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A federal judge ruled last week that the Obama administration has been improperly funding subsidies for consumers buying coverage through the ACA insurance exchanges. The judge's rationale: Congress authorized the program but never actually provided the money for it. This is a huge win for the House of Representatives in its lawsuit against the White House, according to Politico. If the subsidies are ultimately struck down, it would support those who say the HIX plans are not actually affordable. The program will be allowed to continue pending appeal. (Politico) 
Faced with a potential 4-4 tie, the U.S. Supreme Court returned to lower courts cases related to how religious not-for-profits must deal with the Affordable Care Act's contraceptive coverage mandate. "Given the gravity of the dispute and the substantial clarification and refinement in the positions of the parties, the parties on remand should be afforded an opportunity to arrive at an approach going forward that accommodates petitioners' religious exercise while at the same time ensuring that women covered by the petitioners' health plans 'receive full and equal health coverage, including contraceptive coverage,'" the court wrote. (Modern Healthcare) 

According to research published in JAMA Internal Medicine, of the $760 billion spent on prescription drugs between 2010 and 2012, about $73 billion may have been unnecessarily spent on brand-name drugs rather than less costly alternatives. Nearly $25 billion of the $175 billion patients paid out-of-pocket might have been saved by therapeutic substitutions--but that's controversial. "To achieve the benefits of within-class substitution, we need wider adoption of systematic protocols, aligned with physician judgment, as to when such substitutions are beneficial and when not," Dr. Joseph Ross of Yale, JAMA Internal Medicine  associate editor, wrote in an accompanying editorial. (Reuters; JAMA Internal Medicine)

Innovation & Transformation  
Most people may think of pharmacy technicians as people who just assist the pharmacist in filling prescriptions or cashing out customers, over the past 20 years their roles and responsibilities have changed. Many are now also involved in stocking shelves, filling vials, managing inventory and assisting customers with coverage and reimbursement issues. Some states go so far as to allow technicians to check each other's prescriptions through a tech-check-tech program. Others allow telepharmacy companies to be staffed by certified pharmacy technicians. (Drug Topics)
Research published in JAMA Dermatology raises serious concerns about telemedicine. Researchers posing as patients with skin problems sought help from 16 online telemedicine companies. In addition to numerous misdiagnoses, some providers prescribed medications without asking key questions about patients' medical histories or warning of adverse effects, the researchers found. The authors couldn't determine whether the same clinicians seeing the same patients in a traditional setting would have performed better. (Wall Street Journal; JAMA Dermatology) 
Consumers & Providers
More consumers will have only one option on the health insurance exchanges, according to data from the Kaiser Family Foundation. It predicts 650 counties nationwide will be left with just one insurer, compared to 225 in 2016. The most severely affected states are expected to be Alaska, Alabama, Kentucky, Tennessee, Mississippi, Arizona and Oklahoma. Most counties are in rural areas where health care costs tend to be higher and insurance companies are losing more money. The possibility of areas with no ACA marketplace insurers can't be ruled out. (Wall Street Journal) 
It's getting harder to trust EHR data, but patient access can help reduce inaccuracies, according to Dhruv Khullar, MD, MPP, a resident at Massachusetts General Hospital, and Health Datapalooza 2016 panelist. It's a trade-off, said fellow panelist Daniel Barth-Jones, an assistant professor of clinical epidemiology at the Mailman School of Public Health. "We can't get it both ways in terms of having perfect information and perfect protection. But we can find balance points that both provide very small risks and keep the statistical accuracy of the data." (FierceHealthIT)
Polypharmacy is common, especially among the elderly, but it isn't always necessary. Speaking at the American College of Physicians annual meeting, Amit Shah, MD, of the Mayo Clinic, said, "As a geriatrician, I have cured more disease by stopping medications than [by] starting them." Shah identified several factors, including "prescribing inertia" and patients and physicians not wanting to rock the boat. Shah went on to list his 10 steps for successful medication "debridement." Among them: Consider whether the drug has outlived its usefulness for that patient. (MedPage Today) 

Research published in the New England Journal of Medicine finds caregivers of ICU survivors (who received mechanical ventilation for a minimum of seven days) are at a high risk of developing clinical depression. The study found most caregivers reported high levels of depression symptoms, which commonly persisted up to one year and---in some cases--did not improve. (NEJM; Science Daily)
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Coming Soon: Comprehensive medication management
A new report slated for release next week,Get the Medications right:  
a nationwide snapshot of expert practices--Comprehensive medication management in ambulatory/community pharmacy, reveals that clinical pharmacists, in a variety of community and ambulatory care settings, are optimizing medication use and making an impact on the communities they serve. The report, produced by Health2 Resources and Blue Thorn Inc., is sponsored by a grant from the Community Pharmacy Foundation. Look for details next week. 
New & Noted   
End-of-life planning: A new survey out of Massachusetts finds that although 85 percent of survey respondents said they think physicians and their patients should talk about their wishes for end-of-life care, only 15 percent have had such a conversation, according to an announcement by the Massachusetts Coalition for Serious Illness Care. (FiercePracticeManagement)

Colorado Amendment 69: Insurers and hospitals are taking seriously the campaign to establish a universal health care system in Colorado. A single donor, Anthem, has kicked in $500,000 to defeat the initiative, or more than three times the amount given by all proponents combined, the Denver Post reports. (Denver Post)

Mobile health isn't necessarily high tech. Sometimes, it's literally mobile--in a van or bus. "There are a lot of mobile clinics right now, many more than people might imagine," says Caterina Hill, research associate at Harvard Medical School and co-investigator at Mobile Health Map. She places the number around 2,000. "We've estimated that an average visit to a mobile clinic costs the funder $155, but saves 12 times that in terms of long-term benefits and avoided emergency department visits." (Marketplace)

MarketVoices...quotes worth reading
"When I speak with patients, I find that their electronic medical record is littered with inaccuracies." -- Dhruv Khullar, MD, MPP, a resident at Massachusetts General Hospital, and panelist at Health Datapalooza 2016, quoted in FierceHealthIT

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Wednesday, May 18, 2016