Legislation & Regulation: Campaign 2016
Richard Mark Kirkner
Hillary Clinton and Donald Trump promise divergent approaches to the ACA if elected. Basically, Clinton wants to improve it; Trump promises to dismantle it. Of course, no president acts in a vacuum, and a lot will also depend on which party controls Congress.
Richard Mark Kirkner

Bradley C. Leibovich, MD
Mayo Clinic

Sometimes it’s best to hold off. Patients and doctors fight the urge to rush in and treat as more types of cancer lend themselves to active surveillance. The advent of precision medicine makes this a more inviting option.

Even as they’ve become more and more popular with employers, wellness programs have taken hits in recent years with naysayers arguing that the effort discriminates against some workers by leveling fines for not reaching benchmarks and also represent an invasion of privacy. The latest challenge comes from AARP, which is suing the U.S. Equal Employment Opportunity Commission (EEOC) over rules the commission issued in May, Reuters reports.

The inability of the Obama administration to lure younger, healthy enrollees into ACA plans has resulted in a spike in premiums, McClatchy DC reports. Premiums for health plans sold on HealthCare.gov for 2017 rose an average of 25%, federal health officials announced yesterday.

Turns out that what has long been considered the cornerstone of the fight against hospital infection, sinks where workers can scrub down, might be making the problem worse, STAT reports. To add to the irony, hospitals have made the installation of sinks a priority. But recent studies show that they’ve been linked to the spread of dangerous bacteria around the world. STAT mentions that a hospital in the Netherlands slowed the spread of bacteria by actually taking sinks out of patient rooms in the ICU.

Charlotte Huff

Mark Preston, MD

Experts are rethinking routine cancer screening. Genetic tests could be the answer. They may add upfront expense, but might eventually lead to savings by winnowing out unnecessary screening. Concern about false positives helps push this movement along.

More Medicare patients using hospice services accounted for the agency’s increasing spending on hospice by 52% between 2007 and 2015, according to a study by CMS researchers published in Health Affairs. Per patient costs remained largely flat during the period. About 1 million Medicare beneficiaries used hospice in 2007 compared to 1.4 million in 2015. Medicare spent $10. 4 billion on hospice care in 2007 compared to $15.8 billion 2015.

Also of note, CMS researchers found that spending and spending growth varied by geographic region and diagnosis.

Most of the deaths from cancer in the United States can be attributed to smoking, according to a study in JAMA Internal Medicine. In 2014, 167,133 cancer deaths in the U.S. were attributed to smoking (that’s 28.6% of all cancer deaths). There were geographical differences, with the highest death rates due to smoking occurring in the South.

Arkansas led the pack (so to speak), where 40% of cancer deaths were linked to smoking. Utah had the lowest rates, where 22% of the cancer deaths in men, and 11% in women were linked to smoking.

The number of civil case filings against pharmacies, manufacturers, and distributors of opioids dipped drastically from 131 in 2011 to 40 in 2014, according to an investigation by the Washington Post. Suspension orders are the DEA’s strongest weapon of enforcement and they dropped from 65 to nine in the same period.

Within five years of being diagnosed with breast cancer, 8% of Caucasian women die; for African American women, it’s 21%, the Philadelphia Inquirer reports. A troubling disparity that a recent study in Supportive Care in Cancer focused on. The study includes data based on 60 interviews with African American women who survived, as well as surveys of 1,000 other African American survivors. In a Q&A with one of the authors, Patricia K.

Was a time long ago when hospitals sold cigarettes and many doctors would catch a smoke in between seeing patients in the examination room. That’s gone the way of he Edsel, and today many hospitals are treating the selling of sugary drinks in the same manner: That is they are pulling them from vending machines and cafeterias, STAT reports. There’s pushback, of course, and much of it is coming from employees.  

News & Commentary
The U.S. Preventive Services Task Force says there’s not enough evidence to recommend for or against pediatric high-cholesterol screening among asymptomatic children or teenagers. In reaching this conclusion, the USPSTF reaffirmed its recommendation statement from 2007.

Eleven private insurers wrote a letter to the Congressional Budget Office asking that their data on the effectiveness of telemedicine be included when the CBO calculates cost savings created by the technology. CMS is considering paying for telemedicine services as they relate to dialysis for end-stage renal disease, advance care planning and critical care consultations. The insurers currently can include telemedicine in Medicare Advantage plans only as a supplemental benefit.

Primary care physicians don’t practice in a vacuum, and a new report says that Medicare payments do not take into account socioeconomic factors doctors must deal with such as income, marital status, education, and ethnicity, reports AAFP. Most of this data could be collected by CMS when people apply for Medicare. The report, by the National Academies of Sciences, Engineering and Medicine, also suggests that CMS should look at patients’ neighborhoods and take into account things like transportation options, violence, and housing.

Calling out hospitals for overcharging doesn’t work, according to a study in the Journal of Health Care Finance. University of Florida researchers found that a year after U.S. hospitals being publicly taken to task for marking up prices by 1,000%, the 20 Florida hospitals on the list continued to raise prices even after the negative publicity. Hospitals can charge whatever they want, and that’s the problem, say researchers. That, and a lack of transparency and market competition.

Some daunting news for parents who’ve ever used television as a make-shift babysitter while Mom and Dad prepare dinner, pay bills, or do any number of grownup things. (Managed Care conducted a totally unscientific poll and found that that accounts for 70% 80% 85%; well, a whole bunch of parents, let’s say.) The American Academy of Pediatrics (AAP) released new guidelines on how much screen time toddlers should have. The guidelines are actually looser than the old ones, which recommended no screen time for children under 2, and two hours a day for older children.

Thomas Reinke

Jonathan Friedlaender

Meet Jonathan Friedlaender, a cancer survivor whose 20-year-long struggle helps illustrate drug pricing’s important role in this arena.
Retooling Cancer Management
Ed Silverman

Caroline Pearson, Avalere Health

Perhaps with some justification. The organizations that develop these techniques do so with patients and doctors in mind, not health insurers.
Cover Story
Thomas Reinke
CMS’ Oncology Care Model program is bringing bundled payments to cancer care. With drug costs so high and hard to control, the 195 participating practices will have to figure out other ways to control costs if they want to beat financial benchmarks and earn bonuses.