ACA replacement keeps some popular provisions, abolishes mandates

The ACA replacement, unveiled Monday night, effectively repeals the individual and employer mandates and slashes Medicaid expansion. It keeps some popular provisions, including allowing adult children to stay on their parents’ plan until age 26, the ban on lifetime coverage caps, and the prohibition on insurers from charging more to people with preexisting conditions. However, if coverage lapses, insurers can charge a flat 30 percent surcharge on top of the premium. Beginning in 2020, the GOP plan calls for tax credits to help people pay for health insurance based on household income and age. The New York Times provided an interactive graphic to compare the GOP bill to the ACA. ( Kaiser Health News; New York Times; text of bill)

For whom do patient-advocacy groups really advocate?

A new study calls into question whether patient-advocacy organizations are truly advocating for patients. At least 83 percent of the nation’s 104 largest patient-advocacy groups take contributions from the drug, medical device and biotech industries, according to last week’s New England Journal of Medicine. Of the 18 nonprofits not reporting pharmaceutical money, 13 failed to disclose their donors at all. Just one of the 104 groups stated explicitly that it does not accept industry money. The authors recommend more transparency about industry involvement. ( Kaiser Health News ; NEJM)  

Early literacy's impact on poverty, health and well-being

The most effective way to improve a child’s reading ability is to improve access to the written word. But preschoolers from low-income families have far less access to age-appropriate books than do their more affluent peers. The most recent issue brief from Rocky Mountain Health Plans explores this issue. Featured experts: V. Fan Tait, MD, FAAP, chief medical officer of the American Academy of Pediatrics, and Meredith Hintze, executive director of Reach Out and Read Colorado. (issue brief)

Portable policies: Perennial proposal's hard to implement

Republican leaders such as House Speaker Paul Ryan of Wisconsin and Ways and Means Chairman Kevin Brady of Texas have promoted the idea that consumers should have a “health care backpack” that would allow for insurance portability. It’s an attractive idea, but as Kaiser Health News points out, “accomplishing that would not be easy--mostly because the health care system is not built that way.” ( Kaiser Health News)

Reversing the trend, Banner builds psychiatric hospital

A shortage of psychiatric beds means patients with mental health issues often end up in the emergency department. But that may be changing in Arizona, which has one of the worst bed shortages. Banner Health estimates 16,000 mental health patients show up at its ERs every year. At Banner Goldfield Hospital in rural Apache Junction, mental health patients often fill all eight emergency beds. In response to the shortage of treatment options, Banner is building a new $36 million behavioral health hospital with 96 private, in-patient beds. (Marketplace)

Bacteria can shimmy up the drain, study finds

Forget the itsy-bitsy spider: Bacteria are climbing up the drain, according to research published in Applied and Environmental Microbiology. Bacteria can thrive in those U-shaped pipes under the sink. Sinks have been linked to numerous bacterial outbreaks; researchers wanted to determine just how the pathogens spread. With the daily addition of a nutrient “broth” that mimicked liquids commonly poured down hospital sinks, “the bacteria flourished, shimmying up the pipe at a rate of about 2.5 centimeters per day,” Science Magazine reports. Next up: identifying how bacteria move from sinks to patients. ( Science Magazine; Applied and Environmental Microbiology)

Study: NPs, PAs provide same quality of care as physicans

In community health centers, nurse practitioners and physician assistants provide the same quality of care as doctors do, according to research published in Medical Care. Researchers also found that patients seeing NPs were more likely to receive health education and smoking cessation counseling than patients seeing physicians; PAs were more likely to deliver health education counseling than were physicians. The findings, the first comparison to focus on community health centers, could have implications for the structure of health centers in the future, researchers say. ( Advisory Board Daily Briefing; Medical Care)

Expect further ACO refinements

ACOs have become popular for physicians who want to stay independent but need help with administrative burdens. Physician-led ACOs will most likely drive their growth, according to experts interviewed by Medical Economics. Doctors can expect to see further refinements in how groups operate, including new ACO models from CMS. “The ACO program has evolved in the last five years, and all the changes have been based on feedback,” says Tim Gronniger, CMS deputy chief of staff. Experts agree patient engagement is the biggest area of potential savings growth. ( Medical Economics)

It's a thing: abusing pets to get drugs: Around the country, there have been reports of pet owners who intentionally harm their pets to get opioids. A more common scenario, however, involves pet owners who are taking their pets’ pain medicine. Atlanta vet Dr. Duffy Jones points out that either way, it’s cruel. “It’s just as bad because if a dog’s in pain, they really need [the pain medication].” ( CBS)

Medicaid compromise in the works: A group of Republican governors is developing a Medicaid compromise plan that will preserve Medicaid expansion while satisfying Republican goals of repealing Obamacare and giving more control of Medicaid to the states. ( Bloomberg)           

Colonoscopy complications: Research published in Gastroenterology found that 1.6 percent of 325,000 low-risk healthy patients who had a colonoscopy in 2010 experienced complications serious enough to send them to a hospital or emergency department within seven days. ( Medpage Today; Gastroenterology)