the law, Helgerson said.

Categories: Health Industry, Medicaid, Pharmaceuticals, States

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Longer Looks: A Grandmother’s Abortion; Exploding Obamacare; And Doctors In China

Each week, KHN’s Shefali Luthra finds interesting reads from around the Web.

The New Yorker: My Grandmother’s Desperate Choice
Some friends and I had got into a long after-school discussion about abortion, prompted by the gruesome posters that a protester had staked in front of the Planned Parenthood in our Vermont town. I had already begun reading my mother’s Ms. magazines cover to cover, but this was the first time I’d encountered a pro-life position. When I hopped into my mom’s car after school, I was buzzing with new ideas. I had almost finished repeating one friend’s pro-life argument when I saw the look on Mom’s face. That’s when she told me: the “household accident” that had killed her mother had, in fact, been a self-induced abortion. (Kate Daloz, 5/14)

Vox: What Does It Look Like When Obamacare Explodes? This Interactive Graphic Explains.
The biggest risk when health insurance plans quit Obamacare is that some areas could end up with no plans at all. This would mean that, while the law was still technically standing, people there would not have access to the program. They’d have no place to use the financial help the government provides to buy coverage on Healthcare.gov. (Sarah Kliff and Sarah Frostenson, 5/15)

The Economist: Shod, But Still Shoddy: China Needs Many More Primary-Care Doctors
Queues at Chinese hospitals are legendary. The acutely sick jostle with the elderly and frail even before gates open, desperate for a coveted appointment to see a doctor. Scalpers hawk waiting tickets to those rich or desperate enough to jump the line. The ordeal that patients often endure is partly the result of a shortage of staff and medical facilities. But it is also due to a bigger problem. Many people who seek medical help in China bypass general practitioners and go straight to hospital-based specialists. In a country once famed for its readily accessible “barefoot doctors”, primary care is in tatters. (5/11)

WIRED: The WannaCry Ransomware Hackers Made Some Major Mistakes
The WannaCry Ransomware Attack has quickly become the worst digital disaster to strike the internet in years, crippling transportation and hospitals globally. But it increasingly appears that this is not the work of hacker masterminds. Instead, cybersecurity investigators see in the recent meltdown a sloppy cybercriminal scheme, one that reveals amateur mistakes at practically every turn. (Andy Greenberg, 5/15)

The Atlantic: Does Depression Contribute To Opioid Abuse?
It can sometimes seem strange how so much of the country got hooked on opioids within just a few years. Deaths from prescription drugs like oxycodone, hydrocodone, and methadone have more than quadrupled since 1999, according to the CDC. But pain doesn’t seem to be the only culprit: About one-third of Americans have chronic pain, but not all of them take prescription painkillers for it. Of those who do take prescription opioids, not all become addicted. (Olga Khazan, 5/15)

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: Tenn. Hospital Launches GoFundMe Page To Stay Open; ‘Medicare For All’ Rallies To Be Held Across Iowa

Media outlets report on news from Tennessee, Iowa, New Hampshire, California, Washington, Arizona, Indiana, Florida, Ohio and Oregon.

Stat: In Rural Tennessee, A Hospital Turns To Crowdfunding To Stay Afloat
In the southeast corner of Tennessee, one rural hospital has fallen into such dire financial straits it suspended inpatient services earlier this month. Now, the new CEO of the Copper Basin Medical Center has launched a GoFundMe campaign to save the hospital…The campaign seeks to raise just $100,000. That’s just a fraction of its debt — and it’s nothing in the world of online crowdfunding; the team behind an extra-heavy blanket marketed as a treatment for anxiety recently raised more than $3.5 million. (Blau, 5/18)

New Hampshire Public Radio: N.H. Health Department Likely To See $33 Million In Shortfall Dollars 
The New Hampshire House overwhelmingly OK’d a proposal Thursday to allocate $33 million to the state’s Department of Health and Human Services to make up for a budget shortfall. House Finance Chair Neal Kurk urged lawmakers to approve this measure, saying if the department doesn’t immediately get the money, it can’t pay its upcoming bills. Kurk says the shortfall is not the department’s fault, but rather that of state budget writers. He says earlier state budget writers were working with the wrong numbers. (Sutherland, 5/18)

Los Angeles Times: Area School Districts See Gains In Vaccination Rates
Area school districts made gains in the rates of vaccinated students because of a change in state law that eliminated personal exemptions as a reason not to immunize children, according to an Orange County Grand Jury report released earlier this week. “Each district planned well in advance of the change and acted early and successfully in their efforts,” said the report, which listed year-by-year vaccination rates for 24 school districts in the county dating to the 2013-14 school year. (Alderton, 5/18)

Seattle Times: Qliance Closes After 10-Year Effort At New Approach To Basic Medical Care 
Qliance Medical Management, a Seattle-based chain of clinics that provided basic medical treatment on a monthly membership basis, closed Monday after a decade of providing low-cost and insurance-free primary care. Qliance, considered a pioneer of that medical model, told patients in an email that limited services will still be available for the next 30 days. The closure will affect 13,000 members between primary-care and emergency-care services. Qliance’s physicians will independently continue to provide primary care for now in a program serving Seattle firefighters. (Carlson, 5/17)

Arizona Republic: Strep Throat Cases Are On The Rise In Metro Phoenix, Banner Health Says
Banner Health has seen an increase in strep throat cases in children throughout its Phoenix-area health-care centers, and is urging parents to watch for early signs of an infection. The “strep” in strep throat is short for Streptococcus, which is a bacteria, not a virus. Strep A is the most common bacteria involved in strep throat. (Gundran, 5/18)

Modern Healthcare: Physician-Led Group Offers To Buy CHS’ 8 Fort Wayne Hospitals
A leveraged-buyout group led by physicians in Fort Wayne has made an offer to buy Community Health Systems’ eight Indiana hospitals branded as Lutheran Health Network, Fort Wayne City Councilman Dr. John Crawford said Thursday. Crawford, co-founder of Radiation Oncology Associates in Fort Wayne who is not a part of the buyout group, said his eight-physician practice has written a letter supporting the buyout. (Barkholz, 5/18)

Orlando Sentinel/Tampa Bay Tribune: Orlando Health Building Medical Complex, ER In Lake Mary 
Orlando Health is building a free-standing emergency department and medical pavilion in Lake Mary, the health system announced on Wednesday. “Our future vision for the healthcare site includes an acute care hospital, additional medical offices, a potential ambulatory surgery center and other health and wellness concepts,” said Karen Frenier, president of South Seminole Hospital in a news release. The $42-million complex, which is scheduled to open in late fall 2018 and break ground later this year, is about a mile away from Florida Hospital’s new 18,000-square-foot free-standing ER. (Miller, 5/18)

Columbus Dispatch: New Digital Technology Allows For Quicker, More Accurate Cancer Diagnoses
The new technology at the Arthur G. James Cancer Hospital at Ohio State University allows physicians to scan the sliver from a glass microscope slide and transform it into a digital image. That technological shift is a game changer for the pathologists who form diagnoses from biopsies, Parwani said. It means that these diagnoses are delivered faster and more accurately. (Viviano, 5/18)

The Oregonian: Hospital Patients Less Likely To Die If Seen By Younger Doctors, Surprising Study Finds 
Hospital specialists, or “hospitalists,” age 40 and younger have better results — lower 30-day readmission and mortality rates for their patients — than those aged 60 and older, states a new study published in the British Medical Journal. The possible reason: Recent training makes a big difference. … It concluded that “older physicians have decreased clinical knowledge, adhere less often to standards of appropriate treatment, and perform worse on process measures of quality with respect to diagnosis, screening and preventive care.” (Perry, 5/18)

Columbus Dispatch: Former Nursing Home’s Mission To Continue, Without The Building
No longer able to see its way to long-term financial stability, the board of the Isabelle Ridgway Care Center made the difficult decision a few years ago to sell the historic operation to a for-profit company. But Ridgway’s legacy and her mission — to bring comfort and care to elderly, impoverished African-Americans — are set to thrive anew. (Price, 5/19)

Kaiser Health News: California Bill Addresses Safety Concerns At Dialysis Clinics
Saying they are concerned about safety in California’s dialysis clinics, a coalition of nurses, technicians, patients and union representatives is backing legislation that would require more staffing and oversight. The bill, introduced by Sen. Ricardo Lara (D-Bell Gardens), would establish minimum staffing ratios, mandate a longer transition time between appointments and require annual inspections of the state’s 562 licensed dialysis clinics. (Gorman, 5/19)

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

California Bill Addresses Safety Concerns At Dialysis Clinics

Saying they are concerned about safety in California’s dialysis clinics, a coalition of nurses, technicians, patients and union representatives is backing legislation that would require more staffing and oversight.

The bill, introduced by Sen. Ricardo Lara (D-Bell Gardens), would establish minimum staffing ratios, mandate a longer transition time between appointments and require annual inspections of the state’s 562 licensed dialysis clinics.

More than 63,000 Californians receive hemodialysis, which filters impurities from the blood of those with end-stage kidney disease. Demand for the procedure is growing statewide and nationwide as the population ages and more people suffer from chronic conditions that can lead to kidney failure, such as diabetes, hypertension and heart disease.

If the legislation passes, California would join several other states that have imposed minimum ratios for dialysis centers, including Utah, South Carolina and New Jersey.

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The California bill, SB 349, says that inadequate staffing is leading to hospitalizations, medical errors and “unnecessary and avoidable deaths.”

In one case, three patients contracted an infection at a dialysis clinic in Los Angeles County after workers failed to clean and disinfect the machines properly, according to a report in the American Journal of Infection Control.

Patients undergoing dialysis are at risk for low blood pressure, fluid buildup or infections.

Problems can be overlooked if nurses don’t have enough time to devote to their patients and to transition between patients, said Megallan Handford, a registered nurse at a dialysis clinic in Fontana who helped draft the bill. Handford said nurses and technicians often have too many patients at once, making it difficult to ensure they are getting safe care. In some cases, patients left dialysis before they were ready, only to die in their cars, he said.

“We deal with short staffing day in and day out. … Enough is enough,” Handford said during a briefing at the offices of Service Employees International Union-United Healthcare Workers West (SEIU-UHW), which is sponsoring the bill and hopes to unionize dialysis workers. “We’re gonna do what it takes to change this industry.”

Lara agreed, saying oversight of the state’s growing dialysis business is overdue. “We need to keep a closer eye on the dialysis industry,” Lara said in an email.

Dialysis clinics in the state argue that the industry is already well-regulated and the bill would add unnecessary requirements.

Clinics already have a difficult time hiring enough workers and would need even more to satisfy the proposed staff-to-patient ratios, said Kristi Foy, assistant director of the California Dialysis Council, the statewide association of clinics. Besides, she said, there is no evidence that mandated ratios improve quality or patient satisfaction.

Foy added that while there have been “isolated problems,” California is outperforming other states in quality and patient satisfaction. She said a larger percentage of California clinics have high ratings from the federal government, based on factors such as complications, mortality rates and hospitalizations.

“There is no documented need for this bill,” Foy said. “We are very, very concerned that it will result in unintended consequences that will be bad for patients.”

In a survey of dialysis clinics in the state, the council determined that more than 100 of them would be at risk of closing if the bill passed, in part because of the inability to find staff, Foy said. Clinics in rural areas and those who treat large numbers of Medi-Cal patients are particularly vulnerable, she said.

If ratios are put into place, clinics won’t have flexibility when people call in sick or for night shifts that typically require lighter staffing, said Dr. Bryan Wong, a Berkeley-based nephrologist. That could force clinics to offer fewer appointments or turn patients away, he said.

