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HEALTH SCOOP — Xerox, one of two corporations bidding for the contract to run New York State’s $500 million Medicaid management system, has had problems with similar programs it oversees in other states, including claims of mismanagement and cost overruns. On May 9, the Texas Health and Human Services Commission said it would terminate Xerox’s Medicaid claims administration contract “for cause” because “thousands of requests for braces that weren’t medically necessary” had been approved. Xerox has also had problems in North Dakota, California, Montana and Nevada. The company is competing for New York’s contract with Hewlett Packard. http://capi.tl/1gXEVlN
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HAPPENING TODAY -– Supporters of medical marijuana will head back to Albany this morning to advocate for Assembly Health Committee chair Richard Gottfried’s bill. The bill is scheduled to be voted on by the entire Assembly. If it passes, it will be a big win for advocates. But the real action is in the Senate where Diane Savino has passed her version out of committee, and says she has the votes to pass it in the full Senate. The question is: how will she be able to get it to a vote?
NOW WE KNOW–- The emerald ash borer (Agrilus plantipenis), a recent insect immigrant to North America that hopped a ride inside wooden packing material of imported goods, is projected to cause more than a billion dollars in damages annually over the next decade, according to an article in Frontiers in Ecology and the Environment. The insect, a native of Southeast Asia and Eastern Russia, lacks predators in North America and has spread quickly, killing millions of ash trees since its discovery near Detroit, Mich. http://bit.ly/1oBOCpR
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INTERFAITH UPDATE –- A bankruptcy proceeding for Interfaith Medical Center has been postponed until May 30. The Bed-Stuy hospital was hoping to exit bankruptcy last Friday but the parties needed more time to document settlement agreements that had already been reached with creditors. The hospital has already settled a tax claim with the state and pension issues with the New York State Nurses Association. I’m told Interfaith brass do not think there will be any more delays.
MISLEADING HEADLINE –- The New York Times was first to report on new rules from the I.R.S. that prohibit employers using pre-tax dollars to help employees purchase plans on the exchange. The headline for the online version, which was up most of Monday, read “I.R.S. Bars Employers From Dumping Workers Into Health Exchanges.” That isn’t the case, though the Obama administration wishes it was. Employers can still refuse to offer insurance and instead pay employees an increase in their wages to shop on the exchange. Those wages would simply be taxed like ordinary income. http://nyti.ms/1jSJBcM
…Also worth a read is the vox.com explainer of the new rule. “This ruling from the I.R.S. actually changes very little. Employers might still drop insurance coverage and direct their employees to the health insurance exchanges — they just can’t keep claiming a tax preference if they do so.” http://vox.com/e/5515777
Just my guess — If the exchanges are successful, employers will look to dump employees. It’s good for the employer and often good for the employee. Because of the employer mandate penalty, the taxpayer may even be made whole. For a template, look at how pension plans have turned into 401k plans.
HEROIN BUY –- Hoping to combat the heroin coming into New York and New Jersey, Senator Chuck Schumer wants Congress to appropriate $100 million for the federal High Intensity Drug Trafficking Areas Program. Schumer argues the increased funding would help develop coordinated strategies and information-sharing between the feds, NYPD, local law enforcement, as well as state and local public health officials, and would provide additional resources to build better cases against heroin dealers. “Seizures of heroin in New York City in 2014 have already surpassed those of any previous year since 1991, which demonstrates an alarming trend that we must nip in the bud,” Schumer said in a press release. “We all remember the horrors caused by the crack epidemic when it was left unchecked by federal officials and other law enforcement.”
DAVIS SAYS –- Last week, Ken Davis, C.E.O. at Mount Sinai, wrote an editorial for Forbes where he discusses what the future of health care might look like. Davis, who absorbed Continuum, and is making a big professional bet on the ability of integrated services to provide more cost-effective care, doesn’t mention Brooklyn directly but his essay could certainly be read as a sermon on why so many hospitals in that borough are struggling, including LICH and Interfaith. “The number of inpatient beds in a hospital does not equate to better care in a community. This is an outdated metric, particularly in an era where numerous specialties, including pediatrics and HIV/AIDS, require mostly outpatient treatment.” http://goo.gl/jLbEFf
WHAT WE’RE READING –-Austin Frakt, writing for The Upshot, talks about how the lines between health systems and insurance companies are blurring. In New York, we need to look no further than North Shore-LIJ and H.H.C., which are offering plans through the state’s exchange. Several experts have told me there will be more of these. But the inevitable may not be for the best, say Frakt. “Wary of threats to competition and the effects on consumers and patients, health economists and antitrust regulators are watching these market dynamics with a concerned eye.” Frakt, in his own study, found that insurance plans offered by hospitals charge higher premiums. “We also found that such plans are rated to have higher quality by consumers — but that about 70 percent of the additional premium was not attributable to higher quality.” http://nyti.ms/1gtl11p
TELL US HOW WE’RE DOING –- NPR interviewed Gary Schwitzer about his new study, “A Guide to Reading Health Care News Stories,” and the impact of bad health reporting. http://bit.ly/1lNKhff
WARNING LABELS FOR SUGAR –- Reuters reported that a California bill to require sugary soft drinks carry labels warning of obesity, diabetes and tooth decay advanced in the state legislature on Friday. If the bill were to pass, it will be interesting to see if other states, including New York, follow California’s lead. While New York City under Mayors Michel Bloomberg and Bill de Blasio, have favored a ban on large sugary drinks, elected leaders in Albany have not been as vocal on similar issues. The California measure passed on Friday by a 5-2 vote in the state senate’s appropriations committee now heads to the Senate floor. http://reut.rs/1jF92x9
WHAT’S BEHIND THE YIPS -– If, like me, you thought Mike Pelfrey was the next big thing, or never really understood what happened to Chuck Knoblauch, read this New Yorker piece on the science behind the yips, once described as a brain spasm. http://goo.gl/308ZFR
CHARITY CARE ON LIFE SUPPORT -– The New York Times reports that a few hospitals “have started scaling back financial assistance for lower- and middle-income people without health insurance, hoping to push them into signing up for coverage through the new online marketplaces created under the Affordable Care Act.” http://nyti.ms/1guhArm
TODAY’S TIP –- Comes from the Cleveland Clinic, which offers us “8 foods for head-to-toe beauty:” http://ow.ly/xbHxe
-MICE WITH MOHAWKS – Researchers at NYU Langone Medical Center have been breeding mice who have a gene that has suspected ties to Autism Spectrum Disorder. The NYU researchers were looking for mice with sideways, overgroomed hair with a highly stylized center hairline between their ears and hardly a tuft elsewhere. Overgrooming is a repetitive motor behavior, which is symptomatic of autism. If these behaviors can be linked to a specific gene, it could lead to new treatments if the gene’s effects prove reversible. The study was published in Nature. http://bit.ly/1wavbZB
-GENE THERAPY — Researchers have found a mutated gene common to adenosquamous carcinoma (ASC) tumors, according to a study in Nature Medicine. This, according to a press release, would be the first known unique molecular signature for this rare, but particularly virulent, form of pancreatic cancer. The study reports that these types of tumors have somatic mutations in the UPF1 gene, which is involved in a highly conserved RNA degradation pathway called nonsense-mediated RNA decay or NMD. The loss or malfunction of NMD may lead to increased cell growth, which spreads the tumor. http://bit.ly/1lNDxOu
MISSED A ROUNDUP? Get caught up here: 5/23, 5/22, 5/21, 5/20, 5/19
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