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CMS QUALITY RATING SYSTEM NOT EMBRACED BY ALL HOSPITALS

The safety net view:
Caring for sickest patients
Doesn’t get you stars.

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Summaries Of The News:

Marketplace

Justice Department Sues To Block Health Care Mega-Mergers

The department says the Aetna-Humana and Anthem-Cigna deals would lead to higher prices and reduced benefits for consumers.

The New York Times: U.S. Sues To Block Anthem-Cigna And Aetna-Humana Mergers
Within a three-week span last summer, four of the five biggest health insurers announced two mergers totaling $85 billion. Suddenly, what was five would be three, reshaping the industry. But on Thursday, antitrust regulators said, Not so fast. United States Attorney General Loretta E. Lynch announced that the government had filed lawsuits to block the deals, between Aetna and Humana and Anthem and Cigna. (Picker and Abelson, 7/21)

The Washington Post: Justice Department Sues To Block Two Health Care Mega-Mergers
“These mergers may increase the profits of Aetna and Anthem. But they would do so at the expense of consumers, employers and health professionals across the country, inflicting costs that cannot be measured in dollars alone,” U.S. Attorney General Loretta Lynch said during a press conference to discuss the suits, filed in the U.S. District Court for the District of Columbia. (Merle and Johnson, 7/21)

The Wall Street Journal: U.S. Files Suits Seeking To Block Insurer Deals
Both lawsuits argue the mergers create collective problems. Justice officials indicated that they would seek to have the two cases tried together in front of the same judge. The lawsuits use identical language arguing the deals would eliminate “two innovative competitors”—Cigna and Humana—“at a time when the industry is experimenting with new ways to lower health-care costs.” (Kendall and Wilde Mathews, 7/21)

USA Today: Antitrust Suits Aim To Block Two Health Care Mergers
Eleven states and the District of Columbia joined the attempt to block the Anthem deal, which would combine the nation's second- and fourth-largest insurers. Eight states and D.C. joined the suit to block the Aetna deal, which would combine the third and fifth largest. (Bomey, 7/21)

Politico: DOJ Files Lawsuits To Block Mergers Of Insurance Giants
In statement, Anthem called the DOJ lawsuit "an unfortunate and misguided step backwards for access to affordable healthcare for America" and promised to challenge the decision in court. It also left open the possibility of negotiating an agreement with DOJ to let the merger go through. Its partner in the $54 billion merger, Cigna, said it now believes the deal won't close before 2017, "if at all." Aetna and Humana, in a joint statement, also promised to fight the DOJ lawsuit. (Cook, 7/21)

Reuters: Aetna, Humana Map Legal Strategy To Salvage Merger
Aetna vowed to fight “to the very end” after the Department of Justice filed suit earlier on Thursday to block the merger, which had been in the works for more than a year. Antitrust reviewers say the combination will hurt consumers and the companies' proposed fix - selling some health plans to a competitor - is insufficient. (Humer, 7/22)

Los Angeles Times: Obama Administration Moves To Block Health Insurance Mega-Mergers
The lawsuits are unlikely to end maneuvering in the health insurance industry, as health plans try to bolster their positions in a fast-changing industry still being reordered by the 2010 Affordable Care Act. In the last year alone, Los Angeles-based HealthNet merged with Centene Corp., a leading Medicaid plan. And Oakland-based Kaiser Permanente acquired Washington state’s Group Health Cooperative, another well-regarded nonprofit plan. (Levey and Puzzanghera, 7/21)

USA Today: Hospitals, Doctors Funded Consumer Opposition To Insurance Mergers
Hospital and doctor groups helped fund the consumer opposition to the two big health insurer mergers the Justice Department sued to block Thursday. Hospitals, which have been merging fast and furiously on their own, jump started the campaign against the mergers of Aetna and Humana and Anthem and Cigna by funding the Campaign for Consumer Choice with unions. Insurers said they needed to consolidate to deal more effectively with ever-larger hospital companies, which have also been gobbling up doctors' practices. (O'Donnell, 7/21)

Morning Consult: Many Medical Groups, Lawmakers Praise DOJ Effort To Block Insurance Mergers
Medical groups largely lauded the Justice Department’s decision to file lawsuits attempting to block two proposed health insurer mergers. ... “Allowing commercial health insurers to become too big and exert control over the delivery of health care would be bad for patients and vitality of the nation’s health care system,” AMA President Andrew Gurman said in a statement. “With existing competition in health insurance markets already at alarmingly low levels, federal officials have a strong obligation to enforce antitrust laws that prohibit harmful mergers and foster a more competitive market place that will operate in the patients’ best interests.” Families USA Executive Director Ron Pollack also praised the filings: “The mergers would have given the newly combined companies far too much power over the health insurance market, allowing them to dictate prices with little fear of competition.” (McIntire, 7/21)

The Wall Street Journal: Antitrust Suits Could Upend Health Insurers’ Strategies
If the Justice Department wins its two health-insurance antitrust cases, the four companies involved would face business challenges as they move forward alone. All four— Aetna Inc., Humana Inc., Anthem Inc. and Cigna Corp.—would be left without the additional scale that they said would help them pare costs and boost their products. They would remain substantially smaller than the industry’s largest player by revenue, UnitedHealth Group Inc., and could turn to other smaller deals to gain at least some heft in key markets. (Wilde Mathews, 7/21)

Politico Pro: Experts: DOJ Lawsuits Could Empower More Aggressive Moves Against Health Care
The Obama administration just brought the biggest case against health insurers in decades — even as it's mired in a losing streak against hospitals. The Justice Department's move to sue four health insurers on Thursday, on grounds that their mergers would lead to higher premiums and hurt patients' access, was hailed across the health care sector as necessary — except by the insurers themselves, of course. (Diamond, 7/21)

States Join Federal Antitrust Effort Against Anthem-Cigna Deal

The District of Columbia and 11 states, including California, New Hampshire and Tennessee, have joined the Justice Department's lawsuit.

