First Edition: August 15, 2014

Aug 15 2014

Today's headlines include a variety of updates regarding health policy and the health care marketplace.

Kaiser Health News: Capsules: Wide Variation In Hospital Charges For Blood Tests Called 'Irrational'
Now on Kaiser Health News' blog, Roni Caryn Rabin writes: "One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test charged $10,169 -; over 1,000 times more. For another common blood test called a basic metabolic panel, the average hospital charge was $371, but prices ranged from a low of $35 to a high of $7,303, more than 200 times more" (Rabin, 8/15). Check out what else is new on the blog.

The Wall Street Journal: How Agents Hunt For Fraud In Trove Of Medicare Data
Eleven armed FBI agents crept around a stone-and-glass house here just before dawn. An AR-15 rifle and four other guns were registered to the man in the house. … It was no drug lord. The target was a doctor who moonlighted as a movie producer with an Alec Baldwin comedy to his credit. The Justice Department charged the doctor, Robert A. Glazer, with writing prescriptions and certifications resulting in $33 million of fraudulent Medicare claims. The raid in May capped a year-long investigation by the Medicare Fraud Strike Force, a joint effort by the Justice Department and Department of Health and Human Services. Raids that day in six cities resulted in the busts of 90 Medicare providers, including 16 doctors, who were separately charged with generating a total of $260 million of false Medicare billings (Stewart, 8/14).

Los Angeles Times: Medi-Cal Struggles To Provide Services To Ever-Growing Clientele
Concerns about access to care have taken on a new urgency since Medi-Cal enrollment began to swell in the wake of President Obama's federal healthcare overhaul. The program, the state's second-largest expense after schools, is expected to cover one in three Californians by next year. But the current state budget continues a 10% cut in reimbursements to some healthcare providers, a lingering sore point for advocates, lobbyists and lawmakers who have pushed to reverse the reduction (Megerian, 8/14).

The Washington Post's Wonkblog: Wal-Mart Wants To Be Your Doctor
Wal-Mart's newest effort to make a play in the booming health clinic space comes after the big-box retailer has fallen far behind its rivals. And this time, Wal-Mart is shaking up its approach with a new model that's getting some attention in the health-care world. Wal-Mart this year has opened six clinic locations across South Carolina and Texas in which the retailer is providing a broad range of primary care services, as described in a recent New York Times story. The company plans to have a dozen of these clinics open by the end of this fiscal year, executives said on a Thursday earnings call (Millman, 8/14).

The Wall Street Journal: Health Costs, Weak Store Traffic Hinder Wal-Mart
One unexpected headwind came from health care, where costs are rising quickly as more employees sign up for coverage. The company said it now expects to shell out an additional $500 million in health-care expenses related to increased employee enrollment and higher costs, up from the $330 million in increases it originally expected. "Health-care costs increased approximately $180 million versus last year and were well above our initial estimates," said Wal-Mart U.S. CEO Greg Foran, who stepped into the role this week following the departure of Mr. Simon (Banjo and Calia, 8/14).

The Associated Press: VA chief: Firings Of Workers A Deliberate Process
The Veterans Affairs Department is in the process of holding bad employees accountable amid a scandal about long wait times for patients and other problems, VA Secretary Robert McDonald said Thursday, but he declined to say how many people were being fired and who they were. McDonald visited with veterans and employees at the Memphis VA hospital on Thursday, a day after addressing the American Veterans national convention (8/14).

The Associated Press: Candidates Clash In Colorado Congressional Debate
Coffman said he opted out of the congressional health plan and bought his insurance on the Affordable Care Act exchange, which was significantly worse. "If every member of congress did what I did, Obamacare would not be standing today," he said, earning cheers and boos when he called for repealing the law. Romanoff replied: "It'd be a good idea to fix the law rather than repeal it and replace it with nothing but empty phrases." Romanoff supports abortion rights and Coffman opposes them (8/14).

The Wall Street Journal's Pharmalot: CMS Fixes Tech Glitch That Hobbled Pharma Payment Disclosures
The federal government is back online with a website where U.S. doctors and teaching hospitals can review information about payments they have received from drug and device makers, about 11 days after a government agency shut it down to investigate a data mix-up. In a brief statement Thursday afternoon, the Centers for Medicare and Medicaid Services said: "The Open Payments system is once again available for physicians and teaching hospitals to register, review and dispute financial interaction information received from health care manufacturers and Group Purchasing Organizations." CMS plans to provide additional details about the program "by tomorrow" (Loftus, 8/14).

The New York Times: Pharmacies Turn Drugs Into Profits, Pitting Insurers Vs. Compounders
Compounded medicines are the Savile Row suits of the pharmacy, made to order when common treatments will not suffice. Pharmacists say it is the doctors who decide what to prescribe. But many pharmacies have standard formulations and some promise six-figure incomes to sales representatives who call on doctors (Pollack, 8/14).

The Wall Street Journal's Pharmalot: UK Recommends Covering Sovaldi Hepatitis C Pill
The U.K. agency that evaluates the cost effectiveness of prescription drugs has recommended the government pay for the controversial Sovaldi hepatitis C treatment, although not for all patients. The move, which still requires a final endorsement, comes as the medicine causes a ruckus in the U.S. The price tag–$84,000 for a 12-week regimen–has insurers and state Medicaid directors worried that the Gilead Sciences medication will become a budget buster and helped to fuel a national debate over the rising cost of prescription drugs (Silverman, 8/14).

The Washington Post: Ebola Striking Women More Frequently Than Men 
As the number of lives claimed by the Ebola epidemic in West Africa rises above 1,000, the rate of infection among women is outpacing that among men because women are the caregivers, nurses and cross-border traders, health officials report. Outbreaks are thought to originate through contact with infected forest animals, often making men who hunt for bushmeat or handle the meat the first targets of infection (Hogan, 8/14).

The Associated Press: Worst TB Outbreak In 5 Years Hits Alabama Prisons
Alabama's prison system, badly overcrowded and facing a lawsuit over medical treatment of inmates, is facing its worst outbreak of tuberculosis in five years, a health official said Thursday. Pam Barrett, director of tuberculosis control for the Alabama Department of Public Health, said medical officials have diagnosed nine active cases of the infectious respiratory disease in state prisons so far this year (8/14).