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Hospitals React To Proton Therapy Questions

Kaiser Health News - 5 hours 9 min ago

Three hospitals react to KHN's story on proton therapy with the statements:

Maryland Proton Treatment Center

Construction of the Maryland Proton Treatment Center is on schedule, and we plan to open our doors to patients next year.

We are very confident that the Maryland Proton Treatment Center will be successful. Our center is part of a highly developed, integrated system of hospitals in the region, all working together to ensure that cancer patients receive the care they need. This region has a very large population, and we see a real need here for this kind of innovative treatment approach. We will look to the scientific evidence, and what’s best for each particular patient, when deciding what treatments we use.

Many studies already show that proton treatment improves outcomes for different kinds of cancer. And there are more than 50 studies and trials now going on to see how best to use this treatment. This research will help us understand better how to use proton treatment most effectively. We remain confident that PBT can help many patients and are excited about how it improves patient’s lives.

It’s also important to emphasize that the proton treatment technology itself continues to improve rapidly. In particular, our center will use the latest proton approach, pencil beam scanning (PBS), which controls the radiation with extreme precision. PBS is a significant improvement over previous proton technologies.

-- William F. Regine, executive director of the Maryland Proton Treatment Center and chair of radiation oncology at the University of Maryland School of Medicine.

MedStar Georgetown University Hospital

MedStar Georgetown University Hospital‘s Lombardi Comprehensive Cancer Center is excited to be moving forward with construction of the D.C. area’s first proton therapy program.  We have purchased the MEVION S250 proton therapy system which is the world’s smallest single room proton therapy system.  The MEVION S250 gives the same precise non-invasive treatments as the larger, more expensive proton therapy systems but because of its smaller size, the MEVION S250 uses a reduced footprint, has improved reliability and offers more efficient patient access, all at lower cost to build and operate.

Adding proton therapy to our arsenal of cancer-fighting tools is a natural progression for MedStar Georgetown whose Lombardi Comprehensive Cancer Center just earned prestigious redesignation as a “comprehensive cancer center” by the National Cancer Institute (NCI) for the 21st year.  Adults and children who are patients in our well-established and renowned cancer center will benefit from the advantages of proton beam therapy over standard radiation in a cost effective way.  Proton therapy is part of the cutting-edge care patients in this region have come to expect from us.

We are confident that payors will agree that proton therapy is an important treatment option for patients suffering with many forms of cancer.

We look forward to breaking ground on the proton beam project this fall with completion expected in a little over a year.

Johns Hopkins Medicine, Sibley Memorial Hospital

While we don’t know all the issues that resulted in the closure of the Indiana University facility, some of the issues might be related to its location; within an area with a relatively small population, thus lacking a large patient population to support the center. Additionally, the Indiana facility is in need of major upgrades to allow it to deliver proton therapy to patients in the most contemporary manner, and the high costs associated with this renovation may have influenced the decisions to close the center.

This closure does not affect the Sibley Hospital proton therapy project, which is proceeding.

Categories: Health Care

Proton Center Closure Doesn't Slow New Construction

Kaiser Health News - 5 hours 9 min ago

Proton therapy has been touted as the next big thing in cancer care. The massive machines, housed in facilities the size of football fields, have been sprouting up across the country for a decade.

There are already 14 proton therapy centers in the U.S., and another dozen facilities are under construction even though each can cost $200 million to build.

In this May 2013 photo, construction continues at the Maryland Proton Treatment Center in downtown Baltimore (Photo by Jenny Gold/KHN).

But Indiana University shocked experts who watch the industry last month when it announced that it plans to close down its facility in Bloomington, as reported by Modern Healthcare.

“I never thought that in my lifetime I would see a proton center close,” says Amitabh Chandra, a professor at Harvard’s Kennedy School of Government who studies the cost of American medical care.

He’s surprised because until now, industry growth has been entirely in the other direction, even though there’s little evidence that proton therapy is better than standard radiation for all but a few very rare cancers.

“But we do know it is substantially more expensive and substantially more lucrative for physicians and providers to use this technology,” Chandra says.

In the Washington, D.C., area alone, three proton therapy centers are under construction -- one at Johns Hopkins Medicine Sibley Memorial Hospital, another at MedStar Georgetown University Hospital, and a third, the Maryland Proton Treatment Center, is slated to open at the University of Maryland in Baltimore next year.  

All three say they are continuing to build their centers, despite the news out of Bloomington. In email statements, two said that the larger population of the DC-Baltimore area can support a proton facility better than a small city like Bloomington. The third said it’s building a smaller, one room center that will be more cost effective.

Dr. Minesh Mehta, medical director of the Maryland Proton Therapy Center stands with Dr. William F. Regine, radiation oncologist at the University of Maryland and James DeFilippi, vice president of project development at the construction site of the Maryland Proton Treatment Center in this May 2013 photo (Photo by Jenny Gold/KHN).

But in Indiana, a review committee determined that it just wasn’t worth spending the money that would be necessary to update their proton facility. One reason for the closure is that insurers have been refusing to cover the treatment for common diseases such as prostate and breast cancer. Cigna, for example, only covers proton therapy for a single rare eye cancer, says Dr. David Finley, the insurer’s national medical officer.

“When it’s used, however, for all other tumors, it’s not been shown to be any more effective than other forms of radiation therapy,” says Finley.

Proton beam therapy costs three to six times as much as standard radiation therapy for illnesses like prostate cancer, according to Finley. He adds that when insurers pay for expensive care that isn’t any better than the cheaper options, it can increase the cost of everyone’s health care.

“We said if two services offer the same result and one is much more expensive than the other one, we’re only going to pay for the one that is less expensive,” Finley says.

Other major insurers have also limited what they’ll cover with proton therapy, including Aetna and Blue Shield of California.

One health care payer that has not put any restrictions on proton therapy is Medicare. And Medicare pays much more for the treatment than it pays for standard radiation therapy.

“That’s the problem with Medicare payment policy,” says Harvard’s Chandra, “it not only covers treatments that are dubious treatments, it also covers dubious treatments extremely generously.”

But the doctors and researchers involved with building new proton beam facilities don’t think the treatment is dubious. They point to proton therapy’s potential to kill cancer without damaging surrounding tissue, and they say that it’s just a matter of time before clinical trials prove that proton therapy is worth the extra money.

Categories: Health Care

An Interview with Goran Seferovic, Scholar in Residence

In Custodia Legis - 8 hours 39 min ago

This week’s interview is with Goran Seferovic who has been our scholar in residence at the Law Library of Congress this past summer. This interview is part of a series that introduces our scholars and summer interns to In Custodia Legis readers. Dr. Seferovic is a senior research associate at the University of Zurich’s Institute of Law. It has been a pleasure interacting with Dr. Seferovic and learning from him about comparative aspects of direct democracy, a subject he is currently researching extensively for a book.

Describe your background.

I studied law at the University of Zurich Switzerland, where I obtained my doctorate in 2010, for my dissertation, Das Schweizerische Bundesgericht 1848-1874: Die Bundesgerichtsbarkeit im frühen Bundesstaat, on the history of the Swiss Federal Supreme Court (1848-1874). After passing the Zurich bar exam, I joined the Institute of Law at the University of Zurich in 2012, where I am now a senior research associate.

As a senior research associate I teach Swiss constitutional law and conduct research. I am currently engaged in a comparative study of the incorporation of direct democracy into the system of representative government in Switzerland, the United States and Germany.

How would you describe your job to other people?

In addition to researching for my own study I have been working for the Global Legal Research Center which is the unit of the Law Library of Congress that provides research on foreign jurisdictions. In that position I participated in answering requests from the United States Congress, the federal government and even private persons, covering the jurisdictions of the German speaking countries (Germany, Austria and Switzerland). I also contributed some posts to the Global Legal Monitor, a Law Library of Congress online publication that covers legal developments around the world.

Why did you want to do research at the Law Library of Congress?

Since I am comparing Switzerland, the U.S. and Germany in terms of direct democracy, I was looking for a place to access American legal resources. The vast collection of the Law Library and the attractive scholarly program that it offers inspired me to apply for a position as scholar in residence at the Law Library.

What is the most interesting fact you have learned about the Law Library of Congress?

Unlike the Swiss Parliament, the United States Congress has its own library and research services. While the Swiss Parliament has a library, the majority of legislative research is done by the federal administration, which is part of the Executive Branch. This reflects a different understanding of the principle of separation of powers in the United States and Switzerland. I was surprised to learn that the Library of Congress not only provides services to Congress and other government institutions, but also provides reference services to the public for free.