“It would drive up the cost of care because the patient would have to be hospitalized to get their treatment.”

Dr. Randall Maxey, another nephrologist and clinic owner, said the bill is well-intentioned, but he believes the industry is already the “most regulated in the world.”

“If you pass legislation to put more regulations in … there is going to be less dialysis available for people in certain neighborhoods,” he said.

The dialysis industry is largely controlled by two for-profit corporations: DaVita Kidney Care and Fresenius Medical Care, which own nearly three-quarters of the clinics in California. As the demand for dialysis has grown around the country, both companies have acquired smaller dialysis providers.

Meanwhile, studies have shown poorer patient outcomes at for-profit dialysis clinics than at nonprofit facilities. One 2010 study found that mortality rates were higher for patients treated at sites belonging to for-profit chains than for those at nonprofit companies. Another study published the same year, based on data from 2003, showed that patients treated at nonprofit clinics spent fewer days in the hospital.

Supporters of the proposed legislation argue that companies such as DaVita and Fresenius put profits above patient safety.

“This is an industry that is incredibly profitable,” said Joan Allen, government relations advocate at SEIU-UHW. “There is a financial choice that the dialysis industry needs to make, and that is whether they are going to invest in patient safety and patient care or whether they would make a financial choice to reduce access.”

Spokesmen for both DaVita and Fresenius said they were part of a coalition opposing the legislation but declined to comment further.

The bill would require clinics to have one nurse per eight patients and one technician per three patients. The measure would require that patient appointments be at least 45 minutes apart, which supporters say gives staff time to thoroughly clean the equipment and ensure departing patients are safe.

The legislation would also mandate the state Department of Public Health to inspect dialysis centers annually. Lara said clinics are only inspected now about once every six years.

At the SEIU-UHW office in Commerce last week, dialysis technician Carlos Castillo explained why he supports the bill. Watching too many patients at once can be dangerous, he said, especially if one has an emergency. “Dialysis isn’t just about putting needles in patients,” he said. “You never know what will happen.”

Vince Gonzales, 54, who has been on dialysis for 20 years, recalled seeing a patient collapse in his chair and die.

“[Clinic staff] are so busy doing the things they are doing,” he said. “I always have that concern of, ‘Can you take care of me adequately?”

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

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UnitedHealth Doctored Medicare Records, Overbilled U.S. By $1 Billion, Feds Claim

The Justice Department on Tuesday accused giant insurer UnitedHealth Group of overcharging the federal government by more than $1 billion through its Medicare Advantage plans.

In a 79-page lawsuit filed in Los Angeles, the Justice Department alleged that the insurer made patients appear sicker than they were in order to collect higher Medicare payments than it deserved. The government said it had “conservatively estimated” that the company “knowingly and improperly avoided repaying Medicare” for more than a billion dollars over the course of the decade-long scheme.

“To ensure that the program remains viable for all beneficiaries, the Justice Department remains tireless in its pursuit of Medicare fraud perpetrated by healthcare providers and insurers,” said acting U.S. Attorney Sandra R. Brown for the Central District of California, in a statement announcing the suit. “The primary goal of publicly funded healthcare programs like Medicare is to provide high-quality medical services to those in need — not to line the pockets of participants willing to abuse the system.”

Tuesday’s filing is the second time that the Justice Department has intervened to support a whistleblower suing UnitedHealth under the federal False Claims Act. Earlier this month, the government joined a similar case brought by California whistleblower James Swoben in 2009. Swoben, a medical data consultant, also alleges that UnitedHealth overbilled Medicare.

The case joined on Tuesday was first filed in 2011 by Benjamin Poehling, a former finance director for the UnitedHealth division that oversees Medicare Advantage Plans. Under the False Claims Act, private parties can sue on behalf of the federal government and receive a share of any money recovered.

UnitedHealth is the nation’s biggest Medicare Advantage operator covering about 3.6 million patients in 2016, when Medicare paid the company $56 billion, according to the complaint.

Medicare Advantage plans are private insurance plans offered as an alternative to traditional fee-for-service option.

Medicare pays the health plans using a complex formula called a risk score, which is supposed to pay higher rates for sicker patients than for people in good health. But waste and overspending tied to inflated risk scores has repeatedly been cited by government auditors, including the Government Accountability Office. A series of articles published in 2014 by the Center for Public Integrity concluded that improper payments linked to jacked-up risk scores have cost taxpayers tens of billions of dollars.

Tuesday’s court filing argues that UnitedHealth repeatedly ignored findings from its own auditors that risk scores were often inflated — and warnings by officials from the Centers for Medicare & Medicaid Services (CMS) — that it was responsible for ensuring the billings it submitted were accurate.

UnitedHealth denied wrongdoing and said it would contest the case.

“We are confident our company and our employees complied with the government’s Medicare Advantage program rules, and we have been transparent with CMS about our approach under its unclear policies,” UnitedHealth spokesman Matt Burns said in a statement.

Burns went on to say that the Justice Department “fundamentally misunderstands or is deliberately ignoring how the Medicare Advantage program works. We reject these claims and will contest them vigorously.”

A spokesman for CMS, which has recently faced congressional criticism for lax oversight of the program, declined comment.

Central to the government’s case is UnitedHealth’s aggressive effort, starting in 2005, to review millions of patient records to look for missed revenue. These reviews often uncovered payment errors, sometimes too much and sometimes too little. The Justice Department contends that UnitedHealth typically notified Medicare only when it was owed money.

UnitedHealth “turned a blind eye to the negative results of those reviews showing hundreds of thousands of unsupported diagnoses that it had previously submitted to Medicare, according to the suit.

Justice lawyers also argue that UnitedHealth executives knew as far back as 2007 that they could not produce medical records to validate about 1 in 3 medical conditions Medicare paid UnitedHealth’s California plans to cover. In 2009, federal auditors found about half the diagnoses were invalid at one of its plans.

The lawsuit cites more than a dozen examples of undocumented medical conditions, from chronic hepatitis to spinal cord injuries. At one medical group, auditors reviewed records of 126 patients diagnosed with spinal injuries. Only two were verified, according to the complaint.

The Justice Department contends that invalid diagnoses can cause huge losses to Medicare. For instance, UnitedHealth allegedly failed to notify the government of at least 100,000 diagnoses it knew were unsupported based on reviews in 2011 and 2012. Those cases alone generated $190 million in overpayments, according to the suit.

While Medicare Advantage has grown in popularity and now treats nearly 1 in 3 elderly and disabled Medicare patients, its inner workings have remained largely opaque.

CMS officials for years have refused to make public financial audits of Medicare Advantage insurers, even as they have released similar reviews of payments made to doctors, hospitals and other medical suppliers participating in traditional Medicare.

But Medicare Advantage audits obtained by the Center for Public Integrity through a court order in a Freedom of Information Act lawsuit show that payment errors — typically overpayments — are common.

All but two of 37 Medicare Advantage plans examined in a 2007 audit were overpaid — often by thousands of dollars per patient. Overall, just 60 percent of the medical conditions health plans were paid to cover could be verified. The 2007 audits are the only ones that have been made public.

CMS officials are conducting more of these audits, called Risk Adjustment Data Validation, or RADV. But results are years overdue.

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

Categories: Health Industry, Medicare

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Viewpoints: New FDA Commissioner Will Wrestle With Several High-Profile Issues; Reactions To The Administration’s Stepped-Up War On Drugs

A selection of public health opinions from around the country.

The Washington Post: Trump’s New FDA Commissioner Has A Huge Decision To Make
Last week, the Senate confirmed Scott Gottlieb to lead the Food and Drug Administration. That puts the new commissioner in the hot seat to tackle several high-profile issues that are critically important to patients and consumers. Among the most important decisions he’ll have to make early on is whether to accept industry proposals to reduce standards under which drugs can be advertised — regulations that have protected patients for more than 50 years. (William B. Schultz, 5/16)

Lexington Herald-Leader: Paul Right To Reject Failed War On Drugs
The need for criminal justice reform is one of the precious few policy areas that garners widespread bipartisan agreement. Yet, Attorney General Jeff Sessions — a former U.S. attorney and longtime anti-drug crime warrior — reversed an Obama-era policy aimed at keeping non-violent drug offenders out of the federal prison system. Sessions ordered federal prosecutors to charge forward with a policy that has generated enormous human and economic pain with no quantifiable benefits. Kentuckians can be proud that our junior U.S. senator, Rand Paul, called Sessions out on his disastrous decision. (5/16)

The Baltimore Sun: Sessions’ Foolish Drug Policy
The War on Drugs has been such an abject failure — the get-tough approach having served to crowd prisons with non-violent offenders who are disproportionately African-American while having little to no discernible impact on actual narcotics use — that the country’s elected leaders seemed to have reached a bipartisan consensus in recent years that it was better to focus on prevention and treatment. Prosecutors should throw the book at violent, repeat criminals, but they should not pursue long mandatory, minimum sentences for suspects who don’t fit that description. (5/15)

The New York Times: If You’re In A Wheelchair, Segregation Lives
Last year, the former chief of the Santa Fe, N.M., police department, Donald Grady II, said something that stuck with me. “There’s a thing that we call freedom of movement,” he said in an interview with The Atlantic, “which is really revered in this country — that we should have the right to move freely without impingement from the police simply because.” He was speaking as both a black man and a police officer about the ways racial discrimination can limit a basic right. But I related to this on more than one level. (Luticha Doucette, 5/17)

RealClear Health: Over-The-Counter Hearing Aids Legislation Not As Simple As It Seems
One attempted small fix is the Over-the-Counter Hearing Aid Act of 2017 that was introduced on March 21 by Sens. Elizabeth Warren (D-MA), Chuck Grassley (R-IA), Maggie Hassan (D-NH), and Johnny Isakson (R-GA). This bill, which was reported out of the Senate Health Education Labor and Pensions Committee on May 11 — together with a companion measure introduced in the House by Reps. Joe Kennedy III (D-MA) and Marsha Blackburn (R-TN) — has the admirable intent of expanding access to hearing aids for some of the 37.5 million Americans with varying degrees of hearing loss. The bill would for the first time create an over-the-counter (OTC) hearing aid category, allowing the devices to be sold directly to the customer like cheap drug-store eyeglasses. (Andrew Yarrow, 5/17)

Boston Globe: Ambulance Firms Try To Take Insurers For A Ride 
Hope springs eternal on Beacon Hill — and unfortunately, that’s particularly true when it comes to the politically powerful ambulance companies and their desire to leverage higher rates for their services. This year, those companies and their legislative allies are once again hoping to use the budget to advance goals that have otherwise gone nowhere through the more traditional legislative process. (5/17)

Los Angeles Times: Another Way The Rich Get Richer: Study Shows A Widening Gap In Life Expectancy Between Rich And Poor
The United States can take pride in one indisputable marker of racial equality: The gap in life expectancy between the white and black populations has narrowed over time. What was a disparity of more than eight years for Americans born in 1950 has closed to just over three years for those born in 2014, according to actuarial estimates. But let’s not pat ourselves on the back. A different disparity has opened up: The gap in life expectancy between wealthy and low-income Americans is wide and growing wider. And that has implications not only for lifetime health and wealth, but for Social Security. (Michael Hiltzik, 5/16)

The New York Times: Undue Burden: Trying To Get An Abortion In Louisiana
When I set out to make this film in late 2015, the battle over restricting access to abortions in Texas was a national news story. Coverage featured graphs charting the hours women had to drive to find an abortion clinic in the state and maps tracing their paths. Experts weighed in on both sides of a gaping moral divide — politicians made pleas, doctors wrote op-eds. But amid the debate I felt a critical perspective was missing — that of the women across the country who were actually experiencing the effects of these laws. (Gina Pollack, 5/16)

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Different Takes: Benefits Of Broad Health Reform Consensus; Senate’s Path To Crafting Its Repeal-And-Replace Bill

Editorial writers examine different aspects of the current debate surround the GOP repeal-and-replace measure in Congress and the status of Obamacare’s marketplaces.

