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POLITICO New York Health Care: Examining cardiac CON rules -- Cuomo signs Lauren's Law -- No more new hookah bars in NYC

By Dan Goldberg | 10/17/2017 05:43 AM EDT

TODAY IN HEALTH — Assemblyman Michael Kearns and state Sen. Pat Gallivan will discuss the effort to stop the closure of the WNY Children's Psychiatric Center on WCNY's "The Capitol Pressroom" at 11 a.m.

... The State Trauma Advisory Committee meets at 1:30 p.m. The Committee is comprised of trauma professionals that meet to discuss, problem-solve and research current issues in the trauma system. The webcast should be here.

HOUSEKEEPING — I'll be in Albany next Tuesday through Thursday and, as always, would love to meet with readers to discuss how we can do a better job, what stories we are missing, and what we should be paying attention to during the coming legislative session. Email me at dgoldberg@politico.com.

MATTERS OF THE HEART — The state Department of Health is reconsidering how it approves new cardiac catheterization labs that perform percutaneous coronary intervention, also known as PCI. For decades, state officials have relied on volume as a key metric — that is, whether the site will perform enough procedures to ensure not only its financial viability but also its quality. Now, experts across the state are questioning whether that's the right measurement. Hospital consolidation means more physicians are operating at several sites, so a doctor may be performing more procedures than take place in any one physical location. There is also evidence that high-volume hospitals do not have statistically significant lower mortality rates than low-volume hospitals. The Cuomo administration's Regulatory Modernization Initiative team met Monday in Albany to discuss what's wrong with the current method and how it might be improved. It's one of several areas of health care regulation the administration is re-examining as it looks to update 20th century rules to accommodate 21st century medicine. Read my story here.

SHARE ME: Like this newsletter? We've got a brand new link to make it even easier to sign people up. Share this link with your friends, check out our new health care page and please let us know if you have any problems.

AND MAKE SURE YOU FOLLOW Dan on Twitter @DanCGoldberg and Nick at @NickNiedz. And for all New Jersey health news, check out @katiedjennings.

CUOMO MAKES LAUREN'S LAW PERMANENT — Gov. Andrew Cuomo signed a bill Monday requiring driver's license applicants to decide whether they wish to join the state's organ-donor registry. Dubbed "Lauren's Law," after Rockland County resident Lauren Shields who received a heart transplant at age 9, the bill makes permanent a law that was recently extended only through 2020. The measure was first passed in 2012. Cuomo also signed an executive order directing the Department of Health — in conjunction with the Transplant Council and New York Alliance for Donation and others — to develop ways to boost the state's organ donation numbers. Additionally, the state's long-awaited, revamped online registration system went online late last week, according to Aisha Tator, executive director of the New York Alliance for Donation. Read more from Nick here.

NOW WE KNOW — Warning for the parents of teenage children: It is possible to scream so hard your lungs could collapse. That's what happened to a 16-year old girl from Texas at a One Direction concert. The case, which doctors called boy band-induced pneumothorax, pneumomediastinum, and pneumoretropharyngeum, was published in the Journal of Emergency Medicine. Read more from the New York Post here.

WE'D LOVE TO HEAR FROM YOU: This roundup is for you, so please tell us how we can make it even better. Send tips, news, ideas, calendar items, releases, promotions, job postings, birthdays, congratulations, criticisms and corrections to dgoldberg@politico.com.

CHIP CLOCK — It's been 17 days since Congress let the Children's Health Insurance Program lapse. New York has enough cash to keep its program running through December.

NO NEW HOOKAH BARS — Patch.com reports: "Hookah smokers aren't breathing as easily with a trio of new laws Mayor Bill de Blasio signed Monday. The rules ban new hookah bars from opening under the city's Smoke-Free Air Act, while requiring existing lounges to post warning signs and raising the minimum age to buy hookah tobacco to 21 from 18."

PROTECTING REPRODUCTIVE RIGHTS — New York Daily News reports: "With Washington rolling back requirements for employers to cover birth control on insurance plans, Councilman Jumaane Williams says he will introduce a bill to prohibit discrimination based on reproductive health decisions."

