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POLITICO New York Health Care, presented by PhRMA: Nursing home investigation; hospitals react to federal budget negotiations

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 Dan Goldberg

INVESTIGATION — ProPublica writes about SentosaCare, LLC, a for-profit nursing home company, that has racked up fines, violations and complaints for deficient care. “Despite that record, SentosaCare founder Benjamin Landa, partner Bent Philipson and family members have been able to expand their nursing home ownerships in New York, easily clearing regulatory reviews meant to be a check on repeat offenders. SentosaCare is now the state’s largest nursing home network, with at least 25 facilities and nearly 5,400 beds. That unhindered expansion highlights the continued weakness of nursing home oversight in New York, an investigation by ProPublica found, and exposes gaps in the state’s system for vetting parties who apply to buy shares in homes.”

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HOSPITALS CRITICIZE BUDGET DEAL — New York hospital groups, worried their Medicare revenues will take a hit to pay for other federal priorities, criticized the two-year budget deal being negotiated by Congress, and urged their members to lobby for change. Read my story here:

WHAT ELSE IS IN THIS DEAL? — Generic drug companies will have to offer Medicaid larger rebates if the price of their drug grows faster than inflation. This is a measure that Senator Bernie Sanders, a Democratic candidate for president, and Rep. Elijah Cummings have favored for years, but the renewed focus on drug pricing following Turing Pharmaceutical’s 5,000 percent price hike likely gave this a final push. The Congressional Budget Office estimates this will save $1 billion over 20 years.

...The deal will also prevent a Medicare Part B premium spike thanks to a $3 per month charge on each senior enrolled in the program, according to POLITICO.

...The budget also repeals the Affordable Care Act’s requirement that large employers automatically enroll employees in their health plans. The Congressional Budget Office estimates that a different bill to repeal that provision would reduce the federal deficit by $7.9 billion over a decade. See the CBO report here:

... The National Institutes of Health is also slated to see an increase in funding.

NOW WE KNOW — Women and men look at their marital problems differently. Women become worried, sad and frustrated. Men just become frustrated, according to an article in the Journal of Gerontology. "The men don't really want to talk about it or spend too much time thinking about it," Deborah Carr, a professor who studies marital relationships, said in a press release accompanying the article. "Men often don't want to express vulnerable emotions, while women are much more comfortable expressing sadness or worry." The study looked at long-married couples — average of 39 years — and found men reported lower levels of marital strain than their wives.

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** 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 **

DISABILITY HEARING — At an Assembly hearing Tuesday on whether to open a new office for the elderly and disabled, advocates said they largely backed the proposal but were concerned about cuts to services and about the new office's purpose. Assemblyman Steven Cymbrowitz, who heads the committee on aging, and Assemblyman David Weprin, who heads the task force on people with disabilities, heard from various groups in an effort to figure out whether a single, consolidated office — rather than a series of state agencies — would benefit their communities. In an effort to improve delivery services, the 2015-2016 state budget included a proposal to study whether a separate office for "older adults and persons of all ages with disabilities" would be of value to that population. POLITICO New York’s Josefa Velasquez has more:

UPSTATE AFFILIATION — Saratoga Hospital has signed a “letter of intent” to affiliate itself with Capital Region giant Albany Medical Center. Saratoga Hospital will continue to have it’s own Board of Trustees, senior management team and staff under the affiliation, the hospitals said in a press release. POLITICO New York’s Josefa Velasquez has more: [PRO]

SIGNED — Gov. Andrew Cuomo signed legislation to allow hospital patients to designate a caregiver in their medical records. "Often, the hardest part of recovery begins once a patient leaves a hospital," Cuomo said in a statement. "This new law will allow New Yorkers to appoint someone they trust to assist in their care and help them return to their daily lives. I thank Senator [Kemp] Hannon and Assemblymember [Linda] Rosenthal for their diligent work on this important issue. " The law, signed late Monday, will 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.

APPEALING THE BAN — The city of New York appealed a recent court decision overturning Mayor Bill de Blasio's ban on polystyrene, or foam, food containers. In September, New York Supreme Court Justice Margaret Chan overturned the ban saying it violated a law set up by the City Council. The ban would apply to all polystyrene food and beverage containers.

NURSES APPROVE CONTRACT — The New York Professional Nurses Union on Tuesday approved a three-year contract with Lenox Hill Hospital, part of North Shore-LIJ. The nurses will receive between 3 percent and 4.1 percent raises in the first two years of the deal and between 3.2 percent and 4.2 percent in the third year, according to a press release from the union. They are also set to receive more flexible sick leave and the new contract expands maternity care to paternal leave. NYPNU represents about 1,200 nurses at Lenox Hill and Manhattan Eye, Ear and Throat Hospital.

