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POLITICO New York Health Care, presented by the NYeC Gala & PATH Awards: Communities weigh in on health plans; Mt. Sinai expansion

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written by Dan Goldberg

SO FAR, SO GOOD — One month into the ICD-10 transition, providers say it is too soon to know whether there will be unintended consequences from the new billing and coding system. But what we do know is, so far, the sky has not fallen. There are some hiccups, but, most everyone has avoided the worst-case scenarios. POLITICO New York’s Josefa Velasquez has more:

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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

FALLING APART — Health Republic Insurance of New York, the collapsing insurance company that is creating headaches for hundreds of thousands of New Yorkers, misled state and federal officials about its finances, and will not be able to remain in business through the end of the year as originally hoped. The more than 200,000 customers insured with the co-op will lose their coverage Dec. 1. The company announced last month it would unwind its business after losing $130 million during its first 18 month. Health Republic's finances are "substantially worse than the company previously reported in its filings," according to the state Department of Financial Services, which oversees insurance in New York, and the Centers for Medicare and Medicaid Services. A DFS spokesman declined to comment on whether the case was being referred to the state Attorney General's office.

...On the other hand, the federal government hasn’t been totally up front either. Federal officials denied reports that the risk corridor program was underfunded, but then said they could only pay out 12.6 percent of what was owed. Here is the statement from Health Republic: “We have been working closely and transparently with our state and federal regulators since our inception, including monthly regulatory filings and numerous meetings to discuss potential avenues to improve our financial position. As recently as August 2015, CMS conducted an independent financial review. Considering the insurmountable financial gap created largely by the risk corridor program only paying out 12.6 percent of the $149 million Health Republic was owed for 2014, we believe winding down on November 30th is a prudent decision.”

NOW WE KNOW — Finally, someone has looked into how often married couples are sexting (to each other). According to a study in Cyberpsychology, married people do sext but less frequently than young adults. Married couples are also less racy, preferring intimate talk as opposed to nude photos. "Research in the past has suggested that sexting might be a useful therapeutic approach to increase intimacy in couples reporting for counseling,” Editor-in-Chief Brenda Wiederholdm, said in a press release accompanying the article. “The current study, however, seems to indicate that sexting may still be seen as something used by those feeling less secure in their relationships. Clearly more research is called for." Yes, clearly!

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** A message from the New York eHealth Collaborative’s Gala & PATH Awards: Join 300 CEOs, C-level executives, and influencers from New York State health systems, health plans, large employers, and the public sector leading New York's healthcare transformation by reshaping it into a new, secure, digital system. The awards honor individuals and organizations who have contributed to the advancement of health IT in New York State. 2015 Honorees: Steven M. Safyer, MD, President & CEO, Montefiore Medical Center; and Jason Gorevic, CEO, Teladoc. Register today to join our exclusive community of healthcare leaders. November 18, 2015, at Capital, New York, NY. **

MEMORIAL SLOAN-KETTERING EXPLAINED — Why has Memorial Sloan-Kettering been partnering with hospitals in Hartford and the Lehigh Valley? It’s because they want to increase the number of patients available for clinical trials. Trials these days are so specific that you need thousands of patients in your system to ensure you have enough who will qualify for a therapy targeting a subset of a subset of a subset. Read my story here: [PRO]

WHY SHE LEFT — The New York Post claims deputy mayor Lilliam Barrios-Paoli quit because “she was tired of being ignored by a mayor more interested in boosting his national profile than attending to the city’s day-to-day concerns.”

HAPPENING TODAY — The New York State Office of the Medicaid Inspector General will post on its website an Introductory Webinar, the first in a nine-part webinar series on New York’s mandatory compliance program obligation. The Introductory Webinar outlines the eight elements required of mandatory compliance programs, identifies who is required to have a compliance program, and details the areas of a Medicaid provider’s operations to which compliance programs must apply.

OPINION — The New York Post says the city’s health department deserves an “F you” grade for sticking by its rule that sushi chefs must wear gloves. “‘If neurosurgeons can operate with gloves, sushi chefs can use gloves to roll tekka maki,” the Department of Health and Mental Hygiene said. That’s a silly analogy and the Post took the department to task.