DOH HID THE BALL, AGAIN — The Albany Times-Union reports : "When the state Comptroller's office asked the state Department of Health to hand over documents identifying all the subcontractors who would be working to build a medical facility with help from an $11 million state grant, one piece of information was never disclosed: One of the firms involved was facing charges in the upstate bid-rigging scandal. The state Department of Health acknowledged that the project's principal contractor had failed to submit vetting documents to the agency earlier this year, even though Comptroller Tom DiNapoli's staff had asked the agency for all subcontractors' vetting documents for the grant. As a result, DiNapoli's contract reviewers didn't know that a subcontractor for the Buffalo health care project was LPCiminelli, where three former top officials are facing federal bid-rigging charges related to Gov. Andrew Cuomo's "Buffalo Billion" initiative. The $11.2 million grant was awarded by DOH to Kaleida Health, a nonprofit that is the largest health care provider in Western New York. The money supported Kaleida's construction of a children's ambulatory surgery center attached to the new John R. Oishei Children's Hospital on the Buffalo Niagara Medical Campus."

MAD MORTICIANS — The New York Post reports: "New facial-recognition software meant to let funeral directors easily log into the city's system for registering deaths has fallen on its face. The city Department of Health was supposed to roll out its $5.8 million "eVital" system last Monday. It would let undertakers use cellphone selfies to verify their identities on a city site that issues permits to bury, cremate or transport bodies. But when eVital launched, morticians quickly found it didn't work. Many could not log in to enter information about the deceased, confirm the cause of death and ID themselves."

GRANT LAND — The National Institutes of Health awarded researchers at Albert Einstein College of Medicine and the Florida campus of The Scripps Research Institute a five-year, $9 million grant to study the genes of centenarians so they can figure out how the rest of us can live that long. "We're focusing on the genetic differences between healthy centenarians and people with no family history of extreme longevity, looking for rare genetic variants that account for the centenarians' longevity," Dr. Jan Vijg, professor and chair of genetics and the Lola and Saul Kramer Chair in Molecular Genetics at Einstein, and the study's principal investigator, said in a press release. "Once we pinpoint the beneficial effects that these novel gene variants are causing, we'll be in a position to develop drugs that mimic those effects and, ideally, help people attain longer, healthier lifespans."

GRANT LAND — The New York State Health Foundation awarded $125,000 to Roswell Park Cancer Institute to enable easier, more interactive access to medical records for patients. Read all about it here.

NATIONAL ACADEMY OF MEDICINE ELECTS 80 NEW MEMBERS — The inductees include New York City Health Commissioner Mary Bassett and Karen DeSalvo, former acting assistant secretary of the Department of Health and Human Services and national coordinator for health information technology. It brings NAM's total membership to 2,127 and the number of international members to 172. Read the full list.

HIV NONPROFITS EXPAND SERVICES — The Wall Street Journal wrote about how HIV/AIDS clinics are expanding their services now that patients are living longer.

... Longtime readers might remember I wrote a similar story three years ago, which you can read here.

PHARMA REPORT:

TRUMP TAKES ON PHARMA — President Donald Trump took two swings at drugmakers over the high cost of medicines on Monday, bringing attention back to an administration priority he has largely ignored for the past few months. Trump reiterated his desire to get the cost of prescription drugs "way down," claiming during a Rose Garden press conference that "the world is taking advantage of us." Before a Cabinet meeting earlier in the day, Trump accused drug companies of "getting away with murder," repeating an attack line he first used shortly before taking office.

... Even though he has repeatedly lashed out at drugmakers, there's been little indication he will crack down on prices. A leaked draft of a still-pending executive order on drug prices this summer was favorable to the industry. The White House has also abandoned key pledges to allow Medicare to negotiate drug prices and expand importation of cheaper medicines from overseas. The administration has also appointed industry insiders to key posts.