KQED: California Attorney General Joins Federal Suit To Block Anthem-Cigna Merger
California Attorney General Kamala Harris is joining a federal Justice Department antitrust lawsuit to block the proposed health insurance mega-merger between Anthem and Cigna, a consolidation that would create the country’s largest health insurer. While Harris acknowledged that mergers can create benefits for consumers, this deal “does not strike that balance and would drive up costs for consumers and reduce access to quality healthcare for millions of Californians,” she said in a statement. The lawsuit was filed by the Justice Department and attorneys general in nine other states, in addition to California. (Aliferis, 7/21)

San Francisco Chronicle: California Moves To Block Anthem-Cigna Deal
California joined U.S. Justice Department antitrust lawsuits filed Thursday in an effort to block the merger of two major health insurers — Anthem Inc.’s bid to buy Cigna Corp. The Justice Department also sued to block Aetna Inc.’s proposed acquisition of Humana Inc., citing concerns that the two megamergers would drastically constrict competition in key markets, drive up premiums and reduce quality. California Attorney General Kamala Harris said the proposed $48.3 billion merger between Anthem and Cigna, which would create the nation’s largest health insurance company, would “drive up costs to consumers and reduce access to quality health care for millions of Californians.” (Colliver, 7/21)

New Hampshire Public Radio: New Hampshire Joins Lawsuit Challenging Anthem-Cigna Merger
New Hampshire has joined a nationwide effort to block the proposed merger of Anthem and Cigna, the state’s two largest health insurers. New Hampshire is one of a dozen states that have signed on to a lawsuit by the U.S. Department of Justice, challenging Anthem’s plans to purchase Cigna for $54 billion. The suit alleges the merger would reduce competition for millions of Americans who receive health insurance from their employers or through the Affordable Care Act. (Wallstin, 7/21)

Concord Monitor: N.H. Joins Lawsuit To Block Anthem-Cigna Merger
In a move that isn’t entirely a surprise, New Hampshire has joined 11 states and the federal government in a lawsuit opposing the $48 billion merger of health insurance giants Anthem and Cigna, saying it would harm competition...The federal government is also suing to block a similar merger, a $37 billion deal between insurance giants Aetna and Humana, also because of concerns about competition. New Hampshire is not part of that lawsuit because the merger has no effect in this state. (Brooks, 7/21)

The Tennessean: Tennessee Joins Obama In Bid To Block Insurer Merger
Tennessee is joining the lawsuit brought by the federal government to block the proposed $54 billion merger between health insurance giants Anthem and Cigna. The U.S. Department of Justice filed a lawsuit today to stop Anthem's acquisition of Cigna over concerns about competition and market concentration. Tennessee joins 10 other states and the District of Columbia in the lawsuit filed today in the U.S. District Court for the District of Columbia. (Fletcher, 7/21)

Meanwhile, Georgia's insurance department is postponing its hearing on the Aetna-Humana merger —

Georgia Health News: As Feds File Suit Over Insurance Deals, Georgia Postpones Hearing
The state’s Department of Insurance on Thursday postponed next week’s hearing on the Aetna-Humana merger after federal antitrust officials filed suit to block the proposed deal over anti-competitive concerns. The feds also filed a lawsuit Thursday to stop Anthem’s proposed acquisition of Cigna. Anthem has a significant stake here, being the parent company of Georgia’s largest health insurer, Blue Cross and Blue Shield of Georgia. But it’s the Aetna-Humana deal, if consummated, that is expected to have the bigger effect on the health insurance business in Georgia. (Miller, 7/21)

Bedeviled Theranos Brings On Compliance, Regulatory Executives

Theranos said the hires represent the company's latest in a series of "significant actions" to make sure its laboratories, medical products and operations meet the highest standards.

Reuters: Theranos Hires Executives In Regulatory, Compliance Push
Blood-testing company Theranos Inc said on Thursday it hired two executives to oversee regulatory, quality and compliance standards, as the company tries to recover from a series of regulatory sanctions and investigations. The company named former Thermo Fisher Scientific Inc executive Dave Wurtz vice president, regulatory and quality. Daniel Guggenheim, who previously served as assistant general counsel at McKesson Corp, was appointed as chief compliance officer. (Tharakan and Grover, 7/21)

The Wall Street Journal: Theranos Hires Compliance, Regulatory Executives
The company said the moves were the “latest in a series of significant actions Theranos has taken to ensure that it meets the highest standards in its laboratories, medical products and operations.” ... The company faces other threats, including a criminal probe by federal prosecutors of whether it misled investors and regulators, The Wall Street Journal has reported. Theranos also lost its main retail partner, the Walgreens drugstore chain, in June. The company has said it is working closely with regulators and is cooperating with all investigations. (Hufford, 7/21)

San Jose Mercury News: After Sanctions Drop, Theranos Hires Compliance Execs
Theranos declined to offer specifics on how the new hires and the committee will tackle the multitude of problems the company faces -- such as the impending closure of its Newark lab. "Theranos is committed to meeting the highest standards in its compliance practices," Guggenheim wrote in a company news release. "I am eager to start to build on the foundation that Theranos is making to be a best-in-class health care company." (Kendall, 7/21)

Health Law Issues And Implementation

In 2017, Humana Will Reduce Its Health Marketplace Sales, Shrinking From 19 States To 11

The company said it may also get out of the non-exchange markets too.

The Hill: Humana To Leave 'Substantially All' ObamaCare Markets
Humana, one of the nation’s top health insurers, is pulling out of ObamaCare plans in all but a handful of states after a year of nearly $1 billion in losses. The company plans to exit nearly half of the markets next year, it announced during an earnings report Thursday. It will take part in “no more” than 11 state marketplaces, down from 19 states this year, the company said. (Ferris, 7/21)

Politico: Humana Pulling Out Of Many Obamacare Markets
The decision means the company will only offer individual plans in 156 counties in 11 states, down from 1,351 counties across 19 states this year. It had sold plans on Affordable Care Act exchanges in 15 states this year. Humana would not provide a breakdown of how many ACA exchanges it was leaving, or identify which ones. But a spokesman said the carrier was pulling out of states where it had a very limited presence. (Karlin-Smith, 7/21)

And in Minnesota --

Politico Pro: Struggling MNsure's Future Could Hinge On Election
After three years of tech problems, paltry enrollment and insurer dropouts, Minnesota's Obamacare exchange is still struggling. And the future of one of the country's most troubled exchanges may depend on down-ballot races in a turbulent election year. Republicans, who have long criticized mismanagement of the exchange, are hoping to seize on its troubles to win full control of the Legislature this November and scrap the state-run marketplace entirely. Democratic lawmakers, meanwhile, hope to win back the Legislature and push through legislation to shore up the marketplace known as MNsure. (Demko, 7/21)

Advocates In Kansas, Florida Say Expanding Medicaid Would Relieve Stresses Of Uninsured

Speakers at a political meeting in Kansas and a new report in Florida urge state leaders to reconsider decisions not to expand Medicaid under the federal health law.

