Health Law

Writing in the Wall Street Journal (12/30) Health Blog, Jacob Goldstein observed that Missouri state Sen. Jason Crowell (R) has proposed legislation mandating tax breaks for doctors who accept Medicaid patients. "The basic idea is to exempt reimbursements from Medicaid (known in the state as MO HealthNet) from providers' state income tax." The measure, "introduced earlier this month, 'is an acknowledgment that...we are not covering costs,'" Crowell said, adding, "This is another way to hopefully prevent doctors, especially those providing specialist care, from refusing to see Medicaid patients."

Medscape /HeartWire (12/30, Wood) reported that the Food and Drug Administration (FDA) has approved Vasovist (gadofosveset trisodium injection), a "contrast imaging agent approved specifically for use in patients undergoing magnetic resonance angiography (MRA)" imaging of peripheral vascular disease. Epix Pharmaceuticals, the drug's manufacturer, "announced news of the approval on Dec. 22, 2008." According to an FDA statement, "scans performed using Vasovist enhance the visualization of blood-vessel blockages and abnormalities, which, without the addition of contrast, can be properly visualized only 10...to 30 percent of the time." In addition, "Vasovist is injected into a peripheral vein," and requires no arterial puncture, the FDA statement explained.

On the front page of its Marketplace section, the Wall Street Journal (12/31, B1, Whalen) reports that "sales of Novartis's blockbuster drug Diovan (valsartan) are expected to tumble when the high-blood-pressure pill's patent expires" in 2010, thereby putting the company into the "difficult position of finding ways to make up for some $5 billion in annual revenue" during a "global economic downturn" which may persist "for at least the next few years." In an interview, Joe Jimenez, who runs the company's prescription-medication business, said the company plans a "multifaceted approach" of investing "hundreds of millions of dollars in a new hypertension pill," speeding "development of a clutch of new drugs for cancer and other diseases," and aggressively expanding "in emerging markets to try to spur sales growth there," instead of undertaking a "search for a single blockbuster drug."

The San Francisco Chronicle (12/30, Allday) reported, "The city of San Francisco is challenging state legislation that allows insurance companies to charge women more than men for health coverage." In the individual insurance market, "women in California pay up to 39 percent more than men for coverage." This practice, "known as gender rating," is "illegal in 10 states and restricted in two more." In California, however, "state legislation allows insurance companies to set different rates, on the basis that women are more expensive to care for than men, even without including maternity care." Critics claim that the system is unfair. In a letter to the state attorney general, San Francisco City Attorney Dennis Herrera said that the city "intends to sue the state if legislation allowing gender rating is not repealed." At issue are two statutes in particular; the first "was passed in 1991, and the other in 2005." Meanwhile, insurance companies argue that the "premiums reflect the actual costs of healthcare," because "women file more insurance claims."

The Indianapolis Star (12/30, Rudavsky) reported, "So many adults without children have enrolled in the state's year-old subsidized health-insurance plan that their numbers threaten to reach a federal cap." Currently, the Healthy Indiana Plan caps the number of enrollees "without dependent children" at 34,000, and "about half of the 41,948 people" in the plan fall into that category. According to some experts, "if the state reaches its cap on adults without dependent children," the uninsured may "put off needed care until their conditions worsen, or...rely on already crowded emergency rooms," which "costs society more." They contend that "it is more expensive to care for more seriously ill people." Meanwhile, "there is no cap on the number of adults with dependent children." To qualify, however, "their family income must be no more than 200 percent of the federal poverty level." State officials anticipate "even more people...seeking assistance from the Healthy Indiana program in coming months," as the state's unemployment rate increases.

Healthcare IT News (12/30, Monegain) reported that in a Dec. 29 "letter to President-elect Barack Obama" calling "for national investment in state economies," New York Gov. David Paterson (D) "asked the federal government for an investment of $20 billion for several healthcare IT projects." The governor wrote, "With seven health IT projects that are ready to go, New York estimates that we are ready to obligate in excess of $300 million within 180 days to implement a plan for health information exchange and $1 billion for provider electronic health records." He added that "a national investment of $20 billion is necessary to implement qualified statewide programs and to promote the adoption of electronic health records by physicians and hospitals." The governor's "request for healthcare IT investment came under a call for $300 billion for infrastructure investments."

