• CA Supreme Court: Physicians cannot deny care to homosexuals on religious grounds.
• Since the antidiabetic drug exenatide (Byetta) was approved by the FDA, its role in the cause of adverse events resulting in death has largely flown under the radar of the media….until now.
• WP: For teens, access to prescription drugs easier than trying to procure beer.
• Cool study result: Those who survived the extremely deadly influenza pandemic of 1918 are still producing antibodies over 90 years later.
• Ignorance versus inaccessibility — thousands of Kentucky children missing out on available state funded care.

• There’s a new technique for culturing neurons, the functional units of the nervous system; it may shed light on the origins of amyotrophic lateral sclerosis (Lou Gehrig’s disease).

The new cells were derived from 3-millimeter patches of skin removed from the arm of an 82-year-old woman and her 89-year-old sister, who share a rare genetic mutation that causes about 2% of ALS cases.

The scientists from Harvard University and Columbia University focused on the rare form of ALS in part to test whether cells from elderly patients could be reprogrammed, said biologist Kevin Eggan of the Harvard Stem Cell Institute.

“This opens the door to being able to make patient-specific stem cell lines from diseases which affect people very late in life, like Parkinson’s disease or Alzheimer’s disease,” said Eggan, the study’s senior author.

• The race to the finish line for anti-Alzheimer drug development may prove to be a risky proposition for pharma and its research.
• The House of Representatives moves to give the FDA power to regulate tobacco products.  Great news.
• CMS: Medicare payment rates to long term care facilities to increase by over three quarters of a billion dollars next year.

Medicare payment rates to nursing homes will increase by $780 million next year, the Centers for Medicare & Medicaid Services (CMS) announced.

The boost in payments is the result of a 3.4 percent increase in the annual market basket calculation of the cost of goods and services included in a skilled nursing facility stay.

• Michigan physicians are upset over EPA’s decision to allow the state to use a certain antibiotic to “treat” diseased apples.

In an effort to assuage the increasing antipathy of medical lobbyists and physicians against the recent GOP-led campaign to enforce Medicare reimbursement cuts to healthcare providers, Republican leaders recently held a private meeting with top healthcare thought leaders to mend a relationship which has increasingly favored Democrats as of late.  The last time Republicans seemed as though they were in the good graces of the medical leadership community was in 2003, when George W. Bush held his own against those in the medical provider cohort who were being bruised by unfair tort practices nationwide.  That was also the year in which bold GOP initiatives were easily passed and yielded, among other things, a complete overhaul in how the government, Pharma, and patients later obtained prescription medications — under Medicare Part D. 

However, recent spikes in the number of uninsured and a general sense of healthcare management malaise on the part of legislators on both sides of the ideological divide have made a tenuous relationship even more fragile.  Can the Republicans make it up to physicians this time?

In the run-up to the 2006 midterm elections, doctors and the groups that represent them gave 62 percent of their combined $52.4 million war chest to Republicans, compared with 37 percent to Democrats, according to the Center for Responsive Politics. That breakdown mirrors previous cycles since Bush entered the White House.  But since 2006, doctors and related groups have given Democrats 53 percent of their combined $53 million in campaign contributions, according to the watchdog group.  The switch is even more stark for the AMA.  In the run-up to the 2006 election, the AMA’s political action committee gave Republicans 70 percent of its campaign cash, according to the Center for Responsive Politics. In 2004, the AMA’s PAC contributed 80 percent of its total donations to Republican lawmakers and candidates.  Since 2006, that PAC has directed 53 percent of its contributions to Democrats.

If the current state of re-election possibilities continues to wane for the GOP, don’t bet on it. | LINK

For all of its perceived blessings and shortcomings, here’s one thing everyone can agree on when it comes to Medicare legislation.  The government guarantor of healthcare to the elderly turns 43 today.  On July 30, 1965, Lyndon Johnson signed the bill into law, capping a movement of healthcare reform that — up until that point — pitted the medical establishment against the need to address the growing burden of healthcare costs in a rapidly and technologically evolving medical environment.  No one benefited sooner than recent former president Harry Truman as the program’s first recipient of services. | LINK

A sign of things to come in this already very shaky economy?  Political pundicrats always say “as California goes, so does the nation”.  Let’s hope that the (in)solvency of their Medicaid managed care contracts doesn’t bleed over to what the other 49 get in matching funds to provide healthcare for the poor and elderly.

State officials put the healthcare facilities on notice that starting today, payments from the Medi-Cal insurance program for the poor will be frozen until a budget is approved. An emergency pot of cash officials had set aside to pay the healthcare clinics, nursing homes and adult day care centers in the event of a delayed budget has run dry.

Many of those facilities are those whose fiscal lifeblood relies upon Medicaid and associated managed care contracts — long term care facilities and those which serve the developmentally disabled.

“It is very scary this year,” said Cheryl Loflin Wertz, who runs 18 of the group homes in Los Angeles and Orange counties. “We’ve laid people off, haven’t let other people take vacations, cut back. . . . I’ve already borrowed money from my family. There isn’t anyplace to go to borrow.”  Michelle Clarke, who operates 12 group homes between Upland and Loma Linda, said she would be out of cash by mid-August. A lender will give her the $100,000 a week she needs to stay solvent, she said, but each weekly loan will cost her $5,000 in interest and fees.

LINK

• Colorado veterans oppose VA hospital plan to partner with an existing private non-profit.
• Wisconsin Medicaid fraud unit exposes tactics of neuroleptic drug maker.
• Holy menu, Batman!  NYC restaurants can be fined for not showing calorie counts on their offerings.
• House committee will investigate healthcare plan rescissions nationwide.

