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CRO_Health_CROH_July_Medical_Bill_05-15Surprise! California lawmakers waited until the very end of their legislative session before joining an increasing number of states in protecting patients from unexpected out-of-network medical charges. As many as 70 percent of patients staggered by these often hefty bills say they didn’t know they were receiving out-of-network care when it was given.

Gov. Jerry Brown is expected to approve the surprise medical bill legislation, which was bitterly opposed by providers. The measure won bipartisan support in providing that “patients who received care in in-network facilities would have to pay only in-network cost sharing” and only in instances of non-emergency care. As the industry publication Modern Healthcare describes it:

Emergency physicians in California already are barred from balance billing patients. The bill’s provisions [do not apply] to self-insured employer health plans, which are shielded from state regulations by the federal Employee Retirement Income Security Act. Health plans would pay non-contracting physicians the plan’s average contracted rate or 125% of the Medicare rate, whichever is greater. Doctors could appeal that through a binding independent dispute resolution process, which the state Department of Managed Health Care will establish.

gwuhospitalMore than 3,600 hospitals across the United States have taken a star turn. Many aren’t happy about it, and the same may be true for some members of Congress. Whether patients benefit is still murky. But federal officials, who have been planning a new and expanded hospital rating system for a long time now, have gone ahead with it because they say it will clarify for consumers some critical issues of safety, quality, and cost in health care.

Uncle Sam took 64 ratings it already publishes on its Hospital Compare website on measures like emergency room wait times and hospital acquired infection rates, and, summarized these into overall scores for institutions large and small. The Centers for Medicare and Medicaid Services, grouped them, weighted them, and, ultimately, converted the data into stars, from a low of one to a high of five.

Federal officials say this rating system, more common with restaurants and on review apps for the young, like Yelp, gives patient-consumers a fast, easy, clear, convenient way to start to deal with the complex, difficult issue of whether a hospital’s any good or not. The hospitals disagree, strongly, and some members of Congress have sided with them, and against the star ratings.

NFL-vector-logosWhat’s $30 million among friends? When the National Football League offered in 2012 to provide that sum to support concussion research by the National Institutes of Health, the conventional wisdom held that the sports powerhouse was finally coming around. The league basked in public praise for taking a more progressive approach to its challenges with deadly, debilitating head injuries.

But a congressional panel has found the NFL’s magnanimity was a sham. Instead, pro football sought to strip $16 million of its funding from the NIH when the agency wanted to bring in Dr. Robert Stern, a Boston University researcher who has been a major critic of the league.

The NFL, instead, tried to lateral its gift to members of its own committee on brain injuries.  As for these “experts,” the New York Times reports:

We wrote yesterday about contamination at the pharmacy of the NIH Clinical Center in Bethesda. Other big hospitals, judging by media reports, also may need to look at their pharmacy operations, especially when they compound ingredients together into custom drugs for patients.

A major hospital in a San Diego, Calif., suburb may have exposed more than 7,300 of its patients to infection risk due to contaminated medications served up in a pharmacy compounding lab. State officials fined Paradise Valley Hospital $17,500 not only for sanitary violations found in inspections but also because a hospital executive with oversight over the compounding lab was found to have falsified records; no patients came down with infections at the hospital due to the lab woes, otherwise the hospital could have been fined up to $75,000, state officials said.

And in Seattle, the flagship University of Washington Hospital between May 2014 and October 2015 produced medications for  surgical IVs, cancer care chemotherapy, and even simple injectable steroids for joint pain in pharmacies so dirty that they failed that state’s health department inspections, a TV station has reported.

Before they headed off to their holidays, Congress and President Obama wrapped up what many hope will be a helpful fiscal package to benefit Americans’ health: The 2016 omnibus budget bill, which got so much attention, also provided some of the strongest health care funding in more than a dozen years, news reports say. This should better support efforts to address an array of concerns, including fighting cancer and Alzheimer’s disease, improving food safety, and the bolstering initiatives to preserve the effectiveness of antibiotics.

The director of the National Institutes of Health issued a statement praising the $2 billion boost to his agency’s budget, the best he said he had seen in years. The health-related funding took significant bipartisan lobbying, particularly to overcome what has been a tide of partisan, rancorous, and downright anti-scientific activity in Washington.

Compared with what other national needs get funding when Uncle Sam figures how to spend more than $4 trillion annually, the increased healthcare spend might not seem sizable. But the added money is expected to:

July 25 marks the anniversary of a blood transfusion error between two federal health agencies in 2011 that was implicated in the deaths of two patients at the National Institutes of Health (NIH) in Bethesda, Md.

Two patients being treated at NIH received transfusions of platelets from a single donor that were contaminated with the dangerous gram negative bacteria Morganella morganii. Both patients died, one within a few days and the other after six weeks of intense treatment, which never overcame the shock to the patient’s system of receiving a direct injection of bacteria into his bloodstream.

The originating source of the platelets – and where the actual contamination occurred – was the blood bank facility of the former Walter Reed Army Medical Center (WRAMC) in Washington, D.C. The incident occurred as the WRAMC blood bank was in the process of being shut down and activity transferred to the National Naval Medical Center (NNMC) in Bethesda, although the closure did not appear to have anything to do with this event.

Regular readers of this blog know that imaging tests – X-rays and MRIs, for example – are frequently used when there’s no need, or when the need is questionable. The Joint Commission’s new campaign, Speak Up, includes guidelines for the use of these tests that should help patients understand when and why they are appropriate, or not.

The Joint Commission is an independent, nonprofit organization that accredits and certifies thousands of U.S. health-care organizations and programs. Its mission is to improve health care by evaluating health-care organizations and offering resources to enable them to provide safe, effective and appropriate care.

Medical imaging tests help diagnose problems and guide their treatment. But they’re not without risk – some involve radiation, some involve uncomfortable preparation, some carry a risk of infection or allergy. To view the Joint Commission’s graphic, link here. It explains the purpose of each imaging procedure – X-ray, ultrasound, computed tomography, magnetic resonance imaging and nuclear scan – what’s involved and the risks.

We all know about epidemics of infectious disease — that’s how the science of epidemiology got its name in the 19th century when the cause of cholera was first traced by statistics to a contaminated water well in London. But here’s what a modern epidemic looks like — this one not an epidemic of disease but an epidemic of overtreatment.

thyroid_cancer_mortality-thumbThe graph is from a new study about what happened when South Korea started free ultrasound testing for thyroid cancer in 1999. You can see how the incidence rate (detection) of the cancer skyrocketed.

A good thing, right? Wrong.

As more patients in Maryland, Virginia and seven other states are found with severe meningitis infections from an injected steroid pain drug, the tradeoff in how the drug got made is becoming increasingly plain. It’s a new variation on the old line, “Your money or your life.”

The “compounding” pharmacy in Massachusetts that made and distributed 17,000 vials of the drug, contaminated with a fungus, was subject only to the loosest regulations. That kept down their costs and attracted hospitals and pharmacies as customers.

As one law professor, Kevin Outterson of Boston University. told the New York TImes: “The Food and Drug Administration has more regulatory authority over a drug factory in China than over a compounding pharmacy in Massachusetts.”

The Kodak company went bankrupt because it thought it was in the film-making business, and not the image-making business. So when digital technology came along, Kodak wrongly focused on propping up its dying cellulose-based business rather than figuring out how to adapt to the digital age.

As goes Kodak, so goes the U.S. health care system, argues Merrill Goozner in an acute analysis of Mitt Romney’s wrong-headed approach to fixing the woes of health care in America. Read his piece here.

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