Affordable Care Act, CMS, Long term care, Medicaid

Medicaid Weighs Attaching Strings to Nursing Home Payments to Improve Patient Care

By Susan Jaffe  | Kaiser Health News | June 10, 2022 | This KHN story also ran on Fortune logo

The Biden administration is considering a requirement that the nation’s 15,500 nursing homes spend most of their payments from Medicaid on direct care for residents and limit the amount that is used for operations, maintenance, and capital improvements or diverted to profits.

If adopted, it would be the first time the federal government insists that nursing homes devote the majority of Medicaid dollars to caring for residents.

“The absolutely critical ingredient” for good care is sufficient staffing, Dan Tsai, a deputy administrator at the Centers for Medicare & Medicaid Services and Medicaid director, told KHN. [Full story in Kaiser Health News, Fortune, Yahoo News and St. Louis Post-Dispatch]  

 

 

FDA, The Lancet

US Infant formula crisis increases scrutiny of the FDA

Volume 399, Issue 10347
11 June 2022 

 

WORLD REPORT Both Republican and Democrat legislators have called for changes following a shortage of breastmilk substitute. Susan Jaffe reports from Washington, DC..  

The leading US producer of infant formula resumed partial operations on June 4 following a 4-month shutdown, but it may take several more weeks before supplies return to normal, along with the shortage-induced panic and desperation of American parents. When the US Food and Drug Administration (FDA) can regain trust in its ability to police the nation’s food manufacturers is another matter.

The agency’s failure to respond quickly to health hazards at the Abbott Nutrition facility in Sturgis, MI, that released potentially contaminated formula across the country has provoked rare bipartisan outrage in Congress and equally rare apologies from the manufacturer. The shutdown and resulting shortage have also prompted calls for major changes in the FDA’s food safety division, along with questions about why one supplier dominates the market. [Continued here.]  

 

Uncategorized

Raj Panjabi: bringing a global outlook to the US pandemic response

Volume 399, Issue 10338 
14 May 2022

 

PROFILE  Raj Panjabi 

In February, 2022, US President Joe Biden appointed global health physician and epidemiologist Raj Panjabi as a Special Assistant to the President and Senior Director for Global Health Security and Biodefense at the White House National Security Council in Washington, DC, which advises Biden on foreign policy and security issues.[Continued here.]

CMS, Drugs, Medicare, Medicare costs

Medicare Surprise: Drug Plan Prices Touted During Open Enrollment Can Rise Within a Month

By Susan Jaffe  | Kaiser Health News | May 3, 2022 | This KHN story also ran on

Something strange happened between the time Linda Griffith signed up for a new Medicare prescription drug plan during last fall’s enrollment period and when she tried to fill her first prescription in January.

She picked a Humana drug plan for its low prices, with help from her longtime insurance agent and Medicare’s Plan Finder, an online pricing tool for comparing a dizzying array of options. But instead of the $70.09 she expected to pay for her dextroamphetamine, used to treat attention-deficit/hyperactivity disorder, her pharmacist told her she owed $275.90.

“I didn’t pick it up because I thought something as wrong,” said Griffith, 73, a retired construction company accountant who lives in the Northern California town of Weaverville.  “To me, when you purchase a plan, you have an implied contract,” she said. “I say I will pay the premium on time for this plan. And they’re going to make sure I get the drug for a certain amount.”

But it often doesn’t work that way.  [Full story in Kaiser Health News, NPR  and Tampa Bay Times]  

 

 

The Lancet

Health organizations fear effects of US abortion ruling

Volume 399, Issue 10338
14 May 2022 

 

WORLD REPORT Health and human rights groups are concerned that many states would outlaw abortion if the Supreme Court topples Roe v Wade. Susan Jaffe reports. 

Protests and celebrations erupted across the USA following the unprecedented leak of a draft Supreme Court decision that would overturn the court’s 1973 landmark Roe v Wade ruling establishing a woman’s right to a safe and legal abortion. …“States are already working together to create enormous abortion deserts that many people will not be able to cross”, said Nancy Northup, president and CEO of the Center for Reproductive Rights. [Continued here.]

 

CMS, Drugs, FDA, Medicare costs

Medicare covers new Alzheimer’s drug, but there is a catch

Volume 399, Issue 10335
23 April 2022 

 

WORLD REPORT  The federal health plan for older Americans will pay for the controversial new drug aducanumab only for patients participating in clinical trials.  Susan Jaffe reports.  

The Biden administration’s long-awaited decision to pay for a controversial new Alzheimer’s disease treatment, aducanumab, will not make it easier for many older Americans with Medicare health insurance to get it. [Continued here.] 

 

CDC, Drugs, FDA, The Lancet

Califf takes the helm at the US FDA, again

Volume 399, Issue 10330
19 March 2022 

WORLD REPORT   Robert Califf will have to face several controversial health issues in his second tenure as commissioner. Susan Jaffe reports from Washington, DC.  

Califf takes over amid a lull in the COVID-19 pandemic and an array of hotly debated issues 9 months before a congressional election. The
election results could shrink, if not eliminate, the Democratic majority President Joe Biden needs to propel his health agenda, including the relaunched cancer moonshot and the Advanced Research Projects Agency for Health that would accelerate the development of medical treatments. [Plus new COVID-19 tests and treatments, opioid misuse, accelerated approval process, abortion pill conflict, continued here.] 
CMS, Long term care, Medicare, Medicare Advantage

Seeking to Shift Costs to Medicare, More Employers Move Retirees to Advantage Plans

By Susan Jaffe  | Kaiser Health News | March 3, 2022 | This KHN story also ran in Fortune and The Dallas Morning News.

