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Morbid Obesity linked to socioeconomic status was in a Twin Pairs Research on effects of genes and environment in 560 common conditions – Disease and Health by ZIP code (Environment) and genetic code (Human Genome)

Reporter: Aviva Lev-Ari, PhD, RN

 

  • Senior study author Chirag Patel, assistant professor of biomedical informatics in the Blavatnik Institute at HMS.
  • Co-investigators were Braden Tierney and Arjun Manrai of Harvard Medical School, and
  • Jian Yang and Peter Visscher of the University of Queensland, Australia.

Data sets for the study were provided by Aetna insurance company. Aetna had no funding role in the study. The research was supported by the Australian National Health and Medical Research Council (grants 1078037 and 1113400), National Science Foundation (grant 1636870), and Sylvia and Charles Viertel Charitable Foundation.

 

Detailed study results available here: http://apps.chiragjpgroup.org/catch/

Conclusions 

Nearly 40 percent of the diseases in the study (225 of 560) had a genetic component, while 25 percent (138) were driven at least in part by factors stemming from sharing the same household, social influences, and the like. Cognitive disorders demonstrated the greatest degree of heritability — four out of five diseases showed a genetic component — while connective tissue diseases had the lowest degree of genetic influence. Of all disease categories, eye disorders carried the highest degree of environmental influence, with 27 of 42 diseases showing such effect. They were followed by respiratory diseases, with 34 out of 48 conditions showing an effect from sharing a household. The disease category with lowest environmental influence was reproductive illnesses, with three of 18 conditions showing such effect, and cognitive conditions, with two out of five showing an influence.

Overall, socioeconomic status, climate conditions, and air quality in each twin pair’s ZIP code had a far weaker effect on disease than genes and shared environment — a composite measure of external, nongenetic influences including family and lifestyle, household, and neighborhood.

In total, 145 of 560 diseases were modestly influenced by socio-economic status derived by ZIP code. Thirty-six diseases were influenced at least in part by air quality, and 117 were affected by changes in temperature. The condition with the strongest potential link to socioeconomic status was morbid obesity. While obesity undoubtedly has a genetic component, the researchers said, the findings raise an important question about the influence of environment on genetic predispositions.

“This finding opens up a whole slew of questions, including whether and how a change in socioeconomic status and lifestyle might compare against genetic predisposition to obesity,” Patel said.

Lead poisoning was, not surprisingly, entirely driven by environment. Conditions such as flu and Lyme disease were, again unsurprisingly, affected by differences in climate.

When researchers looked at classes of diseases by monthly health care spending, they found that both genes and environment significantly contributed to cost of care, with the two being nearly equal drivers of spending. Almost 60 percent of monthly health spending could be predicted by analyzing genetic and environmental factors.

Large-scale analysis like this study can help forecast long-term spending for various conditions and inform resource allocation and policy decisions, the researchers said.

Detailed study results available here: http://apps.chiragjpgroup.org/catch/

SOURCE

http://apps.chiragjpgroup.org/catch/

https://news.harvard.edu/gazette/story/2019/01/researchers-able-to-determine-the-effects-of-genes-and-environment-in-560-common-conditions/?utm_source=SilverpopMailing&utm_medium=email&utm_campaign=Daily%20Gazette%202%20stories%201%20event%20(no%20Seen%20or%20Heard)%20(1)

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Non pure motives for pushing recertification: The American Board of Internal Medicine attempted to expand its recertification process and keep its medical monopoly that abuses its immense power.

Reporter: Aviva Lev-Ari, PhD, RN

 

“It is incumbent upon The American Board of Internal Medicine (ABIM) and/or the American Board of Medical Specialties (ABMS) to engage a respected independent party to assess the impact of The Maintenance of Certification, (MOC) program and make the findings publicly available” required by The American College of Rheumatology

ABIM’s survival as a medical monopoly that abuses its immense power seems less probable with each passing day. And, because of its arrogance and the appearance of corruption it allowed to metastasize inside the organization, the officials there have no one to blame but themselves.