What’s something most of your co-workers do not know about you?

Before my career in law, I did an apprenticeship as a lab technician and worked at the research department of a chemical company that produces flavors and fragrances for three years.

Categories: Research & Litigation

Project Louise: Can You See The Future?

CommonHealth (WBUR) - 8 hours 56 min ago

 

Slowly, slowly, I seem to be getting somewhere. I think. I’m exercising more than I was, I’m definitely eating better, and all this is contributing to a generally improved sense of well-being. On a good day, anyway. But lately more of them seem to be good.

I owe a lot of this to the exercise that I resisted for months – and I’m not talking burpees. It’s the exercise that coach Allison Rimm kept exhorting me to do, and that I finally did at her workshop this summer: creating a vision statement for my life.

I had resisted for a lot of reasons. I didn’t really see what it had to do with losing weight or working out more; it sounded abstract and a little corporate-mission-statement to me, and, I dunno, it just seemed kind of New Age cheesy, you know? More deeply, I think I subconsciously feared laying out exactly what I want my life to look like because then I’d have to examine, and own, the reasons it doesn’t look like that right now.

But I did it, and last week Allison and I finally sat down together to review it, and I have to tell you: It is a really powerful tool for creating lasting change in your life. In fact, the experience of reading it to another person was so powerful that it actually brought me to tears.

Alison asked me why I was crying – it’s not something I do around other people very much at all, thanks to my WASP genes – and at first I couldn’t even say. But I think it was for exactly the reason I’d feared: Reading my vision statement aloud let me see, in very specific terms, the life I dreamed of having, and at the same instant it led me to reflect on where I am now in relation to that ideal life.

The funny thing is, I’m not that far off. So it wasn’t exactly the gap between reality and ideal that made me cry; it was the recognition that I am, maybe for the first time ever, really stating clearly what I want in life and declaring my intention to create it. And that’s both powerful and scary.

So, even if you’re only following along with Project Louise in hopes of getting a few diet tricks or exercise routines (I promise more exercise news next week!), I urge you to take an hour or so today to write out your vision for your life. (If you want a little guidance on how to do that, Allison’s website offers plenty of help — this post is a good place to start.) And, at Allison’s insistence, I’m going to show you mine. I hesitated to do this because it seems narcissistic, but she says it’s a good model of what you should be aiming for, so here you go. Just promise me you won’t say it’s cheesy.

My vision statement:

I am living in a beautiful, peaceful and happy home, surrounded by people I love who love me too. Everything has its place, and we are free to work and play, together and alone, and to come together at day’s end to laugh, to tell stories and to nurture each other with compassion, humor and respect.

Every day, I write work that is personally meaningful and satisfying. I also work with other people on long-term projects that can only be accomplished by a team. We enjoy and respect each other’s skills and do great work together.

I am healthy, fit and full of energy and power. I move with grace, ease and strength, and I love being in a body that is healthy and full of life. I wear comfortable, beautiful clothes that are simple and elegant. Everything around me is beautiful, useful and in good repair. If I see a problem, I quickly address it to restore harmony and order.

My friendships are rich and sustaining. We take care of one another and have fun. My children love to be at home, and their friends are happy to join us there, too. I cook simple, great meals that sustain and please us all.

The steady, happy home I have created, and the rewarding work I do, give me the energy, time and resources to have wonderful adventures. I travel as often as I like, and I’m always happy to come home. I feel financially secure and can share my wealth with others. I find ways to make the world a better place.

So, that’s mine. What’s yours?

 

 

Categories: Health Care

First U.S. Case Of Ebola Diagnosed In Texas

Kaiser Health News - 12 hours 50 min ago
The patient, who reported took a Sept. 20 commercial flight from Liberia to Dallas, represents the first case in the current outbreak diagnosed outside of Africa. Public health officials were quick to quiet fears, saying the U.S. health care system is well-equipped to control the disease's spread.

The New York Times: Ebola Is Diagnosed In Texas, First Case Found In The U.S.
A man who took a commercial flight from Liberia that landed in Dallas on Sept. 20 has been found to have the Ebola virus, the Centers for Disease Control and Prevention reported on Tuesday. He is the first traveler to have brought the virus to the United States on a passenger plane and the first in whom Ebola has been diagnosed outside of Africa in the current outbreak (Grady, 9/30).

The Washington Post: First U.S. Case Of Ebola Diagnosed In Texas After Man Who Came From Liberia Falls Ill
Experts had said that such an event was increasingly likely the longer the epidemic rages in West Africa. But health officials were quick Tuesday to tamp down any hysteria, emphasizing the ways in which the U.S. medical system is well equipped to halt the spread of the disease. "We're stopping it in its tracks in this country," Thomas Frieden, director of the Centers for Disease Control and Prevention, said during a news conference Tuesday afternoon (Berman, Dennis and Izadi, 9/30).

The Wall Street Journal: First Case Of Ebola In U.S. Is Confirmed
Confirmation of the individual's illness was made by the U.S. Centers for Disease Control and Prevention and the Texas Department of State Health Services on Tuesday. Officials have now launched an intensive medical and public-health effort both to treat the sick individual and to identify and monitor those people who he may have exposed to the disease in the four days between when he first developed symptoms and when he was placed into hospital isolation. The patient isn't the first to be treated for Ebola in the U.S. But he is the first to have become ill here, raising concerns that others may get sick, too, and spark an outbreak (McKay and Campoy, 10/1).

NPR: First U.S. Case Of Ebola Confirmed In Dallas
The CDC has been planning for an Ebola case in the U.S., Frieden said. And the agency, together with state health departments, has successfully dealt with similar viruses — Lassa and Marburg — on five previous occasions. "The bottom line here is that I have no doubt that we will control this importation, or case of Ebola," he said, "so that it does not spread widely in this country" (Doucleff, 9/30).

CNN: 1st Ebola Diagnosis In The United States: Is There Reason To Worry?
But shortly after the news broke Tuesday evening, more than 50,000 tweets about Ebola flew through Twitter in a one-hour period, many of them panicked responses. Should we be concerned? The short answer: no (Yan, 10/1).

Categories: Health Care

State Highlights: Fla. Toughens Drug Compounding Laws; Conn. Hospitals Leave Largest Insurer

Kaiser Health News - 12 hours 51 min ago

A selection of health policy stories from Florida, Connecticut, New York, Michigan, Louisiana, Pennsylvania and Arkansas.

Health News Florida: Tougher Compounding Rules Finally Law
Stricter regulations in the state’s compounding pharmacy industry take effect Wednesday -- two years after a national outbreak of fungal meningitis killed 64 people, including seven in Florida. In 2012, when the New England Compounding Center outbreak happened, the state had hundreds of unregulated, non-resident facilities providing these specialized medications to Floridians. Now, the state will require permits for any pharmacies outside state boundaries that want to ship medications in state (Shedden, 9/30). 

CT Mirror: With No Deal, Hartford HealthCare’s Five Hospitals Leave Anthem’s Network
Anthem Blue Cross and Blue Shield and the parent company of five Connecticut hospitals failed to reach a new contract deal by their midnight deadline, leading Hartford Hospital and four others to exit the network of the state’s largest insurer Wednesday. That means that patients covered by Anthem will have to pay higher out-of-network rates if they seek care at one of the five hospitals owned by Hartford HealthCare -- Hartford, The William W. Backus Hospital in Norwich, MidState Medical Center in Meriden, The Hospital of Central Connecticut in Southington and New Britain, and Windham Hospital. The Institute of Living and Jefferson House are also no longer in Anthem’s network (Levin Becker, 10/1).

The New York Times: Freelancers Union To End Its Health Insurance Plans In New York
The Freelancers Union, which provides health insurance to 25,000 of its members in New York State, is ending an experiment in providing low-cost insurance to independent workers, saying the new landscape created by the federal Affordable Care Act makes it impossible to do so (Hartocollis, 9/30). 

The Washington Post: ‘Death Doctor’ Who Profited From Unnecessary Chemotherapy For Fake Cancers Could Resume Practice In 5 Years
The Michigan state house health policy committee approved the proposal to tighten the rules. Next it will go before the full house for a vote. Fata pleaded guilty in U.S. District Court earlier this month to 13 counts of health-care fraud, one count of conspiracy to pay or receive kickbacks and two counts of money laundering. He will be sentenced in February and faces up to 175 years in prison (Sullivan, 10/1).