Kansas Health Institute: Lack Of Medicaid Expansion Adds To Stresses In Southeast Kansas County
Wednesday’s meeting in Independence was largely attended by political candidates and elected officials, which gave medical professionals like Stewart a platform to explain what they are experiencing since the closure of Mercy Hospital and how the lack of Medicaid expansion has sent the uninsured to emergency rooms, community clinics and jails for medical care. Sheldon Weisgrau of the Kansas Association for the Medically Underserved in Topeka said Montgomery County has more than 3,600 uninsured residents, including about 1,400 who would be eligible for Medicaid under expanded eligibility. “At $4,229 per person per year, that means Medicaid expansion would have brought $5.9 million to Montgomery County,” said Weisgrau, adding that expansion also could have led to the creation of as many as 38 medical jobs in Montgomery County. (Taylor, 7/21)

Miami Herald: Medicaid Expansion In Florida Would Reduce Uninsured, Zika Risk, Reports Say
Expanding Medicaid coverage to nearly all low-income adults of working age would help Florida reduce the numbers of uninsured people in the state while lowering the risk of Zika infection among pregnant women, according to two reports released Tuesday. The nonprofit Urban Institute, in a study funded by the Robert Wood Johnson Foundation, argues that adopting Medicaid expansion in 2017 would reduce Florida's uninsured population by about 877,000 people. (Chang, 7/20)

Administration News

Feds Award $60M More To Battle Zika Just As Virus Is Found In More Widespread Mosquito

After discovering Zika in the Culex mosquito, scientists are warning that more research is needed. But if they begin detecting the virus in the species in large numbers and on a consistent basis, experts say “that would be a game changer.”

Roll Call: Obama Administration Announces Added $60 Million To Fight Zika
Some $60 million will soon flow to states, cities and territories to fight the Zika virus, White House officials announced Thursday. The Centers for Disease Control and Prevention will begin awarding nearly $60 million to localities to "support efforts to protect Americans from the Zika virus," including protecting against the birth defect microcephaly, the agency said in a press release Thursday. CDC said new funding will be available to jurisdictions Aug. 1. ... An Office of Management and Budget aide confirmed on background that the additional $60 million comes from the $589 million in total funds the administration reprogrammed in April to fight the virus, in the absence of Congress appropriating $1.9 billion in emergency funds that were requested in February. (Mejdrich, 7/21)

The Washington Post: Zika Is Found In Common Culex Mosquitos, Signaling A Potentially Larger Risk
Brazilian researchers said Thursday they have found Zika in Culex mosquitoes in the northeastern city of Recife in what could prove to be an important discovery. But they cautioned that more study was needed. Until now, Zika was believed to be carried mainly by the Aedes aegypti mosquito, which is much less numerous, lives in clean water and is more likely to bite during the day. Aedes aegypti thrives in tropical and subtropical climates — it is found in Southern U.S. states such as Florida, but is absent in large parts of the United States. The virus is also carried by the Aedes albopictus mosquito, which lives in more rural environments. (Phillips, 7/21)

Meanwhile, in Florida, officials are investigating a possible second case of locally transmitted Zika, but they're worried their funds are drying up —

The New York Times: Second Possible Zika Infection Is Found in Florida
Florida health officials are investigating a possible second case of the Zika virus that may have been locally transmitted. The announcement of the case, in Broward County, comes two days after the state said it was investigating a possible homegrown case in Miami-Dade County. If the cases are confirmed, they would be the first times a person has been infected with the virus by a mosquito in the continental United States. There are more than 1,300 confirmed Zika cases in the country, but all of them had been contracted through travel abroad — by a mosquito bite or by sexual intercourse with someone who had traveled to a Zika-infected area. (Tavernise, 7/21)

The Associated Press: Zika Investigations Eating Up Funds, Florida Officials Say
Florida mosquito control officials worry they won't be able to keep up their efforts to contain the bugs that carry Zika without federal funding, even as concern mounts that the first infection from a mosquito bite on the U.S. mainland is near. On Thursday, fogging trucks drove through a Miami-Dade County neighborhood where health officials are investigating a Zika diagnosis that doesn't appear to have connection to travel outside the United States. Zika is usually spread by mosquitoes, but nearly all the Zika cases in the U.S. have been contracted in other countries or through sex with someone who got it abroad. (7/22)

And in other Zika news —

Reuters: Doctors Devise Care Plan For Babies As Zika Threat Looms In U.S.
As U.S. public health officials try to determine whether Zika has arrived in the country, doctors are establishing guidelines on how to care for the rising number of babies whose mothers were infected with the virus during pregnancy. ... So far, 400 pregnant women in the continental United States have evidence of Zika infection, up from 346 from a week ago, the CDC reported on Thursday. All of those were related to travel or sex with an infected person who had traveled. (Berkrot, 7/21)

Kaiser Health News: How A Caribbean Island Became Prime Source Of U.S. Zika Cases
More than 1,400 Americans contracted Zika while traveling outside the U.S. this year and a Caribbean-island nation is one of the top destinations where they caught the virus. Visitors to the Dominican Republic account for more than a fifth of the confirmed Zika cases in the U.S. through mid-July, according to data from state health departments. New York, Florida and California alone tally 304 cases linked to the country, the data show. (Galewitz, 7/22)

Orlando Sentinel: OneBlood To Start Testing Donated Blood For Zika Virus
Starting August 1, OneBlood will start testing some of the donated blood for the Zika virus. The company is using an investigational Zika test to screen blood products, which hospitals may need for high-risk patients such as pregnant women. This is in addition to individual screenings that the agency has been conducting since February this year, "so it's adding another level of safety," said Dr. Rita Reik, chief medical officer of OneBlood. (Miller, 7/21)

Medicare

CMS Says It Will Release Hospital Star Ratings 'Shortly'

The quality ratings were set to be released last spring but members of Congress and the hospital industry raised questions about the criteria.