It’s a horror story that has played out for years throughout the U.S. as the ABIM abuses its monopoly power to force doctors to do whatever it decrees, while ignoring the many doctors who have demanded for years that independent researchers conduct comprehensive studies to determine if ABIM’s requirements do anything to improve patient care. This medical protection racket has made millionaires of ABIM top officers, financed a ritzy condominium, limousines and first-class travel, all while sucking huge sums of cash out of the health care system.

But now, after decades of unchecked rule by ABIM, cracks are appearing in the organization’s facade of power. Thousands of doctors began a widespread revolt months ago and, in the last few weeks, evidence that their efforts are succeeding has started rolling in. ABIM officials have proclaimed that they are rushing to make changes—and indeed have announced some changes—but it seems they waited too long and are changing too little.

Rheumatologists, who must fulfill ABIM’s requirements for maintenance of certification, or MOC, recently slapped down the process—and hard.

“There is evidence that many of the MOC requirements have no beneficial impact on clinical care,” the statement says. “Moreover, the direct and indirect costs of the MOC program to physicians and the health care system is excessive.”

The study concluded that internists incur an average of $23,607 in MOC costs over 10 years—with doctors who specialize in cancers and blood diseases out $40,495. All told, the study concluded, MOC will suck $5.7 billion out of the health care system over 10 years, including $5.1 billion in time costs (resulting from 32.7 million physician-hours spent on MOC) and $561 million in testing costs. And remember—all that time and expense is for a program that has not been proven to accomplish anything.

And the NBPAS process is completely different than the one required by ABIM. A two-year recertification through NBPAS costs $169 (a single review course for the ABIM test costs more than $1,000.) It requires that physicians obtain initial certification through ABIM or one of its affiliated organizations. Then, for recertification, it requires physicians to attend 50 hours of what are known as qualified continuing medical education programs every two years. That way, doctors choose what education programs most benefit their practice by attending about 25 hours of those courses and conferences each year. No time is wasted learning about items that have no relevance to the work of a particular doctor.

And the National Board of Physicians and Surgeons (NBPAS) process is completely different than the one required by ABIM. A two-year recertification through NBPAS costs $169 (a single review course for the ABIM test costs more than $1,000.) It requires that physicians obtain initial certification through ABIM or one of its affiliated organizations. Then, for recertification, it requires physicians to attend 50 hours of what are known as qualified continuing medical education programs every two years. That way, doctors choose what education programs most benefit their practice by attending about 25 hours of those courses and conferences each year. No time is wasted learning about items that have no relevance to the work of a particular doctor.

SOURCE

https://www.newsweek.com/abim-american-board-internal-medicine-doctors-revolt-372723

What’s ruining medicine for physicians: MOC costs and requirements

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CMS initiative in Modernizing Medicare to lead to Lower Prescription Drug Costs

Reporter: Aviva Lev-Ari, PhD, RN

 

CMS Takes Action to Lower Prescription Drug Costs by Modernizing Medicare

 

     

CMS Takes Action to Lower Prescription Drug Costs by Modernizing Medicare 
Proposed regulation for Medicare Parts C & D would strengthen negotiations with prescription drug manufacturers to lower costs and increase transparency for patients

Today, the Centers for Medicare & Medicaid Services (CMS) proposed polices for 2020 to strengthen and modernize the Medicare Part C and D programs. The proposal would ensure that Medicare Advantage and Part D plans have more tools to negotiate lower drug prices, and the agency is also considering a policy that would require pharmacy rebates to be passed on to seniors to lower their drug costs at the pharmacy counter.

“President Trump is following through on his promise to bring tougher negotiation to Medicare and bring down drug costs for patients, without restricting patient access or choice,” said HHS Secretary Alex Azar. “By bringing the latest tools from the private sector to Medicare Part D, we can save money for taxpayers and seniors, improve access to expensive drugs many seniors need, and expand their choice of plans. The Part D proposals complement efforts to bring down costs in Medicare Advantage and in Medicare Part B through negotiation, all part of the President’s plan to put American patients first by bringing down prescription-drug prices and out-of-pocket costs.”