The Associated Press: Jindal Administration Rewrites LSU Hospital Deals
Gov. Bobby Jindal's administration has renegotiated contracts for six LSU hospital privatization deals, hoping to reach a compromise with federal health officials that will keep Medicaid dollars flowing to the privatized patient services. The contracts govern the management transfer of hospitals in New Orleans, Lafayette, Bogalusa, Shreveport and Monroe and a deal that closed LSU's Lake Charles hospital and moved its inpatient services to a nearby private hospital. In May, the U.S. Centers for Medicare and Medicaid Services, or CMS, rejected financing plans for those six privatization deals and sought a rewrite of the contractual arrangements. The Jindal administration's new proposal would change the way the hospital managers are paid, establishing a new payment category with a special reimbursement rate (DeSlatte, 9/30).

Philadelphia Inquirer: IBC Discontinues Drug Plan For 9K Customers
Independence Blue Cross, the biggest health insurer in Southeastern Pennsylvania, said it was discontinuing its stand-alone prescription drug plan for people who have traditional Medicare plans or a Medicare supplement plan. IBC said the stand-alone pharmaceutical plans were not cost-effective because they served so few people. The change will affect 9,000 customers, IBC said. Total membership in IBC's Medicare Advantage and supplement plans is around 180,000, the company said. IBC still has Medicare Advantage plans with Part D drug coverage. Open enrollment for Medicare plans starts Oct. 15 and runs through Dec. 7 for coverage starting Jan. 1 (Brubaker, 9/30).

Modern Healthcare: Managed Medicaid Report Sparks Debate On State Network Adequacy Standards
Patient-rights advocates are hopeful that a recent HHS Office of the Inspector General's report will prompt the CMS to clamp down on states regarding the adequacy of managed Medicaid plan provider networks. But state officials adamantly say that more rules from Washington won't remedy such basic issues as the availability of various specialists who will accept Medicaid (Dickson, 9/29).

The New York Times: Loss Of A Democratic Power Leaves Arkansas In Doubt
Mr. Beebe’s knack for knowing what his political opponent needed to get a deal done during his long tenure in the legislature has served him well in the governor’s office. He has been able to get past the kind of partisan impasses that plague Washington. No one tries to lump Mr. Beebe with Mr. Obama, but the same cannot be said for Senator Pryor, whom Mr. Cotton called “a loyal foot soldier for Barack Obama and his agenda.” And yet Mr. Beebe worked with Republican legislators to put together, and pass with the required three-fourths majority, a private-option health insurance program that has helped more than 200,000 poor residents get covered, without the stigma of being associated with the unpopular Affordable Care Act (Chozick, 9/30).

Categories: Health Care

Doctors, Hospitals Went Digital, But Still Can't Share Records

Kaiser Health News - 12 hours 52 min ago

After spending billions to switch from paper to digital records -- much of it taxpayer subsidized through the economic stimulus package -- providers say the systems often do not share information with competitors. Meanwhile, Walgreen Co. warns that higher generic drug costs and lower reimbursement rates will cut profits and UnitedHealth buys a doctor management company.

The New York Times: Doctors Find Barriers To Sharing Digital Medical Records
Regardless of who is at fault, doctors and hospital executives across the country say they are distressed that the expensive electronic health record systems they installed in the hopes of reducing costs and improving the coordination of patient care — a major goal of the Affordable Care Act — simply do not share information with competing systems. The issue is especially critical now as many hospitals and doctors scramble to install the latest versions of their digital record systems to demonstrate to regulators starting Wednesday that they can share some patient data (Creswell, 9/30).

The Wall Street Journal: Walgreen Profit Remains Pressured By Drug Price Miscalculation
Walgreen Co. continues to pay the price for a miscalculation in the pricing of generic prescription drugs. The pharmacy chain shocked investors in August when it slashed its long-term profit forecast because it had failed to account for a rapid rise in the price of generics as it negotiated contracts to provide prescription drugs under Medicare's Part D program. On Tuesday, it warned that lower drug reimbursement rates and higher costs for generic drugs will continue to hurt profits (Ziobro and Calia, 9/30).

Reuters: UnitedHealth To Buy Doctor Management Company MedSynergies
UnitedHealth Group Inc said on Tuesday it agreed to buy MedSynergies, which manages physician practices, adding about 9,300 doctors to the hospital and health system services that its Optum technology-based business currently serves. UnitedHealth, the nation's largest health insurer, has been expanding beyond its core business of managing care for large employers and the government's Medicare and Medicaid programs through its fast-growing Optum business. Optum clients include about 4,000 hospitals such as the Kaiser Permanante and Dignity Health systems. With the acquisition it will expand its reach to manage doctors and other healthcare professionals who are part of the 4,000 systems as well as add new systems like the Catholic Health Initiatives and Texas Health Resources (9/30).

Categories: Health Care

Open Payments Database Debuts, Detailing Financial Connections Between Physicians And Drug Makers

Kaiser Health News - 12 hours 54 min ago

Consumer advocates have pushed for years for this kind of government database in an effort to protect against physicians' conflicts of interest, to safeguard patient care and to prevent unnecessary costs to public health programs.  

The New York Times: Detailing Financial Links Of Doctors And Drug Makers
Pharmaceutical and device makers paid doctors roughly $380 million in speaking and consulting fees, with some doctors reaping over half a million dollars each, during a five-month period last year, according to an analysis of federal data released Tuesday. Other doctors made millions of dollars in royalties from products they helped develop (Thomas, Armendariz and Cohen, 9/30).

Los Angeles Times: Database Shows $3.5 Billion In Industry Ties To Doctors, Hospitals
The details published Tuesday in a new government database have been sought for years by consumer advocates and lawmakers concerned that conflicts of interest in the medical profession are jeopardizing patient care and costing taxpayer-funded health programs. This first batch of payment data covers just five months of 2013, but it shows the extensive ties medical companies have forged with doctors and academic medical centers across the country. About 546,000 U.S. physicians and 1,360 teaching hospitals received some form of compensation (Terhune, Levey and Poindexter, 9/30).

Kaiser Health News: As Payments Database Debuts, Doctors Urge Caution
A federal database unveiled Tuesday afternoon details 4.4 million payments from pharmaceutical and medical technology companies to doctors and teaching hospitals, sparking concerns that consumers might misinterpret the information (Luthra, 10/1).

The Wall Street Journal: Doctors Net Billions From Drug Firms
The database revealed some eye-popping totals, such as the $122.5 million paid by Roche Holding’s Genentech unit to City of Hope medical center in Duarte, Calif., as royalties on sales of several products including blockbuster cancer treatments Herceptin and Avastin. Genentech licensed patents from City of Hope based on research the medical center conducted in the early 1980s. The company said that excluding the City of Hope royalties, about 85% of the physician payments it reported to CMS were focused on drug research. City of Hope said the royalties are allocated to the inventors and to support continuing research (Loftus, 9/30).

The Washington Post’s Wonkblog: You Can Now Track The Billions That Drug Companies Pay Doctors And Hospitals
Thanks to a bipartisan transparency initiative contained in the 2010 Affordable Care Act, the federal government has compiled a massive database of how much drug and device companies spend on consulting fees, research grants, travel, free lunches and other items worth more than $10. … The rollout of this federal database has been somewhat problematic. Records aren't complete — about 40 percent of payments have been de-identified because of problems with the data. The Centers for Medicare and Medicaid Services, the agency publishing the database, is holding back other records that are still in dispute. It's also been difficult to navigate the database this afternoon. But these payments will be published on a regular basis, and the quality and reliability of the information is expected to improve (Millman, 9/30).

The Associated Press: Drug And Device Firms Paid $3.5B To Care Providers
The massive trove of information named companies and many of the recipients. Also listed were types of payments, with details down to travel destinations. Some 546,000 clinicians and 1,360 teaching hospitals received benefits. It’s part of a new initiative called Open Payments, required by President Barack Obama’s health care law. It was intended to allow patients to easily look up their own doctors online, but that functionality isn’t fully developed. In future years, the information will cover a full 12 months and will be easier to search, officials said (9/30).

Reuters: Drug, Medical Device Companies Paid Billions To U.S. Physicians, Hospitals In 2013
U.S. doctors and teaching hospitals received $3.5 billion from pharmaceutical companies and medical device makers in the last five months of 2013, according to the most extensive data trove on such payments ever made public. The payments, disclosed by the Centers for Medicare and Medicaid Services (CMS) on Tuesday, include consulting and speaking fees, travel, meals, entertainment and research grants. The names of the recipients of about 40 percent of the payments reported by companies were withheld because CMS had concerns about data inconsistencies. Some 546,000 individual providers including physicians, dentists and osteopaths and 1,360 teaching hospitals received 4.4 million separate payments from healthcare companies. The companies were required by President Barack Obama's 2010 healthcare reform law to disclose to CMS by March all payments of $10 or more made from August to December 2013. Even payments that physicians requested be sent to a charity were required to be reported (Begley, 9/30).