JAMA: Building A Broader Consensus For Health Reform
Republican leaders in Congress are trying to pass legislation rolling back and replacing key features of the Affordable Care Act (ACA) without securing any Democratic support in the effort. … In political terms, it might be best for Republicans if their effort stalls. The ACA was passed in 2010 with only Democratic votes, and that is a major reason the law remains politically and, to a degree, programmatically unstable. … It would be better for the United States if a broad consensus could be reached on health care. A bill that passed with support from some Republicans and some Democrats has a better chance of political survival than a bill passed by just one party. It should be possible to reach a broader consensus on health policy because both sides of the debate are forced to work within the significant constraints of existing arrangements. (James C. Capretta, 5/15)

Huffington Post: Hope You Don’t Expect The Senate GOP To Be Transparent About Obamacare Repeal
Senate Republicans have spent the last 10 days or so promising not to tackle health care in the same hurried, irresponsible way that their House counterparts did. “We are not under any deadlines,” Sen. John Cornyn (R-Texas) said last week, “so we are going to take our time.” … All of that is probably true ― and less meaningful than it sounds at first blush. It’s possible to write a bill in a slower, more deliberative manner than the House did without allowing the kind [of] lengthy, open public debate that legislation of such magnitude would seem to require. It’s also possible to pass less disruptive, less extreme legislation that would nevertheless take away insurance from many millions of people, causing widespread hardship. (Jonathan Cohn, 5/13)

Los Angeles Times: The Costs Of Trump’s Sabotage Of Obamacare Already Are Showing Up In Rate Hikes
The easiest prediction to make about the healthcare business was that the efforts by Congress and the Trump administration to sabotage the Affordable Care Act would produce a flood of rate hikes by insurers for 2018. We are now standing on the edge of the water. Early rate requests have come in from insurers in five states, according to ace ACA-tracker Charles Gaba, who calculates the weighted average rate request increase in those states at about 30% (that is, weighted for the enrollment of each insurer). (Michael Hiltzik, 5/16)

Cleveland Plain Dealer: GOP Health Care Reform Plan Could Cripple Ability To Treat Opioid Addiction Victims
At the same moment I was caring for more patients struggling with addiction and its devastating health effects, House Republicans passed the American Health Care Act (AHCA). Sadly, the AHCA would replace President Barack Obama’s Affordable Care Act with a law that would end Medicaid expansion and simultaneously make health care more expensive for my most vulnerable patients and reduce important protections for them. (Robert Bonacci, 5/17)

Bloomberg: Cost Of Health Insurance Isn’t All About Fairness
Should women have to pay more for health insurance than men? That has been a critical question for opponents of Republican health-care reform, and it requires grappling with the fundamental nature of insurance, market prices and fairness. Related are questions about how much older people should pay relative to the young, or to what extent individuals with pre-existing conditions should be vulnerable to higher premiums. (Tyler Cowen, 5/16)

WBUR: Hey, Millennials: Want To Help The Underserved? Sign Up For Insurance
I often wonder why President Obama, when he was promoting the Affordable Care Act to millennials, didn’t bring out a young person like me to help my peers understand why it matters… As politically aware, or “woke” as my peers seem to me, I worry that making the effort to understand and sign up for health insurance is low on people’s priority list. (Aditi Juneja, 5/17)

WBUR: Single-Payer Health Care Is The Key To Democratic Victory In 2018 
The Democratic base wants a single-payer system, a slight majority of Independents are warming to the idea and even some conservative voters appear to be growing amenable to cutting insurance companies out of the picture. Thanks to the GOP health care bill’s creation and advancement, the Republican Party’s dream of turning American health care over to the private sector is becoming our new, shared reality. (Miles Howard, 5/17)

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Perspectives: Doctors Are Still Prescribing Brand Name Drugs Over Generics, And You Can Blame Pharma For It

Read recent commentaries about drug-cost issues.

RealClear Health: Why Are Physicians Still Prescribing High Cost Brand Name Drugs? Ask Pharma.
Generic drugs are a boon in health care. Typically lower in cost and as effective as their branded counterparts, they help control pharmacy spending and increase access to important therapies for patients who could be deterred by the high cost of some branded drugs. In fact, research shows that the use of generic drugs produces annual savings in excess of $200 billion. (Troyen Brennan, 5/14)

The Washington Post: Trump’s New FDA Commissioner Has A Huge Decision To Make
Last week, the Senate confirmed Scott Gottlieb to lead the Food and Drug Administration. That puts the new commissioner in the hot seat to tackle several high-profile issues that are critically important to patients and consumers. Among the most important decisions he’ll have to make early on is whether to accept industry proposals to reduce standards under which drugs can be advertised — regulations that have protected patients for more than 50 years. (William B. Schultz, 5/16)

Cincinnati Enquirer: Lowering Prescription Drug Costs Will Improve Care For All Americans
I agree with Gov. John Kasich, we cannot allow Washington politicians with taxpayer-funded health insurance to rip coverage away from Ohioans who are battling cancer, getting regular checkups for the first time, or finally getting treatment for their opioid addiction. Of course we need to do more to lower costs for Ohioans, and I’m ready to work with anyone on commonsense ideas to make our health care system work better. (Sherrod Brown, 5/25)

Cincinnati Enquirer: Who Represents Us?
Negotiated pricing is the common-sense solution to reining in the costs of prescription drugs. It has been in use for many decades, for drugs bought by the Veterans Administration, General Services Administration, all military branches, and the Defense Supply Center Philadelphia; why not Medicare? There is no acceptable reason for these laws. (James Baker, 5/10)

CNN: Health Care Costs Are Bankrupting Us
The financial insecurity experienced by many Americans certainly figures into any root-cause analysis for why President Trump was elected. But for most Americans, the “biggest tax cut ever” will do little to reduce that insecurity. Driving down health care costs — and making them more predictable — is far more important. (H. Gilbert Welch and Elliott Fisher, 5/11)

The Wall Street Journal: The Drug Lobby’s In-House Hygiene
This week’s non-Comey news file contains an encouraging development for U.S. medical innovation amid the running political debate over pharmaceutical prices. The main drug lobby ousted 22 members and adopted corporate governance reforms. (5/10)

Bloomberg: Merck Can’t Say How Good Its Good News Is
Merck & Co.’s 2017 just got a whole lot brighter. The company announced Wednesday evening that its immune-boosting cancer drug Keytruda can now be prescribed in combination with chemotherapy, vaulting it ahead of its rivals in the space. It’s huge news. But exactly how huge it is going forward is largely out of Merck’s control. (Max Nisen, 5/11)

The Fiscal Times: How Trump Can Score A Big, Bipartisan Win On Health Care 
Prescription drugs may not be the costliest part of our health system, but they’re the fastest-rising charge that hits individual pocketbooks directly. The demand for legislative reform is palpable; every politician in Washington has an interest in defusing the drug price explosion. But as close as victory sits, it’s also just out of our grasp. (David Dayen, 5/16)

Montana Standard: Three Easy Steps To Drug Price Control
I find it is despicable the House of Representatives is blaming the high cost of health care on the poor, elderly and chronically ill. They need to address the real reasons for increasing costs of health care, the increasing costs of health care. Take drug costs, for starters. The total drug expenditures for 2015 in America rose 12.2 percent during the previous year. (Michael Bernhardt, 5/11)

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State Highlights: N.Y. State Assembly OKs Single-Payer Bill; Ga. Scrambles To Address Nursing Shortage

Media outlets report on news from New York, Georgia, Massachusetts, Texas, Florida, Illinois, Maryland, California, Minnesota, Wisconsin and Oregon.

The Wall Street Journal: N.Y. Single-Payer Health-Care Bill Passes State Assembly
Democrats in the New York Assembly are relaunching a push for a statewide single-payer health-care program in hopes that the national debate over health care will give their legislation new momentum. The “Medicare-for-all” bill—designed to provide health insurance to all state residents—passed the predominantly Democratic Assembly Tuesday afternoon following several hours of partisan back-and-forth on the chamber floor. (Vilensky, 5/16)

Georgia Health News: Re-Entry Program Brings Former Nurses Back Into The Profession
According to the Georgia Nurses Association, more than 50 percent of the nursing workforce is nearing retirement age. Meanwhile, the aging of the population as a whole means that more nurses and health professionals are needed to act as caregivers. In the Northwest Georgia mountains, Blue Ridge Area Health Education Center (AHEC) is scrambling to relieve the nursing shortage. (Thomas, 5/16)

KXAN: Report: Texas Falling Short On Police Safety During Mental Health Crises 
This investigation involved a 10-month analysis of court and police records, medical histories, media reports and dash and body camera footage, much of it obtained under the Texas Public Information Act. The research revealed shortfalls in police protection statewide: a need for improved mental health training for officers and better communication between law enforcement agencies about potentially violent individuals with mental health issues. (Hinkle and Barer, 5/16)

Orlando Sentinel: Dead Optometry Bill May Be Seen Again
The optometry bill, which for a few weeks reignited the so-called “eyeball wars” between doctors of optometry and doctors of medicine, died in the Legislature this year, but that doesn’t mean the war is over. The state optometry association will decide later this year if it’s going to once again pursue efforts to expand the scope of practice for optometrists in Florida. (Miller, 5/16)

Chicago Tribune: Seniors Seek Affordable Dental Care Options
Like many older people on a fixed income, Ed Slavik knew he couldn’t keep up with the high cost of dental care. So a few years ago, the retired school teacher was relieved to find the Dental Division at Stickney Public Health District, where he had fillings and other routine dental work done for free…But public health researchers are hoping to persuade legislators to add a dental benefit to Medicare by highlighting the many seniors forgoing care until their dental health has deteriorated, sometimes causing trouble eating, swallowing or speaking, and igniting other health problems. (Newumann, 5/16)

The Baltimore Sun: State Approves Apprenticeship Program For Hospital Workers 
State officials have approved Maryland’s first apprenticeship for environmental care supervisors, who work in hospitals cleaning areas such as surgical rooms…Apprentices will receive technical instruction through the Community College of Baltimore County and be paired with mentors Baltimore-area hospitals. Trainees’ wages will increase when they show proficiency in a list of predetermined job functions. Johns Hopkins Hospital will be the first institution to offer the on-the-job training. (Mirabella, 5/16)

Orlando Sentinel: Global Cyberattack Spares Local Health Systems 
The malicious software that quickly spread across six continents last week and locked more than 200,000 computers, including U.K.’s National Health Service, has not affected Central Florida’s two major health systems, officials told the Orlando Sentinel. But their relief is by no means a reassurance for protection from future cyberattacks. (Miller, 5/16)

Sacramento Bee: Botulism Outbreak From Gas Station Nacho Cheese Prompts Lawsuit 
Sacramento County health officials have confirmed five cases of botulism in patients who ate at the Valley Oak Food and Fuel gas station, and are investigating three other probable cases and one suspect case, with all nine patients still hospitalized. Officials believe the outbreak is linked to nacho cheese sauce that was served at the station, but the exact cause of the poisoning is still under investigation, officials said. (Caiola, 5/16)

Pioneer Press: HealthEast, Fairview Merger To Be Completed June 1
The boards of Fairview and HealthEast have approved the merger of the two metro-area hospital systems, and the deal is now expected to be completed June 1, the two organizations announced Tuesday. The combined system will be led by Fairview President and CEO James Hereford. HealthEast CEO Kathryn Correia will join the senior executive team as chief administrative officer. (5/16)

Miami Herald: How Profitable Will Medical-Marijuana Shops Be? Very, Says Confidential Pitch For Investors
A private equity firm’s confidential pitch deck obtained by the Miami Herald shows that only days ago Surterra Florida was seeking investors to buy a $10 million minority stake while also arguing against limits on the number of retail outlets any licensed operator can open. Some potential investors were lured with projections that show Surterra grossing $138 million in sales by 2021 thanks largely to the operation of 55 retail outlets — nearly four times the cap desired by the Florida Senate. (Smiley and Auslen, 5/16)

The Oregonian: Oregon Day Care Closes As Kids Fall Sick After Insecticide Exposure 
A Coos Bay day care center shut down Monday in the aftermath of an insecticide-spraying incident that left at least a half-dozen children and two staff members suffering from inflamed eyes and breathing problems. State regulators opened an inquiry into the May 5 incident but have not sent anyone to visit the Coos Bay Children’s Academy Inc., which had an enrollment of about 80 kids. Instead, the owner voluntarily closed the center Monday as several key employees quit and parents pulled children en masse over concerns about transparency and safety. (Schmidt, 5/16)

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Test Strips Allow People Using Opioids To Test Their Supply For Fentanyl

The synthetic drug is extremely powerful and is contributing to the high number of overdoses across the country. These kits could help people determine if what they are about to take is stronger than they thought it was. Meanwhile, IBM and MAP Health Management are teaming up to create software to help identify and treat addiction.

