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5 Big Healthcare Stories
Week of March 18, 2019
1 Apple’s Watches are Pretty Good at Heart Monitoring
WE HAVE THE TECHNOLOGY.
Over the week, Stanford Medicine announced the results of a collaborative study to determine whether the Apple Watch was actually effective in monitoring for heart rate irregularities (atrial fibrillation). As it turns out, the Apple Watch did a pretty good job in detecting irregularities, even standing its ground against more rigorous heart monitors (an EKG patch). In fact, Apple’s algorithm was found to have about a 71% positive predictive value.
But what about the other 30% and false positives?
A key concern of the highly touted Apple Watch EKG feature centered around whether the false positives the Watch sometimes gave would over-burden the healthcare system and make cardiologists even busier. This study somewhat debunked that claim, stating that Apple’s algorithm (NOT the EKG monitor, mind you) was pretty predictive and effective at finding heart irregularities. Finally, according to the study, only 0.5% of 400,000 (2,000ish people for you math wizards) study participants received irregular notifications, so it’s not as if a rampant portion of the population is going to be stampeding into the doctor’s office demanding to see a cardiologist.
2. The FDA is… Keeping Secrets?
For all the conspiracy theorists out there.
So the FDA maintains a public database of all of the available medical devices that includes safety reports, injuries caused by those devices, and various other problems that any medical device might have been reported for. Except that might not actually be the case – Kaiser Health reported that the FDA may actually, in fact, maintain a separate database hidden from public view. According to Kaiser, some medical devices can be granted ‘exemption’ from this public database, and be stored in the ‘hidden’ database instead under a guise called ‘Alternative Summary Reports.’
Sounds fishy.
The issue came to light when a physician’s medical stapler locked up during an appendectomy. Puzzled, he searched the FDA’s database for the malfunction and came up empty handed. After surveying his peers, though, he found that quite a few had discovered a similar problem with the device. The whole situation is rather bizarre. Even a former FDA commissioner had no idea the separate database existed.
Mystery solved.
The FDA responded to the report and cleared up the medical stapler reporting issue along with Alternative Summary Reporting regulations. The administration stated that these medical stapler devices were not eligible for the Alternative Summary report program and would investigate the matter. Maybe not the complete response we were looking for, but it’s something.
3. Trump’s Healthcare Budget Cuts
A budget with major implications.
The Trump administration released its 2020 budget plan this week and included some very ambitious healthcare changes. The proposed budget would cut $845 billion from Medicare (an entitlement program) and $241 billion from Medicaid over the next 10 years, including a $1.4 trillion cut to Medicaid. This cut would be almost completely offset, though, by a $1.2 trillion proposal to begin ‘block grants’ for Medicaid – meaning that each state would get a lump sum from Uncle Sam to run their Medicaid programs. The budget also indicates a desire to move toward a ‘site neutral‘ payment policy for post-acute facilities (think skilled nursing, inpatient rehab, home health).
Other big budget highlights included the following:
- Increased push for Medicaid work requirements (i.e., prove that you’re working to get Medicaid coverage);
- Lower prescription drug spending through capping seniors’ out of pocket drug costs;
- Raised funding for veterans affairs medical care (in the magnitude of 10%)
- Major cuts to the National Institute of Health (very unpopular);
- More funds to combat the opioid epidemic;
- Higher effort to fight and eradicate HIV/AIDS; and
- Increased taxation of e-cig companies that would help fund FDA oversight.
Let’s slow down.
This budget’s likelihood of getting passed through Congress is akin to me winning the Powerball on Wednesday, so take all of the above with a grain of salt. Still, it’s important to know what the current administration is targeting and prioritizing. Keep these talking points in mind. Also, another government shutdown is probably coming this fall, so we have that to look forward to.
4. Cambia and BCBS North Carolina Link Up
That’s pretty big.
Tell me about it. Two large not for profit healthcare companies, Cambia (which could be described as something of a healthcare ‘conglomerate’) and Blue Cross Blue Shield of North Carolina (a health insurance company) are joining forces to create a $16 billion behemoth (yeah, look at that alliteration). The joint company, retaining the name Cambia, will cover over 6 million people. The merger is a bit interesting, considering most of the companies under the Blue Cross Blue Shield umbrella haven’t participated much in healthcare consolidation. Still, this merger is the latest culprit in the vertical integration trend.
5. PAC Men Join Forces
The dynamic duo.
MedPAC and MACPAC (almost like Mr. and Mrs. Pacman, no?) are exploring different ways to tackle healthcare costs this week. Specifically, they’re eyeing potential changes to ED billing practices, drug pricing associated with Medicare Part B (think physicians and hospital outpatient departments), and the amount that the Feds can reimburse hospitals for taking on charity care patients (this program is known as DSH, or ‘disproportionate share payments,’ which is something we touched on in our 5th story from the week of January 11). These proposals are more specific in nature, considering they’re coming from organizations that know healthcare in a very detailed manner. As a result, Congress might pay more attention to the ideas the PACmen are considering.
Quick Hits
HCA acquires Galen College of Nursing, giving them access to a big labor pipeline to shield against any potential nursing shortages. Planet Money explores whether doctors are overpaid. Here’s a history of urgent cares and what to expect moving forward from major players. And keep an eye on a new cloud-based healthcare startup set to IPO later this year, Livongo (paywall – WSJ).
The Commonwealth Fund built a pretty nifty tool to compare the different healthcare reform ideas floating out there right now. How much do Americans at different ages spend on healthcare? Meet the new FDA commissioner – Ned Sharpless.
Pharmacy Benefit Management companies are the next up to get called to Capitol Hill (remember, drug companies just testified 2 weeks ago and blamed the drug pricing problem completely on these guys). Johnson & Johnson lost a baby powder case and is on the hook for a $29 million fine (they’ll appeal, of course).