Modern Healthcare: CMS Previews How Hospitals Will Fare On New Star Ratings
Ahead of the release of its much-anticipated star ratings for overall hospital quality, the CMS published data Thursday showing how those star ratings are distributed according to hospital characteristics, such as size and status. The agency said it planned to post overall hospital star ratings "shortly" on its Hospital Compare website. (Whitman, 7/21)

Kaiser Health News: Medicare Prepares To Go Forward With New Hospital Quality Ratings
Despite objections from Congress and the hospital industry, the Obama administration said it will soon publish star ratings summing up the quality of 3,662 hospitals. Nearly half will be rated as average, and hospitals that serve the poor will not score as well overall as will other hospitals, according to government figures released Thursday. The government says the ratings, which will award between one and five stars to each hospital, will be more useful to consumers than its current mishmash of more than 100 individual metrics, many of which deal with technical matters. The hospital industry, however, fears the ratings will be misleading and oversimplify the many types of care at the institutions. (Rau, 7/22)

In other Medicare news --

Politico Pro: MACRA Rules Cause Surge In Second Quarter Lobbying
The number of provider and other organizations lobbying on MACRA — Medicare’s massive physician payment reform — doubled in the second quarter as CMS published a 962-page rule on the program. Seventy-seven organizations noted lobbying on MACRA in the second three months of 2016, according to disclosure forms that were due Wednesday. Only 38 had cited the law in the first three months of the year. (Pittman, 7/21)

Pharmaceuticals

FDA Lags On Rule To Strengthen Protections For Patients Using Generics

Only makers of brand-name drugs have a legal duty to update their warning labels if they learn of new risks or side effects, the Supreme Court ruled five years ago. But that leaves millions of users in an unregulated safety gap. Meanwhile, startups are in a race to develop a drug that targets the pathway that helps mellow patients out.

Los Angeles Times: New Warning Rule For Users Of Generic Drugs Is Left In Limbo
Five years after the Supreme Court blocked most personal-injury lawsuits against makers of generic drugs, a rule designed to strengthen patient protections [has] stalled, leaving what consumer groups warn is a safety gap for millions of users. After several delays, the Food and Drug Administration said last year it would ... issue a new rule by the end of this month to require generic drug makers to update their warning labels in response to newly revealed risks. But the agency quietly said recently it had put off a final decision until early next year. (Savage, 7/21)

Stat: How Tinkering With A Mellow Messenger In The Brain Could Yield New Drugs
It’s a well-known messenger in the brain: a neurotransmitter dubbed GABA that mellows us out. Drug developers have been tinkering with it for decades, and they’ve scored some big hits, notably Xanax and Valium. Now, they’re reaching for even bigger targets. A flurry of startups are working to target the GABA pathway with more precision than ever before, hoping to come up with medications that can treat a range of neurological disorders and mental illnesses. (Keshavan, 7/22)

And in other pharmaceutical news —

Stat: Pfizer Spars With The Taxman Again, Seeks $8 Million In Overdue Interest
If nothing else, Pfizer is extremely diligent about anything involving taxes. The big drug maker, which raised a national ruckus by pursuing acquisitions designed to lower its tax rate, has engaged in another showdown of sorts with the US Department of Treasury. The latest dispute however, involves decidedly lower stakes — nearly $8.3 million in interest that Pfizer claims it’s owed on a $500 million overpayment that was noted on its 2008 tax return. (Silverman, 7/21)

The Wall Street Journal: Amgen And Allergan Study Finds Biosimilar Comparable To Herceptin
Amgen Inc. and Allergan PLC on Thursday said a late-stage trial of their treatment being developed as a biosimilar to Roche Holding AG’s breast cancer drug Herceptin met its primary endpoint, another step in bringing cheaper versions of some of biotechnology’s best-known cancer drugs to the market. The study, evaluating the effectiveness and safety of ABP 980 compared with trastuzumab, the clinical name for Herceptin—a multibillion-dollar medicine that in the past two decades has transformed treatment for about 25% of breast-cancer patients—ruled out inferiority but couldn't rule out superiority. (Steele, 7/21)

Health IT

Most HIPAA Violation Complaints Quietly Closed By Government Through Private Letter

Most cases alleging a doctor's violation of patient privacy or medical information security are closed out of public view through these letters. ProPublica now posts hundreds of them in its HIPAA Helper tool. In other health IT news, a New York surgeon experiments with augmented reality to help understand the brain.

ProPublica: The Secret Documents That Detail How Patients’ Privacy Is Breached
As part of its examination into the impact of privacy violations on patients, ProPublica has posted about 300 of these “closure letters” in our HIPAA Helper tool. The app allows users to review details of these cases and track repeat offenders. We obtained the letters under the Freedom of Information Act and this is the largest repository of them ever made public. Most of the letters we’ve received were sent to two large providers, the U.S. Department of Veterans Affairs and CVS Health. (Ornstein, 7/21)

Women’s Health

Florida AG: 24-Hour Waiting Period For Abortions 'Reasonable,' 'Minimally Intrusive'

Attorney General Pam Bondi's office filed a brief with the state's Supreme Court as part of a more than year-long legal dispute over the requirement. Elsewhere, Texas Republican Gov. Greg Abbott is fundraising off rules regulating the disposal of fetal remains.