NPR: Database Flaws Cloud Sunshine On Industry Payments To Doctors
But the database is also something else: a very limited window into the billions in industry spending. Before you dive in and search your doctor, here are five caveats to keep in mind (Ornstein, 9/30).

Politico: ‘Data Dump’ Reveals Billions In Pharma Payments To Docs, Hospitals
In its first hours, the website was tortuously slow. And it was incomplete: About 40 percent of the records do not identify the recipient because CMS could not match data provided by manufacturers with existing databases (Wheaton, 10/1).

Minneapolis Star-Tribune: Drug, Device Companies Paid $3.5 Billion To Doctors, Hospitals
Over protests from doctors and industry, the federal government for the first time Tuesday began to detail the billions of dollars that physicians and teaching hospitals receive from companies that sell medical equipment and drugs. The newly public data cover 4.4 million payments during the last five months of 2013 that totaled $3.5 billion. Fridley’s Medtronic Inc. appeared to be the biggest payer in Minnesota, with more than $10 million in spending just from its spinal and vascular divisions. St. Jude Medical in Little Canada spent just over $3 million (Carlson and Olson, 9/30).

The Wall Street Journal’s Pharmalot: Does The Open Payments Database ‘Distort’ What Docs Get For Research?
The database, which is being administered by the Centers for Medicare & Medicaid Services, will initially display payments made in the last five months of 2013 and will be updated going forward. Already, though, both industry and physician groups have complained that payment data lack sufficient context for the public to understand what doctors are paid. And doctors also griped they had little time to review data. Now, a group of academics from Johns Hopkins University have raised another issue. The law requires drug makers to report the total amount of “research payments” to researchers for use in clinical trials. But the academics – three bioethicists and a professor of medicine and pharmacology – argue this stipulation creates a “distorted” image of the money that doctors may receive, because it does not break out a value assigned to medicines that companies provide for the research (Silverman, 9/30).

Categories: Health Care

On The Campaign Trail, GOP Gov. Snyder Highlights Michigan's Medicaid Expansion

Kaiser Health News - 12 hours 54 min ago

Mich. Gov. Rick Snyder pointed out -- as part of his re-election bid -- that 63,000 more low-income adults have signed up for the program than was projected this year. Meanwhile, a video surfaced of Republican Bruce Rauner, who is running for governor in Illinois, telling conservative activists last year that he would have blocked Gov. Pat Quinn's expansion efforts.  

The Associated Press: Snyder Touts Medicaid Expansion In Re-election Bid
Republican Gov. Rick Snyder on Tuesday touted Michigan's successful Medicaid expansion as part of his re-election bid, saying 63,000 more low-income adults have signed up than projected this year, with 3 1/2 months left. The Republican governor said about 385,000 enrolled between April, when the Healthy Michigan program launched, and Monday. His administration had expected 322,000 signups by year's end. "At that level, we're adding over 9,000 patients a week," Snyder said at an endorsement event at the Michigan State Medical Society, an East Lansing-based professional association of physicians (Eggert, 9/30).

Chicago Sun-Times: Video Shows Rauner Opposing Medicaid Expansion Last Year
Newly surfaced video of Republican Bruce Rauner obtained by the Chicago Sun-Times shows him telling conservative activists in Lake County last year that, as governor, he would have blocked Gov. Pat Quinn’s 2013 expansion of Medicaid. Rauner’s words mark the first time he has publicly staked out that position after sidestepping the question of a possible rollback of the state’s Medicaid expansion during a joint appearance in March with U.S. Sen. Mark Kirk, R-Ill., and at a Chicago Tribune editorial board meeting a month earlier. The new disclosure comes as President Barack Obama himself comes to the Chicago area Wednesday to help raise campaign cash for Gov. Pat Quinn, who enacted the 2013 expansion that was necessitated by the president’s signature health-care reform. The video also coincides with the release Tuesday of new data by Quinn’s administration that showed 468,000 people enrolled in the expanded Medicaid program since last year, more than double original forecasts (McKinney, 9/30).

In other news related to states and Medicaid expansion --

The Associated Press: [Montana] State Panel: No Confidence In Medicaid Contract
Members of a state legislative panel said last week they don’t believe Xerox Corp. will be able to fulfill its $70 million contract to create a new computer program to manage Medicaid payments. The Legislative Finance Committee unanimously supported a no-confidence resolution, more than two months after state officials resolved a breach-of-contract issue with Xerox. The project is more than two years behind schedule (Baumann, 9/30).

Categories: Health Care

N.J. Gets New Insurer; Oregon Shifts To Healthcare.gov

Kaiser Health News - 12 hours 55 min ago

One year in, separating fact and political fiction about the Obamacare marketplaces remains difficult, reports CBS News. Other outlets report exchange developments in New Jersey, Colorado, Oregon and Minnesota.

CBS News: One Year In, Obamacare Marketplace Still Subject To Political Spin
One year after the disastrous launch of HealthCare.gov, the federal website that serves as the Obamacare hub for dozens of states, the views on the 2010 health care law are decidedly mixed. According to the CBS News/ New York Times poll released two weeks ago, 51 percent of Americans disapprove of the Affordable Care Act while 41 percent approve. The split comes down along partisan lines -- 83 percent of Republicans said they disapprove of the law, while 67 percent of Democrats approve of it (Condon, 10/1).

Asbury Park Press: Oscar To Sell Health Insurance In New Jersey
Insurance company Oscar Health Insurance said Tuesday that it will enter the New Jersey market this year, bringing with it easy-to-use technology designed to connect consumers with their doctors. The decision by the New York-based company marks the fifth insurer that will sell policies on the Obamacare exchange when open enrollment begins Nov. 15. That’s two more than last year. Oscar will join AmeriHealth NJ; Horizon Blue Cross Blue Shield of New Jersey; Health Republic Insurance of New Jersey and UnitedHealthcare on the insurance exchange that sells policies to consumers who aren’t covered by their employers. Last year, more than 160,000 New Jerseyans signed up for coverage through the federally operated exchange. Those consumers are a small fraction of the overall insurance market. But the Affordable Care Act has made them a priority since they are most at risk to go without coverage (Diamond, 9/30).

Health News Colorado: Exchange Board Approves $3.5 Million In Additional IT Expenses
Colorado exchange managers are spending an additional $3.5 million on an IT contract, but declined to say specifically why they needed to pen a deal with Oracle. CGI is the primary IT contractor for Connect for Health Colorado and the state exchange has spent millions in tax dollars building a portal where Coloradans can buy health insurance (Kerwin McCrimmon, 9/30).

Fox News: Oregon Pols Debate Over When To Pull Plug On Costly Obamacare Website
Cover Oregon was supposed to be a shining example of ObamaCare at its best. The state insurance exchange for the state of Oregon received $300 million in federal grants to launch a state-of-the-art website. But it never worked, and not a single Oregonian was able to sign up for health care from start to finish. So now, Oregon is in the process of pulling the plug on the site and switching over to the federal exchange and HealthCare.gov -- but the question is, how quickly they can do it (Springer, 10/1).

Oregonian: As Cover Oregon Marks The One-Year Anniversary Of ‘Go-Live,’ Health Exchange’s Struggles Continue
A year ago on Sept. 30, insurance agents around Oregon were feverishly preparing to use the state's new health exchange website to help enroll consumers – only to be stunned by a dire-sounding directive. With open enrollment beginning the very next day, Cover Oregon officials told agents to immediately stop scheduling new Cover Oregon client appointments until further notice, due to technical problems. Officials said the problems could be cleared up by the weekend. One year later, those technological problems are continuing and the exchange has become a national case study in good intentions gone wrong (Budnick, 9/30).

Meanwhile, two insurers join a private exchange in Minnesota to compete for employers' business -

Minneapolis Star-Tribune: Blue Cross, Medica Join Bloom Health’s Online Insurance Market
In a sign that online exchanges are becoming an increasingly popular way to sell health insurance, the state’s two largest insurers will join a single private exchange and compete head to head for employers’ business. Blue Cross and Blue Shield of Minnesota and Medica plan to sell a suite of health plans through an online marketplace developed by Minneapolis-based Bloom Health, in what was described Tuesday as a first-of-its-kind arrangement in the state (Crosby, 9/30).