In the twelve years since the Part D program was launched, many of the tools outlined in today’s proposal have been developed in the commercial health insurance marketplace, and the result has been lower costs for patients. Seniors in Medicare also deserve to benefit from these approaches to reducing costs, so today CMS is proposing to modernize the Medicare Advantage and Part D programs and remove barriers that keep plans from leveraging these tools.

“In designing today’s proposal, foremost in the agency’s mind was the impact on patients, and the proposal is yet another action CMS has taken to deliver on President Trump and Secretary Azar’s commitment on drug prices,” said CMS Administrator Seema Verma. “Today’s changes will provide seniors with more plan options featuring lower costs for prescription drugs, and seniors will remain in the driver’s seat as they can choose the plan that works best for them. The result will be increasing access to the medicines that seniors depend on by lowering their out-of-pocket costs.”

Private plan options for receiving Medicare benefits are increasing in popularity, with almost 37 percent of Medicare beneficiaries expected to enroll in Medicare Advantage in 2019, and Part D enrollment increasing year-over-year as well. The programs are driven by market competition; plans compete for beneficiaries’ business, and each enrollee chooses the plan that best meets his or her needs. Consumer choice puts pressure on plans to improve quality and lower costs.  Premiums in both Medicare Advantage and Part D are projected to decline next year.

Today’s proposed changes include:

  • Providing Part D plans with greater flexibility to negotiate discounts for drugs in “protected” therapeutic classes, so beneficiaries who need these drugs will see lower costs;
  • Requiring Part D plans to increase transparency and provide enrollees and their doctors with a patient’s out-of-pocket cost obligations for prescription drugs when a prescription is written;
  • Codifying a policy similar to the one implemented for 2019 to allow “step therapy” in Medicare Advantage for Part B drugs, encouraging access to high-value products including biosimilars; and
  • Implementing a statutory requirement, recently signed by President Trump, that prohibits pharmacy gag clauses in Part D.

CMS is also considering for a future plan year, which may be as early as 2020, a policy that would ensure that enrollees pay the lowest cost for the prescription drugs they pick up at a pharmacy, after taking into account back-end payments from pharmacies to plans.

Medicare Advantage and Part D will continue to protect patient access, as both programs are embedded with robust beneficiary protections. These include CMS’s review of Part D plan formularies, an expedited appeals process, and a requirement for plans to cover two drugs in every therapeutic class.

CMS looks forward to receiving comments on these proposals and other policies under consideration.

For a blog post on the proposed rule by Secretary Azar and Administrator Verma, please visit: https://www.cms.gov/blog/proposed-changes-lower-drug-prices-medicare-advantage-and-part-d.

For a fact sheet on the proposed rule, please visit: https://www.cms.gov/newsroom/fact-sheets/contract-year-cy-2020-medicare-advantage-and-part-d-drug-pricing-proposed-rule-cms-4180-p.

The proposed rule (CMS-4180-P) can be downloaded from the Federal Register at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-25945.pdf

###

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS

SOURCE

https://www.cms.gov/newsroom/press-releases/cms-takes-action-lower-prescription-drug-costs-modernizing-medicare?mc_cid=ca8901d1c5&mc_eid=32328d8919

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HUBweek 2018, October 8-14, 2018, Greater Boston – “We The Future” – coming together, of breaking down barriers, of convening across disciplinary lines to shape our future

Reporter: Aviva Lev-Ari, PhD, RN

 

HUBweek 2018

Hi Aviva,

 

At HUBweek and in this community, we believe a brighter future is built together. In these times of division, particularly when many are feeling excluded from the benefits brought forth by rapid technological development, there is critical importance in the act of coming together, of breaking down barriers, of convening across disciplinary lines to shape our future.

That’s why this year’s theme for HUBweek is We the Future. It is a call to action and an invitation. Throughout the week, we’ll bring together innovators, artists, and curious minds to explore the ways in which we can shape a more inclusive and equitable future for all.

Today, HUBweek kicks off with dozens of events taking place across the city–from public art tours, a drone zoo, and discussions on nuclear weapons and the impact of emerging technologies on people with disabilities, to a policy hackathon hosted by MIT and the first ever Change Maker Conference.

