A project of the Galen Institute

Issue: "Medical Innovation"

Medical identity theft: How the health care industry is failing us

Laura Shin
Fortune magazine
Wed, 2014-09-03
"Unlike the financial services industry, health care companies lack measures to adequately prevent identity theft, even as they continue to digitize medical records and other sensitive information. Twelve years ago, when Nikki Burton was 17, she tried to donate blood for the first time. She was denied without explanation. Perplexed, the Portland, Ore. resident called Red Cross headquarters to inquire, only to learn that her Social Security number had been used to receive treatment at a free AIDS clinic in California, rendering her ineligible to donate blood. Years later, she wondered if, when asked whether she had any preexisting conditions, that instance of fraud might show up. So she called the Red Cross again. The organization told her that it no longer asked for Social Security numbers and she could donate blood without it. “I said, that’s fine for you guys to receive the donation, but that doesn’t solve the problem of that information existing in your system,” Burton says.

Reform Update: Facing ACA mandates, insurers diversify into technology

Beth Kutscher
Modern Healthcare
Fri, 2014-08-29
"Health insurance companies, now required to spend the lion's share of premium revenue on patient care, are looking for higher investment returns elsewhere. As a result, they're increasingly putting money into technology ventures where they expect to realize higher returns. The medical-loss ratio standard under the Patient Protection and Affordable Care Act requires insurers to spend at least 80% of what they earn from premiums on patient care and related quality improvements. No more than 20% can be used for administrative, marketing and business expenses. The requirement is as high as 85% for large group plans. Tied to that, insurers are trying to maximize their investment returns while also investing in businesses that are exempt from the 80/20 rule. Technology operations check off both those boxes for them. "That's been a catalyst for a substantial amount of investment,” said Joshua Kaye, a Miami-based partner at law firm DLA Piper. “We're really seeing it on a national scale.

More Data to Be Withheld from Database of Physician Payments

Charles Ornstein, Pro Publica
Fri, 2014-08-29
"A new problem has emerged with the federal government's Open Payments system, which is supposed to go live Sept. 30 and disclose payments to physicians by pharmaceutical and medical device companies. A couple weeks ago, the U.S. Centers for Medicare and Medicaid Services said it would be withholding information on one-third of the payments, citing data inconsistencies in company submissions. Now, a source familiar with the matter tells ProPublica that CMS won't disclose another batch of payments: research grants made by pharmaceutical companies to doctors through intermediaries, such as contract research organizations.

Reform Update: Ascension deals signal new economic reality in healthcare

Melanie Evans
Modern Healthcare
Thu, 2014-08-28
"Ascension Health, one of the nation's largest hospital owners, is expanding rapidly with a string of announced deals that its CEO says will grow its reach beyond hospitals to keep pace with rapid Obamacare-induced changes in the marketplace. But notably, Ascension is not on an acquisition spree. Its latest deals—in Illinois, Michigan, Arizona and Wisconsin—are not outright purchases, but rather agreements with regional rivals and other national players to jointly own, operate or contract for hospitals and insurance companies. The deals pair Ascension with well-established players in each market and allow the system to avoid costly competition or wasteful duplication by capitalizing on partners' resources that Ascension lacks, said Robert Henkel, Ascension Health's chief executive. The strategy also will allow Ascension to jointly develop broader services to care for patients at home, in nursing homes and other locations outside of hospitals.

When Medical Care Is Futile, Other Patients Pay The Hidden Price

Richard Knox
WBUR
Wed, 2014-08-27
"Every day in intensive care units across the country, patients get aggressive, expensive treatment their caregivers know is not going to save their lives or make them better. California researchers now report this so-called “futile” care has a hidden price: It’s crowding out other patients who could otherwise survive, recover and get back to living their lives. Their study, in Critical Care Medicine, shows that patients who could benefit from intensive care in UCLA’s teaching hospital are having to wait hours and even days in the emergency room and in nearby community hospitals because ICU beds are occupied by patients receiving futile care.

