Kings, dogs and Burwells: The latest policy posts from the Health Wonk Review #HWR

BHN is hosting this week’s round-up. In anticipation of the King v. Burwell decision, we offer kings and Burwells. The content of the images is not meant as a BHN endorsement for either position. Same goes for the opinions in these posts. Some say the ruling may come down today, others bet on 6/29. SCOTUS Blog is the site to watch. (For actual posts on the pending decision, see the 6/3 edition.)

Finally, our thoughts are with the members of Emanuel African Methodist Episcopal Church and the staff at one more hospital that had to brace for victims of a mass shooting.

The posts:

  • 512px-BBKing07

    By Roland Godefroy

    Joseph Paduda at Managed Care Matters writes:  Health care cost drivers; or, here’s where you’re getting screwed. Two studies published in Health Affairs shed much light on hospital costs and the societal implications of physician practice consolidation.  Both are a bit scary.

  • A post from Health Affairs analyzes the major elements of the final rule recent Medicare Shared Savings Program Final Rule.Lawrence Kocot, of Ross White,
    burwell

    HHS photo

    and Mark McClellan at KPMG  offer alternatives for CMS and the possible future of the program

  •   From David Willams at the Health Business Blog notes: Long term care insurance -narrow framing is not the problem. Why don’t people buy long term care insurance? Because for many it’s not a good value
  •  David Harlow at the HealthBlawg: Outsourced Chronic Care Management Service256px-King_Kong_1933_French_posters Can Help Physicians and Patients. I wrote this post with a client about Chronic Care Management, a newly-reimbursable service under Medicare as of January 2015, and a service that is specifically non-face-to-face. The federales are dedicating significant funds to this service based on the belief that it will reduce expenditures on other services for multiply-chronically-ill elders.
  • From Boston Health News, links to stories on telemedicine and hospitals as step-down units.
  • From Roy Poses at Health Care Renewal: Health Care Professional Societies Whose Leadership Betrays Their Own Members – the APA Alleged to Have Supported Torture, and Deceived its Members to Collect Money. Health care professionals need to be extremely skepticburwellneonal of the leadership and governance of all health care organizations.  True health care reform requires organizational leaders who understand the health care system, uphold its values, and are willing to be accountable.
  •  Tom Lynch of Workers Comp Insider offers “the word of the week: horrendoma. That’s a description he applies to the healthcare system after looking at billed vs paid hospital data and the concept of charges as a “starting point.” See his post: Hospital Medicare Charges: You Don’t Always Get What You Want.
    By Metro-Goldwyn-MayerReproduction Number: LC-USZ6-2067 Location: NYWTS -- BIOG [Public domain], via Wikimedia Commons

    By Metro-Goldwyn-Mayer, Inc.

  • Henry Stern at InsureBlog asks “What carrier in its right mind would cover” sex change surgery? Transjenner Insurance: In case you were wondering: Yes, ObamaPlans *do* cover sex-changes. InsureBlog has the, er, straight scoop.
  • From Health System Ed: Decrying the End of Private Physician Practice? Not so fast!  Experts have been saying that the private physician practice is no longer sustainable under managed care but then along comes ACOs and perhaps that tune is changing when the focus turns from volume to outcomes.
  • This Health Affairs post focuses specifically on the provisions of the rule dealing with benchmarkingBWburwell2 and distribution of shared savings and losses and suggests that CMS consider the possibility of graduated rates of sharing savings and loss distribution.y Carrie Colla, Scott Heiser, Emily Tierney, and Elliott Fisher at Dartmouth
  • Finally, Brad Wright asks : This Father’s Day, Give 1 For Dad
    In honor of his father, he’s donating to “Give 1 For Dad campaign to fund an important clinical trial for prostate cancer at the Duke Cancer Institute. At issue is that the treatment uses a safe generic drug, which is great because it isn’t toxic like other current treatments, but not so great because no major pharmaceutical companies are willing to fund a clinical trial of a generic drug.”

What does your king look like? king-cobra-405623_640(Click on images for credits, rights.)

Cavalier_King_Charles_Spaniel_Floral

My latest from Health Leaders: disparities, quality & TripleAim

by Nora Valdez. Click for more.

by Nora Valdez. Click for more.

Fueled by the financial incentives built into the healthcare reform law, the Institute for Health Improvement’s concept is generating meaningful changes in the way healthcare is delivered, research finds.

Value-based care brings new urgency to the effort to end disparities in healthcare access and outcomes for minorities.

Boston voices in stories on telemedicine and hotels as hospital step-down units

Some Boston links in these story from Health Leaders Media.

connected healthIn a story about telemedicine, Joseph Kvedar, MD, vice president of the Partners’ Center for Connected Health in Boston, says that at two recent health industry meetings “every panel and every conversation had something on telemedicine and virtual visits.” Telemedicine is taking off, but there is resistance from regulators in at least one state, and stubborn questions about reimbursement and efficacy in general.

This column about hospitals discharging patients to hotels starts in Boston and heads out westHLM:

The Wyndham Beacon Hill hotel uses its proximity to Massachusetts General Hospital as a marketing tool. The hotel website includes a hospitals page featuring a blonde model in a white coat with a stethoscope around her neck. The hotel offers a link to each of the city’s hospitals, discounted rates for patient families, and access to a shuttle bus.  

The Wyndham isn’t alone. Often, patients have to travel long distances to places like Boston for specialized care. So hotels have grown up around large hospitals to offer shelter to caregivers. And sometimes patients, too sick to travel home or waiting for follow-up care, need a night or two of lodging as well.

But hospitals have different protocols—or none at all—when it comes to discharging patients to hotels. And hotels have different capacities for hosting them.

But the Occupational Safety and Health Administration’s bloodborne pathogens standard applies to all.