As a parting gesture to a pandemic-ravaged city, former New York Mayor Bill de Blasio hoped to provide the city with a gift that would keep on giving: new health insurance for 250,000 city retirees partly funded by the federal government. Although he promised better benefits and no change in health care providers, he said the city would save $600 million a year.

Over the past decade, an increasing number of employers have taken a similar deal, using the government’s Medicare Advantage program as an alternative to their existing retiree health plan and traditional Medicare coverage. …Scores of private and public employers offer Medicare Advantage plans to their retirees. Yet the details — and the costs to taxpayers — are largely hidden. Because the federal Centers for Medicare & Medicaid Services is not a party to the negotiations among insurers and employers, the agency said it does not have details about how many or which employers are using this strategy or the cost to the government for each retiree group. [Full story in Kaiser Health News, Fortune and The Dallas Morning News]  

 

 

Appeals, CMS, HHS, Medicare costs, Observation care

Medicare Patients Win the Right to Appeal Gap in Nursing Home Coverage

By Susan Jaffe | KAISER HEALTH NEWS | January 28, 2022

A three-judge federal appeals court panel in Connecticut has likely ended an 11-year fight against a frustrating and confusing rule that left hundreds of thousands of Medicare beneficiaries without coverage for nursing home care, and no way to challenge a denial.

The Jan. 25 ruling, which came in response to a 2011 class-action lawsuit eventually joined by 14 beneficiaries against the Department of Health and Human Services, will guarantee patients the right to appeal to Medicare for nursing home coverage if they were admitted to a hospital as an inpatient but were switched to observation care, an outpatient service. [Full story in Kaiser Health News and Modern Healthcare.] 

CDC, CMS, HHS, OSHA, OSHA, The Lancet

The next steps for US vaccine mandates

Volume 399, Issue 10323
28 January 2022 

 

WORLD REPORT   As the Supreme Court blocks one of the Biden Administration’s plans to raise COVID-19 vaccination rates but approves another, Susan Jaffe looks at the next steps.

President Joe Biden’s efforts to encourage the most reluctant Americans to get fully vaccinated against COVID-19 have hit one legal roadblock after another. About one in four adults have still not received either the two-dose or single regimen of the vaccine, according to the Centers for Disease Control and Prevention. However, the path to greater vaccination uptake is shrinking as federal courts muddy his Administration’s pro-vaccine message, cases of infection driven by the Omicron variant continue to rise in many parts of the country, and the president’s popularity ratings fall. …In the first of two rulings on Jan 13, the Supreme Court decided 6–3 to block the Biden Administration’s mandate for private companies with more than 100 employees to require weekly COVID-19 tests for employees who have not been fully vaccinated. ,,,Yet in a pair of lawsuits the court heard along with the employer mandate cases, the court came to the opposite conclusion. In a 5–4 decision, they upheld the Biden Administration’s requirement of vaccination for 10·4 million workers at 76 000 health-care facilities that treat patients covered by the government’s Medicare or Medicaid health insurance.[Continued here.] 

 

 

CMS, FDA, The Lancet

Holmes verdicts prompt questions over justice for patients

Volume 399, Issue 10321
15 January 2022

 

WORLD REPORT   The founder of Theranos was found guilty of defrauding some investors, but cleared of charges that she misled patients. Susan Jaffe reports.

On Jan 3, a federal jury in California found Elizabeth Holmes, creator of the blood-testing startup Theranos, guilty of lying to some of her investors about a portable blood analyser that she claimed would transform health care. It could run dozens of tests from a fingerprick of blood, she said, and deliver dependable results quickly. However, government prosecutors’ account of Holmes’s empty promises and hype failed to convince the jury that she also deceived patients and their doctors who depended on her device’s inaccurate readings. [Continued here.]  
The Lancet

US Supreme Court expected to weaken abortion rights

Volume 398, Issue 10317
11 December 2021

 

WORLD REPORT   The US Supreme Court, now dominated by conservatives, heard arguments last week on the legality of a Mississippi law banning abortion after 15 weeks of pregnancy. However, the justices signalled that they are likely to do more than uphold the law. .[Continued here.]

 

 

CMS, DOJ, FDA, The Lancet

Theranos founder counters fraud charges in federal trial

Volume 398, Issue 10315
27 November 2021

 

WORLD REPORT   Federal prosecutors charged Theranos’ founder Elizabeth Holmes and former Theranos president Ramesh Balwani with wire fraud and conspiracy to commit wire fraud, alleging that they deceived investors and patients and their doctors by claiming that Theranos’s machine could produce accurate test results from blood collected in its tiny “nanotainer” device instead of several vials. But witnesses for the prosecution testified that the devices did not operate as promised…. “When something is brought forward as the next new thing regardless of whether it’s a drug or device, it needs to go through the process of rigorous scientific and clinical testing, then presented to the scientific community for peer review and ultimately publication”, said Roy Silverstein a haematologist and chair of medicine at the Medical College of Wisconsin. “And I’m not aware of any single publication that ever came out of this Theranos technology.” [Full story here.]  

CMS, DOJ, OSHA, The Lancet

Legal challenges threaten Biden’s COVID-19 vaccine rule

Volume 398, Issue 10314
20 November 2021

 

WORLD REPORT  Almost a year after the first COVID-19 vaccine was approved for emergency use in the USA, roughly a third of adults have still not received it. After urging Americans to get vaccinated, US President Joe Biden has taken a tougher approach: under his administration’s new workplace safety standard, people must get vaccinated or undergo weekly tests for the virus if they work for companies with at least 100 employees. “The rule will protect more than 84 million workers from the spread of the coronavirus on the job”, said Jim Frederick, Deputy Assistant Secretary of Labor for Occupational Safety and Health. …A day after OSHA’s announcement on Nov 4, 2021, multiple lawsuits to block the rule started rolling in to federal courts across the country.[Continued here.]