The AP (12/31, Raffaele) reports that "Pennsylvania health officials view" new electronic-surveillance "technology as a critical tool for helping hospitals reduce healthcare costs by identifying potential systemic infection-control problems sooner than is possible by reviewing paper records by hand." Hospitals are now "using software that employs algorithms to do the heavy lifting of sorting through every single laboratory, pharmacy, and X-ray report that is entered into the hospital's computer network." Under a 2007 law, "Pennsylvania is the only state in the nation to include 'electronic surveillance'...in its infection-reporting laws, according to the Association of Professionals in Infection Control and Epidemiology." The law "requires hospitals, outpatient surgery centers, and nursing homes to develop state-approved infection control plans and report all infections to the Centers for Disease Control and Prevention. It also calls for the eventual awarding of bonuses to hospitals that reduce infections by at least 10 percent."

Healthcare IT News (12/31, Merrill) reports that, according to a survey of "about 72 hospital CIOs" conducted in November by the College of Healthcare Information Management Executives (CHIME), many "hospital CIOs feel they are unprepared for the switch to ICD-10 code sets." Sixty percent of respondents said their healthcare IT "vendors have not alerted them to the proposed new regulations and timelines for ICD-10/5010 implementations." Yet "another concern among survey respondents is the amount of time they will have to test transactions with business partners and how those tests will be paid for." In addition, nearly "55 percent of CIOs surveyed by CHIME cite vendor readiness and cooperation as one of the top hurdles in achieving compliance with the new code and transaction sets. Second on the list is short- and long-term budgeting for the transition, mentioned by 45 percent of respondents."

        According to Government Health IT (12/30, Ferris), "Many organizations -- including the Medical Group Management Association, the American Medical Association, and America's Health Insurance Plans -- have asked for more time to comply with the new standards."

Modern Healthcare (12/30, Carlson) reported that, according to a Tennessee Hospital Association (THA) survey of 88 hospitals, the majority of responding hospitals "have reduced their workforces, and many are even cutting services in response to a recession that appears to be hitting healthcare providers harder than past downturns." The survey "shows the cumulative effect of rising bad debt, decreasing elective procedures, more costly variable-rate borrowing, and negative investment earnings." Specifically, "as of Dec. 10, 52 percent of the hospitals in Tennessee have reduced their workforces, and 39 percent are still considering it." In the meantime, "33 percent of the hospitals made cuts in services." Modern Healthcare quoted THA president Craig Becker, who stated, "In the 30 years I've been in this business, I've never seen anything like this."

The AP (12/30) reported, "A state-sponsored insurance pool that offers coverage to the riskiest patients has begun, but administrators are seeking to draw more North Carolina residents who have been pushed out of the private market." The North Carolina Health Insurance Risk Pool has received an estimated 500 applications since October, "with a couple hundred approved." And, although "enrollments have been accelerating," according to the program's executive director Michael Keough, "officials initially projected...up to 4,000 people would join the first year." Keough estimates that "up to 180,000 people would be eligible" in the state. The plan is aimed at "those with high-risk health conditions, such as sclerosis or hemophilia." Qualified applicants "don't have employer coverage and can't get private insurance without paying an exorbitant amount." The pool offers premiums that are "150 to 200 percent of a healthy person's private insurance." Currently, "about three dozen other states already offer such plans."

McClatchy (12/30, Stafford) reported that "a growing...industry" is working "to help people navigate the confusing waters of health insurance and healthcare costs." Consultants are now representing consumers "with the same level of advocacy" seen in "every part [of] healthcare financing," including "insurance companies, hospitals, [and] HMOs." One startup, Healthcare Advocacy, charges "those who could afford to pay," while helping "others for free." Consultants with the company conduct an initial evaluation of the coverage a client already has, as well as coverage that is needed. The company also charges "a contingency fee if" the consultant negotiates "down...medical bills and" gets "hospitals or insurance companies to write off some" debt. Steve Luptak, of Healthcare Advocacy, noted that "most people just don't have the background to understand the complicated fine print of insurance policies and hospital billings." He added that there is "a lot of need among workers who've been laid off and don't know what options exist to maintain health insurance."

