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POLITICO New York Health Care, presented by PhRMA: Aligning Medicare and Medicaid; Obamacare's modest predictions

Dear readers: POLITICO New York Pro subscribers receive this email at 5:30 a.m. each weekday. If you'd like to receive it at that time, along with a customized real-time news feed of New York health care policy news throughout the day, please contact us at and we'll set you up for trial access.

written by Josefa Velasquez

THE STORY EVERYONE IS TALKING ABOUT — Theranos, the billion-dollar startup that promises to revolutionize blood tests, was laid low by a Wall Street Journal investigation that found the company’s technology isn’t living up to the hype. The promise of Theranos was that it only needed a drop of blood to conduct medical tests. That means a finger stick can be used instead of needles drawing blood from patients’ arms. But the Journal reports that of the 240 tests the company offers, only 15 are done by Edison, the company’s proprietary technology. And the results aren’t always accurate. “In a complaint to regulators, one Theranos employee accused the company of failing to report test results that raised questions about the precision of the Edison system.” This is a must read both because of what John Carreyrou uncovered and because of how Theranos allegedly tried to intimidate those who spoke out.

...Late Thursday night, Carreyrou reported that Theranos stopped collecting tiny vials of blood drawn from finger pricks for all but one of its tests because of pressure from federal regulators.

...Theranos, and its 31-year old founder Elizabeth Holmes, have been lauded my almost every major news organization, including The New Yorker, Forbes and the Washington Post.

...For the record, the company said the Wall Street Journal’s article was “factually and scientifically erroneous and grounded in baseless assertions by inexperienced and disgruntled former employees and industry incumbents.” Read their statement here:

...CNBC’s Jim Cramer interviewed Holmes Thursday night, and she personally answered the Journal’s accusations. Watch it here:

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AND MAKE SURE YOU FOLLOW Josefa and me on Twitter @J__Velasquez & @DanCGoldberg. And for all New Jersey health news, check out @katiedjennings

ALIGNING MEDICARE AND MEDICAID — New York State health officials want to align Medicare payment reform efforts with the state's own efforts to reform how Medicaid is delivered. That would let Medicaid providers take advantage of Medicare payment reforms, such as accountable care organizations. And it would mean New York's Medicare providers could use the alternative payment models outlined in the state's Medicaid payment reform roadmap. Readthe state’s proposal here

HEADED TO CUOMO’S DESK — A bill that would let hospital patients designate a caregiver in their medical records has been delivered to Gov. Andrew Cuomo. The legislation, sponsored by Senate Health Committee Chairman Kemp Hannon and Assemblywoman Linda Rosenthal, would also require hospitals to notify and offer to meet with a patient's designated caregiver to discuss the patient’s care plan before their discharge or transfer to another facility. And it would require hospitals to offer to train the caregiver in how properly to care for a patient after his or her discharge. If the patient being admitted is unconscious or incapacitated, the hospital would provide the patient's legal guardian the chance to identify a caregiver. [PRO]

...A separate bill sponsored by the heads of the Senate and Assembly health committees that would make “conforming changes” to the scope of practice for nurse practitioners has been delivered to the governor’s desk. The legislation would amend the public health, education, general business and the vehicle and traffic laws to reflect changes made to the nurse practitioner field earlier this year. The Nurse Practitioners Modernization Act, which took effect at the beginning of 2015, eliminated the requirement for experienced nurse practitioners to have a written practice agreement with physicians. [PRO]

...Also, a bill that would let leashed dogs join their owners at outdoor restaurants has been delivered to the governor’s desk. The “Dining With Dogs Act,” sponsored by Sen. Kemp Hannon and Assemblywoman Linda Rosenthal, passed the Senate unanimously and the Assembly by a vote of 131-16.

NOW WE KNOW — Why do males think about sex more often? A study by the University College London and the Albert Einstein College of Medicine found a pair of extra brain cells in male nematodes that allow them to remember sex and even seek sex at the expense of food.

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

** A message from PhRMA: In 2013 alone, the biopharmaceutical industry invested more than $553 million dollars in clinical trials in New York. Learn more about the economic impact of clinical trials in our communities at **

MODEST PREDICTIONS — The Obama administration predicts 10 million people will be enrolled in private health insurance plans bought through Affordable Care Act exchanges by the end of 2016, a 10-percent increase from 2015. The prediction is well below the original projections made by the Congressional Budget Office, which expected 21 million people would be enrolled by the end of 2016. [PRO]

...Remember, the thing about modest predictions is they are easy to meet, and it is an election year. So, is it possible the Obama administration is lowering the bar on purpose?

WE WANT MORE MONEY — The Cuomo administration says it will help home health care providers pay for increased labor costs brought on by a new federal mandate. But when that help will arrive and whether it will be enough to fully reimburse providers remains uncertain, leaving many on edge as they comply with a requirement to pay employees more for overtime. [PRO]

TOP TEN — The Greater New York Hospital Association came in eighth place among state lobbyists, spending $1.43 million during the first half of the year, according to data with the Joint Commission on Public Ethics. At the top of the list were education organizations and groups tied to real estate. Read the full report here:

CLEAN AIR — The City Council passed a bill Thursday that mandates air quality surveys throughout the city and gleans data on how pollution is affected by factors like traffic and building emissions. Intro 712-A would require the Department of Health and Mental Hygiene to submit annual reports on the data.

PREPARING FOR CLOSURE — Officials at Buffalo-based Kaleida Health have called more than 300 local, state and national developers for proposals to reuse the Women & Children’s Hospital in Elmwood Village, a residential area, the Buffalo News reports. “The message was heard, loud and clear, and generated quick interest from potential developers. The response gives rise to the hope that the property won’t stay empty for long. Redevelopment of previous hospital sites did not go smoothly, taking years for projects to get off the ground.”