NPR: Heroin Test Kits For Purity Are Aimed At Preventing Overdose
In the day room at St. Ann’s Corner of Harm Reduction, which runs a needle exchange program in the Bronx, a group of guys are playing dominoes and listening to salsa music while they wait for lunch. And Van Asher, one of the staffers in charge of “transactions” — that means he gives out needles — is talking up his latest idea for how to keep the users here safe. He wants to tell them what’s really in their stash. “If you’re doing dope,” he says to one client, “we’ll give you a test strip so you can test and see if there’s fentanyl.” (Harris, 5/16)

Modern Healthcare: IBM Watson Health, MAP Health Management Join Forces On Addiction Treatment 
IBM Watson Health and MAP Health Management, a population health software maker, have teamed up to create new software that uses cognitive computing to treat long-term addiction and substance abuse. The new version of the MAP Recovery Network platform is driven by IBM’s Watson technology, which adds cognitive computing and machine learning to the population health software, allowing it to process unstructured data and to learn as it goes, thereby becoming more and more accurate. (Arndt, 5/16)

And in other news on the opioid epidemic —

Stat: After An Officer’s Accidental Overdose, A Police Chief Calls For Stronger Laws
After one of his officers accidentally overdosed during a search and seizure, the police chief of the opioid-besieged town of East Liverpool, Ohio, is calling for stronger penalties for transporting fentanyl and related drugs, and his officers are no longer field testing what they find while on duty. “It’s just too dangerous,” East Liverpool Police Chief John Lane told STAT on Tuesday. “It’s not worth the risk.” It’s been eight months since the town’s opioid crisis made national news, and Lane said very little has changed. Patrolman Chris Green collapsed on Friday after brushing a small amount of white powder from his shirt hours after a field test. (Ross, 5/16)

NPR: HHS Secretary Contradicted Scientific Evidence On Opioid Treatment
Addiction experts are up in arms over remarks by Health and Human Services Secretary Tom Price in which he referred to medication-assisted treatment for addiction as “substituting one opioid for another.” Nearly 700 researchers and practitioners sent a letter Monday communicating their criticisms to Price and urging him to “set the record straight.” (Harper, 5/16)

Roll Call: Senators Push Back On Trump Drug Abuse Actions
As a presidential candidate, Donald Trump pledged to tackle prescription drug abuse and the flow of illegal drugs into the country. But his White House efforts are off to a rocky start so far. … while Republican members continue to hold out hope Trump will keep his pledge to combat the opioid epidemic, a number of GOP senators are becoming more vocal in their criticism of his early actions on the issue. “I am alarmed at the defunding [of ONDCP] because that, to me, signals less emphasis on what I think is a deep problem,” West Virginia Sen. Shelley Moore Capito said. “I think we need an overarching policy and I would like to see it remain in the White House where it would get the ultimate attention.” (Williams, 5/16)

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Drugmakers Deploy Lobbyists As Battle Over High Prices Moves To State Level

May 17 2017

News outlets report on stories related to pharmaceutical pricing.

The Wall Street Journal: As States Wage Battles On High Drug Prices, Drugmakers Fight Back
Amid increasing calls for curbs on U.S. drug pricing, some of the most aggressive legislative action is happening at the state level—and industry lobbyists are fanning out to fight back. Lawmakers have introduced bills in about 30 state legislatures this year, seeking to regulate drug prices; require manufacturers to justify price increases; or to form purchasing groups with other states to negotiate lower prices, according to the National Academy for State Health Policy, a nonprofit policy group that has drafted model drug-pricing bills for state use. (Loftus, 5/17)

Stat: Can Importing Drugs Bring Down Drug Prices For Americans?
Poll after poll shows Americans are increasingly concerned about the price of prescription drugs. With each new survey, the debate about importing drugs from Canada seems to gain steam. At least four different bills have been introduced this year in Congress, and while the fate of legislation to replace the Affordable Care Act dominates the agenda on Capitol Hill, buying drugs across the border is an idea that won’t go away. (Sheridan, 5/11)

Stat: The 5 Most Overpaid Pharma CEOs In The World
There’s no shortage of ways to rank pharma CEOs: Drug sales. Corporate profits. Even haircuts. Here at STAT, we chose to look at it from a shareholder’s perspective. We calculated shareholder returns over the past three years at the 25 biggest drug companies in the world. Then we compared that with CEO compensation. Five outliers popped out: chief executives who got raises well out of step with what they delivered to investors. (Garde, 5/16)

FiercePharma: The Top 15 Generic Drugmakers By 2016 Revenue
Branded drugmakers weren’t the only ones working through a tumultuous 2016. Generics companies faced pricing pressure, too. And while branded companies suffer pricing pain on costly cutting-edge therapies, generics outfits feel the pinch with already-thin margins, making pressure all the more agonizing.How is the industry responding? By consolidating and hoping to save money, for one. Take a look at FiercePharma’s 2014 ranking, and it’s clear that some companies have made leaps too big to depend on organic growth alone. (Sagonowsky, 5/16)

Stat: Researchers Urge FDA To Lower The Bar On Alzheimer’S Drug Approvals
Could changing up regulatory requirements for Alzheimer’s drugs help give desperate patients new options for treatment? A group of researchers and patient advocates think so. They authored a paper that argues that the Food and Drug Administration should evaluate Alzheimer’s drugs for efficacy in either cognition or function — but not both. Efficacy and cognition are the main endpoints measured in Alzheimer’s disease. The hallmark of cognitive impairment is memory loss, while functional impairment involves losing the ability to perform tasks of daily living — from reading to going to the bathroom to getting dressed in the morning. Currently, FDA expects drugs to improve both cognition and function. (Keshavan, 5/15)

NBC News: Patients Beg For Pricey Drugs On Facebook Black Market
Desperate patients are swapping pricey pharmaceutical drugs on Facebook. Doctors say it’s dangerous. But when you need a drug every day to survive, you’re going to find a way to get it. It shouldn’t be that surprising. You can buy, sell or trade almost anything on Facebook, from designer sneakers to unwanted fishing boats to antique medical cots. Now, even life-saving insulin. (Popken, 5/11)

Kansas City Star: 60,000 Older Missourians To Lose Prescription Drug Aid 
Roughly 60,000 older Missourians will lose state aid to help them pay for prescription drugs starting in July. But lawmakers hope the cut won’t be permanent. Seniors who earn less than 85 percent of the federal poverty level, or roughly $10,000 a year for an individual, qualify for both Medicaid and Medicare. (Hancock, 5/11)

Stat: Lower FDA Standards Could Have Cost Billions For Failed Alzheimer’S Drug
Priced at $10,000 per person, the cost totaled roughly $10 billion during that time. To some, this would appear to be a bargain for a drug that combats a pernicious disease, yes? But what if it turns out the drug later failed yet another trial and patients with a mild form of Alzheimer’s weren’t helped, after all? The money —much of it spent by Medicare — would have been wasted and patients’ hopes dashed. (Silverman, 5/12)

FiercePharma: EU Officials Question ‘Unjustified’ Cancer Drug Pricing From Aspen
Upon receiving information that Aspen Pharmacare has taken steep price increases on lifesaving cancer meds in Europe and threatened to pull its products in order to get the hikes through, EU antitrust regulators have pledged to take a close look at the South African drugmaker’s business practices. Europe’s competition authority opened an investigation into Aspen on Monday, seeking to learn whether the company “abused a dominant market position in breach of EU antitrust rules,” according to a release. It noted this is the first time it has looked into excessive pricing in pharmaceuticals. (Sagonowsky, 5/15)

Stat: What Strike? FDA Sees Through Delaying Tactic
That is the lesson that the management at Vikshara Trading & Investments learned the hard way when the company tried to forestall an agency inspection last year by insisting that its workers were on strike and its plant in Gujarat, India, was inaccessible. But were they really on strike?…A year ago, the FDA scheduled an inspection, but last June, Vikshara said employees went on strike and blocked the entrance to the facility. As a result, the agency canceled a planned June 27 inspection. Last July, Vikshara said the strike was ongoing and, in August, provided purported evidence, such as employee resignation letters and a photograph of striking employees blocking the entrance. (Silverman, 5/9)

Stat: Biosimilar Company Uses Citizen’s Petition In A New Way
An aspiring biosimilar manufacturer is employing a citizen’s petition in a novel way in hopes of setting regulatory approval standards. In a May 3 letter, Apotex asked the Food and Drug Administration to set a specific requirement for other biosimilar companies that, depending upon what the agency decides, may serve as a barrier to regulatory approval of their treatments. (Silverman, 5/11)

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Do Best-Selling Drugs That Calm Stomachs Damage Kidneys? The Answer’s Unclear.

Sherry Herman was watching TV when the ad popped up on the screen. Lawyers were seeking clients for a class-action lawsuit, suggesting a link between certain heartburn pills and chronic kidney disease — including the beige capsules she’d taken for years.

“And I was like, ‘Oh my gosh, yeah — me!’” said Herman, a 50-year-old homemaker in Dayton, Ohio.

She’d been on a drug known as a proton pump inhibitor (PPI) for acid reflux disease since 2004. Thinking it was a “very safe drug,” she had taken the prescription pills for a decade, even though the label recommended four to eight weeks.

Then, in 2014, she was diagnosed with chronic kidney disease. “It came as a huge shock because no one in my family has it,” she said. She had no risk factors for the condition, such as poorly controlled high blood pressure.

A growing body of research suggests the blockbuster drug that helped her stomach may have left her — and a number of patients like her — with a potentially much more serious medical problem.

Recent research has linked the proton pump inhibitors, or PPIs, to serious side effects, including chronic kidney disease, and recently filed lawsuits allege, among other things, that the manufacturers should have known of their potential harms. The risk of chronic kidney disease is as much as 50 percent higher in people who’ve taken the drug compared with those who’ve not — although no causative link has been proven and manufacturers insist they are safe.

