Tentative Deal Reached on VA Health Care Reform

The chairmen of the House and Senate Veterans Affairs committees have reached a tentative agreement on a plan to improve veterans’ health care.

Rep. Jeff Miller, R-Fla., and Sen. Bernie Sanders, I-Vt., scheduled a news conference Monday to talk about a compromise plan to fix a veterans’ health program scandalized by long patient wait times and falsified records covering up delays.

Miller chairs the House veterans panel, while Sanders chairs the Senate panel. (more…)

Promising Cancer Drug Fails to Slow Breast Cancer

Researchers had hoped to add breast cancer to the list of cancers for which the drug is already approved

A Phase 3 trial of cancer drug Nexavar in patients with advanced breast cancer failed to delay progression of the disease, according to the drug’s makers, Bayer and Onyx Pharmaceuticals, Inc., an Amgen subsidiary.

The study, called Reslience, evaluated Nexavar in combination with capecitabine, an oral chemotherapeutic agent, in patients with HER2-negative breast cancer. (more…)

When Hospitals Buy Clinics, Prices Go Up

For the past four years, Pennsylvania insurance company Highmark has watched its bills for cancer care skyrocket. The increase wasn’t because of new drugs being prescribed or a spike in diagnoses. Instead, the culprit was a change that had nothing to do with care: Previously independent oncology clinics and private practices have been acquired by big hospital systems that charge higher rates, sometimes three times as much, for chemotherapy drugs. “The site of care and the type of service provided does not change at all,” says Tom Fitzpatrick, Highmark’s vice president of contracting. “The only significant difference that we primarily see is the [patient] gets a wristband placed on them.” (more…)

Can Big Data Cure Cancer?

A tale of two twenty-something computer whizzes, a mountain of money from Google, and one of the oldest, most vexing problems of all time.

You’ve heard the story before. A couple of whiz kids meet at an elite college, bond over their love of computers, and after a few late-night hacking sessions, build a website or an app. Before you know it, their little side project has turned into a startup, and the fresh-faced youngsters raise piles of cash from investors, decamp for SoMa or SoHo, and form a company that turns them into overnight millionaires, at least on paper. (more…)

The drug that’s forcing America’s most important – and uncomfortable – health-care debate

Months before Gilead Sciences’ breakthrough hepatitis C treatment hit the market, Oregon Medicaid official Tom Burns started worrying about how the state could afford to cover every enrollee infected with the disease. He figured the cost might even reach $36,000 per patient.

Then the price for the drug was released last December: $84,000 for a 12-week treatment course.

At that price, the state would have to spend $360 million to provide its Medicaid beneficiaries with the drug called Sovaldi, just slightly less than the $377 million the Oregon Medicaid program spent on all prescription drugs for about 600,000 members in 2013. It potentially would be a backbreaker. (more…)

Outpatient Departments More Costly Than Doc Offices

Do hospitals hire physicians for the noble-sounding goal of “partnering” or “aligning,” or is it sometimes the prospect of an easy buck?

A new study from the National Institute for Health Care Reform (NIHCR) suggests that the easy buck helps explain the current wave of practice acquisitions by hospitals. Researchers found that hospital outpatient departments may charge 2 or 3 times more for common diagnostic imaging, colonoscopies, and lab tests than if those services were rendered in community settings such as a physician’s office or a free-standing imaging or ambulatory surgery center.

Colonoscopies, for example, cost on average $1383 on an outpatient basis versus $625 charged by community-based providers. In Indianapolis, Indiana, knee MRIs that cost on average $563 in community settings ballooned to $1540 in outpatient departments, reported study authors James Reschovsky, PhD, a senior fellow at Mathematica Policy Research, and Chapin White, PhD, a researcher at RAND. (more…)

Specialists Drive Overtreatment of Low-Risk Prostate Cancer

Key clinical point: Patients with low-risk prostate cancer receive widely divergent treatment advice, based on specialists’ preferences above patient characteristics or evidence.Major finding: A large database analysis showed that primary androgen deprivation therapy failed to improve either overall or disease-specific survival at 5 years or 15 years in men with low-risk prostate cancer. In another study, 80% of low-risk men diagnosed by urologists received immediate treatment rather than undergoing observation as recommended, as did 91.5% of those who consulted radiation oncologists.

Data source: A population-based cohort study involving 66,717 men aged 66 years and older diagnosed as having low-risk prostate cancer in 1992-2009, and a population-based cohort study involving 12,068 men aged 66 and older who were similarly diagnosed in 2006-2009 by 2,145 urologists and who consulted with 870 radiation oncologists.