Categories: Health Care

Advocates Cry Foul Over Move To Terminate Immigrants' Health Coverage

Kaiser Health News - 12 hours 55 min ago

Two immigrant groups bring civil rights complaints with the Department of Health and Human Services to block the cancellations for about 115,000 people who bought coverage through healthcare.gov but whose immigration status the government hasn't been able to verify.

The Wall Street Journal’s Washington Wire: Immigrant Groups Try To Block Termination Of Health Plans
Immigrant advocates are accusing the Obama administration of violating antidiscrimination provisions in the federal health-care law by moving to terminate coverage for around 115,000 people who bought coverage through HealthCare.gov who didn’t take additional steps to prove they are legal U.S. residents. Two immigrant groups filed complaints Tuesday with the Department of Health and Human Services’ Office of Civil Rights asking it to block the action, which is being carried out by other units of the department. The Office of Civil Rights is in charge of enforcing rules in the 2010 law that bar discrimination in the sale of health plans (Radnofsky, 9/30).

Politico Pro: Immigration Advocates Assail HHS On Lost Coverage, ‘Data Matches’
A national immigration group accused HHS of violating the ACA’s anti-discrimination provisions during its efforts to reconcile immigration data for hundreds of thousands of Obamacare consumers in a complaint filed with the department’s Office of Civil Rights on Tuesday. The National Immigration Law Center also submitted a FOIA request seeking more information about the estimated 115,000 people set to lose Obamacare coverage today because of unreconciled citizenship information (Wheaton, 9/30).

Categories: Health Care

Viewpoints: Mergers Causing Health Costs To Rise; Reauthorize CHIP; Obamacare's Influence On Politics

Kaiser Health News - 12 hours 57 min ago

The Wall Street Journal: Medical Mergers Are Driving Up Health Costs
Health care costs are going up, and there's a lot of debate about why. Is it the high cost of drugs or our aging population? Is it Americans' insistence on having the newest, most high-tech care? Each of these may contribute to rising costs. But a close look at the data reveals that one factor is increasing costs in recent years more than anything else: consolidation among hospitals and doctors (Suzanne F. Delbanco, 9/30).

Bloomberg: Patient Health Doesn't Explain Cost Differences
The report, by Louise Sheiner, a senior fellow at Brookings, has drawn lots of attention because it brings into question decades of research by the Dartmouth Atlas of Health Care. The Dartmouth team's core findings have been that substantial variation exists in how health care is practiced in the U.S., and that, on average, higher cost does not correlate with higher quality. Together, these suggest it should be possible to reduce health-care costs without harming people's medical outcomes. ... Enter Ms. Sheiner. She accepts that costs vary from state to state in the U.S., but finds "little support" for the notion that differences in medical practice are to blame. What does explain the variation, she claims, is the underlying health of patients: The states with higher costs simply have sicker people (Peter R. Orszag, 9/30).

Dallas Morning News: Congress Can Protect Texas Kids By Reauthorizing CHIP
What if there were a bipartisan health care plan that worked? What if it gave states lots of flexibility and represented a true private-public partnership? What if it delivered quality care for kids at a cost their parents can afford? And what if it were incredibly successful and overwhelmingly popular with voters? You’d think Congress would be rushing to protect it, wouldn’t you? Think again. The Children’s Health Insurance Program, or CHIP, was created by a Republican-controlled Congress and a Democratic president. Recent polling shows that CHIP continues to enjoy strong, bipartisan support. Why? Because CHIP works -- in Texas and nationwide (Bruce Lesley 9/30).

The Wall Street Journal: Why Public Interest Is Cooling In Obamacare As A Political Story
A hot debate continues about the ACA among partisans and experts, and health reform news will always resonate with the public because health is an issue that affects people personally. But unless there is a new development that garners media attention like the rollout did, the ACA story seems to be cooling as a front-page and political story, creating space for implementation to move forward less encumbered by constant controversy (Drew Altman, 9/30).

Los Angeles Times: Why So Many Voters Care So Little About The Midterm Elections
The looming midterm elections, which will decide whether the U.S. Senate is run by Democrats or Republicans, has been called "the Seinfeld election," because so much of the campaign seems to be about nothing. But that's not quite right. The problem is that the campaign has been about too many things. In Colorado, Senate candidates are bickering about birth control, abortion rights and whether "personhood" begins at birth. ... In Georgia, Senate candidates are in a "did so/did not" squabble over whether the Democratic candidate, in league with former President George H.W. Bush, sent money to terrorists. In Iowa, the divide between the parties has included castrating hogs and dealing with stray chickens, issues not covered in either party's official platform (Doyle McManus, 9/30). 

The Washington Post: The Silly, Selective 'War On Women'
It has long been accepted by the conventionally wise that the Republican Party is waging a "war on women." Let's be clear. The war on women is based on just one thing -- abortion rights. While it is true that access to abortion has been restricted in several states owing to Republican efforts, it is not true that women as a whole care only or mostly about abortion (Kathleen Parker, 9/30). 

USA Today: Anti-Abortionists Caught By 'Murder' Trap
Liberal Internet scribes opened fire over the weekend when National Review writer Kevin D. Williamson tweeted that women who get abortions should be executed by hanging. In one sense, the outrage made sense. Three out of 10 Americans will get an abortion by age 45. Hanging them would be a bloodbath unparalleled in U.S. history (Amanda Marcotte, 9/30).

Los Angeles Times: No On Proposition 45
Angered by rapidly rising premiums for automobile insurance, voters approved Proposition 103 in 1988 to give the state insurance commissioner the power to veto unreasonable rate hikes for auto policies. Now, after years of premium hikes in health insurance, voters have the chance to extend that authority to individual and small-group health policies. Proposition 45 would let the commissioner reject any change in premiums, deductibles or related factors found to be excessive, inadequate or "unfairly discriminatory." ... But now would be the wrong time to pass such a measure (9/30). 

Politico: The Ebola Epidemic Is About to Get Worse. Much Worse.
The truth is that we are failing miserably at containing Ebola, despite daily pledges by governments and philanthropic organizations to provide more health care workers and additional financial and logistical support. It’s also despite the heroic work of a limited number of national and international volunteer health care workers and public health professionals who are risking their lives daily so that others may live and the epidemic can be stopped. ... In the end, the only guaranteed solution to ending this Ebola crisis is to develop, manufacture and deliver an effective Ebola vaccine .... This is Plan C, and it is still a long way off (Michael T. Osterholm, 9/30). 

Bloomberg: Ebola Is Going Global. Or Not.
Public health authorities in industrialized nations have considerable expertise in preventing diseases from crossing international borders. The challenge is that someone infected with Ebola can carry the virus for as long as three weeks without showing any symptoms. It thus won't be surprising if cases start showing up elsewhere around the world. The most important time for response is now, before the resources required to contain the disease become many times greater. Effective response to an epidemic is as much about information as it is about medicine (Mark Buchanan, 9/28).

Vox: Don't Panic Over Ebola In America
The first thing to do is to calm down. Ebola is terrifying. But it's not likely to kill you, or to spread widely in the United States. What's scary -- and hyped -- about Ebola isn't what makes it dangerous. Ebola is a hemorrhagic fever. It kills about half of those who contract it. It sometimes, though not always, leads to uncontrollable bleeding. But it's difficult to contract. The only way to catch Ebola is to have direct contact with the bodily fluids -- vomit, sweat, blood, feces, urine or saliva -- of someone who has Ebola and has begun showing symptoms (Ezra Klein, 9/30).

Philadelphia Inquirer: Proceed With Caution: Corbett's Medicaid Plan Risks Severe Side Effects
The Corbett Administration continues to paint a rosy picture of its alternative Medicaid expansion plan, Healthy PA, and of what it will mean for those it will cover. The administration promises that the plan -- which will radically reduce the benefits of 1.2 million adult enrollees -- will "support independence" and "increase health care choices" for low-income Pennsylvanians. Patients, advocates and providers are right to oppose the plan’s many harmful elements, and it is important that the public understand what the proposal will do to our friends, our families, and countless patients in Pennsylvania (Antoinette Kraus, 10/1).

