News & Commentary

Briefly Noted February 2019

The Pancreatic Islet Cell Transplant Program at Penn Medicine in Philadelphia is a small study that packs a lot of promise for a certain sort of type 1 diabetes patient who experiences hypoglycemic events without the usual warning signs, such as tremors, sweating, or heart palpitations. Penn was chosen in 2004 to be one of five centers to run a federally sponsored phase 3 clinical trial of pancreatic islet transplantation—a procedure that could be used in some cases instead of transplanting an entire pancreas. In the islet transplantation, cells from a deceased donor are infused into the liver and immediately begin to produce insulin. Eleven patients received the transplantations between 2008 and 2014, and more than half were able to stop insulin after the first transplant. Ali Naji, MD, the program’s director, tells the Philadelphia Inquirer that “based on our successful trials, we are applying to receive a biologic license application from the FDA, which will allow us to do the transplant at Penn and have insurance companies pay for it.”

Employers this year will try new approaches to health care coverage, reports the Wall Street Journal. Businesses are beginning to realize that just passing on more of the cost to employees in the form of higher deductibles and copayments just isn’t enough to slow their heath care cost trends. “There are a number of strategies in play,” the newspaper reports. “Some organizations are bypassing insurers and negotiating deals with hospitals directly. A growing number are offering their own clinics. And some are launching new efforts to change how they pay for drugs, an area that has left many employers frustrated in the past.”

In yet another example how the health care system is beginning to deal with the social determinants of health, Lankenau Hospital outside of Philadelphia recently wrapped up a pilot program in which medical students delivered fresh produce from the hospital’s Deaver Wellness Farm to some city residents, reports NPR affiliate WHYY. The food is only one aspect of the outreach effort. “Students would ask about the challenges patients faced, whether it was child care, transportation, employment, or food insecurity,” WHYY reports. It was a small pilot, involving just 24 patients who’d visited the hospital’s emergency department 11 or more times in the last year.

Poor health literacy leads to patients not opting to get some preventive care because they believe that they’d have to pay for it, according to a study published in JAMA Network Open. Researchers looked at 506 insured adults, grading them on a 0-to-84 scale, with a lower number meaning less health literacy. Every 12-point increase equaled a 39% lower likelihood that people would delay getting such things as vaccinations and cancer screenings.

In an effort to lower avoidable hospital admissions for nursing home residents, CMS is brandishing both the carrot and the stick, Kaiser Health News reports. The agency lowered a year’s worth of payments to nearly 11,000 nursing homes, while giving bonuses to nearly 4,000 others. As KHN reports, it is “financially tempting” for nursing homes to discharge people too quickly because Medicare fully covers only the first 20 days of a stay and generally stops paying anything after 100 days.

A riveting account of how one cesarean section was avoided by the Team Birth Project highlights one approach to something that’s been a problem for years. About one in three American babies are born via C-section—26% of those to healthy women with low-risk pregnancies. That’s well above the 10%–15% that the World Health Organization says should be the desired overall C-section rate for all women. Since South Shore Hospital in Weymouth, Mass., began using the Team Birth Project four months ago, the hospital’s primary, low-risk C-section rate dropped from 31% to 27%, reports Kaiser Health News. The Team Birth Project was developed at Atul Gawande’s Ariadne Labs. Gawande made headlines last year when he was picked to head the Amazon–Berkshire Hathaway–J.P. Morgan Chase effort to make health care delivery more efficient.

In a move that’s expected to expand insurance coverage for an HIV prevention pill, often known as PrEP, the U.S. Preventive Services Task Force recently issued a draft recommendation that doctors should encourage patients at high risk of contracting HIV to take Truvada. The task force estimates that 1.2 million people in the U.S. are currently eligible for PrEP. James Krellenstein, a founding member of the Prevention of HIV Action Group at ACT UP/New York, tells Stat that the task force’s recommendation could be a sea change in HIV/AIDS prevention. If the task force makes the recommendation final, then “all insurance companies are going to be required to cover PrEP and they won’t be able to [impose] any cost sharing,” says Krellenstein.

Diabetes and obesity rates rose in every state between 2008–2009 and 2016–2017, according to the Gallup-Sharecare Well-Being Index. During that time period, the national rates of adults with diabetes rose from 10.8% to 11.5%, meaning that 1.7 million more Americans have diabetes today than would have been the case if the rates had not gone up.

Here’s the cost-sharing problem in a nutshell from the physician’s point of view: “It’s harder to collect from the patient than it is from the insurance [company],” says Amy Derick, MD, a doctor who heads a dermatology practice outside Chicago. It’s a complaint more physicians voice as health plans shift more of the cost of insurance coverage to beneficiaries in the form of out-of-pocket costs, Bloomberg reports. Patients are often reluctant to reach into those pockets, and in many cases, do not have the ability to afford their cost share.

Hospitals need to be redesigned with an eye on their largest demographic of patients—the elderly—argues Louise Aronson, MD, a professor of geriatrics at the University of California–San Francisco in an opinion piece in Stat. “Old people end up in old buildings,” Aronson writes. “That usually means long walks down halls without railings or chairs with arms for rest stops. It means signs that are hard to read until you are right under them. It means a one-size-fits-all approach to both facilities and care that doesn’t acknowledge that the needs, preferences, and realities of a 75- or 95-year-old with a medical condition might differ from those of a 35- or 55-year-old with the same thing.”

Men in construction and extraction jobs and women in the arts, design, and entertainment, sports, and media are most at risk of suicide, according to a study in the the CDC’s Morbidity and Mortality Weekly Report. Researchers looked at occupations of about 22,000 working-age Americans who died between 2012 and 2015. “A better understanding of how suicides are distributed by occupational group might help inform prevention programs and policies,” the study states. “Because many adults spend a substantial amount of their time at work, the workplace is an important but underutilized location for suicide prevention.”

Some of the social determinants of health will be covered by 273 of the approximately 3,700 MA plans across the country, Kaiser Health News reports. The 1.5 million beneficiaries (about 7% of MA members) will be offered such services as home-delivered meals, transportation to medical appointments, and air conditioners (for asthma sufferers). HHS Secretary Alex Azar said that he’s considering ways to supply public housing for Medicare and Medicaid beneficiaries.

A predictive analytic tool helped reduce sepsis mortality at the North Oaks Health System in suburban New Orleans by 18%. The tool, called the Clinical Care Advisory (CCA), points out which patients may be susceptible to sepsis by using data culled from Epic electronic health records, reports Health IT Analytics. The CCA scans the patient’s health information every 15 minutes and monitors over 80 data points to develop a sepsis risk score. “If the patient’s score reaches a certain threshold,” says Health IT Analytics, “clinicians receive a warning that a patient is at high risk of becoming septic.”

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