The Financial Times (12/30, O'Doherty) reported that under the direction of chief executive Ray King, health insurer Bupa "saw a massive expansion of operations," and "turnover went from £1.8 billion in 1998 to £4.3 billion last year." The company "has also made important changes to its corporate profile," by "selling its private hospital stake," and "continuing development in Spain and the start of a joint venture in India." Now, as the company "shifts away from being a pure health insurer," King "seeks potential growth areas for the business in...health coaching and healthcare commissioning." He stated that the company sees itself less "as an insurance company," and more "a health and care company." Bupa has invested in Health Dialog, a US company that provides "a telephone coaching service to help people with chronic diseases...to monitor their health." Initially, the "model for Health Dialog was as a partner to private American insurers," but King "believes the business can also operate in nationalized health systems."

On its front page, the New York Times (12/31, A1, Singer) reports that "starting Jan. 1, the pharmaceutical industry has agreed to a voluntary moratorium on...branded goodies," such as pens, flash drives, calculators, and mugs, "that were meant to foster good will." The "new voluntary industry guidelines...to counter the impression that gifts to doctors are intended to unduly influence medicine" were "drawn up by Pharmaceutical Research and Manufacturers of America." Critics, however, say the guidelines "still permit" pharmaceutical companies "to underwrite free lunches for doctors and their staffs or to sponsor dinners for doctors at restaurants, as long as the meals are accompanied by educational presentations." In addition, the code allows pharmaceutical makers "to pay doctors as consultants 'based on fair market value,' -- which critics say means that companies can continue to pay individual doctors tens of thousands of dollars or more a year."

The Miami Herald (12/30, Andron) reported that surgical technologist, or "'surgtechs,' as they are known in hospitals, are in demand," and according to "state statistics, more than 300 new surgtechs will be needed annually in Florida through 2015." Although training typically "takes about a year," the position "is a demanding job," because "surgtechs must memorize the names and appearances of hundreds of medical instruments, some of which look very similar to others," while staying "calm under pressure" exerted by physicians in the operating room.

Life Sciences Law

USA Today (12/31, McCoy) reports that five executives from such chain pharmacies as Walgreens, Rite Aid, Wal-Mart, Target, and CVS serve on various state pharmacy affairs panels. They "aren't the only retail chain pharmacists who serve on the state panels assigned to oversee prescription-drug safety for the American public. A USA Today examination shows employees of major drugstore chains or supermarket pharmacies accounted for nearly one in four of the 295 pharmacists on the panels this year. The appointments give consumers the benefit of the pharmacists' expertise. But, they also give the chains a network with potential say about decisions that affect the pharmacy industry."

The Wall Street Journal (12/31, Kamp) reports, "A unit of Bayer AG has filed a patent-infringement lawsuit in a US court against Abbott Laboratories relating to the autoimmune drug Humira (adalimumab)." In a lawsuit filed in the US District Court for the Eastern District of Texas, Bayer's Healthcare unit alleges that "Humira infringes on a Bayer patent issued in 1997 that covers antibodies that fight a protein called 'tumor necrosis factor,' or TNF." The drug, "Abbott's top-selling product," is used to treat "multiple immune system-related diseases, including rheumatoid and other types of arthritis...Crohn's disease, and the skin condition plaque psoriasis."

The Financial Times (12/30, Timmins) reported, "The National Health Service (NHS) might need a partial exemption from rules restricting junior doctors' hours to 48 a week, the Department of Health" said on Monday. The statement comes after a warning from the British Medical Association (BMA) "that many hospitals were insufficiently prepared for a change that doctors' leaders fear will hit training and patient care." A "working-time directive" from the European Union now limits junior physicians "to a maximum working week of 48 hours," which is "down from 56." But, a "recent survey of their hours...suggested that half of posts" are in compliance, leaving "hospitals open to fines." The Department of Health noted that certain "smaller specialisms and more isolated hospitals may not be able to comply on time." The department indicated that "it had until the end of January to seek an extension" on the rule. Meanwhile, the BMA contends that "money meant to help hospitals tackle the issue...appeared not to be reaching the front line."