Journal of the American Medical Association: Evidence-Based Practice Is Not Synonymous With Delivery Of Uniform Health Care
[C]linical variation is considered one of the major drivers of ever-increasing health care costs contributing to the estimated 30 percent of inappropriate or wasteful health care. Perhaps as a natural response to this unsatisfactory situation, a widespread and influential school of thought has emerged contending that greater uniformity of clinical practice is desirable. ... The suggested mechanism to achieve uniformity in part involves clinician adherence to practice guidelines, which is seen as synonymous with evidence-based practice. In this Viewpoint, we explain that this position is based on a misunderstanding of trustworthy guidelines and that striving for uniformity of practice as an end is misguided (Drs. Benjamin Djulbegovic and Gordon H. Guyatt, 9/30).

Journal of the American Medical Association: The Connection Between Evidence-Based Medicine And Shared Decision Making
Links between evidence-based medicine [EBM] and shared decision making [SDM] have until recently been largely absent or at best implied. However, encouraging signs of interaction are emerging. For example, there has been some integration of the teaching of both, exploration about how guidelines can be adapted
to facilitate SDM, and research and resource tools that recognize both approaches. ... Medicine cannot, and should not, be practiced without up-to-date evidence. Nor can medicine be practiced without knowing and respecting the informed preferences of patients. ... Evidence-based medicine needs SDM, and SDM needs EBM. Patients need both (Tammy C. Hoffman, Dr. Victor M. Montori and  Dr. Chris Del Mar, 9/30).

Journal of the American Medical Association: Managing Posthospital Care Transitions For Older Adults
For a generation, health policy experts have recommended longitudinal management of patients with significant chronic illness in a coherent, community-centered delivery system. However, meaningful change in communities and delivery systems has been slow. Concurrently, there has been wide, rapid deployment of intensive, expensive interventions such as hospitalist care, prompt cardiac angioplasty with drug-eluting stents for acute coronary ischemia, and extensive use of statins, sometimes without compelling evidence of overall benefit in the older, frail population. This history suggests that dissemination of more intensive solutions for coordinated management of complex patients may be more a matter of aligned incentives and momentum than of feasibility (Dr. Peter A. Boling, 9/30).

Categories: Health Care

Judge Rules That States Using Federal Health Exchange Can't Offer Premium Subsidies

Kaiser Health News - 12 hours 57 min ago
The decision by a federal district judge in Oklahoma is the latest ruling regarding whether consumers in states that opted to use the federal insurance marketplace are entitled to subsidies. Because court decisions have differed, many experts say the question will ultimately be decided by the U.S. Supreme Court.

The New York Times: U.S. Cannot Subsidize Health Plans In States With No Marketplace, A Judge Rules
A federal district judge in Oklahoma dealt a blow to the Affordable Care Act on Tuesday, ruling that the federal government could not subsidize health insurance in three dozen states that refused to establish their own marketplaces. This appears to increase the likelihood that the Supreme Court will ultimately resolve the issue (Pear, 9/30).

The Wall Street Journal: Federal Judge Rules Against Some Affordable Health Care Subsidies
A federal judge in Oklahoma ruled that subsidies under the Affordable Care Act can't go to consumers who obtained health coverage through a federal exchange. The decision adds to a mix of rulings on whether consumers in states relying on the federal marketplace are legally entitled to subsidies, a question that many expect will wind up before the U.S. Supreme Court. Two U.S. appeals courts in July issued conflicting rulings on health-law subsidies, raising questions about the fate of tax credits provided to millions of Americans (Armour, 9/30).

Politico: Judge Rules Against White House On Affordable Care Act
Judge Ronald A. White said that the administration's decision to allow subsidies to go through either a state-run health insurance exchange or the federal exchange is an improper and invalid reading of the Affordable Care Act and must be struck. White’s ruling marks the second judgment against the government on the subsidy question and comes as the Supreme Court could decide whether to weigh in (Haberkorn, 9/30).

Reuters: Oklahoma Judge Rules Against Obamacare Subsidies
A federal judge in Oklahoma ruled on Tuesday that tax subsidies vital to the implementation of President Barack Obama's signature healthcare law are unlawful, giving a boost to opponents of the measure known as Obamacare. U.S. District Judge Ronald White found that the Internal Revenue Service rule that the Obama administration issued to set up tax-credit subsidies to help people afford insurance premiums under Obamacare was "an invalid implementation" of the law based on his interpretation of it. White, who was appointed by Republican President George W. Bush, put his ruling on hold pending an appeal (Hurley, 9/30).

Categories: Health Care

Political Cartoon: 'Expensive Stutter?'

Kaiser Health News - 13 hours 22 min ago

Kaiser Health News provides a fresh take on health policy developments with "Expensive Stutter?" by Roy Delgado.

And here's today's health policy haiku:

DIAL UP DENTAL CARE

California has
Teledentistry program
Ahhhhhhhhhhhhhhh - and no drilling!
-Beau Carter 

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Categories: Health Care

Worried about the recent data security breaches at your local department stores? What are the current laws protecting us from identity theft?


Take a look at our webpage on Massachusetts Laws about Identity Theft by clicking here.

Within that page is the link to the Attorney General’s Guide on Identity Theft for Victims and Consumers.

Do you have a Massachusetts Trial Court Law Library card? If so, you can access the HeinOnline journal database to read the following law journal articles:

·       Cybersecurity in the Payment Card Industry, by Richard Epstein and Thomas P. Brown, 75 University of Chicago Law Review 2008, pages 203 – 224.
·       Government and Private Sector Roles in Providing Information Security in the U.S. Financial Services Industry, by Mark MacCarthy from I/S: A Journal of Law and Policy for the Information Society, 8 ISJLP 1 2012-2013, pages 242 - 276.
·       State Responsibility for Cyber Attacks: Competing Standards for a Growing Problem, by Scott J. Shackelford and Richard B. Andres, 42 Georgetown Journal of International Law, 42 Geo. J. Int’l L. pages 971 - 1016, 2010-2011.
Don’t have a Law Library card yet? It’s easy to apply for one at any of our 17 Trial Court Law Libraries. Click here for the link to our locations and hours of operation.Interested in reading some additional articles? These are from the Bloomberg Businessweek’s website: 
Categories: Research & Litigation

First Edition: October 1, 2014

Kaiser Health News - 15 hours 1 min ago

Today's headlines include coverage of the debut of the Open Payments database, a federal information trove designed to shed light on the financial connections between physicians and the drug and medical device industry.  

Kaiser Health News: As Payments Database Debuts, Doctors Urge Caution
Kaiser Health News staff writer Shefali Luthra reports: “A federal database unveiled Tuesday afternoon details 4.4 million payments from pharmaceutical and medical technology companies to doctors and teaching hospitals, sparking concerns that consumers might misinterpret the information” (Luthra, 10/1). Read the story.

Kaiser Health News: 'The Health Care System Falls Apart When You're A Complex Patient'
Kaiser Health News staff writer Lisa Gillespie reports: “Jeffrey Brenner doesn’t believe in blaming a person for showing up at an emergency room for a cold or an ear infection, even if the illness could have been treated in a doctor’s office at much lower cost. Instead, he faults the health care system, and he wants to prove that if providers, employers and insurers work together more effectively, that person will stop going to the ER” (Gillespie, 10/1). Read the interview.

The New York Times: U.S. Cannot Subsidize Health Plans In States With No Marketplace, A Judge Rules
A federal district judge in Oklahoma dealt a blow to the Affordable Care Act on Tuesday, ruling that the federal government could not subsidize health insurance in three dozen states that refused to establish their own marketplaces. This appears to increase the likelihood that the Supreme Court will ultimately resolve the issue (Pear, 9/30).

The Wall Street Journal: Federal Judge Rules Against Some Affordable Health Care Subsidies
A federal judge in Oklahoma ruled that subsidies under the Affordable Care Act can't go to consumers who obtained health coverage through a federal exchange. The decision adds to a mix of rulings on whether consumers in states relying on the federal marketplace are legally entitled to subsidies, a question that many expect will wind up before the U.S. Supreme Court. Two U.S. appeals courts in July issued conflicting rulings on health-law subsidies, raising questions about the fate of tax credits provided to millions of Americans (Armour, 9/30).

Politico: Judge Rules Against White House On Affordable Care Act
Judge Ronald A. White said that the administration’s decision to allow subsidies to go through either a state-run health insurance exchange or the federal exchange is an improper and invalid reading of the Affordable Care Act and must be struck. White’s ruling marks the second judgment against the government on the subsidy question and comes as the Supreme Court could decide whether to weigh in (Haberkorn, 9/30).

