March 14, 2019 | NCI scientist named interim FDA lead

Industry News

Anthem pays rehab patient, not facility

Sovereign Health is suing Anthem for sending more than $1.3 million in payments directly to patients for care rendered in out-of-network facilities—including to those in or recently discharged from drug rehab. The lawsuit alleges this was done to pressure providers into joining its network. Unsurprisingly, some patients fail to pay the provider. In court filings, Anthem doesn’t dispute that checks are made out to patients for various out-of-network care. It argued, however, that the treatment centers don't have legal standing to make a case in federal court under ERISA. AHIP also defends the practice. (CNN)

Scientist will lead FDA, for now

Scott Gottlieb has stepped down as FDA chief, and public health advocates are anxious about the fate of some of his more ambitious initiatives, such as those related to e-cigarettes and tobacco. “We have real concerns that the tobacco industry will exploit the leadership vacuum at the FDA to aggressively press its profit-centered policy agenda,” said Nancy Brown, chief executive of the American Heart Association. On Tuesday, Trump named Norman “Ned” Sharpless as interim FDA lead. The director of the National Cancer Institute and a scientist is a different direction from Gottlieb, who brought both industry and government experience to the job. (Washington PostFortune)

It’s a secret: FDA’s hidden file of flawed devices

The FDA has quietly allowed the makers of certain devices to file reports of malfunctions in a database hidden from doctors and the public. A Kaiser Health News investigation found that amid the blackout in information about device risks, patients have been seriously harmed. For instance, there were 480,000 injuries or malfunctions in 2017 alone. Subsequent to the KHN piece, the FDA announced a sweeping plan Friday to review and address the safety of surgical staplers. (Kaiser Health News)

Innovation & Transformation

Cardiologists talk about SDOH, community connections

Like primary care docs, cardiovascular specialists need to consider social determinants of health when treating patients, according to cardiologists featured in Cardiovascular Business. Cardiologists don’t have to serve in the trenches, but—especially in an era of tighter margins—they do need to play an active role in connecting patients to resources that will bridge care from the clinic to the community. A cardiologist may perform the most sophisticated procedures imaginable, but if the system can’t support those patients in their lives at home, that work may be wasted. (Cardiovascular Business)

Study: Payers slowly move to value-based care

CMS has embraced value-based reimbursement, but private payers have been moving slowly, according to a recent HealthEdge Voice of the Market survey. The key take-away? “For payers to have a significant chance at success with VBR programs, they must have modern and flexible technology systems that can easily collect and share data, quickly test and model new programs, and are designed to build more trust among providers of all types.” (FierceHealthPayersurvey)

Consumers & Providers

Doctor delivers terminal prognosis via video feed

A 79-year old grandfather and his family learned over video he was dying at Kaiser Permanente Medical Center in Fremont, Calif. A nurse told the patient and his granddaughter, Annalisia Wilharm, that a physician would make rounds. “A short time later, a robot arrived in the room. A doctor appeared on a video screen. […] Over the robot's video screen, Wilharm says she and her grandfather learned that [her grandfather’s] lungs were failing and he did not have long to live,” according to the KTVU report. According to another report, Kaiser says “the term ‘robot’ is inaccurate and inappropriate.” (KTVUBecker's Hospital Review)

Primary care physicians prolong life

Every 10 additional primary care physicians per 100,000 people in the United States were associated with a 51.5-day increase in life expectancy during the years from 2005 to 2015, according to a study published in JAMA Internal Medicine. The researchers found an increase of 10 PCPs per 100,000 people was associated with a 0.9 percent reduction in cardiovascular mortality, a 1 percent reduction in cancer mortality and a 1.4 percent decline in respiratory mortality. “The surprising result was how much PCP supply has declined despite so much emphasis on primary care over the last decade,” said Sanjay Basu, MD, PhD, the lead author. “I think the problem comes down to money. We pay less for prevention than treatment—and the former is where primary care lives.” (JAMA Internal MedicineStanford announcement)

New & Noted

VA and women’s health: Top VA women’s health officials said at a recent House Appropriations Committee hearing that the Department of Veterans Affairs is working to improve women’s health services, including mental health treatment associated with military sexual trauma. (Wall Street Journal)

Less discretion for HHS: The 2020 Health and Human Services budget includes $87.1 billion in discretionary authority for HHS and $1.2 trillion in mandatory funding. HealthLeaders Media reports that those numbers represent less discretionary authority and more mandatory funding than last year’s proposal. (HealthLeaders Media)


In conversation with SG Jerome Adams

In a “fireside chat” with Health2 Resources' Katie Capps, Surgeon General Jerome Adams chats about an array of issues, including community investment in health, vaccinations and how he came in second to astronaut Mae Jemison. The event was part of the Commission for Case Manager Certification’s New World Symposium. (CCMC video)

MarketVoices...quotes worth reading

On the idea of insurers sending money to patients rather than providers: “My overall, moral reaction is: Are you kidding me? It's almost like winning the lottery, it seems to me. So, I'm not surprised that there are misuses—and I'm enormously surprised that anyone would think this is a doable approach. Only in our crazy, market-driven, bureaucratic mess of a system would we think about this kind of a solution.”—Arthur Caplan, the director of medical ethics for New York University’s School of Medicine, to CNN

Jorden Gunessever