There are 225+ more experiences to take part in throughout HUBweek–a three-day Forum and a documentary film festival; open dialogues with leading thinkers; a robot block party; and collaborative and participatory art. And we’ve got a little fun in store for you, too–make sure you sign up and stop by The HUB later this week to check it all out.

At its core, HUBweek is a collaboration. If not for our partners and the unwavering support of this community, this would not be a reality. A big thank you to our presenting partners Blue Cross Blue Shield of Massachusetts, Liberty Mutual Insurance, and Merck KGaA, to our sponsors, and to the hundreds of collaborating organizations, speakers, artists, and creative minds that are behind this year’s festival.

On behalf of the HUBweek team and our founders The Boston Globe, Harvard University, Mass. General Hospital, and MIT, we’re thrilled to invite you to join us at HUBweek 2018.

 

Linda Pizzuti Henry

SOURCE

 

From: Linda Pizzuti Henry <hello@hubweek.org>

Reply-To: <hello@hubweek.org>

Date: Monday, October 8, 2018 at 9:38 AM

To: Aviva Lev-Ari <AvivaLev-Ari@alum.berkeley.edu>

Subject: Welcome to HUBweek

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PCI, CABG, CHF, AMI – Two Payment Methods: Bundled payments (hospitalization costs, up to 90 days of post-acute care, nursing home care, complications, and rehospitalizations) vs Diagnosis-related groupings cover only what happens in the hospital.

Reporter: Aviva Lev-Ari, PhD, RN

 

UPDATED on 8/17/2018

Certain risk factors make survivors of an acute MI more likely to suffer major cardiovascular events within a year, researchers said.

A model with 19 factors (comprising 15 unique variables) was created for the identification of high-risk patients; the strongest factors in the training sample (n=2,113) were found to be:

  • Age 85 years and older: HR 6.73 (95% CI 2.83-15.96)

  • Prior angina: HR 2.05 (95% CI 1.17-3.58)

  • Prior ventricular tachycardia or fibrillation: HR 2.15 (95% CI 0.99-4.70)

  • Ejection fraction under 40%: HR 2.86 (95% CI 1.89-4.34)

  • White blood cell count greater than 12,000 per μL: HR 2.65 (95% CI 1.53-4.61)

  • Heart rate faster than 90 beats per minute: HR 2.02 (95% CI 1.43-2.84)

With the tool, 11.3%, 81.0%, and 7.7% of patients were stratified to high-, average-, and low-risk groups, with respective probabilities of 0.32, 0.06, and 0.01 for 1-year events. Moreover, the model showed predictive ranges of 1.2%-33.9%, 1.2%-37.9%, and 1.3%-34.3% in these groups.

“This may aid clinicians in identifying high-risk patients who would benefit most from intensive follow-up and aggressive risk factor reduction,” the researchers wrote, noting that past efforts to identify risk factors have focused on the period immediately after initial hospitalization for acute MI.

SOURCE

https://www.medpagetoday.com/cardiology/myocardialinfarction/74528?xid=nl_mpt_cardiodaily_2018-08-17&eun=g99985d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=AHAWeekly_081718&utm_term=AHA%20Cardiovascular%20Daily%20-%20Active%20Users%20180%20days

PCI, CABG, CHF, AMI – Two Payment Methods: Bundled payments (hospitalization costs, up to 90 days of post-acute care, nursing home care, complications, and rehospitalizations) vs Diagnosis-related groupings cover only what happens in the hospital.

Bundled payments (hospitalization costs, up to 90 days of post-acute care, nursing home care, complications, and rehospitalizations) vs Diagnosis-related groupings cover only what happens in the hospital.

A retrospective, cross-sectional comparison of the BPCI model 2 bundles for percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), congestive heart failure (CHF), and acute myocardial infarction (AMI).

The bundled payments covered hospitalization costs and, in most cases, up to 90 days of post-acute care, including nursing home care, complications, and rehospitalizations. Diagnosis-related groupings cover only what happens in the hospital, while bundled payments cover the entire 90-day episode in most cases.

A Good, Not Simple Idea

Blumenthal and Joynt Maddox agree that the idea of using financial incentives to drive quality improvement is a good one, but one that requires careful consideration and input from clinicians.

