By Dan Goldberg | 12/06/2017 09:57 AM EDT
ACOs in NY — Accountable Care Organizations in New York State lost $60 million against their benchmarks in 2016, according to a report from the United Hospital Fund. It is a relatively poor performance given the high hopes for ACOs. The ACO model works like this: provider groups try to save the federal government money by better coordinating care, and, if successful, they are eligible to receive a share of the savings. There were 32 ACOs in the state in 2016. Only five of the ACOs saved enough money to qualify for a share of the savings. An additional seven saved the federal government money but not enough to earn a share. The remaining 20 ACOs generated a net loss of over $120 million, with $45 million of that attributed to Mount Sinai's ACO and Beacon's ACO, according to the United Hospital Fund.
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NOW WE KNOW — STAT tells us that new research finds at least 49 genes involved in determining whether our earlobes are detached or are stuck to the side of our face. Scientists collected genetic data and earlobe info from nearly 10,000 people, and pinpointed six genes that seemed strongly tied to earlobe attachment.
AD BUY — Save My Care announced the release of a new ad urging Rep. John Katko, a Republican, who previously voted against health care repeal, to oppose the GOP tax bill, which he has already voted for once. The Senate's version of the tax bill eliminated the Affordable Care Act's individual mandate and could destabilize the insurance market, according to the Congressional Budget Office. The conference committee must reconcile that with a House version that does include a repeal of the mandate. Watch the ad here.
... Radio ads were also made targeting Rep. Claudia Tenney. Listen here.
CHIP CLOCK — It's been 67 days since Congress let the Children's Health Insurance Program lapse. New York has enough cash to keep its program running through December.
INFOGRAPHIC: The CHIP Funding Gap — Congress' failure to renew the Children's Health Insurance Program could put 350,000 New York children at risk of losing health insurance. Check out POLITICO's graphic here.
NO INTENT — The chair and CEO of the troubled New York City Housing Authority, Shola Olatoye, said she had "no intent to deceive" anyone when she signed off on forms falsely stating the agency had conducted mandatory lead paint inspections. Olatoye was interrogated by Chairman Ritchie Torres during a lengthy and contentious hearing of the City Council Committee on Public Housing over the ongoing lead inspection scandal. More here.
SOCIAL DETERMINANTS — The Department of Health is creating a sub-division focused on the state's initiatives targeting the social determinants of health like supportive housing for certain Medicaid recipients. The Bureau of Social Determinants of Health will work with community-based organizations, health plans and care providers on initiatives addressing lack of housing, poor nutrition, and education gaps, among others. The state has tried to address these factors, which influence the disparate health outcomes among socioeconomic groups, in an attempt to improve population health and potentially control costs in the long term.
WHAT WILL HAPPEN TO AETNA'S MOVE? — The Hour reports: "In regulatory documents filed Tuesday in conjunction with its planned merger with CVS Health, Aetna left open the question of whether it will complete a move of its headquarters to New York City from Hartford where it has long been based."
MAKING ROUNDS — The Samaritan Hospital will open its new emergency room Thursday, according to the Troy Record.
DON'T DO THAT — They bought multimillion-dollar Brooklyn apartments, paid for with cash. They took luxury vacations. They splurged at high-end stores such as Hermes, Tourneau and Bulgari, purchasing handbags and jewelry. That's how Kristina Mirbabayeva and her partners allegedly spent some of the ill-gotten gains they received from defrauding Medicaid and Medicare of $146 million over a three-year period that ran through last week, according to acting Brooklyn District Attorney Eric Gonzalez, who announced the arrest of 20 people, including four physicians, on Tuesday.
... Speaking of doctors behaving badly, The Star-Ledger takes a long look at a case of medical fraud that has so far led to 51 convictions, including 38 doctors, and is not done yet.
... How long has this been going on? I wrote about the original indictment almost five years ago.
ENROLLMENT PLANS — NY State of Health, the online marketplace created by the Affordable Care Act, is partnering with community colleges at more than 30 on-campus enrollment events this Friday, sponsored by Young Invincibles, according to the state Department of Health. More here.
SEXUAL HARASSMENT — STAT scoop: "The founder of biotech's largest and most powerful hedge fund has for years perpetuated a toxic culture of sexual harassment, former employees told STAT, routinely subjecting young female assistants to pornography in the workplace, lewd jokes, and pervasive sexist comments."
WHAT WE'RE READING:
HARVEY TOLL — The Houston Chronicle reports: "Three months after Hurricane Harvey, local health officials now are beginning to see the storm after the storm."
BLUNT NONCOMMITTAL ON NEW OPIOID FUNDING — Senate Appropriations Health Subcommittee Chairman Roy Blunt (R-Mo.) on Tuesday would not commit to new funding to combat the opioid crisis after the White House this week said it would defer to Congress on the issue.
CMS FALLS SHORT ON SOME FRAUD PREVENTION TACTICS — The Centers for Medicare and Medicaid Services efforts to detect fraud in the Medicare and Medicaid programs only partially align with best practices detailed by the Government Accountability Office, according a report issued Tuesday. Specifically, CMS doesn't require fraud-awareness training on a regular basis for employees, which GAO has identified as a way to create a culture of integrity. Read the report here.
OBAMACARE LATEST — House Ways and Means Chairman Kevin Brady (R-Texas) said Republicans and Democrats are negotiating a bill to cover Medicare extenders and delay some Obamacare taxes, POLITICO's Jen Haberkorn reports.
RESUME PROBLEMS — The Associated Press reports: "When it comes to filling jobs dealing with complex science, environment, and health issues, the Trump administration is nominating people with fewer science academic credentials than their Obama predecessors. And it's moving slower as well."
COMMUNITY HEALTH CENTER CLIFF — Millions of patients served by community health centers may lose access to care, and 161,000 people could lose their jobs if Congress does not restore the community health center fund, according to an analysis produced by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University's Milken Institute School of Public Health. Read more here.
CARROTS ARE DELICIOUS — Kaiser Health News examines the trend of Medicaid programs offering incentives to patients to take advantage of preventive medicine such as mammograms.
FOOD SHORTAGE — There's a shortage of the nutrients needed to feed premature infants, according to NBC News.
THIS IS BACKWARDS — Big-city hospitals find asthma hot spots more profitable to neglect than fix, Jay Hancock of Kaiser Health News and colleagues write. More here.
TODAY'S TIP — Comes from Gov. Andrew Cuomo's office: "New Yorkers are urged to prepare, plan ahead and drive with caution as Lake Effect snow is expected to hit Western NY, Central NY and the North Country late Tuesday through Friday."
HELP FOR FETAL ALCOHOL SYNDROME — Lithium chloride, typically used to treat bipolar disease, blocks the sleep disturbances, memory loss and learning problems tied to fetal alcohol syndrome in mice, according to a study in the journal Neuroscience from researchers at NYU School of Medicine. Read the press release here.
FLU WORKS — Researchers from the Icahn School of Medicine at Mount Sinai, writing in Nature Communications, found the flu virus triggers an inflammatory cell death in immune cells. That lets the body know something is wrong and activate an immune response. But pandemic flus inhibit the inflammatory response. That's what makes them so dangerous. Read the study here.
California: CalPERS and value-based pricing — A new Health Affairs study compared two benefit designs used by the California Public Employees' Retirement System to steer patients to so-called high-value providers to help control the costs of hip and knee replacement surgeries. Both approaches — using reference-based pricing for PPO members, and sending HMO members to "centers of excellence" — prompted higher use of designated lower cost/higher quality centers by CalPERS members, POLITICO's Victoria Colliver notes.
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