Archive for March 2nd, 2009

You Might Feel a Slight Pinch

March 2nd, 2009 | No Comments | Source: Wall Street Journal

Medicare Advantage providers like Humana, Cigna and UnitedHealthGroup have been receiving payouts that are 14% higher than what the government pays for other Medicare beneficiaries, and throughout his campaign the Big O said his administration was going to stop that.

BigOattacksInsurersIt’s now become apparent that the Big O’s follow-through on campaign promises is just as pristine as that on his sweet lefty J.

In fact when Obama proposed a $634 billion down payment on universal health coverage last week, he accounted for $177 billion of the total by removing funds that had been designated in previous budgets to pay for those Medicare Advantage programs.

The private insurer’s fees had heretofore been established using secret sauce, but now the Big O’s proposing they’ll have to bid competitively beginning in 2012 for the contracts.

thisgoeswhere?It’s the mother of all Heimlich maneuvers for Big Insurance, which knew something bad was gonna’ happen but expected a smaller hit and a slower phase-in.

Several companies threatened that the moves will force them to pull out of certain markets altogether, but that sounds a bit hollow since Advantage plans have been their only source of growth now that employer plan membership numbers are dropping like a stone.

So for the moment they’ve held fire. “We will be a constructive participant in efforts to reform all parts of Medicare,” a simmering Robert Zirkelbach told the Wall Street Journal.

Then the spokesperson for Big Insurance hinted at a possible counterattack strategy. “This proposal asks seniors to pay a disproportionate share of the cost of health-care reform,” Zirkelbach said.

Enrollment in Medicare Advantage plans grew 14% last year. Seniors were attracted by low premiums and plentiful benefits compared with relatively spartan government plans.

Nearly 25% of all Medicare beneficiaries are enrolled in these plans.

Humana stock dropped nearly 20% on the day the story broke. Aetna slid 11% and Cigna lost 9%.

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Nawlins’ Charity Still Shuttered

March 2nd, 2009 | No Comments | Source: USA Today

Hurricane Katrina was hell on Charity Hospital, but things haven’t improved much since the day it left patients stranded in sweltering, unsanitary conditions with no power and vanishing supplies of water, food and medicine.

thosewerebaddaysCharity was the place where caregivers stored bodies in hallways because the morgue was flooded, and made horrible decisions about patients for whom they could not comfort, let alone care for properly.

It’s been 3 ½ years since Katrina and now the ghost of Charity stands in silence, surrounded by a chain-link fence and barbed wire, boarded up like a set for a B-grade horror movie.

Until the storm, the 70-year old facility had been the go-to place for the city’s poor and uninsured. It was the only Level One trauma center in town and by far the most important site for training new physicians.

But plans to replace the gigantic structure and restore these services are dead in the water. The hang-up according to USA Today, is money.

Louisiana requested $492 million in disaster aid from the federal government. It wants to pick up the balance on a $1.2 billion downtown medical center.

But FEMA contends Charity was neglected and in disrepair before the storm. Disaster aid doesn’t cover that, so it countered $150 million, or $51 million more than what it calculated were the costs of storm-related damage.

underwaterNothing’s going to happen until the stand-off is settled, according to LSU’s general counsel Raymond Lamonica. The dispute is likely headed to court.

Meanwhile, the state is focusing on site-designs and buying land for a new Charity. “That’s going to take a couple of years,” Lamonica said. “Hopefully by then we’ll have our money.”

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Bone Drugs Fight Breast Cancer

March 2nd, 2009 | No Comments | Source: NEJM, NY Times

goodforbonesandmoreZoledronic acid, the intravenous biphosphonate normally used to reduce bone loss in middle-aged and elderly women, reduces by 36% the risk of recurrent or metastatic disease in some women with breast cancer.
 
To reach this conclusion, Michael Gnant and colleagues at Medical University of Vienna randomized 1,803 premenopausal women with endocrine-responsive, early-stage breast cancer to receive either standard therapy with ovarian suppression plus tamoxifen or the same regimen plus zoledronic acid.

weregonnabeatthisthingPatients were followed for a median of 4 years.

In that time, 54 women in the treatment group and 83 women in the control group experienced a recurrence in the opposite breast or a bone metastasis.

Other studies of the matter are nearing completion, so James Ingle, the Mayo Clinic’s head of breast cancer research told the New York Times, “it’s a reason for real enthusiasm, but for now…we are not ready to make this a standard treatment.”

But Marc Lippman had a different opinion. The breast cancer specialist and chairman of medicine at the University of Miami said that many women receiving standard treatments for breast cancer already take biphosphonates to counteract the bone-depleting effects of the therapy itself.

So why not just give them zoledronic acid?  “I think you have to give it,” he told the Times.

Lab and animal studies have shown that bone-building biphosphonates have many anti-cancer effects. They suppress the activity of osteoclasts for example, and when these cells are active they stimulate cancer cell growth in bone tissue.

reclastThe bone-builders also appear to prevent malignant cells from generating their own blood supply, invading other tissues and replicating. They even kill cancer cells directly, at least in laboratory studies.

Novartis markets zoledronic acid using the brand names Zometa and Reclast.

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