The Wall Street Journal’s Washington Wire: Immigrant Groups Try To Block Termination Of Health Plans
Immigrant advocates are accusing the Obama administration of violating antidiscrimination provisions in the federal health-care law by moving to terminate coverage for around 115,000 people who bought coverage through HealthCare.gov who didn’t take additional steps to prove they are legal U.S. residents. Two immigrant groups filed complaints Tuesday with the Department of Health and Human Services’ Office of Civil Rights asking it to block the action, which is being carried out by other units of the department. The Office of Civil Rights is in charge of enforcing rules in the 2010 law that bar discrimination in the sale of health plans (Radnofsky, 9/30).

The New York Times: Detailing Financial Links Of Doctors And Drug Makers
Pharmaceutical and device makers paid doctors roughly $380 million in speaking and consulting fees, with some doctors reaping over half a million dollars each, during a five-month period last year, according to an analysis of federal data released Tuesday. Other doctors made millions of dollars in royalties from products they helped develop (Thomas, Armendariz and Cohen, 9/30).

Los Angeles Times: Database Shows $3.5 Billion In Industry Ties To Doctors, Hospitals
The details published Tuesday in a new government database have been sought for years by consumer advocates and lawmakers concerned that conflicts of interest in the medical profession are jeopardizing patient care and costing taxpayer-funded health programs. This first batch of payment data covers just five months of 2013, but it shows the extensive ties medical companies have forged with doctors and academic medical centers across the country. About 546,000 U.S. physicians and 1,360 teaching hospitals received some form of compensation (Terhune, Levey and Poindexter, 9/30).

The Wall Street Journal: Doctors Net Billions From Drug Firms
The database revealed some eye-popping totals, such as the $122.5 million paid by Roche Holding’s Genentech unit to City of Hope medical center in Duarte, Calif., as royalties on sales of several products including blockbuster cancer treatments Herceptin and Avastin. Genentech licensed patents from City of Hope based on research the medical center conducted in the early 1980s. The company said that excluding the City of Hope royalties, about 85% of the physician payments it reported to CMS were focused on drug research. City of Hope said the royalties are allocated to the inventors and to support continuing research (Loftus, 9/30).

The Washington Post’s Wonkblog: You Can Now Track The Billions That Drug Companies Pay Doctors And Hospitals
Thanks to a bipartisan transparency initiative contained in the 2010 Affordable Care Act, the federal government has compiled a massive database of how much drug and device companies spend on consulting fees, research grants, travel, free lunches and other items worth more than $10. … The rollout of this federal database has been somewhat problematic. Records aren't complete — about 40 percent of payments have been de-identified because of problems with the data. The Centers for Medicare and Medicaid Services, the agency publishing the database, is holding back other records that are still in dispute. It's also been difficult to navigate the database this afternoon. But these payments will be published on a regular basis, and the quality and reliability of the information is expected to improve (Millman, 9/30).

The Associated Press: Drug And Device Firms Paid $3.5B To Care Providers
The massive trove of information named companies and many of the recipients. Also listed were types of payments, with details down to travel destinations. Some 546,000 clinicians and 1,360 teaching hospitals received benefits. It’s part of a new initiative called Open Payments, required by President Barack Obama’s health care law. It was intended to allow patients to easily look up their own doctors online, but that functionality isn’t fully developed. In future years, the information will cover a full 12 months and will be easier to search, officials said (9/30).

NPR: Database Flaws Cloud Sunshine On Industry Payments To Doctors
But the database is also something else: a very limited window into the billions in industry spending. Before you dive in and search your doctor, here are five caveats to keep in mind (Ornstein, 9/30).

Politico: ‘Data Dump’ Reveals Billions In Pharma Payments To Docs, Hospitals
In its first hours, the website was tortuously slow. And it was incomplete: About 40 percent of the records do not identify the recipient because CMS could not match data provided by manufacturers with existing databases (Wheaton, 10/1).

The Wall Street Journal’s Pharmalot: Does The Open Payments Database ‘Distort’ What Docs Get For Research?
The database, which is being administered by the Centers for Medicare & Medicaid Services, will initially display payments made in the last five months of 2013 and will be updated going forward. Already, though, both industry and physician groups have complained that payment data lack sufficient context for the public to understand what doctors are paid. And doctors also griped they had little time to review data. Now, a group of academics from Johns Hopkins University have raised another issue. The law requires drug makers to report the total amount of “research payments” to researchers for use in clinical trials. But the academics – three bioethicists and a professor of medicine and pharmacology – argue this stipulation creates a “distorted” image of the money that doctors may receive, because it does not break out a value assigned to medicines that companies provide for the research (Silverman, 9/30).

The New York Times: Loss Of A Democratic Power Leaves Arkansas In Doubt
Mr. Beebe’s knack for knowing what his political opponent needed to get a deal done during his long tenure in the legislature has served him well in the governor’s office. He has been able to get past the kind of partisan impasses that plague Washington. No one tries to lump Mr. Beebe with Mr. Obama, but the same cannot be said for Senator Pryor, whom Mr. Cotton called “a loyal foot soldier for Barack Obama and his agenda.” And yet Mr. Beebe worked with Republican legislators to put together, and pass with the required three-fourths majority, a private-option health insurance program that has helped more than 200,000 poor residents get covered, without the stigma of being associated with the unpopular Affordable Care Act. The program allowed the state to take federal money to expand Medicaid under the Affordable Care Act and use that money to buy private insurance for the poor, instead of adding them directly to the Medicaid rolls. Also, it brought the state national attention for its bipartisan collaboration (Chozick, 9/30).

The New York Times: Doctors Find Barriers To Sharing Digital Medical Records
Regardless of who is at fault, doctors and hospital executives across the country say they are distressed that the expensive electronic health record systems they installed in the hopes of reducing costs and improving the coordination of patient care — a major goal of the Affordable Care Act — simply do not share information with competing systems (Creswell, 9/30).

The Wall Street Journal: Walgreen Profit Remains Pressured By Drug Price Miscalculation
Walgreen Co. continues to pay the price for a miscalculation in the pricing of generic prescription drugs. The pharmacy chain shocked investors in August when it slashed its long-term profit forecast because it had failed to account for a rapid rise in the price of generics as it negotiated contracts to provide prescription drugs under Medicare's Part D program. On Tuesday, it warned that lower drug reimbursement rates and higher costs for generic drugs will continue to hurt profits (Ziobro and Calia, 9/30).

The New York Times: Freelancers Union To End Its Health Insurance Plans In New York
The Freelancers Union, which provides health insurance to 25,000 of its members in New York State, is ending an experiment in providing low-cost insurance to independent workers, saying the new landscape created by the federal Affordable Care Act makes it impossible to do so (Hartocollis, 9/30).

The Washington Post: ‘Death Doctor’ Who Profited From Unnecessary Chemotherapy For Fake Cancers Could Resume Practice In 5 Years
The Michigan state house health policy committee approved the proposal to tighten the rules. Next it will go before the full house for a vote. Fata pleaded guilty in U.S. District Court earlier this month to 13 counts of health-care fraud, one count of conspiracy to pay or receive kickbacks and two counts of money laundering. He will be sentenced in February and faces up to 175 years in prison (Sullivan, 10/1).

Check out all of Kaiser Health News' e-mail options including First Edition and Breaking News alerts on our Subscriptions page. 

Categories: Health Care

Why To Exercise Today: Breaking Down Your Kynurenine Could Fight Depression

CommonHealth (WBUR) - 15 hours 21 min ago

(eccampbell via Compfight)

Never heard of kynurenine? Me neither, until I read today’s Phys Ed column in The New York Times: How Exercise May Protect Against Depression.

It describes a recent mouse study in the journal Cell that puts forth a new theory for the power of exercise to fight depression. You may be familiar with the longer-standing wisdom that exercise spurs the birth of new neurons in the brain, which also somehow lifts mood. But Phys Ed columnist Gretchen Reynolds writes that the key to the effect may lie in the working muscles, which then affect the brain.

She describes a fascinating experiment in specially bred mice with high levels of PGC-1alpha1, an enzyme thought to guard against depression. The scientists came to focus on kynurenine, a chemical whose levels in the blood rise after stress.

Kynurenine can pass the blood-brain barrier and, in animal studies, has been shown to cause damaging inflammation in the brain, leading, it is thought, to depression.
But in the mice with high levels of PGC-1alpha1, the kynurenine produced by stress was set upon almost immediately by another protein expressed in response to signals from the PGC-1alpha1. This protein changed the kynurenine, breaking it into its component parts, which, interestingly, could not pass the blood-brain barrier. In effect, the extra PGC-1alpha1 had called up guards that defused the threat to the animals’ brains and mood from frequent stress.

Initial studies suggest something similar may happen in humans; more research is under way.