Health News Florida: State Says Abortion Waiting Period Doesn’t Infringe On Rights
Trying to move forward with a requirement that women wait 24 hours before having abortions, Attorney General Pam Bondi's office has filed a brief at the Florida Supreme Court saying such a waiting period "does not significantly burden the right to privacy." The brief is part of a more than year-long legal dispute about a 2015 law that would require 24-hour waiting periods. (7/21)

The Texas Tribune: Abbott Fundraising Off Rule To Bury Or Cremate Fetal Remains
Weeks after Texas health officials quietly proposed rules that would require the cremation or burial of fetal remains, Republican Gov. Greg Abbott is raising political funds off his administration's new effort to regulate abortion providers. In a fundraising email sent to supporters Thursday, Abbott cited the rule change, saying Texas is working to “turn the tides” against the abortion industry in the state and protect the “rights of the unborn.” (Ura, 7/21)

Public Health And Education

Immigrant Families And The Opioid Crisis: In America 'The Only Village Taking Care Of Your Kids Is The Street'

Anecdotal evidence suggests that the epidemic has also hit hard in immigrant communities that are unfamiliar with both the signs of drug abuse and the labyrinth of treatment options available.

The New York Times: Heroin And Pill Overdoses Claim Immigrant Victims, Catching Families Off Guard
The country’s epidemic abuse of opioids — heroin, or prescription pills — is often seen as an affliction of white suburban and rural communities, but it has also spread to New York City’s immigrant neighborhoods. There is no city data that breaks down drug abuse by ethnicity, but anecdotal evidence suggests that it is emerging or even worsening where it already has a foothold. Experts and those enmeshed in the fight against drugs see many possible explanations. Immigrant parents are often unfamiliar with the signs of drug abuse and may not know how to navigate the world of treatment and recovery. Immigrant families, steeped in traditions, can also have an especially strong culture of shame around addiction that discourages asking for help. (Robbins, 7/21)

Elsewhere, Montana patients with chronic pain take desperate measures to get medication under tight opioid regulations and St. Louis gets federal money to set up a prescription drug monitoring database —

Kaiser Health News: Montana's 'Pain Refugees' Leave State To Get Prescribed Opioids
Federal authorities say about 78 Americans die every day from opioid overdose. In Montana, health care officials report that abuse there is worse than the national average. But the casualties of the opioid epidemic are not all drug abusers. On a recent night, three Montana residents, who call themselves pain refugees, boarded an airplane from Missoula to Los Angeles. They say that finding doctors willing to treat chronic pain in Montana is almost impossible, and the only way they can get relief is to fly out of state. (Cates-Carney, 7/22)

St. Louis Public Radio: St. Louis County Could Get Federal Money For Opioid Monitoring
St. Louis County could receive federal funds to establish a regional prescription drug monitoring database, under a new law passed by Congress that President Barack Obama has said he will sign. The measure allows for local governments, not just states, to apply for federal grants to set up a database to alert physicians when a patient may be receiving too many opioid prescriptions. (Bouscaren, 7/21)

Meanwhile, drug overdoses test the resources of ER departments —

The Wall Street Journal: K2 Patients Put Emergency Rooms To The Test
Emergency departments ... are on the front line in the medical response to K2, a drug-laced herbal mixture that has no antidote and is often labeled as potpourri or incense to mask its illicit purpose. K2 is cheaper than cocaine, heroin or marijuana, and its ever-shifting chemical makeup has defied regulators’ efforts to control it. Last week, 130 people suspected to be on the drug, which is often referred to as “spice” and sometimes erroneously marketed as legal marijuana, were brought to emergency rooms across New York City, according to the Department of Health and Mental Hygiene. (Furfaro, 7/21)

The Little-Known Tinnitus Treatment No One Is Trying

A study has found that one in 10 U.S. adults reported experiencing tinnitus, a persistent ringing, roaring or buzzing in the ears. But surprisingly few doctors are recommending behavioral therapy, which has been found to be effective. In other public health news, the first CRISPR trial with human patients may start next month, medical journals are doing little to police studies using contaminated or misidentified cells and officials warn about a potentially dangerous tick-borne disease.

NPR: Psychotherapy Helps People Tune Out The Din Of Tinnitus
About three years ago, a high-pitched "eeeeeeeee" sound started ringing in Linda Gray's ears. Sometimes, the ring would suddenly turn into a roar, sending Gray into panic mode. Her heart would speed up. She'd try to find a quiet room. "You're trying to escape it. It's like, 'Turn this off!' " she says. A lot of people experience ringing, roaring or buzzing, also known as tinnitus. It can be maddening. ... Doctors writing Thursday in the journal JAMA Otolaryngology-Head & Neck Surgery found that about 1 in 10 U.S. adults reported experiencing tinnitus within the past year. And, surprisingly, very few of them talked with their doctors about one of the few methods known to help with it. (Bichell, 7/21)

Stat: First CRISPR Trial In Humans Is Reported To Start Next Month
Scientists in China plan to use the genome-editing technology CRISPR-Cas9 in patients as early as next month, Nature reported on Thursday. If they go ahead, it would be the first time people would be injected with cells whose DNA has been altered by CRISPR. A US proposal to run a similar study received approval by a federal ethics and safety panel last month, but it faces months of additional regulatory hurdles before it can go ahead by the end of 2016 at the earliest. (Begley, 7/21)

Stat: Thousands Of Studies Used The Wrong Cells, And Journals Are Doing Nothing
But science journals face no such repercussions for marketing some decidedly rotten studies as 100 percent sound. The problem is this: Recent estimates suggest that between 20 percent and 36 percent of cell lines scientists use are contaminated or misidentified — passing off as human tissue cells that in fact come from pigs, rats, or mice, or in which the desired human cell is tainted with unknown others. But despite knowing about the issue for at least 35 years, the vast majority of journals have yet to put any kind of disclaimer on the thousands of studies affected. (Oransky and Marcus, 7/21)

WBUR: Another Tick-Borne Disease To Worry About: Powassan Virus
State public health officials are voicing concern about a little-known, but potentially dangerous tick-borne disease. It's called Powassan virus: a rare but serious disease transmitted by the bite of a black legged tick, also known as a deer tick. The Department of Public Health says it's received reports of nine cases of the virus in Massachusetts since 2013. (Zimmerman, 7/21)

State Watch

Texas Hospitals Receive Federal Funds To Improve Access

Meanwhile, in New Hampshire, a new, 10-bed crisis unit at the state hospital is experiencing challenges and growing pains. Also, a new study details the reasons why rural hospitals struggle.

