This has been a striking week for news in healthcare. Here are seven of the most interesting issues.
1. The Centers for Disease Control confirmed the first Ebola diagnosis made in the United States Tuesday. The man is currently in critical condition at Texas Health Presbyterian Hospital in Dallas. He took a commercial flight from Liberia that arrived in Dallas Sept. 20 to visit relatives, but displayed no symptoms of the virus at the time of travel. In fact, the man did not show symptoms until about four days later. He sought care at Texas Health Presbyterian, but was sent home when his early symptoms were not recognized as Ebola. He returned to the hospital with worsening conditions on Sunday, Sept. 28, and was then placed in isolation.
Edward Goodman, MD, epidemiologist with Texas Health Presbyterian, told the New York Times the hospital has had a plan in place for Ebola exposure for some time now. "Ironically, we had a meeting the week before of all the stakeholders who might be involved. We were well prepared to care for this patient." CDC Director Thomas Frieden, MD, is also bullish about the outcome. He said there is "zero chance" the patient infected anyone else on the flight. "I have no doubt that we'll stop this in its tracks in the U.S.," he said Tuesday.
2. The government launched its Open Payments website Tuesday, detailing $3.5 billion in payments made from August to December 2013 to physicians and teaching hospitals by pharmaceutical and medical device companies. The companies made a total of 4.4 million payments to 546,000 physicians and nearly 1,360 teaching hospitals. Although the data release is seen by some as a step toward greater transparency, the website also comes with its fair share of criticism and caveats. One important thing to keep in mind: The database provides a limited window to gauge money exchanged.
CMS already said it withheld one-third of the payment records due to data inconsistencies, and as Charles Ornstein with ProPublica pointed out, drug and device companies are allowed to delay publication of sensitive data related to new product research or other trade secrets. "It is unclear how much money is involved, but, again, just because a doctor doesn't show up as receiving a research payment doesn't mean he or she hasn't received one," he wrote. The four-month timeframe is another caveat, as those few months may not reflect a company's spending throughout an entire year. CMS is expected to release data on payments for the full 2014 calendar year in summer 2015.
3. Debate over the merit of hospital consolidation continues, with many industry experts taking to the op-ed pages to express their strong opinions on the issue. In her opinion piece for the Wall Street Journal Tuesday, Suzanne Delbanco, executive director of Catalyst for Payment Reform, said consolidation among hospitals and physicians is one factor that has increased healthcare costs in recent years more than anything else. She cited a 2012 report from CPR that found payments to hospitals nationwide on behalf of the privately insured are an estimated 3 percent higher as a result of consolidation. "That may sound small, but 3 percent of the almost $900 billion the U.S. spends on hospital care each year is a hefty chunk of change," wrote Ms. Delbanco.
Ms. Delbanco's criticism of consolidation is at odds with many healthcare insiders who point to the drivers and benefits of the trend. Kenneth Davis, MD, president and CEO of Mount Sinai Health System in New York City, wrote an op-ed for the WSJ earlier this month titled "Hospital Mergers Can Lower Costs and Improve Medical Care." He said mergers can expand access to specialists, "the best treatments" and reduce overlap in regional healthcare offerings. "Finally, the fear that mergers curtail competition, leading to higher prices for medical care, reflects an old way of thinking that doesn't account for the introduction of population-health management," Dr. Davis wrote.
4. A federal judge in Oklahoma found it unlawful for tax subsidies under the Patient Protection and Affordable Care Act to be provided to consumers who purchased insurance through a federal exchange. The healthcare reform law says tax subsidies for health insurance must be provided "through an exchange established by the state." Based on that wording — which did not specifically permit the subsidy of insurance bought on federal exchanges — lawsuits were filed challenging an IRS regulation that allows people to receive subsidies in all states. Oklahoma challenged the IRS rule in 2012. On Tuesday, U.S. District Judge Ronald White ruled in favor of the state, saying that the Obama administration's decision to award subsidies through either a state-run exchange or federal exchange is an improper and invalid interpretation of the law and must be struck.
This week's ruling is the latest in a medley of court judgments about the same issue, but the second judgment against the government on the subsidy question. The core question is whether subsidies may be awarded in the 36 states that chose not to set up their own insurance marketplaces and instead relied on the federal government's exchange.
In July, a divided three-judge panel of the D.C. Circuit Court of Appeals ruled tax subsidies may not be provided in states that did not establish their own exchanges. Two hours later, a three-judge panel from the Fourth U.S. Circuit Court of Appeals unanimously held low- and middle-income Americans in all states can legally receive subsidies for health insurance under the PPACA.
5. Earlier this month, the Treasury Department firmed up tax codes to deter U.S. companies from moving their legal headquarters to tax-friendlier countries. When a company makes that move, known as an inversion, it reincorporates in a country with lower taxes, such as the United Kingdom or Ireland, while maintaining most operations in the U.S. The tax code changes took effect immediately and could influence several pending mergers and acquisitions, including Medtronic's proposed acquisition of Irish medical devicemaker Covidien and Salix Pharmaceutical's acquisition of the Italian Cosmo Pharmaceuticals, according to the WSJ.
6. Some of the most recognizable leaders in healthcare are pinning end-dates to their careers. Nancy Schlichting, CEO of Henry Ford Health System in Detroit, is the latest. She shared her plans this week to retire in December 2016 after leading the system since 2003. The announcement came with news that Wright Lassiter, CEO of Alameda Health System in Oakland, Calif., will begin work as president of the System Dec. 15 before taking over as CEO upon Ms. Schlichting's departure.
Speaking of CEO exits, the departure of an executive in the financial world has sparked conversation about what it means when the face of an organization suddenly leaves to work elsewhere. Bill Gross, co-founder and chief investment officer of Pimco, left the company he founded in 1971 to join the smaller Janus Capital Group. The news follows reports of tension between executives at the company. Early this week, Pimco saw about $10 billion withdrawn in the wake of Mr. Gross' departure. Executives called Wall Street firms and financial advisers to diminish any sense of turmoil, reinforce their confidence and ultimately maintain the company's position as the largest bond manager in the world. If rivals were to persuade Pimco clients to move their business elsewhere, the bond world would be reordered, according to the WSJ.
7. John Sheridan, president and CEO of Cooper University Health System in Camden, N.J., and his wife were found dead in their home early this week after a house fire. Mr. Sheridan, 72, began his work at Cooper in 2005 as senior executive vice president before he was appointed president and CEO in 2008. Before then, Mr. Sheridan was a senior partner and co-chairman of a New Jersey law firm and also served for several years as general counsel to the New Jersey Turnpike Authority and the Carrier Clinic in Belle Meade, N.J.
Detectives from the county's arson task force and major crimes unit have been assigned to the case. As of late Tuesday, the Somerset County Prosecutor's Office was still waiting for preliminary results from the state medical examiner before it releases further details about the Sheridans' deaths.
Several in the healthcare and political community in New Jersey have expressed their grief. New Jersey Governor Chris Christie released a statement saying, "John was an outstanding public servant, a leader in the healthcare industry and a true New Jersey treasure. Joyce was an outstanding teacher, wife and mother. Their family and loved ones are in our thoughts and prayers as they deal with the loss of these two special people."