Categories: Health Care

As Payments Database Debuts, Doctors Urge Caution

Kaiser Health News - 17 hours 10 min ago

A federal database unveiled Tuesday afternoon details 4.4 million payments from pharmaceutical and medical technology companies to doctors and teaching hospitals, sparking concerns that consumers might misinterpret the information.

The Centers for Medicare & Medicaid Services website itemized $3.5 billion worth of payments to 546,000 doctors and 1,360 teaching hospitals, made between August 2013 and December 2013. But about 40 percent of those payments were listed without noting who received them, either because of concerns about whether CMS had the correct recipient information, or because the physicians named hadn’t had enough time to verify the payment information.

The database is the result of a Sunshine Act that was incorporated into the health law and is intended to intensify scrutiny of the relationships between physicians and the drug and device industries. Consumer advocates have argued that making this information available to the public – on gifts, speaker fees, research grants, meals, travel and investment interests worth $10 or more – is a vital step in ensuring doctors don’t have conflicts of interest affecting their research and medical decisions.

Pharmaceutical and medical device companies submitted the information, and CMS was required to give doctors and hospitals 45 days to review and contest any claims.

Another 199,000 records were not published because they detailed ongoing pharmaceutical research or because physicians were still disputing their contents. That information will be updated and published as it becomes ready, CMS Deputy Administrator Shantanu Agrawal said in a conference call with reporters.

Providers and industry groups said they hope consumers don’t reach the wrong conclusions.

“You have to understand, there are many facets of the relationship between physicians and industry,” said John Murphy, associate general counsel at Pharmaceutical Research and Manufacturers of America. “And they are vital to ensuring drugs get developed and get to the market.”

Industry representatives have suggested the database could distort relationships that are either innocuous or promote valuable research. But those supporting the Sunshine Act say that when making medical decisions, patients have a right to know their doctor’s connections. Research from the Pew Charitable Trusts found that doctors who receive money from the industry will sometimes change their prescription practices based on those interests.

In response to industry concerns, CMS is working to appropriately contextualize the information included in the database, Agrawal said.

“The intention is to provide a very balanced view of what the data is and what it is not,” said Agrawal, who is also director of CMS’ Center for Program Integrity. Some information, he added, might indicate productive relationships between providers and industry, while other details could note conflict of interest.

In addition to a broader statement explaining what the data may or may not indicate, the site includes information companies may have provided to describe specific payments, Agrawal said.

“We’re heartened to see – it looks like CMS put quite a fair amount of effort in putting in some context and background” on the site, Murphy said.

But, given the difficulty some have faced in accessing or navigating the site, it’s still hard to tell how effective some of those explanations have been and how accurate the information is, said Linda Burns, president of the American Society of Hematology.

“We want the data to certainly be transparent and publicly available, but we also understand that it’s only beneficial if the data is complete and accurate,” Burns said. “And I think that’s still yet to be seen.”

Other concerns about the site’s accuracy surfaced earlier this summer. In August, a physician reviewing which payments were attributed to him found incorrect information in the site. Following that, CMS temporarily took the site down to address that information – ultimately leading to the 40 percent of payments the agency published but did not identify.

That discovery prompted calls from interest groups such as the American Medical Association to push back the site’s launch to March 31, 2015. The AMA argued that site inaccuracies could unfairly harm physicians and that technical challenges had left doctors insufficient time to review and challenge the information included.

Robert Wah, president of the AMA, cited data from CMS that indicated about 26,000 physicians registered with the Open Payments site to review and dispute any claims. That number, he noted in an interview, was much smaller than the 546,000 doctors in the system, meaning most doctors have had little time to review information.

He cautioned consumers that “there is a high likelihood of inaccuracy when only 26,000 physicians had a chance to look at it.”

CMS intends to unveil a second, more user-friendly site for consumers in October, Agrawal said. Some questioned how accessible the site now is. For instance, a PDF of a dictionary meant to help users navigate the site and understand its terminology spans 51 pages. Others pointed out the lengthy period of time it took to download the spreadsheet of payment information.

“I’m hoping we’ll see some fact sheets and Q&As – which they promised but I don’t see yet,” Murphy said.

Categories: Health Care

'The Health Care System Falls Apart When You're A Complex Patient'

Kaiser Health News - 17 hours 10 min ago

Jeffrey Brenner doesn’t believe in blaming a person for showing up at an emergency room for a cold or an ear infection, even if the illness could have been treated in a doctor’s office at much lower cost. Instead, he faults the health care system, and he wants to prove that if providers, employers and insurers work together more effectively, that person will stop going to the ER.

Jeffrey Brenner. (Photo by MacArthur Foundation)

Brenner, a 2013 MacArthur Fellow and executive director of the Camden Coalition of Healthcare Providers, is testing this theory with a randomized controlled trial. Findings are due out in 2016.

The trial extends what the Coalition has been doing for years in hospitals and primary care offices that serve the low-income neighborhoods of Camden, N.J. For the past decade, the nonprofit has worked to bring together hospitals, physician offices and other providers to create programs to better coordinate care for the high proportion of Medicare and Medicaid patients in the region. Brenner’s team flags patients with multiple hospital visits -- the so-called “super utilizers” -- and sends a care coordinator to their bedside. The goal is to find out why they went to the hospital instead of a doctor’s office. Then, a nurse, a health coach and a social worker meet regularly with patients, and determine how to address their continuing needs.

Employer health plans also have super-utilizers who rack up medical bills, prompting some employers to experiment with ways to control these costs.

Brenner recently spoke with KHN’s Lisa Gillespie about the trial and the work still left to be done. An edited transcript of that conversation follows.

Q: Can you explain the randomized trial? What are you trying to show? 

A: We identify the patients … who have had two or more hospital admissions, and then they get randomized into the control [group] -- care as usual -- or they have 90 to 120 days of intensive wrap-around coaching. [We] will track them for a year and possibly longer. The end point [measures] are [whether we achieve] a reduction in ER and hospitalization utilization. We also look at [the] patients’ overall wellbeing.

We’re trying to prove that we’re using the wrong methods to approach these patients. You don’t need new money [to care for patients], you just need new service delivery systems. We have to stop giving up on poor people. There is a feeling that it’s the patients’ fault that their care process isn’t going well, and that the health care system has done everything it can do and the rest is up to the patient.

We spend money in the wrong places delivering the wrong services at the wrong time, and this is about rethinking how we deliver care. As I meet with congressmen, hospital CEOs, the numbers of stories told behind closed doors of family members getting lost in the health care system is tragic. As baby boomers age, more and more families are experiencing what it feels like to get lost and have too much unnecessary stuff done to a family member.

Q: So the trial is looking at a high proportion of Medicaid and Medicare patients, but do you think the findings could also prove helpful to employers regarding the health costs of workers’ and retirees’ coverage?

A: A lot of the failures happening for poor people are happening for the middle class. [We] are all trying to solve a similar problem: how do you engage very sick people and help them work their way through problems? In every population that you look at, a small percentage of patients is responsible for most of the costs.  So for employees and their dependents, you’ll find the same pattern -- that 1 percent of patients account for 25 percent of costs. Whether you’re middle class or poor, the health care system falls apart when you’re a complex patient. We need to coordinate care and have engagement models for the sickest patients.

Take for instance a middle class woman with a master’s degree getting care at a five-hospital integrated system, connected electronically. She was going to the ER repeatedly and, in a three-and-a-half-year period, she had 79 CT scans to the head. A group of family medicine residents got to know her and found out she had severe anxiety, so they got her working with a psychologist and she stopped going to the ER.

These hospitals were electronically connected. They could have seen the other CAT scans, but they did not. So I don’t think the phenomena we’re talking about is exclusively for poor patients. If you have good insurance, you can also have an enormous amount of unnecessary care.

Q:  Are public and private insurance plans already doing some of this coordinated care you’re talking about?

A:  There are lots of examples: Boeing has a patient-centered medical home for employees, and Bravo Health has a Medicare Advantage plan in Philly.

There’s been a big shift amongst health care plans because telephonic health case management isn’t effective. It takes boots on the ground to shift the trajectory. So you’re seeing more and more insurers get into the work of delivering care. Bravo Health has built two physical offices to deliver care, with shuttles and vans picking people up and [with] phenomenal hospitalists. They’ve put these in two of the poorest neighborhoods in Philly. They’ve made incredible profit, and Cigna bought them and now they’re trying to scale the model. That’s evidence that there’s money to be made on delivering coordinated care.

Categories: Health Care

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