In light of recent studies and lawsuits, Herman wonders whether her heartburn medication is to blame for her chronic kidney disease. (Ty Greenlees for KHN)

The drugmakers strongly defend their products. AstraZeneca is “confident in the safety and efficacy of Nexium and Prilosec when used in accordance with the FDA approved label,” said spokeswoman Abby Bozarth, in an emailed statement.

Proton pump inhibitors, such as Nexium and Prilosec, among other brands, are blockbusters in the U.S. With 15.3 million prescriptions written in 2013 alone, they are considered highly effective at relieving gastroesophageal acid reflux as well as preventing and treating ulcers. Widely advertised, they are frequently prescribed for even minor indigestion, with serial renewals leading to chronic use — even though they were approved as safe by the Food and Drug Administration only for short-term treatment.

Studies have shown that PPIs could be prescribed unnecessarily as much as two-thirds of the time. And it’s not uncommon for patients to take the heartburn pills for years, even though their labels recommend limiting treatment to a few weeks or a few months. The result has been sales worth many billions of dollars a year for pharmaceutical companies, according to commercial intelligence firm EvaluatePharma.

Tens of millions of Americans take the drugs, whether in prescription or over-the-counter formulation. Given those numbers, critics say that even the suggestion of risk is a problem for a drug that is over-prescribed by doctors and used inappropriately by patients.

“When patients complain of gastrointestinal distress, it’s easy to just prescribe a PPI,” said Steven Chen, a doctor of pharmacy and associate dean for clinical affairs at the University of Southern California School of Pharmacy. Once patients start taking the drug, it’s easy to “forget that they may not need to be on it that long.”

What’s more, fueling debate and the emerging lawsuits is FDA’s patchwork system that experts say is poorly equipped to track adverse events — even when they involve drugs like the PPIs that have been used by many millions of American over three decades. With no universally mandatory system to track the use of drugs and their side effects over time, the U.S. instead relies on manufacturers, doctors and patients to convey suspicion of harm as part of a mostly voluntary system.

Dr. Sammy Almashat, of the research group Public Citizen, said only a small fraction of side effects are reported to the FDA and the database is “underutilized” by researchers and regulators. “We do what we can in this country with what we’re given. It’s not much.”

Herman reviews her notes from past doctor appointments, including her creatinine levels and glomerular filtration rate, which help indicate how well her kidneys are functioning. (Ty Greenlees for KHN)

A Godsend With An Uncertain Risk-Benefit Ratio

PPIs, which came to market in 1990, were a godsend for many patients.

When Paula Cox, 69, of Bainbridge Island, Wash., first tried Prilosec, it was like “heaven” because the medication prevented the “extremely intense” heartburn symptoms that had plagued her since the 1980s. She’s been on the pills for over 14 years, and although she hasn’t suffered any of the major health problems linked to them by research, she’d like to stop her daily regimen, especially in light of news about possible side effects. But Prilosec is “the only thing that’s working,” Cox said.

PPIs work by blocking an enzyme in the cells that line the stomach, preventing them from secreting acid. They are the leading proven therapy for upper-gastrointestinal disorders, available by prescription and, in lower doses, over the counter.

Chronic kidney disease damages the organs over time, rendering the body unable to eliminate wastes from the blood and excrete them through urine. The disease can be life-threatening, and patients may need dialysis or a kidney transplant to survive.

Two huge studies, including data from hundreds of thousands of patients taking prescription PPIs, raised concerns about a link between the pills and kidney failure in 2016. (Over-the-counter medications were not studied because of the difficulty of collecting data.)

Both studies, one published in JAMA Internal Medicine and the other in the Journal of the American Society of Nephrology, found that those taking prescription PPIs were more likely to develop kidney disease than patients taking another class of drugs known as H2 blockers, which treat similar digestive symptoms. The research showed that patients taking the PPIs twice a day were more likely to develop the disease, and that the kidney risk associated with the pills increased over time for the first two years. Each study had the same limitation: It was “observational,” meaning it was not a gold-standard clinical trial that could prove cause and effect. Based on a collection of health records, the research could identify only association — i.e., whether patients taking PPIs were more likely to develop chronic kidney disease than patients who weren’t on the drugs.

“Although they’re seen as pretty benign medicines, [they] may not be,” said Johns Hopkins nephrologist Dr. Morgan Grams, noting that the drugs might cause damage by lowering magnesium levels or triggering an immune reaction.

But others, like Dr. John Danziger, a nephrologist at Beth Israel Deaconess Medical Center and a professor at Harvard Medical School, are skeptical about the association noting that PPIs have also been tied to a number of other risks, including a rare type of infectious diarrheas, pneumonia and bone fracture.

“Is it that the PPI is really causing all these different things or is it the fact that sicker people get PPIs and sicker people have bad outcomes?” Danziger said. “I think it’s probably the latter.”

The experience of Harry Mason, 69, shows how difficult it is to sort out the question of cause and effect, and the legal quandaries that arise from that.

The Vietnam veteran from western Illinois “suffered kidney failure requiring a kidney transplant while taking Nexium as prescribed in 2006,” according to a lawsuit he filed against AstraZeneca in May 2016.

But he has also had congestive heart failure, diabetes and an enlarged prostate, and he takes medication to control his cholesterol. While a law firm initially advised him to sue, it later dropped the case because it determined his kidneys were likely harmed by something else, said Mason. AstraZeneca had filed a request to dismiss the case, claiming Mason’s “sweeping accusations” weren’t backed up with facts.

A Legion Of Lawsuits

Attorney Paul Pennock said his New York-based firm, Weitz & Luxenberg, is investigating roughly 3,500 cases involving kidney harm allegedly from heartburn drugs, although he acknowledges not all will merit a lawsuit. Nationwide, Pennock said, about 122 suits have been filed, against AstraZeneca and other PPI makers such as Takeda Pharmaceuticals, Pfizer and Procter & Gamble, which produces over-the-counter Prilosec.

Allyanna Anglim of Pfizer media relations says legal actions against the company are “without merit” and its PPI labels “have always provided accurate information on their benefits and risks.”

Why, after all these years, aren’t the risks better known?

FDA spokeswoman Andrea Fischer said data linking chronic kidney disease and PPIs “are limited” but that the agency continues to monitor the potential risks. Both medical researchers and the Government Accountability Office have concluded that its methods for doing so are inadequate.

Reports to the FDA mentioning PPIs in relation to a range of kidney problems trickled in and reached a few dozen per year by the late 1990s, according to a Kaiser Health News analysis of the federal Adverse Event Reporting System. The number of kidney-related reports naming PPIs as a primary suspect slowly crept up over the years and then doubled to more than 400 in 2016, the year the two prominent studies were published.

Doctors, consumers and manufacturers submit the reports mostly voluntarily, and they are not verified.

The full side-effects profile of the pills only slowly becomes apparent over the years. Based on dozens of studies and cases, the FDA began requiring PPI labels to include the risk of bone fracture, low magnesium and infectious diarrhea from 2010 to 2012.

Through a lawsuit, the consumer advocacy group Public Citizen forced the FDA in 2014 to add acute interstitial nephritis, a kidney disorder in which structures in the kidneys become swollen, said the nonprofit’s Almashat. Public Citizen is not planning further action on PPIs in light of the two recent studies flagging chronic kidney disease, but as more research is published the organization may consider it.

Research about the potential harms of PPIs don’t mean the “sky is falling,” but doctors should have a “nuanced” conversation with patients about the risks versus benefits of the drugs, said Dr. Kenneth DeVault, a past president of the American College of Gastroenterology. He considers recent PPI research when deciding whether he should prescribe the medication, he said, as should other gastroenterologists.

Sherry Herman of Ohio has decided to keep taking her generic PPI even though she has stage 3 kidney disease, for the pain relief it gives. “It’s such a scary thing to me that I just try to block it out,” she said.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

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Report: Congressional Ethics Office Probing Rep. Chris Collins’ Aussie Investment

The Office of Congressional Ethics is examining New York Rep. Chris Collins’ role in attracting U.S. investors to an Australian biotech company in which he is the largest shareholder, The Buffalo News reported Tuesday.

The story cited unnamed sources who told the newspaper that the office began sending letters to investors seeking information about a month ago. Legally, they are not required to provide it or submit to interviews.

The ethics office investigators interviewed several investors from the Buffalo, N.Y., area on Monday and Tuesday, according to the story. Collins, a Republican who is a prominent ally of President Donald Trump’s, represents a district in the Buffalo area.

The newspaper said the probe focuses on investments in Innate Immunotherapeutics, a company whose stock Collins first bought in 2005. Others with ties to Collins — some of them campaign donors — later became investors, too. They included executives at Buffalo-area companies and institutions, such as a physician at Roswell Park Cancer Institute in Buffalo.

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Collins’ spokesman said in a statement that his boss had done nothing wrong.

“Despite the continued partisan attacks insinuating otherwise, Congressman Collins has followed all ethical guidelines related to his personal finances during his time in the House and will continue to do so,” Collins aide Michael Kracker said.

The company fell into a political controversy late last year when former congressman Tom Price — now the secretary of Health and Human Services — was identified as an investor. News reports about Collins’ and Price’s holdings in Innate raised questions about whether they benefited from legislation that could help Innate.

Price said at his confirmation hearing this year that he bought Innate stock after Collins told him about the company. He later sold the stock as he had promised, Price disclosed recently, and reportedly tripled his investment.

Public Citizen, a government watchdog group, asked the ethics office to open an investigation into Collins’ activities in February, citing a Kaiser Health News story about the congressman. The office has received at least four complaints about Collins’ involvement with Innate, The Buffalo News reported.

Sources told the newspaper that they were unsure whether the ethics probe would lead to further action. Most investigations do not, the Office of Congressional Ethics has said.

If it finds wrongdoing, the office can refer allegations to the House Committee on Ethics for potential disciplinary action.

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It’s Time To Take The Pulse Of Our Readers

Even the most exalted among us realize health care policy is complicated.
Here’s a pop quiz to see what you have learned as a regular reader of Kaiser Health News.

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

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Viewpoints: ‘Biomedical Ecosystem’ Requires Care; How Smart Phones Could Revolutionize Medical Care

A selection of public health opinions from around the country.