Boston news from #BIO2015: Will old labs make good housing? Do expensive drugs reduce health costs?

Over here in Kendall Square, pharma has invested a lot of money in buildings that look like they were designed by Ikea. If this bubble is about to burst, as suggested below, the city could use some nice low-rise housing. photo2 (1)

This story also includes the argument that pricey drugs save the system money by, for example, curing HepC patients and keeping them out of the hospital. Will the push by insurers to pay for effectiveness put some numbers to that claim?

More From Robert Weisman.

PHILADELPHIA — The funding model for drug development is under severe strain as venture capitalists shift money to safer investments, the US government bankrolls less basic research, and a backlash builds against high-priced medicines, a panel of biotechnology industry leaders warned Monday.

Joshua Boger, founder and former chief executive of Vertex Pharmaceuticals Inc. in Boston, said drug companies should be enjoying a reputation for helping the health care system to save money by keeping patients healthy and out of the hospital.

“We’re the cost-lowering part of the medical world, and instead we’ve taken on the role of the whipping boys on cost. And it’s just not true.” Boger said.

Health insurers and lawmakers have complained about the high cost of new specialty medicines such as the hepatitis C drug Sovaldi, which can cost $1,000 per pill. Vertex itself charges more than $300,000 per patient each year for a drug that treats some cystic fibrosis patients

Vintage photos of cancer, genetic research from Dana-Farber, MIT and NCI

Looking for art for you health or science blog? NCI Visuals Online contains images from the collections of the Office of Communications and Public Liaison, National Cancer Institute. For more information about Visuals Online, including reuse and contact information, see About Visuals Online. Click for NCI captions and IDs.

Here are a few, including shots from MIT, Dana-Farber

MGH surgeon, who treated #bombing victims in Afghanistan and #Boston, brings #tourniquet campaign to area schools

How sad is it that teachers are learning how to use tourniquets?  Dr. David King, a Mass General surgeon tells the Globe that he thinks some of the students at Newtown might have survived if teachers had those skills.

After a stint in Afghanistan, where he responded to a truck bomb, and hours the Mass General OR working on the those injured in the marathon bombing,  King is familiar with lower limb injuries.

The lay people, the volunteers, the teachers: Those are the people who are truly the first who can respond to these kinds of incidents,” he said.

To prepare for such unforeseen events, King and other doctors are calling for greater access to commercially manufactured tourniquets and for training in their proper use.

In this story from Health Leaders Media, he explains why the marathon bombing made this clear.

His experiences here and overseas where 75 percent of all injuries were caused by explosions— have made King a huge promoter of the tourniquet. The bystanders at the finish line did their best with t-shirts, belts, and other makeshift tourniquets, he said. But, it takes a medical-quality device to stop arterial hemorrhaging and prevent blood loss that can make a leg wound fatal.

Here he talks about his own experience that day, when he was called in MGH after finishing the marathon himself.

Dr King’s Marathon from Tinker Ready on Vimeo.

Is female Viagra a scam? Boston women’s health group questions drug, supporters

indexThe non-profits pressuring the FDA to approve a drug billed as female Viagra do not quite make up a top ten list or women’s health advocacy organizations. This health writer has never heard of most of the groups cited in Sunday’s New York Times story.

But familiar women’s health groups, like Boston’s Our Bodies, Ourselves, are siding with the FDA on this one. From their response to an earlier review of the drug.

imagesWomen taking the drug had less than one additional “sexually satisfying event” (orgasm not required) than women taking a placebo. And in the meantime, the drug caused dizziness, nausea and fatigue, particularly with long-term daily use, in some women — hardly the recipe for sexual excitement.

The FDA also considered whether the drug had increased women’s desire — a crucial element of the HSDD diagnosis, which involves low or no sexual interest to the point of distress in people who are physically healthy and not depressed — and found that the drug failed in this area.

The FDA takes another look — and offers  a live webcast of the deliberations —  on Thursday.

In it’s report on the 2010 FDA rejection of the drug, the OBOS  website notes another Bay State-based critic of the drug:

According to Julia Johnson, the panel’s chairwoman and head of the department of obstetrics and gynecology at the University of Massachusetts Medical School, the impact of the drug flibanserin … was “not robust enough to justify the risks.”

More here from another independent, feminist women’s health group, The National Women’s Health Network:

Members of the campaign called “Even the Score” are challenging the FDA on what they claim is a perpetuation of a gender bias by virtue of the claim that the FDA is holding drugs that treat women’s sexual problem to a higher standard than those for erectile dysfunction.  Even the Score has engaged prominent women’s rights organizations, health care providers, the media and members of Congress in a public relations misinformation campaign to criticize the FDA.  There are Female Sexual Dysfunction drugs currently under FDA review, and Even the Score is attempting to move the discussion away from the safety and effectiveness of these drugs and towards controversy about gender bias. 

The reality is that no amount of public relations or slick marketing can get around the fact that the drugs currently being proposed for Female Sexual Dysfunction simply don’t work and may be quite dangerous. Poor efficacy, a strong placebo effect, and valid safety concerns have plagued all of the drugs that have been tested so far. There are many reasons why the proposed drugs may not have been effective in increasing women’s sexual enjoyment; chief among them is the heterogeneity of female sexuality and, of course, research demonstrating that sexual problems are mostly shaped by interpersonal, psychological, and social factors. Nevertheless, pharmaceutical executives will continue to drum up hype over the possibility of a “pink Viagra” because the profit market for this type of drug is estimated to be over $2 billion a year.

Note that neither of these groups accept funding from the pharmaceutical industry. Even the score supporter include Sprout, the company seeking approval for the drug and Trimel Pharmaceuticals, a company testing a nasal testosterone gel for “female orgasmic disorder.”

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