The Dallas Morning News: Texas Hospitals To Get More Than $9.5 Million To Expand Health Care Workforce
Fort Worth’s Texas Christian University is one of nineteen organizations in the state that will receive federal funding to bolster training for health care professionals. More than $9.5 million in grants will be distributed to 19 hospitals, health systems and other groups statewide. The awards announced Thursday are meant to help improve access to care in high-need areas, and are part of $149 million national effort of the Health Resources and Services Administration. (Rice, 7/21)

New Hampshire Union Leader: Growing Pains For State Hospital's Crisis Unit
When the 10-bed mental health crisis unit at New Hampshire Hospital opened on July 5 with much fanfare after a one-year delay, state health and human services officials predicted it would fill up immediately, given the long list of patients waiting in emergency rooms at hospitals throughout the state. Two beds were immediately occupied the day the Inpatient Stabilization Unit opened, according to Health and Human Services spokesperson Jake Leon, who predicted at the time that all 10 beds would soon be occupied. (Solomon, 7/21)

North Carolina Health News: Kaiser Study: Rural Hospitals Close For Many Reasons
Across the United States, 76 rural hospitals have closed since 2010, three of them in North Carolina. A new report by the Kaiser Commission on Medicaid and the Uninsured attributes rural hospital closings to a broad range of factors. They include, but aren’t limited to, corporate decisions on profitability, lack of community expertise in dealing with large health-care organizations, changes in federal reimbursement policies, and some states’ decision not to expand Medicaid. (Goldsmith, 7/22)

State Highlights: In Mass., Hallmark Health Physicians Leave Partners For Rival System; N.Y. Repeals Tampon Tax

Outlets report on health news from Massachusetts, New York, Connecticut, Nevada, Georgia, Iowa and California.

Boston Globe: Hallmark Doctors To Leave Partners, Join Tufts
A group of nearly 400 doctors north of Boston has decided to end its longtime ties with Partners HealthCare and join a rival physician network affiliated with Tufts Medical Center. The decision by the Hallmark Health System physician group follows the announcement last month that Hallmark would pursue a merger with Tufts’s parent company. The move shakes up the competitive market for doctors in Eastern Massachusetts and is a blow to Partners, the state’s largest health system. (McCluskey, 7/21)

The Associated Press: New York Repeals Sales Tax On Tampons And Sanitary Napkins
New York state has repealed its tax on tampons and other feminine hygiene products, a move expected to save women $10 million a year. Democratic Gov. Andrew Cuomo signed the measure into law Thursday, calling it “a matter of social and economic justice.” The repeal passed the Legislature earlier this year after female lawmakers from both parties complained the tax was sexist because personal products including condoms and bandages were already exempt from the sales tax. (Klepper, 7/21)

The CT Mirror: Union Ad Features Disabled Woman’s Appeal To Reverse State Layoffs
Connecticut’s largest health care workers union took to the airwaves Thursday to protest ongoing state employee layoffs. The commercial launched by SEIU, New England 1199 and airing on Connecticut stations and the internet, features a woman, identified as Jenny, who is living with cerebral palsy. In the 30-second spot, Jenny, who "speaks" using a computer that reads her eye signals, makes a direct appeal to Gov. Dannel P. Malloy to restore her state-appointed speech pathologist, identified only as "Mallory." (Phaneuf, 7/21)

The Associated Press: Nevada Ending Discrimination Of Prison Inmates With HIV
Nevada’s Department of Corrections is changing a series of policies and practices that the U.S. Justice Department says illegally discriminate against prison inmates with HIV by housing them separately and denying access to work assignments that can speed their release. The Justice Department concluded last month the state was violating inmates’ civil rights under the policies based largely on outdated and unfounded fears about the transmission of the virus that causes AIDS. (Sonner, 7/21)

Atlanta Business Chronicle: Emory, Metaclipse Therapeutics Get $2.4 Million Grant For Breast Cancer Vaccine
A team of Emory University and Atlanta-based Metaclipse Therapeutics Corp. researchers landed a $2.4 million grant from the National Institutes of Health and National Cancer Institute. The five-year grant will be used to develop new cancer vaccine immunotherapies for patients with triple-negative breast cancer (TNBC). TBNC is very hard to treat because it doesn't present any defined targets for drugs or vaccines to attack, and five-year survival rates are lower for it than other types of breast cancer. (Hensley, 7/20)

Iowa Public Radio: Transgender State Employee Alleges Workplace Discrimination
A long-time employee at the Iowa Women’s Prison in Mitchellville has filed a complaint with the Iowa Civil Rights Commission alleging discrimination on the basis of gender identity. According to the complaint, 34-year old Department of Corrections transgender nurse Jesse Vroegh is being denied access to male restrooms and locker rooms, but is allowed to use unisex facilities instead. ...The complaint also names Wellmark Blue Cross and Blue Shield for denying coverage for what is called medically necessary surgery. (Russell, 7/21)

Georgia Health News: Piedmont-United Dispute Shows No Sign Of Resolution
Three weeks after their old contract expired, Piedmont Healthcare and UnitedHealthcare remain far apart in trying to reach a new one. Since July 1, five Piedmont hospitals, as well as health system doctors, have been “out of network” to tens of thousands of United members. Those patients now face higher out-of-pocket costs if they choose to go to Piedmont facilities and physicians. (Miller, 7/21)

Center for Investigative Reporting: ‘I Was Greedy And Stupid’: Workers’ Comp Attorney Admits To Bribes
Sean E. O’Keefe was a well-known attorney in San Diego, advertising on his website that his team put injured workers’ needs first. In recently released court records, O’Keefe testified that he paid a firm to send him two-thirds of his clients. He also promised the recruiter, Carlos Arguello, that he would make sure those workers ran up bills at certain medical providers who offered MRIs, sleep studies, psychology, medications and toxicology screenings. (Jewett, 7/18)

KQED: Oakland, S.F. Revise Medical Marijuana Regulations In Face Of New State Law
A new state law has Oakland and San Francisco remaking their medical cannabis laws in the face of new state requirements. The actions are distinct from a November statewide ballot measure that would legalize recreational marijuana for adults over 21 years old. The present law, passed last fall, imposes new regulatory measures on medical pot businesses in California. Previously, businesses needed only a city license. (Levi, 7/21)

Health Policy Research

Research Roundup: International Travel Risks; Telehealth; Freestanding ERs; Methadone Use

Each week, KHN compiles a selection of recently released health policy studies and briefs.

