late-breaking news from your medical association volume XXIII/ no. 1 February 2016
local One Medical Group receives new funding One Medical Group, the high-tech-infused primary care medical group, has raised $65 million in capital to fuel its market expansion. The 250-provider San Francisco-based group now has doctors in 40 locations nationally, including 20 offices in the Bay Area. Many of the 200 primary care providers cited by the San Francisco-based group are nurse practitioners and physician assistants.
Digital health faces business opportunities and pitfalls There is no doubt that the Bay Area is central to the digital health universe. Rock Health, a company that tracks digital health venture deals nationwide of $2 million or more, reports that 36% of U.S. digital health companies are located here. Included in this figure are big names like Fitbit and Jawbone, as well as up-and-comers like Omada Health, 23and Me, Healthloop, and Grand Rounds. Even companies that have scored big in recent memory may face tough times ahead when going public. FitBit went public but its stock price has plummeted lately; Practice Fusion was expected to launch an IPO, but still hasn’t; and Theranos, the blood testing startup, is facing intense scrutiny over its technology. One local entity that seems to be on a roll is Omada Health, which helps people change habits that can lead to chronic conditions such as heart disease and diabetes. This startup is working with Kaiser enrollees and Stanford Health Care employees to improve their health and lower their employers’ costs, and Humana to help Medicare Advantage enrollees lose weight. Time will tell whether this startup will succeed in the long term.
state CURES registration deadline looms On January 8, 2016, the DOJ released the upgraded CURES 2.0 system, which enables prescribers to request and receive approval to access its network online. The new deadline is July 1, 2016. Go to https://cures.doj.ca.gov to register.
Brown & Toland and UnitedHealthcare form ACO Brown & Toland and UnitedHealthcare have formed a new accountable care partnership (ACO) to care for 15,000 Bay Area enrollees with care provided by B&T’s 1,500 physicians in the Bay Area.
UK taps Dr. Wachter Dr. Wachter, the UCSF doctor who wrote The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age, has been selected by the government of Great Britain to help it review its digital health future.
U.S. infant mortality rate higher than other developed countries As is well known, the United States has the highest infant mortality rate compared to other countries that spend more than 10% of their GDP on healthcare, at 5.9 deaths per 1,000 live births. Interestingly, Japan has the lowest rate, followed by Norway and Sweden.
state (continued) Marijuana is a public health risk, says UCSF’s Barry Researcher Rachel Barry, lead author of a report by UCSF’s Center for Tobacco Control, Research and Education, writes that people get the wrong idea when they hear the words “medicinal marijuana.” People think it is not harmful and actually beneficial; however, research shows that it is not harmless and has similar cardiovascular effects to cigarettes. Ms. Barry’s report concludes that the toxicity of marijuana smoke is “similar” to tobacco smoke, which makes it likely that marijuana use will have comparable health effects as tobacco, including harm caused by secondhand smoke. There are two proposed state initiatives that, if enacted, would legalize marijuana use, but neither call for monitoring, education, regulation or research that would allow researchers and government officials to better measure the health risks associated with smoking marijuana.
CMA releases end-of-life prescription guidelines CMA has issued guidelines for physicians writing prescriptions for lethal doses of drugs for terminally ill patients. The 15-page guide details the complicated legal and medical path that doctors must take before they can authorize medication to hasten a patient’s death. The guidelines are available for free to members at www.cmanet.org (login required); members can also contact the SMCMA to request a copy.
national Cancer incidence higher among certain ethnicities The American Cancer Society recently published a study on cancer incidence among Asian Americans, Native Hawaiians, and Pacific Islanders. Among males, prostate cancer is the most commonly diagnosed cancer and the fifth-leading cause of cancer death. Cancer incidence in Samoan men is more than twice that in Asian Indian/Pakistani men.
What patient factors trigger bias by physicians? According to a recent study conducted by Medscape, 62% of male and female physicians selected patients’ emotional problems as the patient factor most likely to trigger physician bias; weight was the second-most cited factor, by 56% of male and 48% of female physicians. See www.medscape.com/features/slideshow/lifestyle/2016/public/overview#page=7s.
Health insurance premiums have increased by 203% since 1999 The Kaiser Family Foundation recently released a report on trends in employer-sponsored health insurance. Some of the key findings include: 1. 2. 3. 4.
Between 1999 and 2015, premiums increased by 203%. Family coverage premium growth slowed from 11%/year from 1999-2005 to 5%/year from 2005-2015. Eight percent of covered workers are enrolled in a family plan worth more than $24,000. Deductibles have risen 67% since 2010, compared to 24% for premiums and 10% for earnings.
High-deductible plans don’t make patients smart shoppers A recent JAMA article found that a high percentage of high-deductible plan enrollees are no more likely to shop for healthcare based on price than those with plans with different financial incentives. The survey conducted by researchers at USC concluded that hardly anyone chooses providers based on costs. Among the high-deductible plan enrollees, 60% said they believed that there were large differences in price and quality across healthcare providers, but only 17% said they thought that higherpriced physicians provided better care. Only 56% of high-deductible plan enrollees said they would even use healthcare price information if it were available.