Disclosures: Dr. Lu-Yao’s study was supported by the National Cancer Institute and the Cancer Institute of New Jersey. She reported ties to Merck and Schering-Plough, and one of her associates reported receiving research funding from Myriad. Dr. Hoffman’s study was supported by the Cancer Prevention and Research Institute of Texas, the National Cancer Institute, the American Cancer Society, the Duncan Family Institute, the University of Texas M.D. Anderson Cancer Center, and the National Institutes of Health. She reported no potential financial conflicts of interest, and one of her associates reported receiving research support from Varian Medical Systems.

Low-risk prostate cancer in older men is still being overtreated, according to two separate studies that examined the issue from different perspectives, both of which were published online July 14 in JAMA Internal Medicine.

One group of researchers found that primary androgen deprivation therapy fails to improve either overall or disease-specific survival in this patient population, yet it still is widely used as the initial treatment for localized disease. And another group found that urologists and radiation oncologists are the driving force behind the overly aggressive approach to low-risk prostate cancer in older men.

Both groups of investigators called for efforts to limit these harmful trends.

In the first study, Grace L. Lu-Yao, Ph.D., and her associates analyzed information on 66,717 cases of prostate cancer in the Surveillance, Epidemiology, and End Results (SEER) and Medicaid databases diagnosed in 1992-2009. All the patients were aged 66 years and older, and all had T1/T2 disease. There were 5,275 deaths from prostate cancer and 39,801 deaths from all causes during nearly 20 years of follow-up.

Primary androgen deprivation therapy failed to improve either overall or disease-specific survival at 5 years or 15 years. Further study using instrumental variable analysis to control for an imbalance in risk factors between users and nonusers of androgen deprivation therapy confirmed these results, as did several sensitivity analyses, “suggesting that our conclusions are robust” (JAMA Intern. Med. 2014 July 14 [doi: 10.1001/jamainternmed.2014.3028]).

“For patients with less aggressive cancers, deferred androgen deprivation therapy is safe and reduces the risks of treatment-associated adverse effects, such as osteoporosis, weight gain, decreased libido, decreased muscle tone, diabetes mellitus, and metabolic syndrome,” wrote Dr. Lu-Yao of Rutgers Cancer Institute of New Jersey, New Brunswick, and her associates.

“Physicians and patients often believe that treatment is necessary and beneficial. Our data suggest that this may not be the case, at least for primary androgen deprivation therapy,” they said.

In the other study, investigators examined physician and patient factors that influence treatment decisions in low-risk prostate cancer. They also analyzed SEER data, this time involving 12,068 men aged 66 years and older (median age, 72 years) who were diagnosed as having low-risk prostate adenocarcinoma in 2006-2009. These men were diagnosed by 2,145 urologists; 68% of them also consulted a radiation oncologist, said Dr. Karen E. Hoffman of the University of Texas M.D. Anderson Cancer Center, Houston, and her associates.

Original Article:


APNewsBreak: Medicaid Enrollees Strain Oregon

Low-income Oregon residents were supposed to be big winners after the state expanded Medicaid under the federal health care overhaul and created a new system to improve the care they received.

But an Associated Press review shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been actively seeking to avoid.

The problems come amid nationwide growing pains associated with the unprecedented restructuring of the U.S. health care system, and they show the effects of a widespread physician shortage on a state that has embraced Medicaid expansion.

It’s too early to tell whether there will be lasting troubles associated with these immediate challenges. Overhaul supporters say they anticipated the need for more doctors and are already implementing solutions to improve access to care. They also point to the crush of new Medicaid enrollees as proof that their efforts are necessary and working.

Still, early indications show clear challenges associated with expanding Medicaid and establishing coordinated care networks, the centerpiece of Gov. John Kitzhaber’s plan to reduce costs and improve care by focusing on primary care and keeping patients out of emergency rooms.

“As soon as people got insured, they all showed up at once, wanting to deal with the problems they couldn’t deal with for years,” said John Guerreiro, a primary care doctor in northwestern Oregon.

Under the federal overhaul, the state this year added nearly 360,000 people to the Oregon Health Plan, its version of Medicaid. It was more than twice the number projected and swelled the state Medicaid rolls to nearly 1 million people, about a quarter of the state’s population.

Timothy McDaniel, a self-employed computer programmer from Springfield, gained Medicaid coverage in January and said it took him six months to find a doctor. He even went to an urgent care clinic seeking a wellness exam but was turned away, because the facility didn’t provide such evaluations.