The New England Journal of Medicine: Medical Considerations Before International Travel
In 2015, international tourist arrivals in all countries exceeded 1.2 billion persons. In 2014, the total number of arrivals in countries with emerging markets nearly surpassed the number in developed countries. Depending on the destination, 22 to 64% of travelers report some illness; most of these illnesses are mild and self-limited, such as diarrhea, respiratory infections, and skin disorders. Some travelers return to their own countries with preventable life-threatening infections. ... Yet 20 to 80% of travelers do not seek pretravel health consultation. ... Persons who are planning to travel to other countries often ask their health care providers for information about preventive interventions. Nonspecialists can provide information and care to healthy adults traveling to common destinations by following protocols such as those offered in this review. (Longo, 7/21)

The New England Journal of Medicine: State Of Telehealth
Telehealth is the provision of health care remotely by means of a variety of telecommunication tools, including telephones, smartphones, and mobile wireless devices, with or without a video connection. Telehealth is growing rapidly and has the potential to transform the delivery of health care for millions of persons. Although several reviews have examined the historical use and effects of telehealth, few articles have characterized its current status. Here we examine the trends of telehealth, its limitations, and the possibilities for future adoption. (Dorsey and Topol, 7/14)

Annals of Emergency Medicine: Where Do Freestanding Emergency Departments Choose To Locate? A National Inventory And Geographic Analysis In Three States
We identified 360 freestanding EDs located in 30 states; 54.2% of freestanding EDs were hospital satellites, 36.6% were independent, and 9.2% were not classifiable. The 3 states with the highest number of freestanding EDs accounted for 66% of all freestanding EDs: Texas (181), Ohio (34), and Colorado (24). Across all 3 states, freestanding EDs were located in ZIP codes that had higher incomes and a lower proportion of the population with Medicaid. In Texas and Ohio, freestanding EDs were located in ZIP codes with a higher proportion of the population with private insurance. In Texas, freestanding EDs were located in ZIP codes that had fewer Hispanics ... and had more physician visits and medical spending per year than ZIP codes without a freestanding ED. (Schuur et al., 7/12)

JAMA/Kaiser Family Foundation: HIV Awareness And Testing, 2013 And 2014
This Visualizing Health Policy infographic provides a snapshot of HIV-related awareness and experiences among adults in the United States and 2 demographic groups that make up a disproportionate share of people with HIV: black adults and gay and bisexual men. In 2014, 4 in 10 black adults, and more than half of gay and bisexual men said they personally knew someone who is HIV-positive (HIV+) or who has died of HIV/AIDS, compared with only 28% of adults in the United States overall. Only 21% of US adults were aware that consistent antiretroviral treatment can significantly reduce the risk of HIV transmission, and only 14% had heard of a new prevention strategy, preexposure prophylaxis. Awareness was only slightly higher among black adults and gay and bisexual men. (Firth et al., 7/12)

Morbidity and Mortality Weekly (CDC): Trends In Methadone Distribution For Pain Treatment, Methadone Diversion, And Overdose Deaths — United States, 2002–2014
Use of the prescription opioid methadone for treatment of pain, rather than for treatment of opioid use disorder, has been identified as an important contributor to the rise in opioid-related overdose deaths. In recent years, a number of actions to reduce the use of methadone for pain treatment have been taken. ... During 2002–2006, the national distribution rate of methadone increased, on average, 25.1% per year, methadone-involved drug overdose deaths increased 22.1% per year, and methadone diversion increased 24.3% per year. After 2006, methadone distribution declined 3.2% per year, and methadone-involved overdose deaths declined 6.5% per year. Rates of methadone diversion continued to increase during 2006–2009, but substantially more slowly, and then declined an average of 12.8% per year beginning in 2010. (Jones et al., 7/8)

Morbidity and Mortality Weekly (CDC): Vital Signs: Motor Vehicle Injury Prevention — United States And 19 Comparison Countries
CDC analyzed 2000 and 2013 data compiled by the World Health Organization and the Organisation for Economic Co-operation and Development (OECD) to determine the number and rate of motor vehicle crash deaths in the United States and 19 other high-income OECD countries .... In 2013, the United States motor vehicle crash death rate of 10.3 per 100,000 population had decreased 31% from the rate in 2000; among the 19 comparison countries, the rate had declined an average of 56% during this time. Among all 20 countries, the United States had the highest rate of crash deaths per 100,000 population (10.3) ... and the fifth highest rate of motor vehicle crash deaths per 100 million vehicle miles traveled (1.10). Among countries for which information on national seat belt use was available, the United States ranked 18th out of 20 for front seat use. (Sauber-Schatz et al., 7/6)

The National Bureau of Economic Research: Strategic Formulary Design In Medicare Part D Plans
The design of Medicare Part D causes most Medicare beneficiaries to receive fragmented health insurance, whereby prescription drugs and other medical care are covered by separate insurance plans. Fragmentation of insurance plans is potentially inefficient since separate insurers maximize profits over only one component of healthcare spending ... Relative to fragmented plans, integrated plans systematically design their drug formularies to encourage enrollment by beneficiaries with medical conditions that are profitable under Parts A & B. However, integrated plans also more generously cover drugs that have the potential to causally reduce medical costs. These large differences in incentives and plan design between integrated and fragmented plans are likely the precursors of substantial differential selection of enrollees, and the basic design of Medicare Part D abets this covert selection. (Lavetti and Simon, 6/24)

The Urban Institute/Kaiser Family Foundation: A Look At Rural Hospital Closures And Implications For Access To Care: Three Case Studies
[T]he examination of rural hospital closures in three communities as well as interviews with national experts show that a number of factors contribute to rural hospital closures, including demographics (aging, poor, and declining populations), hospital finances (high uninsured rates and high shares of public paying patients), and overall changes in how care is delivered. ... the hospital closures reduced local residents’ access to care (especially emergency care), led to an outmigration of health care professionals, and worsened pre-existing challenges in obtaining access to specialty care. ... The experience of study hospitals, stakeholder interviews, and other research show that a state’s decision about the Medicaid expansion has an important impact on hospital revenues and access to care, but the sustainability of rural hospitals depends on a broader set of factors. (Wishner and Rudowitz et al., 7/7)