AD-BUY — The Manhattan Institute has a full-page ad in this morning’s New York Times, calling for modernization of the Food and Drug Administration. “Congress should lay the foundation for a 21st century FDA by creating an external advisory network drawing on the expertise of the scientific and patient communities to assist the FDA in setting standards for how biomarkers can be better integrated into the drug development process,” the ad says.

MAKING ROUNDS — Constantinos Hadjipanayis has been named Professor and Chair of the Department of Neurosurgery at Mount Sinai Beth Israel, and has been appointed as Director of Neurosurgical Oncology for the Mount Sinai Health System and Director of the Brain Tumor Nanotechnology Laboratory in the Tisch Cancer Institute. Hadjipanayis was the first surgeon in the US to perform fluorescence-guided surgery for malignant gliomas, and his lab developed a trial for brain tumors using magnetic nanoparticle therapeutic agents that can target brain tumor cells and can also be seen by MRI, according to a press release from Sinai.

GRANT LAND — Montefiore Health System has received a $1.2 million grant from the federal government to develop a preventive medicine residency program. The four-year program will begin in July with two residents who will work with the master's of public health program at CUNY's Lehman College, Institute for Family Health, the Pacific College of Oriental Medicine, and the city's Department of Health and Mental Hygiene. [PRO]

…The University at Albany has received two grants for drug abuse research. The U.S. Department of Health and Human Services gave M. Dolores Cimini and Jessica Martin $944,982 to develop a program to train substance abuse practitioners in “Screening, Brief Intervention, and Referral to Treatment.” The National Institute on Drug Abuse also gave Cimini $452,000 to research prescription stimulant abuse among college students.

FATHER SUES SLOAN KETTERING TO SAVE SON — Patrick Girondi is accusing Memorial Sloan Kettering of delaying a gene therapy that could potentially cure his son of an inherited blood disease because of ties the cancer center’s president has to a venture capital firm, according to The New York Times.

PHARMA REPORT — A federal judge ruled the U.S. Health Resources and Services Administration cannot enforce a rule requiring safety-net hospitals and clinics to get drugs used to treat rare diseases at a discount rate, Ed Silverman reports.


-BANNED — The U.S. government is calling for an end to conversion therapy, the so-called treatment for lesbian, gay, bisexual and transgender youths, according to Reuters. “The report released today by the Substance Abuse and Mental Health Services Administration (SAMHSA) comes less than a year after the Obama administration endorsed efforts to ban the practice, which aims to change a person's sexual orientation, gender identity or gender expression.”

-MEDICAID SPENDING UP — The New York Times reports that Medicaid spending was up nearly 14 percent in the last fiscal year. “But for most of those states, the per-member, per-month cost of the new enrollees was not higher — in a few cases, in fact, it was lower — than expected, according to the report, released Thursday by the Kaiser Family Foundation.”

-GUIDANCE — The Federal Trade Commission released guidance on how states can avoid antitrust actions, POLITICO’s David Pittman reports.“The release responds to a February decision by the Supreme Court that could impact telemedicine regulation by states. States in general may only create regulatory boards that serve in an advisory capacity or are made up of people with no financial interest in the occupation being regulated, according to the guidance.”

-NEW CHANGES TO HIPPA? — New language in both the Senate and House health technology bills is worrying privacy advocates who argue it may allow drug companies, and people mining for data, easy access to a patient’s health information. Currently, HIPPA allows health care institutions to share patient data for treatment, payment or operations, but not for research. The new language would allow doctors and hospitals to share patient data with researchers and for public health activities, POLITICO’s David Pittman reports. While supporters say that it will aid medical research, those on the other side of the argument say it opens access for pharmaceutical companies.

TODAY'S TIP — Comes from the New York City Health and Hospitals Corporation. When admitted into a hospital, make sure each person administering your medication checks your ID bracelet beforehand.


-SAFETY NET HOSPITALS PERFORM WORSE — Becker’s reports: “Safety-net hospitals have higher mortality and readmission rates, as well as higher costs associated with surgical care. These outcomes remained even after adjusting data for patient characteristics and hospital procedure volume, according to the study in JAMA Surgery. ‘These outcomes are likely owing to hospital resources and not necessarily patient factors. In addition, impending changes to reimbursement may have a negative effect on the surgical care at these centers,’ the study concludes.”

-SEX AND ALCOHOL — If a young woman’s first experience with sex involves alcohol, she is more likely to be at risk for sexual assault, a study at the University at Buffalo Research Institute on Addictions found. The study, published in the Journal of Adolescence, found that 20 percent of young women in the alcohol-involved group reported that their first experience with sex was without consent, or even rape. These young women were found to be three times more likely to be victims of incapacitated rape in the future.

-DIETARY SUPPLEMENTS LEAD TO HOSPITALIZATION — A study published in the New England Journal of Medicine found more than 23,000 emergency room visits a year are caused by dietary supplements. The most common cause for visits were weight-loss or energy products for young adults, which manifested into cardiovascular problems.

** A message from PhRMA: Every day in New York, countless people fight life-threatening diseases. Their bravery inspires countless researchers and scientists across the country in their quest to develop medicines that help patients live longer, healthier lives. Here in New York, the biopharmaceutical industry has invested more than $553 million during the 2,476 clinical trials that took place in 2013 alone. Each step brings us closer to a cure. To learn more, please visit **

MISSED A ROUNDUP? Get caught up here: 10/15, 10/14, 10/13, 10/12, 10/9

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