September 19, 2019 | It’s still a man’s world

September 19, 2019


Verma: No more "surprises"

Saying Americans are fed up with high health care costs and surprise billing, CMS Administrator Seema Verma called on hospitals to get on board with transparency and value-based payment policies, warning they could face tougher times and more government insurance competition if they resist. “Our choices are clear, we can choose Medicare for All or a public option, doubling down on government and a one-size-fits-all, socialist approach, with government price setting . . . [or move] to a system of competition and value,” she warned. (Modern Healthcare)

Doctors want a say in prior authorization

Physicians—practicing physicians—should have a seat at the table when it comes to deciding how prior authorization should work, doctors told a House committee. “Instead of pharmacy benefit managers deciding on how best to administer prior authorizations, have the physicians who are at the point of the spear weigh in,” said Howard Rogers, MD, PhD. He says there’d be much greater buy-in from physicians if it were a collaborative endeavor. John Cullen, MD, called having generics go through prior authorization “absolutely ridiculous.” The committee responses suggest bipartisan support for physicians. (MedPage Today)


Administer specialty drugs in office, home—not hospital

Administering pricey specialty drugs in doctors’ offices and patients’ homes instead of hospitals could reduce drug costs by $4 billion a year for insurance plans, according to a study from UnitedHealth Group. “Compared to independent physician offices, hospitals charge more for specialty drugs and their administration, whether treatment takes place in a hospital facility or in a hospital-owned physician practice,” the study said. (FierceHealthcare; UHG infographic)

Medicaid expansion increased hospital visits

New Medicaid patients in states that expanded the program under the Affordable Care Act increased hospital visits on average by about 20%, mostly with outpatient visits to the emergency department for deferrable conditions, according to research from the Brookings Institution. Nevertheless, the authors determined that expansion ended up being “well-targeted,” with those who previously had the highest unmet needs receiving better access to services. (Brookings research; Healthcare Dive)


It’s still a man’s world

Female pediatricians made less than their male counterparts in 2016, even after controlling for many factors that influence income. One reason could be that female pediatricians spend more time on household responsibilities than their male counterparts. “When you put together the fact that women are getting paid less and they’re doing more at home, we feel we need to explore this more to see how we’re going to attract and retain women in pediatrics given these discrepancies,” Bobbi Byrne, MD, also of Indiana University, told MedPage Today. (Pediatrics; MedPage Today)

Finally: Dealing with harassment of providers

Health systems, including the Mayo Clinic, are starting to take seriously sexual harassment by patients. It’s past time, Stat reports: A 2018 Medscape survey found that of more than 6,000 doctors surveyed, 27% reported sexual harassment by patients within the past three years; only 7% reported harassment from clinicians, administrators or other personnel. Mayo’s approach includes a policy to address patient behavior, a reporting structure for providers to use following incidents, protocols for dealing with patients who behave improperly and training for staff and students. (STAT)


It’s not over: Purdue Pharma declared bankruptcy and announced plans to become a “public benefit trust” that would continue selling opioids but turn its profits over to those who have sued the company. But given that half the states suing Purdue aren’t happy with the plan—and many are also suing the Sackler family—this is far from the end of the saga. (Associated Press)

Transparency lessons: Transparency initiatives come “in many shapes and sizes,” Robin Gelburd, founding president, FAIR Health, writes in a piece for STAT. Some are very effective, some are not and some hover around the middle. She shares what her organization has learned from its transparency efforts. (STAT)

Heresy, or a new revelation? Men and women experience heart attacks differently, right? Maybe. Using artificial intelligence to analyze how hundreds of patients described symptoms, researchers are challenging that dogma, at least in terms of angina pain. Not recognizing that may keep women from getting help. “We see this in patients all the time, where they say ‘Yeah, I was having crushing chest pain, but aren’t women supposed to present differently?’” Dr. Martha Gulati told WBUR. (WBUR; American College of Cardiology)



The annual report from the Census Bureau, found that 27.5 million Americans were without health insurance last year, an increase of nearly 2 million from 2017. The increase was the first in a decade and came as unemployment and other economic indicators have been good. What’s does it mean? Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Tami Luhby of CNN and Rebecca Adams of CQ Roll Call will talk about that in KHN’s weekly podcast, “What the Health?” (KHN)


“They were pretty much giving us minor-league heroin and saying it was safe. There should be more consequences for that family. Your average drug dealer gets in way more trouble than this family that’s just taken out a whole generation of our people.”Shaun Wallace, 40, who has been in recovery five years from an opioid addiction that he says started with OxyContin, talking about the Purdue deal with the Associated Press

Jorden Gunessever