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POLITICO New York Health Care, presented by PhRMA: Communities weigh in on health plans; Mt. Sinai's expansion

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

IT’S UP TO YOU — Individual communities will vote on which areas of public health the de Blasio administration should prioritize for their neighborhood under a plan that aims to reduce health inequities across the city by the end of the decade. Dr. Mary Bassett, the city’s health commissioner, announced the initiative, dubbed Take Care New York 2020, at the Brooklyn Public Library on Thursday, saying the community-driven process was a first for the city's health department.The community meetings began Thursday night and will take place through the winter. And the voting won't be limited to adults, Bassett said. Children who are engaged enough to show up can vote as well. Read the full story here:

SOUTHERN EXPANSION — Mount Sinai Health System announced it had acquired Palm Beach Cardiovascular Clinic, a move that further expands the Manhattan-based health system into South Florida. The reason Sinai, and other big New York systems, want to invest in Florida is because that's where their patients and donors are spending a chunk of their time. As health care payment models move more toward care management, and with the growing popularity of value-based contracts, which reward providers for keeping patients out of the hospital, health systems want to know where and how care is delivered throughout the year, wherever a patient might be. Executives at these systems, who are investing heavily into care coordination, want access to the medical records and to be assured certain standards of care are being practiced. A poorly treated patient in Florida could become an expensive liability in New York if that person ends up needing care that should have been prevented. [PRO]

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HEALTH EXCHANGE FOR THE DEAD — Just in time for Halloween, an audit from state Comptroller Tom DiNapoli’s office found a series of “design and process flaws” in the state’s health care exchange that allowed deceased individuals to be enrolled for Medicaid coverage. The audit, which covered October 2013 through October 2014, found that the New York State of Health System eligibility process allowed for “inappropriate” Medicaid enrollments that resulted in $3.4 million in overpayments. Auditors also found the health exchange enrolled deceased individuals and continued Medicaid coverage for people who had died, resulting in roughly $325,000 in Medicaid overpayments. The state’s health exchange also issued multiple identification numbers to individuals, which resulted in $2.85 million in Medicaid overpayments and an additional $188,000 in potential overpayments.

...In an email, the state Department of Health said, “OSC is aware, or should be aware, that there have been delays with the Federal government's’ Periodic Verification Composite to identify deceased individuals and remove them from the system. Until the Federal system is up and running, NYSOH receives a weekly file from eMedNY of suspected deceased individuals that are manually researched and closed, as appropriate. DOH strongly disagrees with the recommendation to create an interim process, as it would waste limited resources and DOH would be paying twice to obtain the same information at a cost that is likely to exceed the overpayments identified by OSC.”

NOW WE KNOW — A spot of mold on a loaf of bread is just the tip of the iceberg. Mold, according to Marianne H. Gravely, an educator with the U.S. Department of Agriculture’s Food Safety and Inspection Service, has long threadlike roots that permeate food. Just because you pick off the moldy spot on a slice of bread, doesn’t mean the bread is OK to eat. To ensure you don’t get sick, you need to cut away a big section surrounding the mold.

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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 **

NY’S PLAN FOR YEAR THREE OF OBAMACARE — The state’s new Essential Health Plan, which begins in January, is an experiment in cost reduction that aims to attract more than one million New Yorkers who still don’t have health insurance. Dan Goldberg follows the story of Anne Marie Paniagua, a single mom in the Bronx who earns about $400 a week. Like many, she earns too much to qualify for Medicaid but still finds private health insurance too costly. The Essential Health Plan offers additional subsidies to individuals who fall in the gray area with no deductible. The problem? Paniagua, 23, said she hadn’t heard of The Essential Plan, highlighting one of the state’s challenges as the health department readies itself for the third open enrollment period.

...With the open enrollment period just around the corner, state Attorney General Eric Schneiderman is issuing pamphlets to help consumers shop for health insurance.

GILLIBRAND CONFIDENT IN ZADROGA — U.S.Sen. Kirsten Gillibrand said she has a filibuster-proof majority to re-authorize, fully fund and permanently extend the James Zadroga 9/11 Health and Compensation Act, the federal law that provides benefits for 9/11 victims and first responders. The news comes the same day House Republicans introduced a separate measure to partially fund the Victims Compensation Fund and extend the Zadroga Act for just five more years — a proposal that was quickly trashed by House Democrats. Gillibrand said her bill has 237 co-sponsors in the House — more than enough to pass.

ON THE MOVE — The Feinstein Institute for Medical Research, the research arm of North Shore-LIJ, has appointed David Dangoor, president of the marketing and PR firm Innovative Partners LLC, and Scott Rechler, chairman and CEO of RXR Realty LLC, to its board of directors. Rechler, appointed by Gov. Andrew Cuomo, served as vice chairman of the board of commissioners of the Port Authority of New York and New Jersey.

