Stay in the know with Becker's Hospital Review's weekly roundup of the nation's biggest healthcare news. Here's what you need to know this week.
1. The drug with a 5,000% price hike
Martin Shkreli is the 32-year-old CEO of Turing Pharmaceuticals. After his company acquired an antiparasite medication developed 62 years ago called Daraprim, he increased the price from approximately $13.50 per pill to $750 overnight. The New York Times first reported the story about Daraprim on Sunday, leaving Mr. Shkreli to fiercely defend his business decision early this week. Late Tuesday, he told TV news networks Turing will cut the $750 price, but he did not specify by how much. "I think that it makes sense to lower the price in response to the anger that was felt by people," he told NBC News.
2. UPMC stops organ transplants to investigate, contain mold problem
On Sept. 22, UPMC Presbyterian in Pittsburgh voluntarily stopped all transplants while hospital officials and state and federal infectious control experts investigate a mold outbreak potentially linked to four infections and three deaths of transplant patients at UPMC Presbyterian and UPMC Montefiore.
3. Hillary Clinton launches attack against big pharma, insurers
Presidential candidate Hillary Clinton unveiled her plan to curb rising drug costs on Sept.22, promising to give Medicare bargaining power over drug prices. In addition, she proposed a monthly cap of $250 on covered medications.
4. Adventist Health System to pay record-breaking $118.7M to settle improper physician compensation claims
Altamonte Springs, Fla.-based Adventist Health System agreed to pay $118.7 million to the federal government and to the states of Florida, North Carolina, Tennessee and Texas to settle allegations it violated the False Claims Act by maintaining improper compensation arrangements with referring physicians. The settlement resolves allegations that Adventist paid bonuses to employed physicians based on a formula that improperly took into account the value of the physicians' referrals to Adventist hospitals, according to the Department of Justice.
5. MA enrollment to soar, premiums remain stable
CMS announced Monday Medicare Advantage premiums will not increase and projected enrollment in the program is expected to hit a new high in 2016, breaking its own record for the sixth year in a row. According to CMS, 59 percent of MA enrollees will not face a premium increase next year. In fact, the average MA premium in 2016 will decrease $0.31 to $32.60. By next year, CMS expects MA premiums will be down 10 percent since the Affordable Care Act was enacted in 2010.
6. Ex-hospital CEO pleads guilty to perjury charge in Chicago
The former owner and CEO of Edgewater Hospital and Medical Center in Chicago, Peter Rogan, on Tuesday pleaded guilty to a criminal perjury charge stemming from the hospital's financial collapse in 2002. Mr. Rogan's guilty plea is part of a deal he reached with prosecutors. Under the deal, Mr. Rogan will receive a prison sentence of at least one year.
7. IOM releases landmark report on improving diagnostics in healthcare
Roughly 15 years ago, the Institute of Medicine released "To Err is Human: Building a Safer Health System," a report that changed the industry forever. On Sept. 22, the IOM released "Improving Diagnosis in Health Care," a follow-up to the earlier report that focuses on diagnostic errors and what can be done to prevent them. The report outlines key issues "that must be addressed if diagnostic errors are to be reduced," including education and training, improving the utility of health IT in the diagnostic process, developing approaches to monitor the diagnostic process and establishing a culture that encourages open discussions and feedback on diagnostic performance. To read the full IOM report, click here.
8. 1.5M patient records exposed on Amazon Web Services
Sensitive health information stored by a company handling insurance claims was accidentally made publicly available on Amazon Web Services, a cloud-computer platform. Chris Vickery, a self-described tech enthusiast, allegedly discovered the data in September. He estimates the information of around 1.5 million patients was exposed. The breached information came from Systema Software, a company that handles insurance claims, and was the result of a contractor's mistake. Mr. Vickery was the only person to access the data.
9. Texas hospital files for bankruptcy due to out-of-network payment challenges
Forest Park Medical Center at Frisco (Texas) has filed for chapter 11 bankruptcy protection, according to a Dallas Business Journal report. Todd Furniss, chairman of The Management Company at Forest Park Medical Center, told the Dallas Business Journal the physician-controlled board at the Frisco facility felt bankruptcy protection was necessary due to financing challenges and a reduction in out-of-network payments from insurance companies that the hospital relies on.
10. Study: Pioneer ACO program reduces low-value services
A study published Monday in JAMA Internal Medicine shows the Medicare Pioneer accountable care organization program was associated with modest reductions in "low-value" services in 2012, the first year of the program. They found pioneer ACOs reduced the quantity of low-value services by 1.9 percent in the first year, which was associated with a 4.5 percent reduction in spending on low-value services. ACOs that already provided more low-value services than the average organization in their market improved more than those already performing better than the market average, according to the study.
11. New database lists prices for 100+ medical procedures in California
Analysis performed by Consumer Reports, the University of California, San Francisco and the California Department of Insurance is included in a new tool called California Healthcare Compare that aims to help patients shop for their healthcare. The new Consumer Reports database is a searchable online database that houses payment information on more than 100 medical conditions and procedures, including childbirth, knee replacement, back pain, diabetes care and colon cancer screening. The database also shows the quality of care provided, broken down by hospital or physician group within the state of California.
12. Patient sues Blue Shield of California over denied artificial disc replacement: 5 key notes
A patient who underwent artificial cervical disc replacement surgery is suing Blue Shield of California for refusing to cover the procedure, according to a Courthouse News report. The plaintiff, Jeff Bush, hurt his neck in August 2014 and an orthopedic surgeon recommended artificial disc replacement. At that time, Blue Shield of California refused to pay based on the lack of long term efficacy and safety when compared with spinal fusion. In his lawsuit, Mr. Bush alleges the refusal to cover artificial disc replacement surgery breaches Blue Shield of California's duty as a fiduciary of an ERISA health plan because there is "valid scientific evidence" to support disc replacement procedures.