“It was rather frustrating because I’m getting older, I’m in my late 50s,” McDaniel said. “I thought I had this health insurance. I wanted to use it. I wanted to get checked out, and I couldn’t.”

The flood of new enrollees like McDaniel has hit hardest in rural parts of the state, where the physician shortage is most severe. But problems have been reported from every corner, the AP has learned after contacting each of 15 regional coordinated care organizations, regional networks of doctors and nurses intended to see patients more often for treatment of small and chronic problems.

The coordinated care model has been championed by the state’s Democratic governor, an early supporter of President Barack Obama’s Affordable Care Act, and is unique to Oregon.

Five of the 15 regional coordinated care organizations declined to comment. The others reported a list of complications.

— Two regions have stopped accepting new patients, locking out more than 16,000 new enrollees in western and southern Oregon, state data shows. The new patients are still insured, but without a coordinated care network, they’re on their own to find a doctor.

— Eight regions saw some practices, clinics and individual doctors close to new Medicaid enrollees.

— In five regions, thousands of enrollees haven’t been assigned to a doctor or been in for their first medical appointment.

— Seven regions report that new patients are facing long waits for primary care visits, delays that can last months.

— Seven regions report an increase in ER visits, up to 30 percent, in a statistic that has been particularly troubling for supporters of Oregon’s efforts.

Officials say the jump in ER use is likely fueled by newly covered patients who are unable to access primary care. “Medicaid expansion has exposed how serious the provider shortage is, that we definitely need more doctors,” said David Cole, CFO of the Eugene-based coordinated care organization Trillium, one of the two that’s turning away Oregon Health Plan patients. Trillium also has more than 9,000 enrollees for whom it’s yet to find a doctor.

For critics, these problems are the latest in a series of Oregon woes that include the state’s decision to spend a quarter of a billion dollars on an online marketplace that failed under a litany of embarrassing problems and prompted a switch to a federal site.

But many state officials consider such issues as bumps in the road, far from anything that would threaten the overhaul. They say they’re working on bringing in all enrollees into the coordinated care system by year’s end.

“I would consider it a rare success story for Oregon to absorb all these new patients,” said Leslie Clement, chief policy director at the Oregon Health Authority, a state medical regulating agency. “The primary care shortage is a national problem; it’s not an Oregon issue.”

Solutions include starting a new residency program in Eugene and using more nurse practitioners, physician assistants, pharmacists and a system of team-based care.

Coordinated care organizations are also opening new clinics and offering grants to physicians who’ll accept more Oregon Health Plan members, offsetting low federal reimbursements that had prompted many doctors to turn Medicaid patients away. Two coordinated care regions have even increased Medicaid reimbursement rates for doctors to run even with commercial rates.

The Virginia Garcia Memorial Health Center, which comprises nine clinics in northwestern Oregon, serves 36,000 patients in Washington and Yamhill counties. The center has been working through a backlog to link thousands of people to doctors, using innovations such as group visits and telemedicine.

About 2,600 new patients are yet to be assigned at the Beaverton clinic where Guerreiro practices alongside seven other doctors. “It’s a little intimidating,” Guerreiro said, “but we need to bring all these new patients in.”

It’s widely agreed that Kitzhaber’s coordinated care organizations have provided examples of success, most notably the 2-year-old system led to a decrease in ER visits before the massive influx of new patients. And supporters say the approach will save billions once it’s operating properly.

It’s not clear, however, when that will be.

“From 2007 to 2014, we’re going to triple our enrollment,” said Bill Guest, executive director of southern Oregon’s Cascade Health Alliance, the other coordinated care organization that has closed its doors to new patients.

“Unfortunately,” he added, “the primary care supply has not tripled over that period.”

Original Article:


ObamaCare Subsidies in Jeopardy

A pillar of ObamaCare was put in jeopardy Tuesday as two appeals courts split on whether the law’s premium subsidies are legal in 36 states.

In the first ruling, the D.C. Circuit Court of Appeals said the Affordable Care Act (ACA) does not permit the IRS to distribute premium subsidies on exchanges established by the federal government. (more…)

Half of Americans think expensive medical care is better. They’re wrong.

There’s a lot of clamoring in health care right now for more transparency in prices, making it easier for a patient to know how much their hip replacement costs before they land on the operating table.

Right now, it’s nearly impossible to find out how much a given medical service will cost in advance; hospitals have an easier time giving out parking prices than those for surgeries. One recent paper estimated that, if patients had better access to price data, we could save $100 billion in the next decade. (more…)