News & Commentary

Briefly Noted July 2017

The bleeding of the Obamacare exchanges continues, with the New York Times reporting that Anthem, one of the industry’s biggest players, will not participate in Ohio’s marketplace next year. “While Anthem had warned that it might leave some or all of the states where it offers individual plans, its exit from Ohio signals that even some of the market’s stalwarts are unnerved,” the newspaper reports.

Medicare Part D beneficiaries have been buffeted by the high cost of drugs, according to an analysis by the Wall Street Journal. The newspaper’s review found that the number of drugs with out-of-pocket costs of $1,000 or more rose by 86%, from 118 in 2011 to 220 in 2015.

Financial counseling offered as part of a worker’s wellness package can greatly reduce stress in the workplace, according to a survey by Money Management International, a not-for-profit credit counseling organization. The survey found that 86% of workers at Samaritan Health Services, a not-for-profit health organization in Corvallis, Ore., reported less stress after progressing on financial goals after counseling.

Will insurers have to cover healthy meals someday? Doctors in Boston are studying the benefits of medically tailored meals. The focus of their efforts is Community Servings, a not-for-profit organization that has been providing such sustenance for about 30 years by shopping for, preparing, or both, for people with chronic diseases. Seth Berkowitz, MD, a primary care physician at Massachusetts General Hospital, is doing research on the program. He told STAT: “We know lack of access to healthy food is associated with bad outcomes in virtually every area you look. What we don’t really know is how to intervene on the issue.” Some insurers cover what Community Servings does as a medical expense. Berkowitz wants to see if a case can be made for the entire health care system to follow suit.

In Colorado alone, there are about 17.5 tons of unused prescription drugs worth nearly $10 million that have to be thrown out when patients in long-term care facilities either move out, die, or no longer need the medication, ProPublica reports. Iowa is doing something about this, and its Safe­NetRx program looks to recover and redistribute about $5 million worth of drugs this year.

Blame the rise of drug-overdose deaths in Massachusetts on fentanyl, reports Kaiser Health News. In keeping with a pattern seen across New England, about 75% of the men and women in Massachusetts who died of an overdose last year had the substance in their system. That’s up from 57% in 2015. Fentanyl may be especially lethal because it’s potent and is mixed with other drugs in varying amounts unknown to the user, Kaiser reports.

Asian Americans are vulnerable to developing type 2 diabetes, yet are 34% less likely to be screened for the disease than non-Hispanic whites, according to a study published in the Journal of General Internal Medicine. University of Chicago researchers analyzed data from telephone surveys of more than 500,000 people.

Rather than tally environmental exposures individually, the Environmental Quality Index (EQI) combines them from five domains (air, water, land, built environment, and socio­demographic environment). Comparing the EQI with the incidence of cancer at the county level, researchers found that poor environmental quality was associated with cancer and that the relationship was strongest for prostate and breast cancer.

There’s a greater risk of longer length of stay, readmissions, and death if a patient gets a preventable hospital-acquired complication—and that’s especially true for patients who have kidney disease, according to a study in the Clinical Journal of the American Society of Nephrology. The researchers used data on all the adults hospitalized in the province of Alberta from 2003 to 2008 to conduct their study.

California’s legislators are considering a single-payer health care system in the state, but the cost is giving some lawmakers pause, reports Kaiser Health News. It would come to about $400 billion annually, with half of that money coming from a 15% payroll tax and the other half from all of the public funds already allotted for health care.

Fewer skilled nursing home admissions and shorter lengths of stay helped ACOs in the Medicare Shared Savings Program bring about a 9% decrease in postacute spending, according to a study in JAMA Internal Medicine. Reductions in use of nursing homes and length of stay were mainly because of within-hospital or within-nursing home changes in care specifically for ACO patients, the researchers found.

The main caregiver for someone with Alzheimer’s or another form of dementia is usually a family member, and that person often feels overwhelmed. A new “boot camp,” sponsored in part by the Archstone Foundation, gives caregivers tips and advice.

Efforts to subsidize premiums for private health insurance for low-income people may not work as well as policymakers had hoped, according to a study by economists at MIT and Harvard. Looking at data from CommCare, Massachusetts’ subsidized insurance exchange, researchers found that people’s “willingness to pay” is three to four times below their expected medical costs. “As a result,” the abstract says, “we estimate that take-up will be highly incomplete even with generous subsidies: If enrollee premiums were 25% of insurers’ average costs, at most half of potential enrollees would buy insurance, and even premiums subsidized down to 10% of average costs would still leave at least 20% uninsured”.

Listen to your doctor, patients have always been told and there was always an “or else” implied. Usually it was “or else, you won’t get better.” Now, it’s “or else he or she will tell you not to come back,” according to a research letter in JAMA Internal Medicine. The authors, from Mathematica Policy Research and CMS, say patient dismissal could be an unintended consequence of the shift to value-based care as clinicians face pressure to limit their panel to patients for whom they can readily demonstrate value in order to maximize revenue.

Only half of employers offer vision benefits, according to MetLife’s 2017 Employee Benefit Trends Study, even though more than half of employees rate vision care as an essential benefit, right behind medical and dental benefits.

Yet more data suggesting that too much imaging can be a bad thing. A study in the May issue of the Journal of Hospital Medicine included 376 patients who were hospitalized because of chest pains at an academic medical center. Of these, 197 (52%) had new radiologic findings, and those findings were associated with a 26% increase in length of stay yet only 7% of the findings were clinically significant.

Sexual abuse in nursing homes is underreported, and often the perpetrators go unpunished, reports the Kansas City Star. It will take a lot to fix the problem, including soul-searching, because the abuse “hides behind reporting systems that fail to catalog such complaints separately from other forms of abuse that afflict the elderly and disabled.” The Administration for Community Living, which collects data from state-level ombudsmen, has cataloged more than 20,000 complaints of sexual abuse at long-term care facilities over 20 years, which works out to nearly three such complaints a day, the newspaper reported. And the newspaper says that tally is incomplete and does not include resident-on-resident sexual assaults.

The number of children and adolescents admitted to children’s hospitals because of suicidal thoughts or self-harm more than doubled from 2008 to 2015, according to research presented at a recent meeting of the Pediatric Academic Societies. Significant increases were seen in all age groups but were higher among the older children, according to a press release about the findings presented by Gregory Plemmons, MD, an associate professor of pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

Even drugs not on the DEA’s schedules have high abuse potential in prisons, reports Jeffrey E. Keller in his blog, Jailmedicine. Keller is the medical director of Badger Medical, which provides medical services to several jails and juvenile facilities in Idaho. Drugs on Keller’s list include trazodone, albuterol, and first-generation antihistamines like Benadryl. There is an active market for drugs among inmates, Keller writes, so even if an inmate has no interest in abusing the drugs himself, he may want to sell the drugs.

There’s no definitive way yet for physicians to determine which prostate cancer cells will become aggressive and which a man can live with. But methods that can do just that appear to be in the works, according to STAT. One, called multiparametric MRI, shows the size and density of prostate cancer and connections to the blood supply. Dutch researchers reported at a European meeting earlier this year that multiparametric MRI reduced unnecessary biopsies by 70%, according to STAT.

The health situation in America for black men is so bad that they often live longer in prison than out, according to a study in Lancet. “Black male prisoners, for instance, have far lower mortality than similarly aged black men in the general population,” the study states. Why? It’s not exactly clear, but decreased risk of death by violence or accidents, reduced access to illicit drugs and alcohol, and improved access to health care possibilities.


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