Boston Globe: Nurturing The Biomedical Ecosystem
There is no better example of the power of the innovation produced by this biomedical ecosystem than Massachusetts, which is the envy of the world. … But like any ecosystem — on a local or national scale — care is required. If we nurture and support it through continued NIH funding, meaningful intellectual property protections and appropriate rewards for breakthrough innovations, great things will happen for patients, the health care system and our economy. If we don’t, the opportunity in front of us to cure the next wave of serious diseases will be lost. (Jeffrey Leiden and David Torchiana, 5/16)

RealClear Health: Paging Dr. Siri
Smart-phone apps are about to revolutionize medical care. These technologies can predict when cancer patients are about to relapse, detect rare side effects of experimental drugs, and prod patients to maintain healthy behaviors. Pharmaceutical firms could temper widespread concerns about high drug prices by incorporating these technologies into treatment regimens. Doing so would unlock the full potential of existing treatments. It would result in healthier patients and lower medical spending. (Vidya Ramesh and Sandip Shah, 5/15)

The Wall Street Journal: Trump And Christie’s First Steps To Solving The Opioid Crisis
President Trump has tapped New Jersey Gov. Chris Christie to tackle America’s opioid crisis—a complicated task to say the least. Because the root cause of rising addiction and overdose is still unclear, any government response must be flexible and nuanced. The single biggest question regarding the opioid epidemic remains: Is it driven mainly by patients who become addicted to their prescriptions? Or are recreational users the underlying cause? This is difficult to figure out. Among the many heartbreaking personal anecdotes, hard data is scant and contradictory. (Josh Bloom and Alex Berezow, 5/15)

The Des Moines Register: Anti-Abortion Law Disrespects Women, Tramples On Rights
Now Iowa is left to deal with the aftermath of the 2017 legislative session. For understaffed state government, that means writing administrative rules, changing policies and enforcing new laws. State attorneys will try to muster a legal defense for Senate File 471, a morally indefensible Republican-crafted statute that imposes significant restrictions on access to abortion. (5/15)

Sacramento Bee: California Must House Its Mentally Ill 
A report by the nonpartisan Stanford Justice Advocacy Project finds that 30 percent of California state inmates receive treatment for serious mental disorders, a 150 percent increase since 2000. … Sen. Jim Beall, D-San Jose, one of the few current members of the Legislature to take an interest in the issue, is carrying Senate Bill 142 to require that judges consider a defendant’s mental health history when imposing sentences and provide counties incentives in the form of payments if they can find ways to reduce the number of mentally ill felons they send to state prison. … For the bill to work, however, there must be places to house people in need. Too few humane options exist. (5/15)

The Kansas City Star: Secondhand Smoke’s Hidden Risks For Kids
With the recent push to increase the tobacco tax in the state of Kansas by a dollar or more per pack of cigarettes, citizens should remember that this issue is not just about reducing the number of people who smoke and improving their health. It is also about the children who are involuntarily exposed to tobacco smoke. (David A. White, 5/15)

Los Angeles Times: No Sanctuary For Marijuana In California
When Californians approved Proposition 64 to legalize marijuana in California last November, it was no secret that the drug would remain illegal under federal law. But that fundamental contradiction seemed manageable at the moment …. Now, however, we have President Trump, who seems to have forgotten his laissez faire stance on marijuana, and Atty. Gen. Jeff Sessions, who comes from the “Reefer Madness” school of law enforcement. Proponents of Proposition 64 … rightly worry that the federal government may decide to crack down on cannabis operators even if they fully comply with state rules. It’s understandable that state lawmakers want to resist potential federal intervention. But a proposal to make California a so-called sanctuary state for marijuana is not the way to go. (5/16)

Stat: An End To Pandemics Is Within Reach, But We Must Redouble Efforts Now
At the end of May, World Health Organization member states will convene their annual meeting in Geneva and elect a new director-general. This leadership transition at WHO unfolds at a defining moment, when shifting demographics are forging a new global public health landscape. Competing priorities — from non-communicable diseases to universal health coverage and polio eradication — will drive the agenda. But perhaps none is more suited to the health mandate of a community of nations as the existential threat of a pandemic. When the new director-general takes the helm on July 1, at the top of his or her list should be a focused and targeted approach to ending the pandemic era. (Daniel Schar, 5/15)

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State Highlights: Blue Cross Blue Shield Of KC Asks Mo. Regulators For Filing Deadline ‘Flexibility’; Harken Health Shuts Down In Ill., Ga.

Media outlets report on news from Missouri, Illinois, Georgia, Wisconsin, Texas, Kansas, California, Louisiana, Minnesota, Massachusetts, Ohio and Florida.

Kansas City Star: Blue Cross Blue Shield Of KC Requests Obamacare Filing Flexibility 
A spokeswoman for Blue Cross Blue Shield of Kansas City said Monday the company has “requested flexibility” from the Kansas Insurance Department on a deadline to file plans to sell on the Affordable Care Act exchange next year. The company’s decision not to file by Monday’s midnight deadline casts uncertainty on 2018 “Obamacare” coverage options for people in two eastern Kansas counties and 30 western Missouri counties. (Marso, 5/15)

Chicago Tribune: Insurer Harken Health Shutting Doors
Insurer Harken Health is closing its doors in Illinois and Georgia, ending an experiment to combine health insurance and care. The insurer, which operates five health clinics in Chicago, Skokie and Des Plaines, began selling plans in Illinois and Georgia in 2015. A subsidiary of UnitedHealthcare, Harken offered its members unlimited free doctor visits at its health centers, which also offer wellness programs, such as acupuncture, yoga and meditation. (Schencker, 5/15)

Milwaukee Journal Sentinel: Doctors’ Fees In Milwaukee Area 41% Higher Than National Average, Study Says
By one important measure, doctors in the Milwaukee area are paid 41% more than the estimated national average for the services they provide, a new study says. The same was true across much of eastern Wisconsin: Fees paid to doctors by employers’ health plans in the Sheboygan area were 63% above the national average, ranking them the highest among the 61 markets included in the study by the Health Care Cost Institute. (Boulton, 5/15)

Stat: Texas Leans Into Unproven Stem Cell Treatments, To The Dismay Of Scientists
HB 810 is one of three bills being considered in the Texas Legislature that would make it easier for sick people to try unproven therapies at their own risk, and cost. Springer’s bill would allow clinics offering unapproved stem cell treatments to treat patients in Texas. HB 661 would permit people with chronic illness to get therapies in early-stage clinical trials — not just terminally ill patients, as the state’s current “right-to-try” law does. And HB 3236 would allow companies to charge patients for unproven therapies. (Joseph, 5/16)

St. Louis Public Radio: Missouri Budget Cuts Family Planning Funds For Uninsured Women, Restricts Provider Choice
Missouri is poised to strip additional providers from a state-run program that provides family planning services for uninsured women. The budget lawmakers are sending to Gov. Eric Greitens contains a provision that prohibits hospitals and clinics from participating in the Missouri Women’s State-Funded Health Services Program if the organization also provides abortion services, as defined by a state law for sexual education in schools. (Bouscaren, 5/15)

KCUR: As Kansas Foster Care System Sets Records, Advocates Call For More Family Services
Family preservation services — including training for parents, referrals for food assistance and other support — are designed to promote that healing. According to DCF, most families that receive preservation services succeed: About 82 percent of families who participated statewide were able to avoid having a child removed from the home. But many at-risk families don’t receive preservation services, and some people who have worked for years in the social services system say the lack of help is pushing more children into foster care. (Wingerter, 5/15)

Modern Healthcare: Kaiser Hits $1 Billion Operating Gain In Q1 
Kaiser Permanente Monday posted a record $1 billion operating gain in its first quarter, just days after holding its largest-ever bond offering. The Oakland, Calif.-based health plan and hospital giant eclipsed the $1 billion barrier on revenue of $18.1 billion. That compared with an operating gain of $701 million on revenue of $16.3 billion in the year-earlier quarter. The 5.5% operating margin in the first quarter beat the strong 4.3% operating margin from the year-earlier period. (Barkholz, 5/15)

New Orleans Times-Picayune: This Man Went To An In-Network ER In New Orleans. Why Did He Get A $1,360 Doctor’s Bill? 
What happened to [Steve] Fair is known as “balance billing,” an increasingly common practice in our nation’s convoluted health care system. Rather than staff their own ERs, many hospitals around the country hire physicians employed by staffing companies like Schumacher, experts say. Insurance companies then pay these contract physicians a pre-negotiated rate for their hospital services. Because they have no contract with the insurer, however, these doctors don’t have to accept the negotiated rate as their total fee. Instead, they go after patients for the full amount. Since the prices of most medical procedures are hidden from view, doctors have no incentive to lower them.  (Lipinski, 5/15)

Minnesota Public Radio: Minnesota Measles Outbreak Spreads To Le Sueur County
Minnesota health officials say the number of measles cases rose by four over the weekend and the highly contagious disease has now moved into a southern Minnesota county. Two new cases of measles were discovered in Le Sueur County, the Minnesota Department of Health reported Monday in its daily measles tally. (Zdechlik, 5/15)

Boston Globe: Disabled Homeless Girl At Center Of Fight Over Housing Policy 
Cristal is a 2-year-old girl born with spina bifida, a condition that has required multiple surgeries and left her with limited sensation in her lower extremities.Over the past month, she has endured long, uncomfortable commutes between the Lowell homeless shelter where the state is housing her family and frequent appointments with her medical providers in Boston, according to recent court filings… The case illustrates the human dimension of one of thorniest entitlement program debates facing Massachusetts as Baker works to reduce the number of homeless families in motels at state expense to zero. (Miller, 5/15)

California Healthline: California Bill Would Protect Patients’ Access To Their Chosen Family Planning Providers
As national Republican leaders continue to try to defund Planned Parenthood, California and other states are considering steps to protect access to family planning services. California legislators have introduced a bill that would lock into state law a federal rule that allows Medicaid patients to see family planning providers of their choice. The bill is designed to preserve Californians’ access to Planned Parenthood and other reproductive health clinics should federal officials drop the rule. (5/16)

Boston Globe: Walmart Settles Discrimination Lawsuit On Spousal Benefits For Same-Sex Couples 
A federal judge approved a $7.5 million settlement Monday in a class-action lawsuit against Walmart that found the retail giant violated gender-discrimination laws for years when it denied spousal benefits to same-sex couples. The lawsuit was filed on behalf of a New Bedford woman by the advocacy group GLAD. The settlement was based in large part on US Supreme Court rulings affirming the rights of same-sex couples to marry and, in an earlier ruling, their entitlement to federal spousal benefits. (Valencia, 5/15)

Cincinnati Enquirer: Transgender Lawsuit Settled, Cincinnati Public Library Now Covers Transgender Surgery
Rachel Dovel didn’t mean to become a crusader for transgender rights. But the library employee found herself cast in that role last year when the library’s health insurance refused to pay for her gender confirmation surgery – and the library’s board wouldn’t budge. She underwent surgery in December – and Monday she and her legal team announced she settled a lawsuit against the Public Library of Cincinnati and Hamilton County. (Coolidge, 5/15)

Boston Globe: Newburyport Hospital Joining Beth Israel Deaconess-Lahey Merger
Beth Israel Deaconess Medical Center and Lahey Health have enlisted another hospital in their campaign to create a stronger rival to Partners HealthCare, the market leader. Anna Jaques Hospital of Newburyport said Monday that it plans to join the Beth Israel Deaconess-Lahey merger, which was announced in January after years of on-again, off-again talks. (Dayal McCluskey, 5/15)

Boston Globe: Spaulding To Cut 35 Jobs
Spaulding Rehabilitation Network, part of the Partners HealthCare network, is slashing 35 jobs to cut costs. The cuts come as the entire Partners network embarks on a three-year initiative to rein in spending and become more efficient. (Dayal McCluskey, 5/15)

Health News Florida: Orlando Air Quality Prompts Warning For People With Asthma
The Environmental Protection Agency is warning that the Orlando area’s air quality is not healthy for sensitive groups. That means people with asthma and lung disease, as well as the elderly and children, should cut down on prolonged or heavy exercise outside. They recommend keeping asthma medication nearby. (Aboraya, 5/15)

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With Opioid Crisis Continuing To Escalate Cherokee Nation Takes Drug Distributors To Court

This first-of-its-kind lawsuit takes on companies such as CVS Health, Walgreens and Wal-Mart and alleges that they did not properly monitor prescription drugs. Meanwhile, New York health officials have issued new warnings for the western part of the state regarding a weekend spike in overdose deaths associated with various drug combinations of fentanyl.

WBUR: Cherokee Nation Takes Drug Distributors To Tribal Court
As the nation’s opioid addiction and overdose crisis grows, the Cherokee Nation is launching the first-ever lawsuit against drug distributors that will be litigated in a tribal court. The suit takes on companies including pharmacies CVS Health, Walgreens and Wal-Mart, and drug distributors Cardinal Health, Inc. and McKesson Corporation, alleging that they didn’t properly monitor prescription painkillers, which eventually “flooded” every Cherokee county. (Young, 5/15)

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Experts Race To Patch Vulnerable Health Networks Following Massive International Cyberattack

Some medical devices were infected, but primarily the latest attack reinforced the need to correct any weaknesses in medical cybersecurity systems.