FOLLOW THE MONEY — From STAT: "In his last race in 2014, [Senate Majority Leader Mitch] McConnell raked in $550,923 from the pharmaceutical and health products industries — more than any other individual lawmaker received that year, according to the Center for Responsive Politics, which analyzes political spending data from the Federal Election Commission. Through a separate leadership political action committee, McConnell brought in another $244,000 from the sector, the database shows."

TRUMP WILL DECLARE OPIOIDS A NATIONAL EMERGENCY 'NEXT WEEK' — President Donald Trump says he'll make an official national declaration of emergency for the opioid crisis "next week," more than two months after he indicated he would do so. More from POLITICO here.

A BIG DEAL — The Wall Street Journal reports: "Impax Laboratories Inc. and Amneal Pharmaceuticals LLC are close to agreement on a merger that would create the nation's fifth-largest generic-drug company by revenue, according to people familiar with the matter."

MOHAWK ALLERGAN DEAL INVALIDATED — A federal judge ruled Monday that patents protecting Allergan's $1.5 billion blockbuster dry-eye drug, Restasis, are abstract and invalid. Read more here.

SCHUMER BLASTS DRUG CZAR NOMINEE — Senate Minority Leader Chuck Schumer called on President Donald Trump to withdraw the nomination of Rep. Tom Marino for "drug czar" after media reports the Pennsylvania Republican championed a law that hobbled DEA efforts to combat the abuse of opioids. "Confirming Rep. Marino as our nation's drug czar is like putting the wolf in charge of the henhouse," Schumer said on the Senate floor Monday afternoon, echoing a request from Sen. Joe Manchin of West Virginia earlier in the day. "The American people deserve someone totally committed to fighting the opioid crisis, not someone who has labored on behalf of the drug industry."

CVS, EPIC TEAM UP ON DRUG PRICING INFORMATION — Two of the biggest names in retail pharmacy and health IT announced a partnership Monday that will make patients' out-of-pocket drug costs more apparent during visits to the doctor. CVS Health will use Epic's Healthy Planet technology to navigate the complex matrix of health plans, drug formularies and cost-sharing arrangements so patients know how much they'll pay before they get to a pharmacy. It could also help prescribers identify the lowest-cost drug, if appropriate.

WHAT WE'RE READING:

TRUMPCARE LATEST — President Donald Trump urged Republican Sen. Lamar Alexander to seek out an Obamacare deal with Democrats — encouragement that might help sway Republicans who are skeptical of a bipartisan agreement. Alexander said Trump told him by phone Oct. 14 he'd like to see a bill that funds the Obamacare cost-sharing subsidies that he abruptly cut off last week. In return, he wants to see "meaningful flexibility for the states in providing more choices," said Alexander, of Tennessee. Read more from my D.C. colleagues here.

PREVENTING ABORTIONS — The Trump administration is preventing an undocumented, pregnant teenager detained in a Texas refugee shelter from getting an abortion in a policy shift with big implications for hundreds of other pregnant, unaccompanied minors held in such shelters. She is not the first to be stopped, according to advocates who work with undocumented teenagers. Read more from POLITICO here.

POLITICO SCOOP — Most Americans are confused and under-informed ahead of open enrollment, according to a poll from Get America Covered, which was conducted by Hart Research Associates between Sept. 28 and Oct. 3, before President Donald Trump's recent actions to unwind Obamacare regulations.

PUERTO RICO CRISIS — STAT reports: "Three weeks after that direct hit [of Hurricane Maria], nearly four dozen deaths are associated with the storm. But the true toll on Puerto Rico's 3.4 million residents is likely to involve sickness and loss of life that will only become apparent in the coming months and in indirect ways."

CMS QUIETLY POSTS ACO RESULTS — Three groups of accountable care organizations generated a combined $836 million in gross savings last year, nearly double the amount they posted 2015. It's a promising sign for one of the government's chief initiatives aimed at encouraging better and more efficient health care.