“I think policymakers think that it’s easier than it really is and, to be fair, why would a lawyer in DC understand how to make good health policy? I think we really need more clinicians and people with clinical knowledge involved in policymaking,” Joynt Maddox said.

“The idea is to build the bridge between inpatient and outpatient care, by coordinating care better, coordinating transitions better, reducing unnecessary care, and avoiding complications and readmissions,” she added.

An example might be to switch from automatically sending certain patients from the hospital to a nursing home for 30 days. “Maybe they only need 10 days or 1 week, or maybe they can just go home,” she said, but to allow better transitions and lower costs, there needs to be “someone to strategically approach the issue, and a lot of hospitals don’t have that ability.”

“You could argue that all hospitals should have the ability, and I totally agree that we should be doing a better job of organizing across settings, but the problem is that realistically these voluntary programs aren’t going to attract under-resourced hospitals, so this pilot will tell us what is possible in a well-resourced hospital but not much more,” said Joynt Maddox.

To date, the only outcomes reported on the new payment models have been a few evaluations from the federal government. Joynt Maddox recently reported some preliminary outcomes showing a lack of “clinically meaningful changes in access, utilization, or clinical outcomes” with episode-based payment for AMI, CHF, and pneumonia. Her final findings will be published soon.

SOURCE

https://www.medscape.com/viewarticle/899026?nlid=123768_3866&src=WNL_mdplsfeat_180710_mscpedit_card&uac=93761AJ&spon=2&impID=1680511&faf=1#vp_2

Brief Report
June 27, 2018

Factors Associated With Participation in Cardiac Episode Payments Included in Medicare’s Bundled Payments for Care Improvement Initiative

JAMA Cardiol. Published online June 27, 2018. doi:10.1001/jamacardio.2018.1736
Key Points

Question  Are hospitals participating in Medicare’s Bundled Payments for Care Improvement initiative for cardiac bundles different from nonparticipating hospitals in ways that could limit the generalizability of program outcomes to all US acute care hospitals?

Findings  In this cross-sectional study, participation in Bundled Payments for Care Improvement model 2 bundled payments for acute myocardial infarction, congestive heart failure, coronary artery bypass graft surgery, and percutaneous coronary intervention was associated with larger hospital size, non–safety net hospital status, and access to cardiac catheterization laboratories.

Meaning  Outcomes of cardiac bundled payments included in Bundled Payments for Care Improvement may have limited external validity, particularly among small and safety net hospitals with more limited cardiac capabilities.

Abstract

Importance  Medicare’s Bundled Payments for Care Improvement (BPCI) is a voluntary pilot program evaluating bundled payments for several common cardiovascular conditions. Evaluating the external validity of this program is important for understanding the effects of bundled payments on cardiovascular care.

Objective  To determine whether participants in BPCI cardiovascular bundles are representative of US acute care hospitals and identify factors associated with participation.

Design, Setting, and Participants  Retrospective cross-sectional study of hospitals participating in BPCI model 2 bundles for acute myocardial infarction (AMI), congestive heart failure (CHF), coronary artery bypass graft, and percutaneous coronary intervention and nonparticipating control hospitals (October 2013 to January 2017). The BPCI participants were identified using data from the Centers for Medicare and Medicaid Services, and controls were identified using the 2013 American Hospital Association’s Survey of US Hospitals. Hospital structural characteristics and clinical performance data were obtained from the American Heart Association survey and Centers for Medicare and Medicaid Services. One hundred fifty-nine hospitals participating in BPCI model 2 cardiac bundles and 1240 nonparticipating control hospitals were compared, and a multivariable logistic regression was estimated to identify predictors of BPCI participation.

Exposures  Bundled payments.

Main Outcomes and Measures  Hospital-level structural characteristics and 30-day risk-adjusted readmission and mortality rates for AMI and CHF.