The Wall Street Journal: International Cyberattack Affects Some Corners Of U.S. Health Care, Including Medical Devices
The international cyberattack that swept the globe has had some impact on the U.S. health-care system, as hospital systems scramble to prevent its further spread. On a conference call with health-care organizations Monday, U.S. federal officials said several medical devices had been infected with the ransomware that proliferated across dozens of countries, but declined to identify the devices, according to a person on the call. The Department of Health and Human Services, which organized the call, referred questions to Homeland Security, which didn’t immediately respond to a request for comment. (Evans, 5/15)

Los Angeles Times: WannaCry Cyberattack: When A Hack Shuts Down A Hospital, Who’s To Blame?
It’s one thing to fall victim to a burglar. It’s another to realize the thief got in because you left the front door wide open. The distinction could lead to difficult legal battles for organizations affected by the WannaCry cyberattack, which crippled an estimated 300,000 of the 2 billion Windows computers worldwide in recent days, slowing factories, canceling surgeries, eating homework assignments and shuttering gas stations. (Dave and Peltz, 5/15)

In other health IT news —

Kansas City Star: Children’s Mercy App Helps With Pediatric Decisions
Children’s Mercy Hospital has teamed with a local tech company to develop a smartphone app that can help doctors and nurses spot the scary cases. Russell McCulloh, an infectious disease specialist at the hospital, presented the CMPeDS: Pediatric Decision Support app to an international audience last week at the Pediatric Academic Societies Meeting in San Francisco. (Marso, 5/15)

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Drugmakers Would Be Required To Notify HHS, Justify Price Hikes Under New Bill

The companies would have to provide manufacturing, R&D, marketing costs, as well as net profits associated with the drugs. In other pharmaceutical news, consolidation and how it’s led to higher drug prices; direct-to-consumer ads and their role in pushing drugs; and what happens when a patient’s body turns against the drugs trying to save them.

Stat: Bipartisan Bill Will Be Reintroduced To Make Pharma Justify Price Hikes
A bipartisan group of lawmakers will re-introduce a bill on Tuesday that would require drug makers to justify their pricing and provide a breakdown of their expenses before raising prices on some medicines. Under the Fair Drug Pricing Act, companies will have to notify the US Department of Health and Human Services and submit a report 30 days before they increase the price of certain drugs that cost at least $100 by more than 10 percent in one year, or 25 percent over three years. The bill is being co-sponsored by Senator Tammy Baldwin (D-Wis.), Senator John McCain (R-Ariz.), and US Representative Jan Schakowsky (D-Ill.) (Silverman, 5/15)

Modern Healthcare: Consolidation Spurs Drug Price Spikes 
More consolidation among healthcare distributors and pharmacy benefit managers has led to higher drug prices, according to a new article. The major players in both the distribution market and the PBM sector dominate their markets, the article published Monday in JAMA said. As the firms grew, prices for prescription drugs swelled, the article found. (Kacik, 5/15)

Kaiser Health News: Overwrought Marketing? Ads, Not Research, Create Some Pharma Best-Sellers
An overhead light drawing attention to his face, actor Danny Glover starts to cry, dropping his head into one hand — then, he abruptly switches over to deep belly laughs, before resuming a straight face. “When I act, if I do this it’s totally in my control,” he says, getting to the point: “But for someone with pseudobulbar affect, choosing to cry or laugh may not be your decision. ”The 60-second TV advertisement, which ran widely late last year, concerns a neurological condition known by the acronym PBA, characterized by inappropriate, uncontrolled outbursts of laughing or crying. (Appleby, 5/16)

The New York Times: When The Immune System Thwarts Lifesaving Drugs
The miracle treatment that should have saved Becka Boscarino’s baby boy almost killed him. Doctors diagnosed her newborn son, Magglio, with Pompe disease, a rare and deadly genetic disorder that leads to a buildup of glycogen in the body. Left untreated, the baby would probably die before his first birthday. (Kolata, 5/15)

Meanwhile, Politico investigates lawmakers’ investments in a certain biotech company that was caught up in the controversy surrounding Health and Human Services Secretary Tom Price’s nomination —

Politico: Reckless Stock Trading Leaves Congress Rife With Conflicts
Even a looming scandal wouldn’t deter some of Congress’ most eager stock traders. Rep. Tom Price (R-Ga.), President Donald Trump’s nominee to be Health and Human Services secretary, was under siege, the harsh lights of a Senate hearing upon him. News reports showed he had bought shares in a tiny biotechnology company while sitting on committees that could influence the firm’s prospects. A colleague, Rep. Chris Collins (R-N.Y.), had tipped him off to the investment. (Severns, 5/14)

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For Medicaid Enrollees In Maine, Concerns Grow About Possible Cuts In Funding

Families that depend on the federal-state health care program for low-income residents fear that changes championed by congressional Republicans could undermine coverage, especially for people with disabilities and seniors who need long-term care. Also, Illinois officials are preparing to shake up which companies provide managed care services for the state’s Medicaid program.

Maine Public: Already Financially Stressed, Maine Caregivers Fear Medicaid Cuts In AHCA
Under the Republican-backed health care plan passed by the U.S. House earlier this month, the federal Medicaid program would undergo a major overhaul. States would receive a fixed amount of money for the program, versus the open-ended federal support they now get. Supporters of the American Health Care Act say the change would control spending and give states more flexibility. But opponents argue that it will result in cuts to care. In terms of sheer numbers, low-income children and adults account for most of the people enrolled in Medicaid. But that’s not where most of the program’s costs go to — they go to people like Evan Klane of Fairfield. … When Evan was born 26 years ago, he experienced birth trauma. (Wight, 5/15)

Chicago Tribune: 4 Insurers Out Of Running For Rauner’s Medicaid Overhaul 
Illinois Medicaid beneficiaries are about to see a major shake-up of the program, with several insurers now out of the running to be part of Gov. Bruce Rauner’s overhaul plan. On Monday, the state released a list of insurers that responded to a request for proposals to be part of Rauner’s re-imagined Medicaid managed care program. In Medicaid managed care, private insurers administer Medicaid benefits, whereas the state administers benefits in traditional Medicaid. (Schencker, 5/15)

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Former Insurance Executive Details How Companies ‘Rigged’ Medicare Payments

In an interview with The New York Times, former UnitedHealthcare official Benjamin Poehling talks about his allegations that Medicare Advantage plans would list patients as very sick to get better federal payments. In other Medicare news, some groups representing health care providers are asking federal officials to give more consideration to the process of removing Social Security numbers from Medicare ID cards and John Oliver uses his show to skewer a dialysis provider.

The New York Times: A Whistle-Blower Tells Of Health Insurers Bilking Medicare
When Medicare was facing an impossible $13 trillion funding gap, Congress opted for a bold fix: It handed over part of the program to insurance companies, expecting them to provide better care at a lower cost. The new program was named Medicare Advantage. Nearly 15 years later, a third of all Americans who receive some form of Medicare have chosen the insurer-provided version, which, by most accounts, has been a success. But now a whistle-blower, a former well-placed official at UnitedHealth Group, asserts that the big insurance companies have been systematically bilking Medicare Advantage for years, reaping billions of taxpayer dollars from the program by gaming the payment system. (Walsh, 5/15)

Modern Healthcare: Medicare ID Overhaul Sparks Fears Of Patients Being Denied Care
Providers warned the CMS on Thursday that its plan to remove Social Security numbers from Medicare ID cards could cause patients to be denied care. The American Medical Association, American Academy of Family Physicians and several other provider groups on Thursday called on the CMS to undergo a formal rulemaking process before changing Medicare ID cards so providers can weigh in on the transition plan. (Dickson, 5/15)

Stat: John Oliver Riffs On Dialysis Controversies On ‘Last Week Tonight’
After imploring viewers to not press the “Dear God Literally Anything Else” button on their remotes, comedian John Oliver devoted most of Sunday’s “Last Week Tonight” to the for-profit dialysis industry. The segment focused on one of the country’s largest providers, DaVita, which has settled lawsuits about kickbacks to physicians, Medicare billing discrepancies, and the overuse of a medication. (Oliver also spends some time ruminating about DaVita CEO Kent Thiry’s personal eccentricities, such as making dramatic entrances riding a bicycle or horse while wearing a medieval costume.) (Sheridan, 5/15)

The Washington Post: John Oliver On Kidney Dialysis, Taco Bell And Death
Megallan Handford, a former DaVita nurse who claims he was fired for trying to unionize its employees, told Oliver the company’s focus “was all about numbers,” sometimes at the expense of patient safety. “When I was working at DaVita, the priorities for transitioning patients was to get them on dialysis and get the next patient on as soon as possible,” Handford told Oliver. “You would have sometimes 15, maybe 25 minutes to get that next patient on the machine, so you were not properly disinfecting.” (Wang, 5/15)

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Overwrought Marketing? Ads, Not Research, Create Some Pharma Best-Sellers

An overhead light drawing attention to his face, actor Danny Glover starts to cry, dropping his head into one hand — then, he abruptly switches over to deep belly laughs, before resuming a straight face. “When I act, if I do this it’s totally in my control,” he says, getting to the point: “But for someone with pseudobulbar affect, choosing to cry or laugh may not be your decision.”

The 60-second TV advertisement, which ran widely late last year, concerns a neurological condition known by the acronym PBA, characterized by inappropriate, uncontrolled outbursts of laughing or crying. Though no drug is mentioned, the advertisement is sponsored by Avanir Pharmaceuticals, an Aliso Viejo, Calif., firm that launched Nuedexta, a pricey, brand-name medicine that targets the disorder. The ad ends by referring people to a website and toll-free number for more information.

PBA is real, mostly affecting people with neurological conditions such as multiple sclerosis, a recent stroke or Lou Gehrig’s disease. It runs the spectrum from mild to severe impairment. Because the definition of the condition is ambiguous, estimates of its prevalence vary widely. Some clinicians say PBA is relatively uncommon among their patients, while Avanir sets the number at nearly 2 million.

But the ad campaign has helped fuel the controversy over how direct-to-consumer (DTC) advertising — typified by ads that call on you to “ask your doctor” about a possible treatment — takes niche medicine and promotes its use for a broad range of patients and fosters the use of pricey prescription products when cheaper ones might suffice.

“I suspect this disease is being redefined to include overly emotional people” through advertising, said Adriane Fugh-Berman, a doctor who teaches at Georgetown University Medical Center and has investigated pharmaceutical marketing practices. The United States is one of two countries that allows advertising of prescription drugs.

Not so, says the company in a written statement outlining that its efforts are “focused on raising awareness about PBA to help people better understand the symptoms of a condition that is often overlooked, misunderstood and misdiagnosed.”

The case of Nuedexta is notable because of its price, more than $700 a month for a supply of the twice-a-day pills. The drug is a combination of two low-cost ingredients — an over-the-counter cough medicine and a generic heart drug — that, purchased separately, would run roughly $20 a month based on online cost estimators. To be sure, the comparison is apples to oranges because the dosage of the heart drug is so much lower in Nuedexta than is generally available on its own by prescription. Experts say a do-it-yourself treatment would be difficult and potentially dangerous for a consumer to try to concoct. “You’d have to get the exact doses right, and that would be tricky,” said Dr. Aiesha Ahmed, a neurologist at Penn State Hershey Medical Center who has researched the prevalence of PBA and its treatment options.