... But you'd be forgiven for missing it: The Centers for Medicare and Medicaid Services didn't publicly announce the results, POLITICO's Adam Cancryn notes. Unlike in years past, the agency has no plans to tout the results of the program which was started by the Obama administration and is under review as part of a planned reimagining of its Innovation Center initiatives. And in a statement to POLITICO, a spokesperson downplayed the savings, noting they don't reflect "spillover effects of ACOs on the market" as well as $701 million in bonus payments to high-performing ACOs participating in the Medicare Shared Savings Program.

TODAY'S TIP — Comes from Northwell Health's Dr. Lora Weiselberg, says that aside from skin cancers, breast cancer is the most common cancer in American women. If you or someone you love has been diagnosed, here's five ways to fight it.

STUDY THIS:

WHERE IT ALL BEGINS — Most — and possibly all — ovarian cancers start in the fallopian tubes, not the ovaries, according to a multicenter study of ovarian cancer genetics led by researchers from Perlmutter Cancer Center at NYU Langone Health, which was published in Nature Communications. "Based on a better understanding of its origins, our study suggests new strategies for the prevention and early detection of ovarian cancer," senior study author Dr. Douglas Levine, director of the Division of Gynecologic Oncology said in a press release. The idea is that if tubal cells display biomarkers, then future blood tests and better Pap smears might detect ovarian cancer earlier.

DIVERSITY JOURNEY — More males and people of color are becoming nurses, and more nurses are earning bachelor's degrees compared with a decade ago, according to a study from NYU Rory Meyers College of Nursing researchers , which was published in Nursing Outlook.

REASONS FOR RACIAL DISPARITIES STAT reports: "Black and Hispanic children with developmental delays are less likely to receive early intervention services than white children, and a new study published in Pediatrics suggests some possible reasons why. Researchers gleaned these main points from interviews with black and Hispanic mothers: They compared their children to others based on their own observations and felt like they didn't see a difference. They believed that each child develops in her own time. They were skeptical of a doctor's findings and relied on advice from social circles. They were too busy or had too many other challenges to focus on their child's delays. And they had limited or conflicting information. Understanding why parents don't seek early interventions for their children could help improve methods for identifying and supporting such children, the researchers wrote."

MISSED A ROUNDUP? Get caught up here.

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Stories from States Pro

State re-examining rules for cardiac cath labs Back

By Dan Goldberg | 10/16/2017 06:31 PM EDT

The state Department of Health is reconsidering how it approves new cardiac catheterization labs that perform percutaneous coronary intervention, also known as PCI.

For decades, state officials have relied on volume as a key metric — that is, whether the site will perform enough procedures to ensure not only its financial viability but also its quality.

Now, experts across the state are questioning whether that's the right measurement.

Hospital consolidation means more physicians are operating at several sites, so a doctor may be performing more procedures than take place in any one physical location. There is also evidence that high-volume hospitals do not have statistically significant lower mortality rates than low-volume hospitals.

The Cuomo administration's Regulatory Modernization Initiative team met Monday in Albany to discuss what's wrong with the current method and how it might be improved.

It's one of several areas of health care regulation the administration is re-examining as it looks to update 20th century rules to accommodate 21st century medicine.

It's only the first meeting, but these ideas will eventually be passed to the Department of Health, which could implement new regulations for the state.

There are 63 licensed PCI labs in the state, and there were approximately 53,000 PCIs performed in 2016.

A new cardiac catheterization lab must perform at least 36 emergency PCI and 200 total PCI procedures within its first year, according to the state's current regulations. The state, to approve a new facility, must also ensure that all other facilities within an hour's drive can maintain a minimum volume of 300 procedures per year, though the health commissioner has authority to waive these provisions.

"Our regulations ... limit entry into markets," said Dan Sheppard, a deputy commissioner. "The logic for that is that it serves a greater public health purpose, that there is a strong correlation between volume and quality. ... So the question here is, 'Do the existing volume thresholds warrant that?'"

Volume may not be the best metric because doing the wrong thing a lot doesn't make for good quality, said Robert Frankel, vice chair of the cardiology department at Maimonides Medical Center.