Results  Compared with nonparticipants, BPCI participants were larger, more likely to be privately owned or teaching hospitals, had lower Medicaid bed day ratios (ratio of Medicaid inpatient days to total inpatient days: 17.0 vs 19.3; P < .001), and were less likely to be safety net hospitals (2.5% vs 12.3%; P < .001). The BPCI participants had higher AMI and CHF discharge volumes, were more likely to have cardiac intensive care units and catheterization laboratories, and had lower risk-standardized 30-day mortality rates for AMI (13.7% vs 16.6%; P = .001) and CHF (11.3 vs 12.4; P = .005). In multivariable analysis, larger hospital size and access to a cardiac catheterization laboratory were positively associated with participation. Being a safety net hospital was negatively associated with participation (odds ratio, 0.3; 95% CI, 0.1-0.7; P = .001).

Conclusions and Relevance  Hospitals participating in BPCI model 2 cardiac bundles differed in significant ways from nonparticipating hospitals. The BPCI outcomes may therefore have limited external validity, particularly among small and safety net hospitals with limited clinical cardiac services.

SOURCE

https://jamanetwork.com/journals/jamacardiology/article-abstract/2686124

Invited Commentary
June 27, 2018

What Can We Learn From Voluntary Bundled Payment Programs?

JAMA Cardiol. Published online June 27, 2018. doi:10.1001/jamacardio.2018.1734

SOURCE

https://jamanetwork.com/journals/jamacardiology/article-abstract/2686128

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Top 10 Medical Innovations for 2018 by Cleveland Clinic

Reporter: Aviva Lev-Ari, PhD, RN

 

Top 10 for 2018

#1 Hybrid Closed-Loop Insulin Delivery System

#1 Hybrid Closed-Loop Insulin Delivery System

This approach has not just made T1D management easier than ever, it is also getting praise for stabilizing blood glucose at an unprecedented level.


#2 Neuromodulation to Treat Obstructive Sleep Apnea

#2 Neuromodulation to Treat Obstructive Sleep Apnea

While C.P.A.P. is the gold standard treatment for OSA, the risk of misuse or discontinued use has created an opportunity for innovators to search for a less intrusive way to treat it. The result is ne


#3 Gene Therapy for Inherited Retinal Diseases

#3 Gene Therapy for Inherited Retinal Diseases

In 2018 gene therapy is expected to make its comeback with expected FDA approvals for a variety of inherited retinal diseases (“IRDs”).


#4 The Unprecedented Reduction of LDL Cholesterol

#4 The Unprecedented Reduction of LDL Cholesterol

These new drugs are taking cholesterol to low levels never seen before.


#5 The Emergence of Distance Health

#5 The Emergence of Distance Health

In 2018, the prevalence of connectivity enables distance health.


#6 Next Generation Vaccine Platforms

#6 Next Generation Vaccine Platforms

In 2018, innovators will be upgrading the entire vaccine infrastructure to support the rapid development of new vaccines (a concept that was #1 on the Top 10 Medical Innovations for 2015).


#7 Arsenal of Targeted Breast Cancer Therapies

#7 Arsenal of Targeted Breast Cancer Therapies

For breast cancer patients that are BRCA1 or BRCA2 positive, there is new hope for a targeted therapy that is already seeing success in the ovarian cancer market.


#8 Enhanced Recovery After Surgery

#8 Enhanced Recovery After Surgery

After seeing substantial growth in hospital readmissions and an opioid epidemic spiraling out of control, it is clear that physicians need to overhaul the post-surgery strategies currently in use.


#9 Centralized Monitoring of Hospital Patients

#9 Centralized Monitoring of Hospital Patients

Centralized monitoring has emerged as the answer, as part of a “mission control” operation in which off-site personnel use advanced equipment monitor patients.


#10 Scalp Cooling for Reducing Chemotherapy Induced Hair Loss

#10 Scalp Cooling for Reducing Chemotherapy Induced Hair Loss

The practice of “Scalp Cooling” has been shown to be highly effective for preserving hair in women receiving neoadjuvant or adjuvant chemotherapy for early-stage breast cancer.

SOURCE

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Defining Health Care’s Future: Digital Health, Innovation Accessible, Prevention Importance as Cure – The Vision of Stanford Medical School Dean delivered at 2018 JP Morgan in San Francisco

Reporter: Aviva Lev-Ari, PhD, RN

 

At JPM 2018: Three Challenges That Will Define Health Care’s Future

Lloyd Minor

Lloyd Minor, LinkedIn Influencer

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