The pill doesn’t cure PBA but must be taken for the rest of a patient’s life to help reduce the laughing or crying episodes. While it’s the only Food and Drug Administration-approved drug specifically for PBA, doctors have successfully treated the condition with several alternatives costing far less — all antidepressants.

“The cost for mixing two old drugs together is unconscionable,” said Jerry Avorn, professor of medicine at Harvard Medical School and chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital.

The strategic marketing of Nuedexta is part of a broader trend in which even small pharmaceutical firms turn to high-cost airwaves to encourage use of their products. Pharmaceutical industry spending on DTC television ads has been on the rise — up 62 percent since 2012 to an estimated $6.4 billion in 2016 — even as TV advertising for other product types stayed flat, according to Kantar Media, a consulting firm that tracks multimedia advertising. By last year, drug ads were the sixth-most-common category of television advertisement — behind such things as cars and restaurants — up from 12th just five years ago.

A number of the ads, like Nuedexta’s, promote medication for relatively unusual conditions, such as a sleep disorder that affects only people who are blind; or more common conditions, such as opioid-induced constipation.

Drugmakers defend the slew of advertisements as educating patients who may not understand they have a disease or that their symptoms can be treated. The uncontrolled laughing or crying of PBA “is quite debilitating,” and Nuedexta provides substantial relief for many, said Avanir’s chief medical officer, Rick Malamut, a neurologist who recently joined the company.

Avanir declined to say how much it is spending to market Nuedexta. In justifying the price, Malamut said the company had invested hundreds of millions of dollars over 10 years on research before winning FDA approval in late 2010. More is now being spent to research whether it — or other Avanir products — could help with other neurological conditions.

“We understand the cost of medication is burdensome for people without [insurance] coverage,” he said, noting the company offers financial assistance to help such patients.

Some experts say the cost isn’t worth it: “If it were your loved one, there would probably be a value to prevent these episodes,” said Mark Pauly, a health economist at the Wharton School of the University of Pennsylvania, of the bouts of laughter and crying. But, he added: “As a hardhearted economist, I have to ask if it’s worth $700 a month.”

Still, the market has proved lucrative. Nuedexta’s sales have risen from about $37 million in 2012 to $218 million last year, according to EvaluatePharma, which tracks pharmaceutical industry pricing and markets.

Strategically Raising A Drug’s Profile

The story of Nuedexta began with Richard Smith, a neurologist whose Center for Neurologic Study was looking to develop a new treatment for Lou Gehrig’s disease, also known as ALS. In the early 2000s, Smith combined dextromethorphan — the main ingredient in cough syrups such as Robitussin — with quinidine, a drug used to treat irregular heart rhythms. The heart drug helps boost and maintain levels of the dextromethorphan in the bloodstream.

What his research team observed in preliminary studies was that patients “almost immediately started reporting an effect on PBA,” said Smith, in a telephone interview. The drug was eventually sold to Avanir. In October 2006, the FDA responded that the drug looked approvable, but investigators had “fundamental questions about both the effectiveness and safety of the product.”

The company then lowered the dose of the heart drug and performed another clinical trial, which found the drug cut in half the number of episodes of uncontrolled laughing or crying by patients who took it rather than a placebo. It was not compared with other treatments already in use and the patients in the study had either MS or ALS. It gained the FDA’s OK in late 2010.

Early on, Avanir executives were clear that they had big ambitions for the new product. In 2013, then-CEO Keith Katkin touted the drug as a “pipeline in a pill” to investors, predicting it could eventually be used in a host of conditions, from pain related to MS to agitation in patients with dementia.

During and after approval of the drug, Avanir provided educational talks for doctors aimed at raising the profile of the little-known condition and expanding the use of their drug.

It made a pitch to consumers with a 2013 ad campaign online and on television that directed viewers to a website. The campaign produced “an overwhelming” response, with “350,000 new unique visitors to the website or calls to the hotline,” Keith A. Katkin, the chief executive at the time, told investors that year.

That potential — along with other drugs in Avanir’s research labs — helped prompt Japan-based Otsuka Holdings to purchase Avanir in 2014 for $3.5 billion.

But after marketing surveys found that, still, only about one-third of potential patients and primary care doctors who treat such patients knew about PBA, Avanir decided to enlist Glover’s celebrity firepower, said Lauren D’Angelo, senior director of marketing for Avanir.

The ad featuring Glover, who doesn’t himself have PBA or any personal link to it, was on cable and national news programs sporadically in 2015 and through the end of December the following year. Glover’s publicist didn’t offer any additional comment for this story.

The ad is “non-branded” — meaning the drug is not mentioned — and therefore isn’t required by the FDA to list side effects and risks. Instead, it simply suggests patients ask their doctor about treatment or go a website to find out more about PBA. Awareness among primary care doctors rose to 72 percent and 52 percent among patients.

“It was an extremely successful campaign,” D’Angelo said. “We drove a lot of patients into doctors’ offices. The challenge was they did not ask for Nuedexta by name.” For sales, that was a problem. Instead of getting Nuedexta, some patients were incorrectly diagnosed or prescribed an antidepressant, she said.

So, in 2017, the drugmaker unveiled a new advertising campaign.

This one, which is currently running on prime-time TV, features a man inexplicably bursting into tears at a child’s birthday party. It intends to move potential customers beyond “could you have PBA?” to “ask your doctor for Nuedexta.”

“We are mimicking what we want them to do, to ask about PBA and ask about Nuedexta,” said D’Angelo.

And there’s good reason for this kind of messaging. A 2016 poll, for instance, conducted by Medscape, an online physician education website, found that 62 percent of physicians said they would or might prescribe an innocuous, even placebo treatment to a patient who didn’t need it but demanded it.

Some neurologists are fans of the drug. Kenneth Heilman, a professor of neurology at the University of Florida School of Medicine and a fellow of the American Academy of Neurology says Nuedexta “seems to control [PBA symptoms] very well.” He also doesn’t object to the advertising campaign, since it might be useful in alerting family physicians who don’t know about the disorder. (Dr. Heilman does not get any money from Avanir.)

Who Needs Nuedexta? Do You?

But PBA can be difficult to diagnose, because symptoms — crying and emotional volatility — can be attributed to other conditions, such as depression. Inappropriate laughter or tears are relatively common in dementia, referred to merely as “emotional lability” in many other countries, but may not constitute a problem that needs treatment. Many experts worry that “patient awareness” and pressing doctors to write prescriptions will lead to overuse.

On the PBA informational website, created by Avanir, the company provides a seven-question self-assessment.

The questionnaire allows a range of answers about the frequency of symptoms, with test takers able to respond never, rarely, occasionally, frequently or most of the time. Questions include: “There are times when I feel fine one minute, and then I’ll become tearful the next over something small or for no reason at all.” “I find myself crying very easily.” “There are times when I won’t be thinking of anything happy or funny at all, but will suddenly be overcome by funny or happy thoughts.” 

The scale automatically awards seven points to those who take it — even when “never” is the answer to all questions. A score of 13 is needed to indicate the potential for PBA. A consumer answering “never” to one of the questions, “rarely” to five and “occasionally” to just one scores 14.

Early on, FDA reviewers raised questions about this test and some experts continue to express similar concerns.

Diagnosing who actually has a PBA condition requires asking how it affects a person’s life, said Dr. Laura Boylan, a neurologist and adjunct professor at New York University School of Medicine who treats patients with psychiatric concerns related to neurological diseases.

While she acknowledged that PBA — which she says is more accurately called “pathologic affect” — is under-recognized by the medical profession, she worries about overprescribing: “I’m the kind of person who gets all teary at AT&T ads,” said Boylan. “I’m just like that and would not want to take a medicine to stop that. What if we start giving Nuedexta to people who are just emotional people?”

Categories: Cost and Quality, Health Industry, Pharmaceuticals

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Viewpoints: Mental Health Issues And Schools; Electronic Medical Records — The Bane Of Doctors’ Existence?

A selection of public health opinions from around the country.

Milwaukee Journal Sentinel: Mental Health Issues Becoming Pervasive For Schools
There doesn’t appear to be much in the way of precise numbers, but experts in the field say there has been an increase nationwide in mental health needs of kids. Possibly, a factor may be that we’re paying more attention and doing more about problems. The statement is frequently made that one in five school-age children have mental health issues that go beyond normal, and 80% do not get professional help. (Alan Borsuk, 5/13)

WBUR: Death By A Thousand Clicks: Leading Boston Doctors Decry Electronic Medical Records
Electronic medical records, or EMRs, were supposed to improve the quality, safety and efficiency of health care, and provide instant access to vital patient information. Instead, EMRs have become the bane of doctors and nurses everywhere. They are the medical equivalent of texting while driving, sucking the soul out of the practice of medicine while failing to improve care. To fix them, hospital administrators and clinicians need to work together to demand better products from EMR manufacturers and to urge government to relax several provisions of the HITECH Act, the 2009 law that spawned many of the problems with EMRs. (John Levinson, Bruce Price and Vikas Saini, 5/12)

Austin American-Statesman: Amid Shift In Healthcare, Nurses Remain A Constant
During our combined 74 years working in this field, medical advances have revolutionized healthcare, allowing us to provide patients with an unparalleled level of care. At the same time, these changes have presented new challenges. Regardless of what happens with our nation’s healthcare system, one thing has not changed — the steadfast support provided by nurses. (David Huffstutler and Sheila Fata, 5/15)

The Washington Post: The Simple Moment When My Autistic Son Was Treated Like Any Other Person
Unlike with most of the important changes I go through, I can pinpoint the exact moment when I stopped grieving a recent traumatic event in my son’s life. This unexpected shift happened during one of those crazy-hot days we had in April. The sky was hazy with the new green from baby leaves; the cherry trees were bursting with pink confetti. I had taken my son, Nat, home with me for the afternoon — he lives in a group home with other intellectually disabled adults. He’s supposed to stay at the home on weekends, to get used to this new house, to become independent of us. But on that sunny Sunday, I just wanted him with me. (Susan Senator, 5/12)

Stat: Failing In Public Can Teach Doctors Much-Needed Lessons In Humility
Beyond the immediate guilt of overlooking a diagnosis, I felt the shame that comes from the professional exposure of failure. I pulled aside my supervising resident physician, who was attending to the baby. We talked about my assessment of the baby and where I had fallen short. She discreetly but directly covered the consequences of moving too quickly and viewing an X-ray through the dingy overhead light of a county hospital. She recognized that I had learned from my failure the most important lesson it could have taught me. Medical internship is a remarkable time. In the course of a year, a person moves from being a brand-new medical school graduate to an almost independently thinking physician. The transformation brings a level of confidence that has you believing you can see a sliver of air between the chest and lung through the glare of a fluorescent light. (Bryan Vartabedian, 5/12)

The New York Times: Why Marathons Are More Dangerous For Nearby Residents Than Runners
At least 21 runners died in United States marathons from 2000 through 2009, most from heart problems. Seven more died a day later. Those results from a study published in 2012 sound scary, until you consider that this was out of more than 3.7 million participants. A recent study suggests that the far bigger cardiovascular danger is not faced by runners, but by older people who live in the cities where marathons are occurring and might be delayed from receiving care. (Aaron E. Carroll, 5/15)

Los Angeles Times: Make Good On A Tobacco Tax Promise To Pay Higher Rates To Medi-Cal Doctors
The $183.4-billion revised spending plan Brown unveiled Thursday restores some things that were on the chopping block in January and even finds a little more money to hand out. There’s $1.4 billion more for education above the amount required by Proposition 98. There’s $500 million more to pay child care providers. There’s about $400 million more to help counties pay for in-home health services and $6.5 million more for the California attorney general to fight President Trump. But no more for Medi-Cal providers? (5/12)

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