The experts the Department of Health convened for this meeting agreed that the quality of the physician is more important than the volume of procedures taking place at an institution.

"The hospital plays less of a [role] because these patients are being discharged four hours later," said Frankel, a member of the workgroup.

Another concern with volume as a threshold is that it can encourage physicians to perform procedures they are not qualified to do, or operate on patients who really aren't that ill, all to make their number, said Dan O'Dea, a cardiologist from Poughkeepsie.

Most agreed, however, that there needed to be some minimum threshold for doctors.

"There has to be some criteria, maybe around the team's volume or the team's experience," said Barry Kaplan, executive director of cardiology for Northwell Health and a member of the workgroup. "I'm not sure we can completely ignore that. ... Somehow we have to deal with operator volume, but hospital volume is less important."

State officials want to re-examine these rules, in part, because cardiac interventions have become commoditized over the last few years.

What was once considered an exotic inpatient procedure is now handled on an outpatient basis, allowing smaller facilities to offer the service in communities closer to where many patients live. That's leading to an uptick in applications.

Driving these expansions, at least partly, is the desire of health system executives to make sure that patients don't leave their orbit. Heart failure is the most common diagnosis in the United States, and cardiovascular disease is the leading cause of death in New York state. Systems that preach population health — and they all do — don't want their patients bolting for another health system when they need cardiac care.

Cardiac surgery volume has increased since 2011 in part because of transcatheter aortic valve replacement, or TAVR, procedures. TAVR allows patients to leave the hospital a lot quicker, which can mean less revenue for an individual hospital. To make up for that difference, health systems need more patients, and that leads to more cath labs across the state.

There are, for example, six applications for cardiac cath labs from facilities in the Hudson Valley currently under consideration. The state Public Health and Health Planning Council recently approved two applications for facilities on the eastern end of Long Island, even though the Department of Health said there was not enough volume to safely approve both facilities.

The next meeting is Nov. 8.

To view online click here.


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Years in the making, online organ donation registry nears completion Back

By Nick Niedzwiadek | 10/04/2017 05:08 AM EDT

ALBANY — New York has lagged behind other states in organ and tissue donation rates for years, but advocates are hopeful that the long-awaited launch of a fully online registration portal will increase participation and save lives.

The online portal is undergoing final testing before being unveiled to the public, according to Aisha Tator, executive director of the New York Alliance for Donation, who has overseen its development. She said she could not disclose a launch date but said it was "imminent," barring any setbacks in testing.

"This is something that the rest of the country has had for a very long time," she said. "It's not a magic bullet, or a magic wand, but it gives the community a much more robust tool."

A prospective donor can currently fill out a registration online, but has to print out and physically sign the document before submitting it by mail or email. The new system would allow users to write an electronic signature to certify their registration, simplifying the process and making it more like an online service offered by the Department of Motor Vehicles.

The complete online registry has taken the better part of the decade to get up and running. Former Gov. David Paterson signed the law authorizing an online portal in 2010, and the state turned over control of the organ donor registry to a nonprofit organization as part of the 2014-2015 budget, following the model of higher-performing states.

Tator said the registry's back-end security and database capabilities had to be revamped before allowing people to input sensitive medical information online. That tweak accounted for a portion of the delay.

New York is mired at the bottom of national rankings for donations in part because of factors inherent to a place like New York City. Many people don't own cars or have driver's licenses, meaning fewer people take advantage of organ donation sign-ups at the DMV. What's more, there are fewer traffic fatalities in a city defined by mass transit. While that's a good thing, it means the supply of available organs struggles to match the needs of one of the country's most populous states.

LiveOnNY, an organ procurement organization, estimates that one person dies every 18 hours waiting for an organ transplant in New York. Helen Irving, its president and chief executive officer, said she was cautiously optimistic about increasing organ and tissue donation rates through the online registry.

"No one wants to put a number on it," she said. "I think everyone's nervous because that's really going to be a measure of our success going forward."

She said that it could help boost the state's participation rate — which is around 30 percent of those eligible — by 10 percentage points. The national average is a bit over 50 percent, though it varies by state.