NO REASON TO GET EXCITED — The state health department says a Legionnaires' outbreak at St. Joseph's Hospital Health Center in Syracuse involves four patients but does not pose any risk to the public, according to the Syracuse Post-Standard. “Kathryn Ruscitto, president and CEO of St. Joseph's, said in a statement issued late Wednesday afternoon that there have been no new cases of patients with hospital-acquired Legionella at St. Joseph's in the last three weeks.”

IN CASE YOU MISSED — POLITICO New Jersey’s Katie Jennings examines Health Republic of New Jersey and explains why it is succeeding when so many other co-ops have failed. The nonprofit reported net income of $3.1 million for the first half of 2015, according to its second quarter filing with the National Association of Insurance Commissioners. This is a huge turnaround, considering it saw a net loss of $16.5 million at the end of last year.

DON’T DO THAT — Federal prosecutors arrested three people on charges they engaged in one of the largest oxycodone schemes ever uncovered. Pharmacist Lilian Jakacki and her husband, who operated Chopin Chemists in Brooklyn and Queens, were arrested in Connecticut for illegally distributing 500,000 oxycodone pills, authorities said.

INSURANCE REPORT — POLITICO’s Paul Demko reports: “Anthem and Aetna, two of the country's largest insurers that are in the midst of major acquisitions, expressed disappointment in their experiences in the Obamacare exchanges during calls with investors this week. But the companies remain bullish on the long-term prospects of the exchanges and don't plan to significantly alter their participation.”

PHARMA REPORT — Dublin-based Allergan is in talks with New York-based Pfizer to create the world’s biggest drugmaker.


-ICD-10 UPDATE — The Center for Medicare and Medicaid Services said less than one in 1,000 Medicare claims filed in the first four weeks of October were rejected because of invalid ICD-10 codes, POLITICO’s David Pittman reports. “An average of 4.6 million claims were submitted each day between Oct. 1 and Oct. 27, and 2.0 percent of those claims were rejected ‘due to incomplete or invalid information,’ but that's a broader category that can include a number of problems, the agency said.The total number of claims denied — roughly 10 percent — is about the same of those denied in an average period before the move to ICD-10, CMS said.CMS said claims are ‘processing normally,’ and it plans to have more information in November.”

-LOSING BILLIONS — California is at risk of losing billions of dollars if the state and federal government can’t agree on a plan to reform their Medicaid program this week. California’s public hospitals are relying on $7.25 billion in state and federal funds to treat low-income and uninsured patients. The current Medicaid waiver, which took effect in 2010, is set to expire Oct. 31.

-FDA SAYS YOU SHOULD WORRY — Bloomberg reports: ”When FDA inspectors showed up at a Chinese company that supplies key ingredients to two of the U.S.’s biggest drug companies, a curious thing happened. After lunch, they walked into a quality control lab on the second floor, where they saw a worker pull what looked like a memory stick from a computer and put it in the pocket of his lab coat. The inspectors asked to see what he’d taken. And then the man turned and ran. The U.S. Food and Drug Administration inspectors at Zhejiang Hisun Pharmaceutical Co. never found out what the worker took from the computer, but they found plenty of other things, according to agency documents describing problems at the company, obtained through a Freedom of Information Act request by Bloomberg. There was evidence that quality control staff deleted records of tests that might show a drug was impure. Audit trails disappeared. A paper shredder was kept close by machines that recorded quality data.”

-MERGER MANIA — The Times reports, ”In a fast-paced financial version of musical chairs, health care companies of all kinds — drug makers, hospital groups and insurers — have been frantically circling to be sure they are not left out of the latest frenzy of deal making. Mergers and acquisitions worth about $270 billion have been announced in the first nine months of 2015 in the United States, easily outpacing the activity in recent years, according to a tally by Mergermarket.”

TODAY'S TIP — Comes from the Cleveland Clinic. If you’re a man and have enlarged breasts you should go to a doctor to ensure that you aren’t suffering from a hormone imbalance.


-WE’RE ALL THE SAME AFTERALL — There’s no significant size difference in the the area of the brain that stores new memories and connects emotions to the senses between women and men, researchers at the Rosalind Franklin University of Medicine and Science. It had been previously believed that women had a larger hippocampus than men, resulting in greater emotional expression and interpersonal skills.

-BREAST CANCER RATES — The incidence rate of breast cancer for African American women in the U.S. is equal to that of white women, a report from the American Cancer Society found. “It’s been known that white women are more likely to be diagnosed with breast cancer, but black women are more likely to die from it,” said Carol E. DeSantis, senior epidemiologist at the American Cancer Society and the lead author of the report. “Now what happens? Now the incidence rates are similar, and black women are still more likely to die from it. Our conclusion is that the widening mortality disparity is likely to continue, especially now in light of the increasing incidence.”

** 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: 10/29, 10/28, 10/27, 10/26, 10/23,

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