Employee Benefit Research Institute: Views On The Value Of Voluntary Workplace Benefits: Findings From The 2015 Health And Voluntary Workplace Benefits Survey
The benefits package that an employer offers prospective workers is an important factor in their decision to accept or reject a job. More than one-third (36 percent) of workers say the benefits package is extremely important, while 41 percent say it is very important. ... Workers overwhelmingly consider health insurance to be the most important workplace benefit. Nearly two-thirds (64 percent) say this benefit is extremely important, while an additional 24 percent consider it to be very important. Indeed, having access to health insurance through their employer is considered so important that 6 in 10 (60 percent) report they are planning to work longer than they would like in order to continue receiving health insurance through their employer. (Fronstin and Hellman, 7/5)

Here is a selection of news coverage of other recent research:

Morning Consult: Report: ACA Enrollees Are Less Healthy, Uninsured Are Healthier
During the first year of Obamacare’s implementation, the individual insurance market became less healthy while the uninsured and Medicaid populations became healthier, according to a new analysis. A Health Affairs data analysis ... underscores the often stated observation that the Affordable Care Act has brought sicker, more expensive enrollees into the individual marketplace while healthier people have tended to resist enrollment. (Owens, 7/6)

Houston Chronicle: Wealthy Get More Health Care Than Other Americans
There is little debate that health care costs are growing too fast, and the United States needs to discourage over-utilization. Co-pays and deductibles can achieve those goals, but this study shows that people with higher incomes are not as deterred as lower-income Americans. (Tomlinson, 7/12)

Editorials And Opinions

Viewpoints: Donald Trump On Imported Prescription Drugs; In 'Shadow' Of GOP Convention, Obamacare's Impact

A selection of opinions on health care from around the country.

Stat: Say What You Will About Donald Trump. He’s Right About Drug Companies
As a physician, I believe that Trump is absolutely right about allowing cheaper pharmaceutical drugs manufactured abroad to be sold in the United States. He is right that the pharmaceutical companies essentially sell their products to the federal government via Medicare and Medicaid without competitive bidding. In other areas of the budget, such as defense, federal laws require competitive bidding. It is outrageous this doesn’t occur with drugs and devices, especially since the health care budget is right behind defense in terms of expense. Trump is right when he says that drug companies control the landscape. (Charles D. Rosen, 7/22)

The Huffington Post: In GOP Convention’s Shadow, Obamacare Is Paying Big Dividends
The Republicans gathering inside the Quicken Loans Arena don’t care too much about the nitty-gritty of policy. But if there’s one substantive issue that generates passion among convention delegates and party leaders, it’s Obamacare. They think it crushes freedom. They think it’s a handout. And they think it’s a policy disaster. (Jonathan Cohn, 7/21)

The Washington Post: Costs Skyrocket For Feds’ Long-Term-Care Insurance
Federal employees and retirees who participate in the Federal Long Term Care Insurance Program (FLTCIP) are in for some serious sticker shock. They pay the full cost of that insurance, and on Nov. 1, it will jump by up to 126 percent. The average increase will be 83 percent or $111 per month. That leaves retirees livid. (Joe Davidson, 7/21)

Sacramento Bee: Health Insurance Mergers That Are Too Big Not To Fail
For the past year, federal authorities have been reviewing a $48 billion offer from Anthem – already a dominant supplier of employer-based insurance – to acquire its smaller competitor Cigna. Officials have also been studying a $37 billion proposal from Aetna to acquire Humana. These massive deals would give Anthem the largest enrollment in the nation and allow Aetna to capitalize on the demographic growth generated by baby boomers in the Medicare Advantage market. But an even bigger driver for health insurers has been the sense that, post-Affordable Care Act, size matters. (7/21)

Los Angeles Times: Starbucks Unveils A Private Health Insurance Exchange. Is That A Good Thing?
To hear Starbucks tell it, the company’s introduction this week of expanded insurance choices for workers represents a major advance in health coverage. “Providing industry-leading benefits for eligible full- and part-time partners is a cornerstone of who we are as a company,” Ron Crawford, Starbucks’ vice president of global benefits, said in a statement. “Much like a travel site, our partners will be able to navigate an easy-to-use online platform to choose between more insurance carriers and coverage levels at more competitive prices to help them find the right plan for their own needs.” (David Lazarus, 7/22)

The Des Moines Register: Why More Psychiatric Beds Aren't The Solution
The Register’s editorial on June 13 (“Iowa ranks last for psychiatric beds”) and subsequent coverage of mental health care June 19 (“Mentally ill Iowans stranded for months in hospitals”) fail to convey a complete picture of the state of mental health delivery in Iowa and the progress underway. The United States is in the midst of health care reform. As a part of this reform, many states — including Iowa — are redesigning their mental health care delivery systems to provide the best patient care in the least restrictive setting. While placing mental health patients in institutions was once considered the standard of care, clinical research has proven that non-institutional, community-based care provides better patient outcomes for most patients while reducing the cost of that care. (Dennis Duke, 7/21)

The Washington Post: My Brother Loves Politics. But He Thought His Disability Meant He Couldn’t Vote.
My brother and I sat in stiff chairs in a government office, a clipboard of paperwork in front of us. He’d recently moved, and we were there to sign him up for health care. Flipping through the papers, he came upon a voter-registration form. “People like me can vote?” my brother asked. I had to look away from him for a moment so that I wouldn’t cry in the middle of the waiting room. Like millions of Americans, my older brother lives with a disability. He was diagnosed with schizoaffective disorder, which means he hears voices and battles mood fluctuations. He also struggles with some learning disabilities that resulted when doctors used forceps to help deliver him as a baby. Thanks to good doctors, medication and a remarkable day program, he is doing well. He is strong, compassionate and funny. He watches the news and is well informed; we’ve discussed the Islamic State, North Korea, the poor, jobs, what to do about the homeless and the presidential campaign. But he didn’t know he could vote. (Wendy Button, 7/22)