As of Oct. 2, there are 9,460 New Yorkers awaiting an organ or tissue donation, according to federal data maintained by a branch of the Department of Health and Human Services.

A bill, S. 2498, that would have reimbursed donors for up to $14,000 in lost wages and other expenses incurred by living organ donation — such as giving a kidney or part of a liver — failed to gain traction this session. The state already offers a $10,000 tax deduction for travel costs and lost wages for organ or bone marrow donations. A separate bill, S. 2497 , to convert that deduction to a tax credit, passed the state Senate this year but languished in the Assembly.

Improving the state's record on organ donation has been one of state Senate Majority Leader John Flanagan's personal priorities since he took charge of the chamber in 2015. The Long Island Republican wears a bracelet in support of organ donation to honor Assemblyman Jim Conte, a two-time kidney transplant recipient who died nearly five years ago.

"I want to do everything I can given the bully pulpit," Flanagan said in an interview. "We've been making progress, slowly. I wish we were going faster."

He said he supports the effort to modernize the registration system, but said he will continue to look for other ways to improve donation rates.

Since February, 16- and 17-year-olds have been allowed to add their names to the state's donor rolls. The previous minimum age to join the New York State Donate Life registry was 18.

Visitors to the state's insurance marketplace can also sign up for the state's registry as part of a law passed last year. The state health department said 63,164 have registered to donate through the New York State of Health marketplace.

"That is the type of expanding opportunity that is critically important to turning around our registration numbers," Irving said.

CLARIFICATION: This story has been updated to further clarify existing online registration procedures for organ donation.

To view online click here.


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Cuomo signs 'Lauren's Law' bill, promotes organ donation Back

By Nick Niedzwiadek | 10/16/2017 03:40 PM EDT

Gov. Andrew Cuomo signed a bill Monday requiring driver's license applicants to decide whether they wish to join the state's organ-donor registry.

Dubbed "Lauren's Law," after Rockland County resident Lauren Shields who received a heart transplant at age 9, the bill signed Monday makes permanent a law that was recently extended only through 2020. The measure was first passed in 2012.

"Lauren's effort to make this change was inspirational and I am thankful to have been a part of it," state Sen. David Carlucci (D-Clarkstown), the sponsor of NY S1206 (17R), said in a statement. "Now we owe the thousands of other people in similar situations the chance to get the same help Lauren did."

New York has long lagged behind the national average in organ donation sign-up rates, and slightly fewer than 10,000 residents are on the waiting list.

Cuomo also signed an executive order directing the Department of Health — in conjunction with the Transplant Council and New York Alliance for Donation and others — to develop ways to boost the state's organ donation numbers.

Additionally, the state's long-awaited, revamped online registration system went online late last week, according to Aisha Tator, executive director of the New York Alliance for Donation.

Prospective organ donors can now fill out their registration completely online through a designated DOH portal, rather than having to print out and physically sign the document prior to submitting it by mail or email. The new system removes that complication, making it similar to a service offered by the Department of Motor Vehicles.

The state started taking steps toward having an online registration portal back in former Gov. David Patterson's administration.

Tator, who helped oversee the project's development over the past few years, said her group has been encouraged by the portal's early performance. Cuomo on Monday urged residents to take advantage of the new measures.

"These aggressive steps break down barriers and take proactive action to encourage more New Yorkers to become organ donors, while helping to save countless lives in the process," Cuomo said in a statement. "I encourage all New Yorkers to take action, become an organ donor and help us create a healthier and stronger Empire State for all."

In recent years, the state permitted 16- and 17-year-olds to add their names to the state's registry, and allowed for visitors to the New York State of Health marketplace to sign up for organ donation.

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A welcome crisis for New York AIDS clinics Back

By Dan Goldberg | 10/07/2014 10:48 AM EDT

AIDS clinics across New York are facing a heartening dilemma.

Thanks to recent advances in the treatment of patients with H.I.V., demand for the clinics' services has dropped dramatically, with patients now visiting three or four times a year instead of six or eight.

