By Dan Goldberg | 04/19/2017 09:59 AM EDT

COURT CONCERNS — A state Appellate Court decision has home care agencies on edge as they await the outcome of a lawsuit that could cost the state hundreds of millions of dollars and upend the industry. At issue is whether home care employees who are on call 24 hours per day, seven days a week, should be paid for 24 hours or whether state Department of Labor guidance, which says they need only be paid 13 hours, is valid. A ruling in Tokhtaman's favor could mean home care agencies would be required to provide years of back pay to thousands of employees. The state Department of Health would almost certainly have to intervene and provide more Medicaid funding to the agencies to pay for the increased hours. Those who don't rely on Medicaid would have to pay for the increase out of their own pocket. Read my story here.

HOOKED ON HCRA — The Citizen's Budget Commission released a report saying it is time to rethink HCRA taxes. The paper argues that these taxes are both inefficient and regressive.

... Yes, but they also bring in about $4.3 billion per year, and no one is offering an idea as to where else that money would come from. Cutting expenses, particularly health care expenses, is really hard, and does anyone think the Legislature or governor would increase taxes on people in order to cut taxes on insurance companies?

NOW WE KNOW — A study in JAMA Dermatology found great movie villains all have some dermatology issues. Looking at the 10 greatest villains, ranked by the American Film Institute, these researchers found that six of the top 10 villains have some skin problems. So maybe that witch from the west would not have been so wicked if she hadn't veruca vulgaris (warts), and maybe the Queen from Snow White would have been more secure had she taken care of that periorbital hyperpigmentation (dark circles under the eyes). Hannibal Lecter and Darth Vader probably would have been bad hombres even if they bought a toupee to cover up that alopecia, but who really knows? The authors say this is really a study about stigma. "Specifically, unfairly targeting dermatologic minorities may contribute to a tendency toward prejudice in our culture and facilitate misunderstanding of particular disease entities among the general public." Fair point, and for the record, there is no scientific link between alopecia and cannibalism. Read the study here.

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EMERGENCY CONTRACEPTIVES FOR MINORS — The state's Medicaid program has lifted the age restriction for non-prescription emergency contraceptives, meaning that women — regardless of age — will be eligible to receive emergency contraception without a prescription. Read the Medicaid update here.

TABLETS — The Times Telegram reports: "Little Falls Hospital, a subsidiary of Bassett Healthcare Network, recently received $12,500 in funding from Avangrid Renewables to purchase 26 Microsoft Surface Pro tablets for staff to enhance patient care and reduce costs."

FINANCES — Crain's reported that SUNY's three hospitals and their affiliated clinics reported an operating loss of $98.6 million last fiscal year, a 77.3 percent increase over its shortfall the previous year.

IN CASE YOU MISSED — The Daily News reports: The city is preparing to deploy a new weapon in the war on rats: birth control. The Department of Health and Mental Hygiene said it will launch a pilot program in which female rats are sterilized after consuming a compound dubbed ContraPest.


GRASSLEY GOING AFTER INSURER — Senator Chuck Grassley is now probing one of the largest insurers in the mid-Atlantic region, asking CareFirst BlueCross BlueShield to explain a complicated policy that he suspects may force patients to overpay for brand-name medications, according to STAT. "The issues at stake not only have a financial impact, but a medical impact," the Iowa Republican wrote in a letter to CareFirst chief executive officer Chet Burrell on Monday. "Many patients have tested generics, but have found that their body simply does not react positively to them and, therefore, require brand name drugs." Read the rest here.

BREAKTHROUGH STATUS — Reuters reports: "Novartis's push into oncology and liver disease, two of its treatment priorities, advanced on Monday as the Swiss drugmaker won a second U.S. breakthrough tag for its cancer gene therapy while striking a separate pact with Allergan."


APPARENTLY HEALTH REFORM IS IMMINENT — My colleagues in D.C. report: "President Donald Trump made big promises on Tuesday, pledging to quickly deliver on health care, tax reform and infrastructure, while offering tough talk on trade, including putting Canada on notice. Despite the administration's failed effort to usher legislation to repeal and replace Obamacare through the Republican-controlled House last month, Trump suggested health care reform was imminent, casting it as the first major hurdle to cross before accelerating through his legislative agenda."

INSURERS GET NO CLARITY FROM VERMA — Health insurers who met with the Centers for Medicare and Medicaid Services Administrator Seema Verma on Tuesday didn't get clarity on whether the Trump administration would continue to pay Obamacare's cost-sharing subsidies, according to several sources briefed on the meeting.

COMING UP — President Trump is expected to sign a bill today that would extend a temporary program that gives veterans access to private-sector health care, the Associated Press reports.

A WIN FOR BIG ANKLE — Axios reports on a big policy change found in the new Medicare payment rule — one that benefits providers and medical device companies that are involved with ankle replacement surgeries. "The federal government proposed moving all ankle replacements from a broad, lower-paying joint category into a higher-paying Medicare code (MS-DRG 469 for all you wonks out there) based on comments from unnamed 'requestors.' That would bump up average baseline Medicare payments for ankle replacements by more than 60 percent, to almost $20,000, based on this 2015 document from Wright Medical Group, a medical device manufacturer."

... One of the winners will be Zimmer Biomet, a medical device manufacturer. CNN reported earlier this year that days after Rep. Tom Price bought the stock, he introduced legislation to delay a regulation that would have hurt Zimmer Biomet. Price is now Secretary of Health and Human Services and published the new Medicare rule.

... Former U.S. Attorney Preet Bharara was reportedly overseeing an investigation into Price's stock trades when he was fired.

GOING PUBLIC — Charles Ornstein at ProPublica reports that the "Centers for Medicare and Medicaid Services wants to require that private health care accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them." Read the story here.

HIDING THE NUMBERS — STAT reports: "The number of babies born in Puerto Rico with microcephaly and other birth defects caused by the Zika virus appears to be unexpectedly low — so low that experts are beginning to question whether the actual count is being significantly under-reported by authorities on the island.

ROBUST PROFITS FOR UNITEDHEALTH AFTER EXCHANGE EXITS — UnitedHealth Group enjoyed a blockbuster first quarter of 2017, with nearly double-digit revenue growth and increased earnings projections. More from Reuters.

TODAY'S TIP — Comes from the Department of Health and Human Services: "If we educate teens about healthy relationships, we can stop dating violence early."


HOW DENGUE DEFEATS THE IMMUNE SYSTEM — Researchers from the Icahn School of Medicine at Mount Sinai, writing in Nature Microbiology, explain how the dengue virus counteracts the mechanism that tells the immune system to attack. Watch them discuss the research.

THE BEST WAY TO DO IT — Researchers from Weill Cornell Medicine and New York-Presbyterian, writing in JAMA Internal Medicine, say that combining a kidney ultrasound with a visual examination of the bladder and urethra appears to be the most cost-effective way to screen for cancers of the genitourinary tract in people with microscopic amounts of blood in their urine. Read more here.

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