...On the subject of silly analogies, can we all agree that referring to health department inspectors as “nazis” as the Post did in its lede might be a bit hyperbolic? They invaded a sushi restaurant, not Poland.

SETTLED — Two New York hospitals are part of a settlement with the Department of Justice involving cardiac devices implanted in patients that violated Medicare coverage requirements. The DOJ reached 70 settlements with 457 hospitals in 43 states — including New York-Presbyterian Hospital and Winthrop University Hospital — for more than $250 million. Presbyterian paid $4.1 million and Winthrop paid $4 million. The $25,000 cardiac device delivers a shock to the heart to treat life threatening heart rhythms. To be covered by Medicare, patients have to display certain risk factors. Doctors must follow specific guidelines for how long they have to wait to implant the device after a patient has a heart attack or bypass. The hospitals were found to be in violation of the waiting period outlined by Medicare.

CALLING OUT FLANAGAN — Gay Men's Health Crisis, which advocates for people with HIV and AIDS, criticized State Sen. John Flanagan on Friday and called the majority leader a hypocrite for suggesting Gov. Andrew Cuomo overreached when he announced he would use executive orders to extend legal protections to transgenders. GMHC argued it is hypocritical for Flanagan to say the Senate should have been part of the process when the Senate refused to bring the Gender Expression Non-Discrimination Act [GENDA] to the floor. "Senator Flanagan needs to remember that he has been a part of the New York State Senate since 2002, and at no point has he taken leadership on protecting transgender New Yorkers, nor taken any action at all on GENDA," the statement from GMHC said. "[Friday], he said he believes that the legislature 'can and should be included' in these types of 'deliberations, regardless of outcome.' Perhaps the Senator has amnesia, because he was Senate Majority Leader last session, which gave him the power to bring GENDA to the floor for real deliberation and debate. He did not, even as the Assembly passed the bill for the eighth time."

BILL TRACKER The chairman of the Senate health committee introduced two bills Friday that would create a health care proxy registry and allow certain group practices to operate malpractice prevention programs. One of the bills Sen. Kemp Hannon introduced would create the registry within the state Department of Health to store submitted health care proxies and provide access to attending physicians and health care providers. The legislation is sponsored in the lower house by Assemblyman Steve Englebright. In a separate bill, Hannon wants to establish the category of “qualified group practice” for medical, dental or podiatric practices and allow for those types of practices to operate a malpractice prevention program.

PHARMA REPORT — Philidor Rx Services, LLC, is shutting down following Valeant’s decision to sever all ties, according to The Wall Street Journal. “Valeant’s relationship with Philidor has come under close scrutiny, partly because of the aggressive tactics Philidor has used to ensure that pharmacy-benefit managers — essentially middlemen in the drug-distribution process — pay for Valeant drugs, rather than lower-cost alternatives that are preferred by insurers.”


-THINK ABOUT THIS — The New York Times says now that heroin is impacting white people, the nation is changing how it talks about the drug and addiction. To be clear, white people have been using heroin for decades, so what the Times is really getting at is as much about income and class as it is about race.

-THE CONTROVERSIAL THING KIDS ARE BEING TAUGHT ABOUT MCDONALD’S — Here’s the story of a guy who ate nothing but McDonald’s for six months and lost weight.

-ANOTHER CO-OP FAILS — Arizona's Meritus became the 11th co-op to fold when state regulators placed the co-op plan under supervision and removed its policies from just two days before the start of the health law's third open enrollment season, according to POLITICO. Meritus officials didn't agree with the state order requiring it to cease operations, according to the Arizona Department of Insurance.

-THE COST OF CARE — Kaiser Health News reports: “UnitedHealthcare said Thursday it will expand its high-profile test of whether bundled payments for chemotherapy can help slow rising cancer treatment costs, part of a growing effort by insurers to find new ways to pay for care.”