That drop in demand, along with recent changes to the state's Medicaid program that further disrupted what had been a steady source of revenue, is forcing the clinics to branch out, or go under.

"Everyone is thinking about what can we do, how else can we stay relevant," said Dr. Doug Fish, medical director of the AIDS Treatment Center and the inpatient H.I.V. Unit at Albany Medical Center.

AMC, like other clinics around the state, has begun to capitalize on the drop-off of demand for H.I.V. treatment at its clinics in Albany and Kingston by offering other services, and expanding services to H.I.V.-negative patients. It has started an STD clinic, offering a full suite of screenings, as well as offering pre-exposure-prophylaxis, sometimes known as PreP, which is a relatively new H.I.V. prevention method. The clinic is also looking into the possibility of treating patients with Hepatitis C, who are likely to be seen monthly if they are on interferon.

Other clinics across the state are considering expanding to treat mental illness and drug addiction.

Some of the urgency surrounding these changes stems from changes to reimbursement rates that have affected the clinics' bottom line.

For years, New York State has tried to push its Medicaid population away from a fee-for-service model toward a managed care or capitation model. The state accelerated these efforts under the administration of Andrew Cuomo.

By most accounts, this effort has succeeded in its primary goal, which is to help reduce costs. But one of the ways it does so is by insisting that patients have a primary care physician who refers them to a specialist.

H.I.V. and AIDS patients had been exempt from having to join a managed care program until the end of 2011, when that exemption was lifted. That left those patients with two choices: They could join an H.I.V. managed care plan, called a Special Needs Plan, or choose a regular managed care plan.

Many chose a regular managed care plan, meaning fewer were receiving primary care at an H.I.V. clinic, cutting visits and revenue. It also meant that if patients showed up without a referral, they might not be seen, or might be seen but without the clinic ever getting paid for it.

AIDS clinics are also confronting what is, for them, a relatively new phenomenon: geriatric patients.

There are about 132,000 New Yorkers living with H.I.V. or AIDS, according to the state's department of health. More than three-quarters are now over the age of 40, and nearly half are over the age of 50.

As shown in a study recently published in the journal Experimental Neurology, long-term complications such as neurocognitive disorders are becoming more prevalent among patients who are H.I.V. positive.

Dr. Antonio Urbina, an associate medical director at the Institute for Advanced Medicine, said that for some of his patients with H.I.V., it isn't their most pressing health issue anymore. He gave as an example an 87-year old H.I.V.-positive patient who presented with diabetes, cardiac issues and an enlarged prostate.

"H.I.V. is number 4 or 5 on my problem list," Urbina said. "As H.I.V. becomes more a chronic management disease, the role the clinics play is more primary care."

The extent of these challenges for clinics depends on where they are and who they serve—variations in the same socioeconomic factors that define health outcomes in New York and around the country.

In 2012, nearly 80 percent of New Yorkers who died because of illnesses related to H.I.V. were black or Hispanic, according to a report from the state, related to patients' inability to follow prescribed treatment regimens due to poverty, drug addiction or mental illness. This, perversely, has meant that the clinics serving the best-equipped pools of patients are facing the most severe challenges to their ability to stay in business.

"There is more drug use in the Bronx, Brooklyn and Queens, so that leads to more difficulty in controlling H.I.V.," said Dr. Barry Zingman, Medical Director of the AIDS Center at Montefiore Medical Center in the Bronx. "If you have a gay white male population, then they tend to do extremely well. If that's your primary population, you will be suffering as a clinic. If you have a more mixed population, which will have more patients not doing as well, challenged by substance abuse and mental illness, then it has not been as hard for the clinics to specialize and survive."

Christine Kerr, medical director of H.I.V. and hepatitis programs at Hudson River HealthCare in Peekskill, said the clinic is continuing to explore how it fits into a primary care system, considering different sources of funding for case management including state money for Hepatitis C treatment programs.

"We have noticed the effect of changes in funding and case management funding that have led us to think about new ways we can serve our community," she said.