A congressional committee will investigate health insurers’ practice of canceling coverage when policyholders get sick, its chairman said Thursday.
The problem first came to light in California, but witnesses testifying before the House Oversight and Government Reform Committee suggested that it was more widespread. The problem affects the individual insurance market, in which 14 million Americans, including nearly 3 million Californians, purchase medical benefits on their own. In light of proposals to expand the individual market, the committee’s chairman, Rep. Henry A. Waxman (D-Beverly Hills), said the individual market demanded more scrutiny, especially of cancellation practices.

• McCain criticizes Obama for voting against so-called “partial birth” abortion ban.

It looks like the state of Louisiana gets it. As the discipline of primary care medicine becomes known more for cuts in Medicare and Medicaid reimbursements than for treatment and prevention of disease, the state — whose brush with hurricane Katrina in 2005 has done more for its sense of healthcare activism than in many other southern states — is being proactive in overhauling its healthcare delivery systems to its un- and underinsured. How is Louisiana approaching primary care reform? By lobbying hard for government pilot projects that emphasize parity among provider networks in the delivery of chronic disease management, while giving traditional fee-for-service Medicaid programs a run for their money. | LINK

In the increasingly crowded long-term care marketplace, there are many alternatives to traditional nursing home care. Licensing and credentialling issues aside; resources such as block nursing programs, upstart hospice organizations, privately owned durable medical equipment wholesalers and suppliers are just a few of the entities out to compete for the business of seniors’ healthcare needs. Many, if not all, of them are reimbursed not only via private insurance plans, but also by that ol’ standby — state Medicaid programs. Ninety-nine percent of the time, billing and reimbursements are legitimate, but there are always a few chinks in the armor. | LINK

If George W Bush had an explanation for this, it would probably contain the phrase, “activist judges”. Citing procedural improprieties in forming the Medicaid rules, a federal judge blocked a Bush administration regulation slashing $5 billion in Medicaid funds over 5 years for California public hospitals. The ruling actually came down last Friday (23), just two days before a moratorium on blocking the Medicaid cuts set by Congress was to expire. The losses imposed by such cuts in the state’s Medicaid program would be substantial, affecting acute care reimbursements statewide. The loss may be short-lived, however, as the ruling affects implementation of the rules, not the Bush admin’s substance of the original regulation. | LINK

CMS is not known for speedy reactions to policy promises, but when the nation’s largest healthcare insurer jumps on a target, it usually sees the project through — this, in spite of the usual critical grumbling by detractors of organizational underfunding and understaffing in getting the job done.

CMS is proposing new rules targeting private plans which misrepresent associations with Medicare or engage in fraud and abuse with respect to marketing practices.  These plans were made possible with revisions described in the landmark Medicare Modernization Act of 2003.  Although the bill which led to sweeping changes in Medicare was passed in 2003, the proposed rules would cover infractions for marketing practices 2006 and onward – around the time many programs offering seniors choices began to flourish (via Part D prescription drug plans and Medicare Advantage plans).

“At first glance, the proposed rule offers an improvement over the status quo,” said Rep. Pete Stark, D-Calif. “However, in order for it to be effective, the rule must be accompanied by a commitment to aggressive enforcement.”

That’s an understatement. | LINK 1 | LINK 2

In 2007 the federal government footed a little less than two-thirds of the Medicare funding in this country with the states coming up with the balance. Nationwide, almost 50 million beneficiaries of state Medicaid programs were served. The House wants to maintain the status quo, at least for another year.

In the face of opposition from the White House and George W Bush, the U.S. Congress wants to thwart the former’s efforts at healthcare cost-cutting by imposing a one-year moratorium on Bush’s new Medicaid rules. It is the administration’s hope that instituting the new rules would save over $33B over the next 10 years, curbing costs related to what it feels is due to “fraud, waste and abuse”.

In contrast to Medicare, the Medicaid program is funded by government partnerships with the individual states — an arrangement that is constantly variable and certainly ripe for abuse. However, congressional support for the bill appears to be bipartisan as lawmakers on both sides realize the importance of keeping healthcare access to Medicaid beneficiaries a priority in these troubled economic times. | LINK

UPDATE: The House has indeed voted to override the Bush administration’s plan for cutting Medicaid spending. Senate will probably follow suit. | LINK

What’s this? One state’s legislature passes an affordable health insurance bill, but Democratic lawmakers deride it?

The plan, discussed in the middle of the night after a rancorous marathon session, would give people options on what kinds of services to get coverage for - from preventive care to office visits to emergency care.

 

It would also aim to create a public-private corporation that House Republicans said would help create a marketplace for health-care services and insurance — a feature that is the main difference from a plan put forth by Gov. Charlie Crist and approved by the state Senate on Wednesday.

The House staff estimated it would take $1 million to run the corporation. Crist’s analysts said it could cost up to $8 million, while the governor’s plan wouldn’t cost anything.

It’s not enough of a peoples’ plan in the eyes of the Florida Democrats — while the state’s Republicans try to create the perfect blend of market-driven, government sponsored healthcare choice. | LINK

It’s nothing short of a miracle.  The Bush administration has announced the immediate need for universal, complete government backed and sponsored healthcare coverage.  Starting today, any patient can go anywhere for his or her healthcare and the government will pick up the tab.  They can be seen for anything without regard to cost.  Sky’s the limit.  Big Pharma, all major managed care organizations, device companies, and yes — even CMS — are all on board with this sudden change in healthcare policy.  It appears as though the Democratic candidates for president, Hillary Clinton and Barack Obama, are a little perplexed over this breaking news — as they now have no compelling healthcare platform to differentiate themselves from what the current president is proposing.