Wearable sensors are first step to bioelectric tattoos A company called MC10 has announced two new commercial wearable devices that will stick to the user’s skin to keep an eye on his or her health. The thin, flexible frame contains inertial sensors and a gyroscope to monitor movement, as well as chips to keep an eye on the electrical activity of one’s muscles and heart. It weighs just 0.2 ounces and is a tenth of an inch thick. It runs for 36 hours on a charge of its 15mAh battery, and beams data via Bluetooth. The product goes on sale later this year. Another device, in collaboration with L’Oréal, is the UV Patch, designed to tell how badly one’s skin is being damaged by sunlight. It is a thin sticker that contains dyes that change color during exposure to UV radiation. 2
February 2016
national (continued) CT scan usage zooms at hospital ERs Hospital emergency rooms in California are performing increasingly more CT scans on patients with minor injuries, part of a nationwide trend. The analysis of more than 8.5 million patient records by UCSF and Stanford researchers suggest that hospital ERs were more than twice as likely to perform at least one CT scan on a patient with minor trauma in 2013 compared to 2005. The prevalence rose from 3.5% of patients to 7.17% three years ago. According to the study published in the Journal of Surgical Research, 39% of all the scans ordered were done so by level one and two trauma centers, compared to just 3% at hospitals that did not have a trauma center designation. Groups of patients were also more likely to undergo scans, particularly those between the ages of 18 and 24, adults most vulnerable to suffering aftereffect of radiation exposure because of the many years they expect to live. In 2009, the FDA issued an advisory about the overuse of such scans. The American College of Emergency Physicians added the use of unnecessary head scans to the ABIM’s “Choosing Wisely” list of overused medical procedures. This study did not delve into whether there is a financial component that may be prompting hospitals to perform more CT scans. Chargemaster data filed with OSHPD indicate that hospitals charge many times more on average to perform a scan than an x-ray.
Genetic testing for some cancers raise questions Pennsylvania-based Independence Blue Cross has announced that it will cover a complex type of genetic testing for some cancer patients. Independence, with its 3 million members, has become the largest insurer to cover whole genome sequencing for select cancer patients. The analysis looks at the entire sequence of each tumor’s DNA and identifies mutated genes. Physicians can request this sequencing for children with tumors, patients with rare cancers, people with a type of breast cancer called triple negative, and patients who have exhausted conventional therapies for metastatic cancer.
Older single persons face greater health expense than couples According to a recent study published by the Employee Benefit Research Institute (EBRI), single persons aged 85 and older spend an average of $13,355 on non-recurring health expenses such as home health care, nursing home stays, overnight hospital stays, and outpatient surgery, compared with only $8,530 for couples over the same two-year period. See the report at www.ebri.rg/pdf/PR1153.OldSngles.21Jan16.pdf.
medicare 2015 Meaningful Use exception deadline now March 15, 2016 Because of the delay in the publication or regulations governing Medicare meaningful use program, CMS is allowing eligible physicians and hospitals to apply for an exception under the “extreme and uncontrollable circumstances” category. To avoid penalties in 2016, file for a 2015 hardship exception before March 15. Apply even if you are uncertain you will meet the program requirements. Download the application at https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms download application. Complete and submit your application, checking box “2.2.d” in order to avoid a penalty.
Meaningful Use not dead After CMS Administrator Adam Slavitt announced the phasing out of Meaningful Use “as we know it” J.P. Morgan Annual Health Care Conference in January, many people rejoiced at what they inferred was the “death” of MU. A week later, Slavitt and National Coordinator for Health IT Karen DeSalvo clarified that Meaningful Use is not going away but will be transformed through incremental changes. However, in spite of the renewed support of Meaningful Use, it is still likely a lame-duck program. For starters, it was recently reported that 257,000 Medicare eligible professionals would be hit with a 1-2% penalty to their Fee Schedule payments for failing to meet Meaningful Use in previous years. This situation is bound to create widespread backlash as providers already report reduced productivity and increased administrative burden under the Meaningful Use reporting requirements.
CMS moves to bundle knee and hip surgery payments CMS has released its final rule that bundles acute-care payments for knee and hip replacement surgeries, the most common type of inpatient surgeries for Medicare beneficiaries. CMS believes this change will make hospitals responsible for quality and costs during the care “episode” (day of surgery plus 90 days), reward hospitals when costs are less that the target amount, and encourage hospitals, physicians, and other providers to work together to deliver more effective and efficient care. (Biotech/IT)
February 2016
3
FIRST CLASS MAIL U.S. POSTAGE PAID SAN MATEO, CALIF PERMIT NO. 668
Address Service Requested Return Postage Guaranteed 777 Mariners Island Boulevard, Suite 100 San Mateo, California 94404
biotech/IT SF digital health startup spinoff raises $95M to take on WebMD Healthline Networks, a S.F.-based digital health company with two discordant products lines, has split in two. One portion, HealthLine Medical, has raised $95 million and will attempt to take on WebMD. The other line, Talix, will continue to offer information tech software to existing clients while it “evolves.” Healthline Networks provides medically reviewed clinical content, and has been the fastest growing health information site over the last two years. It currently is the fourth-largest health information site.
AMA seeks to join digital health revolution Health2047 Inc, a new S.F. health care innovation startup, is getting $15 million from the American Medical Association, its founding partner, to get off the ground. The new company hopes to create innovative solutions at a system level by integrating ideas, development and funding. At its Silicon Valley “innovation studio,” a multi-disciplinary team uses a co-laboratory model to originate early-stage ideas, co-develop products, and partner with established entities to optimize their business entries in the health care economy.
4
February 2016