-NEWS DUMP — On Friday afternoon, CMS announced it will pay for biosimilars under Medicare Part B the same way it pays for generic drugs. This disappoints biosimilar developers who argued they should be paid more because biologics are harder to create than generics. Read the payment rule here:

-DEATH PANELS — CMS also finalized rules for how Medicarewould reimburse physicians for end-of-life consultations. These are the rules that once sparked fears over government death panels. Read the payment rule here:

… A loyal POLITICO Health Care reader
pointed out that New York already has two laws — Public Health Law Sections 2997-c and 2997-d — requiring doctors and other practitioners treating a terminally ill patient to offer counseling on palliative care and other end-of-life options, and requiring hospitals and nursing homes to facilitate access to that counseling.

DIALING BACK HOME HEALTH VBP PROGRAM — POLITICO reports: “CMS is easing up a bit on a mandatory value-based-purchasing pilot program for the home health industry, after widespread criticism from the industry and lawmakers about the aggressive program design. Now, the program will withhold 3 percent of a home health agency's payment for an incentive or penalty in the first year, down from 5 percent in the original proposal. That percentage will still gradually increase to 8 percent over the course of the five-year program, though more slowly than proposed. They're also sticking with their original January start date, despite complaints. (The rule also cuts payments to the industry overall by 1.4 percent, down slightly from the 1.8 percent cut it suggested in July.)” The text:

TODAY'S TIP — Comes from Health and Hospitals Corporation, which offers us “helpful tips to eat smart.”


-GAME CHANGE — Aaron Carroll points to a study of superlatives in news articles when it comes to cancer drugs. Turns out there aren’t as many breakthrough, game-changers as the media would have you believe.

-BIG FAT PROBLEM — Researchers at Weill Cornell Medicine found obesity impairs the body’s ability to use vitamin A and leads to deficiencies in the organs. The study, published in Scientific Reports, found that normal-weight mice are healthy on that diet, but obese mice show severe vitamin A deficiencies in their livers, kidneys and pancreas. Particularly interesting was that vitamin A levels were normal in the blood. The deficiency was only seen in the organs. “We call this ‘silent vitamin A deficiency’ because it would not be picked up by a standard blood test for the vitamin,” first author Dr. Steven Trasino, a postdoctoral fellow in pharmacology at Weill Cornell Medicine, said in a press release from WCM.

-PRECISION MEDICINE — Researchers at the Icahn School of Medicine at Mount Sinai identified clinically and genetically distinct subtypes of patients with Type 2 diabetes. The paper, published in Science Translational Medicine, describes how they analyzed more than 11,000 electronic medical records and grouped patients into three subtypes. Then they conducted a genomic analysis to find common genetic variants representative of each subtype. Patients, according to the study, were more likely to suffer diabetic nephropathy and retinopathy in subtype 1; cancer and cardiovascular disease in subtype 2; and neurological disease, allergies, and HIV infections in subtype 3. For each subtype, the researchers discovered unique genetic variants in hundreds of genes, according to a press release accompanying the article. “This project demonstrates the very real promise of precision medicine to improve healthcare by tailoring diagnosis and treatment to each patient, as well as by learning from each patient,” Dr. Joel Dudley, senior author on the paper and Director of Biomedical Informatics at the Icahn School of Medicine at Mount Sinai, said in the release. “It is absolutely encouraging that we were able to paint a much higher-resolution understanding for a common and complex disease that has long stymied the biomedical community with its heterogeneity.”

WHAT’S THE DIFFERENCE? — Research in the journal Child Abuse and Neglect looked at filicide — parents killing their children. The study found that filicide by mothers and fathers differs in important ways. Females accused were more common among people under 18, and males dominated in older age groups. Women made up four out of five accused who were single and never married, and men represented two-thirds of accused who were divorced, separated or widowed. More men than women were accused when revenge or jealousy was the motive.

** A message from the New York eHealth Collaborative’s Gala & PATH Awards: Join 300 CEOs, C-level executives, and influencers from New York State health systems, health plans, large employers, and the public sector leading New York's healthcare transformation by reshaping it into a new, secure, digital system. The awards honor individuals and organizations who have contributed to the advancement of health IT in New York State. 2015 Honorees: Steven M. Safyer, MD, President & CEO, Montefiore Medical Center; and Jason Gorevic, CEO, Teladoc. Register today to join our exclusive community of healthcare leaders. November 18, 2015, at Capital, New York, NY. **

MISSED A ROUNDUP? Get caught up here: 10/30, 10/29, 10/28, 10/27, 10/26

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