Pharma tells the Federal Government: Transparency Works Both Ways

Peter Loftus
Wall Street Journal
Wed, 2014-08-27
"File this under ‘how ironic.’ Drug makers are asking for more transparency from the government agency that is requiring them to be more transparent about how much they pay doctors. The Pharmaceutical Research and Manufacturers of America, or PhRMA, is calling on the Centers for Medicare and Medicaid Services to further explain why the agency has removed one-third of the payment information from an online database that is due to be made public by Sept. 30. Earlier this month, CMS said it would withhold about one-third of the payment data from the so-called “Open Payments” system. The agency also said it would return the records to drug makers because they were “intermingled,” including the erroneous linking of payment information for some doctors to still other doctors with similar names.

Verizon supporting telemedicine clinical trials

Mohana Ravindranath
Washington Post
Sat, 2014-08-23
"Verizon is making a bet that telemedicine — a term for virtually administered medical care — could provide a big business opportunity. The company recently announced it was providing private network services to the University of Virginia and Stanford University for a study on a so-called “artificial pancreas” — a series of devices that could monitor glucose levels in Type 1 diabetics and automatically release insulin into the body. For the past few years, Verizon has been supporting universities as they perform clinical trials on telemedicine, providing them with the required network services. Verizon declined to share the financial terms of these agreements, though it said it was providing a private wireless network and data center services, among other services. The artificial pancreas uses a tiny glucose monitor, inserted under the skin, which relays glucose levels to a smartphone.

FDA vs. right to try: Our view

Editorial board
USA Today
Tue, 2014-08-19
"The deadly Ebola outbreak spreading through Africa is so extreme, it is driving health officials to do something that they would instinctively resist in normal circumstances: Subject patients to unproven experimental drugs. The drugs are risky. Some have not even been tested on humans. Even so, a World Health Organization ethics committee just declared such use ethical, and its reasoning is hard to dispute, at least for patients who would otherwise die. Some chance is better than none, even with unknown side effects. Too bad American patients suffering from terminal illnesses have so much trouble getting the same chance. The process for getting experimental drugs is so daunting that fewer than 1,000 people sought and got federal approval to take such drugs last year. Food and Drug Administration rules require patients to clear a series of hurdles. First, they and their doctors must find a company to provide its drug.

States, Feds on Collision Course Over ‘Dallas Buyers Club’ Laws

Jonathan Easley, Morning Consult
Tue, 2014-08-19
"Health policy hashed out in Washington is usually discussed in terms of billions of dollars or percentage of market share. But, more often than other areas of policy, it can also lead to a focus on whether it will directly cause unnecessary suffering or even death for individuals. Pointing to the deeply personal implications of health policy is not unfamiliar. Consider Sarah Palin’s accusation that Obamacare would create “death panels,” or recent debates over FDA approval of Avastin, a cancer drug. The argument that the government shouldn’t regulate the behavior of a dying patient has sprouted up once again in 2014, and may be setting the stage for a showdown between the states on one side, and the federal government and Congress on the other. In May, Colorado Gov.

First Look At Medicare Quality Incentive Program Finds Little Benefit

Jordan Rau, Kaiser Health News
Thu, 2014-08-07
"One of Medicare’s attempts to improve medical quality –by rewarding or penalizing hospitals — did not lead to improvements in the first nine months of the program, a study has found. The quality program, known as Hospital Value-Based Purchasing, is a pillar of the federal health law’s campaign to use the government’s financial muscle to improve patient care. Since late 2012, Medicare has been giving small increases or decreases in payments to nearly 3,000 hospitals based on how patients rated their experiences and how faithfully hospitals followed a dozen basic standards of care, such as taking blood cultures of pneumonia patients before administering antibiotics. As much as 1 percent of their Medicare payments were at stake in the first year and 1.25 percent this year, though most hospitals gained or lost a fraction of that.

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