Is Obamacare's Research Institute Worth The Billions?

On the ninth floor of a glassy high rise in downtown Washington, partitions are coming down to make more room for workers handing out billions of dollars in Obamacare-funded research awards.

Business has been brisk at the Patient-Centered Outcomes Research Institute or, PCORI, as it is known. The institute was created by Congress under the Affordable Care Act to figure out which medical treatments work best -measures largely AWOL from the nation's health care delivery system.

Since 2012, PCORI has committed just over $1 billion to 591 "comparative effectiveness" contracts to find some answers, with much more to come. Money has thus far gone to researchers and medical schools, advocacy groups and even the insurance industry's lobbying group, which snagged $500,000.

NPR

CEOs at Aetna, Anthem Help to Reshape Health-Insurance Industry

The leaders of the top five health insurers periodically get together to discuss policy issues, Aetna Inc.Chief Executive Mark T. Bertolini told investors in a private meeting earlier this month. The group had a nickname, he joked: the G5.

Soon, that could be down to the G3.

The change would come thanks to Mr. Bertolini, who has struck a $34 billion deal for Humana Inc.,and Anthem Inc.CEO Joseph Swedish, whose company is seeking to acquire Cigna Corp.for $48 billion. The unprecedented tandem deals could reshape the industry into one topped by three giants, each with more than $100 billion in annual revenue. UnitedHealth Group Inc.would be the third major player and still the largest by revenue.

Wall Street Journal

Cerner, Leidos and Accenture win massive Defense contract for EHR system

And the winner is Cerner Corp., which joined up with defense computing contractor Leidos and Accenture Federal Services as the prime contractor and configuration specialist, respectively.

The prize is one of the largest health information technology contracts in U.S. history, awarded by the Defense Department for its global Military Health System.

The military's new EHR system, the fruits of a 22-month, Defense Healthcare Management Systems Modernization procurement effort, or DHMSM, pronounced "dim sum," will serve 55 hospitals and 600 clinics.

Modern Healthcare

For clinicians, one of the problems with medication adherence is that patients may have difficulties with pharmacological therapy unrelated to the drug itself; patients may have difficulty in swallowing pills that can hinder the start or continuation of their treatment. Certain medications like biologic agents require administration via injection, which could be a barrier for patients with a fear of needles or prefer other delivery methods. However, in recent years significant advances have been made to improve the delivery of drugs by alternate routes. Of particular interest is the use of so-called "microneedles", in which extremely small needles are utilized to safely and effectively deliver drugs directly to the stomach lining from capsules or under the top layer of skin via a patch. Most of these alternate drug delivery systems are still in the experimental stages, but in the coming years a pill or patch could replace certain injections as the primary mode of transit for many medications that typically require subcutaneous administration like insulin and vaccines.

MPR

FDA Warns Clinicians of Potentially Dangerous Prescribing Error

The Food and Drug Administration (FDA) is warning healthcare providers and patients that the name confusion between Brintellix (vortioxetine; Takeda and Lundbeck) and Brilinta (ticagrelor; AstraZeneca) has led to the wrong medication being prescribed or dispensed.

Brintellix is a serotonergic agonist and antagonist indicated for the treatment of major depressive disorder (MDD). Brilinta is a P2Y12 platelet inhibitor indicated to reduce the rate of thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) (unstable angina or non-ST-elevation myocardial infarction [MI] or ST-elevation MI).

EPMR

CMS Corrects Recent ICD-10 Guidance for Physicians

CMS and AMA recently developed guidance on new ICD-10 flexibility for physicians during the first year of compliance. Now, at the request of stakeholders who found errors, CMS has substantially changed the guidance in Questions 3 and 5.

Below is background on policy changes that necessitated the guidance.

Under pressure from the AMA and other provider organizations, CMS agreed to:

* Not deny claims solely based on the specificity of diagnosis codes as long as they are in the appropriate family of codes, so physicians won't be penalized because of a coding error;

* Not audit Medicare claims in the first year of ICD-10 based on specificity of diagnosis codes if in the appropriate family of codes;

* Authorize advance payments if Medicare contractors cannot process physician claims coded with ICD-10;

* Not penalize physicians via reduced reimbursements for errors in selecting and calculating quality codes for the EHR meaningful use, PQRS and Value-based Modifier reporting programs as long as they use codes within the appropriate family of codes. Penalties also will not be applied if CMS has difficulty calculating quality scores during the ICD-10 transition; and

* CMS will establish an ICD-10 Ombudsman office to help physicians resolve problems during the transition.

Health Data Management

Could Pharmacokinetics Play A Role In Addictive Risk With Drugs?

A study appearing in the September issue of Neuroscience and Biobehavioral Reviews suggests that pharmacokinetics play a significant role in the risk of abuse and misuse associated with varying drugs, from nicotine to cocaine.

Researchers from the University of Montreal conducted a literature review to evaluate the role of pharmacokinetics and addiction risk with varying drugs of abuse and misuse. They discovered that how fast a drug reaches the brain and how often brain levels rise and fall are essential to the development of drug addiction; for example, when a drug is smoked or injected intravenously, the amount of the drug in the brain increases and decreased quickly compared to if the drug is inhaled or swallowed. This high and rapid peak of drug concentration, followed by a rapid decline, are critical to drug addiction risk.

Clinical Pain Advisor

FDA: Hackers Could Go After Medical Devices

With new cyber attacks hitting the news every day, it shouldn't be a surprise when the FDA, the U.S. Department of Homeland Security's Industrial Control Systems Cyber Emergency Response Team (ICS-CERT), and Hospira issued a joint press release warning health care facilities about cybersecurity vulnerabilities associated with medical devices that can be accessed remotely through a hospital's network.

Based in Lake Forest, Illinois, Hospira, a global pharmaceutical and medical device company, confirmed with an independent researcher that its Symbiq Infusion System, a computerized drug infusion pump, couldn't protect against an unauthorized user from controlling the device and changing the dosage the pump delivers.

Clinical Pain Advisor

Two Narcotic Injectables No Longer Available

Purdue Pharma announced the discontinuance of Dilaudid-HP (hydromorphone HCl) Injection 50mL single dose vials and Dilaudid-HP Injection Sterile Lyophilized Powder 250mg vials as of July 27, 2015. The Company stated that no new orders were being shipped because there is no more inventory of these products.

Both Dilaudid-HP products are opioid narcotics indicated for the management of moderate-to-severe pain in opioid-tolerant patients who require higher doses of opioids. Hydromorphone HCl is a mu-opioid receptor agonist whose principal therapeutic action is analgesia. The precise mode of analgesic action of opioid analgesics is unknown but specific CNS opiate receptors have been identified.

MPR

Moderate Drinking May Ease Disability from Chronic Pain

Patients with chronic widespread pain (CWP) who consume moderate amounts of alcohol have lower levels of disability, according to a large new population-based study from the United Kingdom.

The research doesn't determine whether the relationship between alcohol consumption and CWP is causal although the magnitude of the association suggests further study is needed, according to Gary J. MacFarlane, PhD, MD, Epidemiology Group, Institute of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Scotland, and colleagues.

Phantom Med Schools Lurking in Medicare Data

Thomas "Randy" Lombardo, MD, has been a well-regarded cardiologist in the Beaumont, Texas, area for decades, but a look at his entry in the Medicare provider database would make anyone do a double-take.

It says he graduated from Gate City Medical College in 1981, which is a problem because the school was shut down in 1911 after its dean was found to be selling phony diplomas for $50.

MedPage Today