BASSETT ON THE ROAD — New York City Health Commissioner Mary Bassett (class of 1974) went to Harvard on Monday to talk racism and public health. The Crimson reports that the discussion, “which was introduced and moderated by School of Public Health Acting Dean David J. Hunter, was entitled “#BlackLivesMatter — A Challenge to the Medical and Public Health Communities” and focused on topics Bassett discussed in an article of the same name published in the New England Journal of Medicine this March.”

DON’T DO THAT — Jacquelyn Gentile, the former chief operating officer of the Schenectady-based nonprofit Young Housing, Industries and Treatment, was sentenced to 90 days in jail and three years of probation for filing a fraudulent reports with the Office of Alcoholism and Substance Abuse Services, Attorney General Eric Schneiderman’s office announced. Gentile filed reports with the state in excess of $600,000 and claimed that the funds were being used for a drug treatment center in Brooklyn, when in fact they were being used to subsidize employees and programs upstate.

PHARMA REPORT — Gilead Sciences Inc. said its two hepatitis C drugs, Sovaldi and Harvoni, generated $4.8 billion in sales in the third quarter, topping Wall Street estimates for global sales of $4.47 billion, according to The Wall Street Journal.

...Remember on Tuesday, I wrote about how New Yorkers were on pace to spend $1 billion on Hepatitis drugs in 2015.

SETTLED — Novartis AG will pay $390 million to settle a lawsuit claiming the company paid kickbacks to increase sales of several prescription drugs, according to Bloomberg News. “The U.S. had sought as much as $3.3 billion from Novartis for Exjade and Myfortic claims, claiming it had referred patients to specialty pharmacies and paid kickbacks in the form of rebates to get those pharmacies to recommend the drugs to patients and to increase sales.”


-MORE THERANOS TROUBLE — The Wall Street Journal reports: “The Food and Drug Administration declared the tiny vials used by Theranos Inc. to collect finger-pricked blood from patients an “uncleared medical device” that the laboratory company was shipping across state lines. Inspection reports posted on the agency’s website Tuesday also showed that the FDA found deficiencies in Theranos’s processes for handling customer complaints, monitoring quality and vetting suppliers. … In a statement Tuesday, Theranos’s general counsel, Heather King, said company officials “addressed and corrected” all the observations made by FDA inspectors ‘at the time of, or within a week of, the inspection and have submitted documents to FDA that say so, including extensive documentation.’”

...Bowing to criticism, Theranos CEO Elizabeth Holmes said she will submit her company’s blood tests to greater scrutiny and publish data that attest to their accuracy.

JEB BUSH’S HEALTH PLAN — Jeb Bush unveiled his proposal to overhaul Social Security and Medicare Tuesday morning, POLITICO reports. “Bush's plan would transform Medicare into a premium support program, adopting one of Rep. Paul Ryan's most controversial budget ideas to give beneficiaries a set amount of money to purchase either a private insurance plan or traditional Medicare.”

-ANOTHER ONE BITES THE DUST — Utah's Arches Health Plan became the 10th co-op to fail.

MEXICO CUTS BACK SODA TAX — Early evidence suggest that Mexico’s so-called soda tax was working. But Mexico’s lower legislative house, the Chamber of Deputies, voted to cut the tax in half for drinks that contain less than five grams of sugar per 100 milliliters, according to The New York Times. “That, legislators said, would prompt soda producers to put less sugar in their drinks.”

TODAY'S TIP — Comes from the Cleveland Clinic, which tells us to: “Get the scoop on your poop with these five must-know facts.”


-THE PLEASURE CENTER — Insulin isn’t just about hunger and blood sugar. According to researchers from NYU Langone Medical Center insulin plays a larger role in releasing dopamine than previously thought. "We found that when there's more insulin in the brain, there will be more dopamine released, not less," study senior investigator and NYU Langone neuroscientist Dr. Margaret Rice, said in a press release accompanying the article. The article, published in Nature Communication, found a 20 percent to 55 percent increase in dopamine released in the striatal region of the rodent brain. This could be why a sugar rush feels so good. It’s actually a dopamine rush.

-INADEQUATE NETWORKS — POLITICO reports on a JAMA study, which found provider networks in nearly 15 percent of insurance plans sold on didn't provide patients with adequate access to at least one specialty. “The study authors, who analyzed 135 plans sold on across 34 states this year, found 14 percent of the plans didn't include at least one type of specialist within a 50-mile radius - which they say may be a violation of broad federal requirements for exchange plans to maintain adequate provider networks.”

** 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: 10/27, 10/26, 10/23, 10/22, 10/21

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