Urbina, from the Institute for Advanced Medicine, said, "I think people are going to start testing the waters. I think the key word is inclusive, not exclusive."

This article appeared in the October issue of Capital magazine.

To view online click here.


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Trump says he will declare opioid crisis a national emergency 'next week' Back

By Brianna Ehley | 10/16/2017 02:49 PM EDT

President Donald Trump says he'll make an official national declaration of emergency for the opioid crisis "next week," more than two months after he indicated he would do so.

Trump, during a Rose Garden press conference Monday, said the declaration would be a "very big statement, and a very important step."

The president's opioid commission, led by New Jersey Gov. Chris Christie, recommended in August that Trump declare the crisis a national emergency. At the time, Trump said he was "drafting up the paperwork to do so." But such a declaration has not been made. Christie last week said the delay was "not good," but added "legal issues" had held it up.

The panel said declaring a national emergency would allow the federal government to quickly free up resources for states to respond, similar to how they can address other emergencies like hurricanes or floods. It also allows Trump to say he's fulfilling a promise he routinely made as a presidential candidate to combat the opioid crisis that's killing 142 Americans every day. Trump easily won states like West Virginia and Kentucky that have been hit hard by the epidemic.

The opioid commission recommended expanding access to inpatient treatment as well as drugs that can reverse a potentially lethal overdose. It also advised the Trump administration to beef up law enforcement efforts to crack down on drug trafficking and speed up development of new non-opioid pain medications.

"This country frankly, the world has a drug problem," Trump said. "But we have it and we are going to do something about it. "

Separately, Trump said he would be "looking into" his nominee Rep. Tom Marino as the White House's "drug czar" following a Washington Post-60 Minutes report that a bill he sponsored has effectively weakened the DEA's oversight of opioid manufacturers and distributors amid the drug crisis.

"We will be looking into Tom," Trump said.

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Many of the messages in Spamdex's archive contain forged headers in one form or another. The fact that an email claims to have come from one email address or another does not mean it actually originated at that address! Please use spamdex responsibly.


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Google + Spam 2010- 2017 Spamdex - The Spam Archive for the internet. unsolicited electric messages (spam) archived for posterity. Link to us and help promote Spamdex as a means of forcing Spammers to re-think the amount of spam they send us.

The Spam Archive - Chronicling spam emails into readable web records index for all time

Please contact us with any comments or questions at questions@spamdex.co.uk. Spam Archive is a non-profit library of thousands of spam email messages sent to a single email address. A number of far-sighted people have been saving all their spam and have put it online. This is a valuable resource for anyone writing Bayesian filters. The Spam Archive is building a digital library of Internet spam. Your use of the Archive is subject to the Archive's Terms of Use. All emails viewed are copyright of the respected companies or corporations. Thanks to Benedict Sykes for assisting with tech problems and Google Indexing, ta Ben.

Our inspiration is the "Internet Archive" USA. "Libraries exist to preserve society's cultural artefacts and to provide access to them. If libraries are to continue to foster education and scholarship in this era of digital technology, it's essential for them to extend those functions into the digital world." This is our library of unsolicited emails from around the world. See https://archive.org. Spamdex is in no way associated though. Supporters and members of http://spam.abuse.net Helping rid the internet of spam, one email at a time. Working with Inernet Aware to improve user knowlegde on keeping safe online. Many thanks to all our supporters including Vanilla Circus for providing SEO advice and other content syndication help | Link to us | Terms | Privacy | Cookies | Complaints | Copyright | Spam emails / ICO | Spam images | Sitemap | All hosting and cloud migration by Cloudworks.

Important: Users take note, this is Spamdex - The Spam Archive for the internet. Some of the pages indexed could contain offensive language or contain fraudulent offers. If an offer looks too good to be true it probably is! Please tread, carefully, all of the links should be fine. Clicking I agree means you agree to our terms and conditions. We cannot be held responsible etc etc.

The Spam Archive - Chronicling spam emails into readable web records

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