Governor Rauner Seeks to Cut Medicaid by $1.5 Billion :: Illinois Nursing Home Abuse Blog

 

…..But the governor’s cuts go far beyond that to broader and traditional medical providers. While eligibility requirements will not change, and copays or premiums will not increase for individual patients, certain providers will pick up the slack. Hospitals will lose 13% of its budget down to $735 million and could lead to the loss of thousands of jobs at those hospitals, based on at least one estimate. As far as nursing homes, about $216 million would be removed from the Medicaid budget for expenses at those facilities. There would be an additional $40 million cut from pharmaceutical-related expenditures.
State's Budget Woes

The state budget cuts here are an attempt to make up for Illinois’s immense $6.2 billion deficit. Yet while the state may save and work toward balancing its budget, it remains to be seen whether medical providers – largely hospitals and nursing home in this situation – will truly take a cut, or simply pass the cost on to private insurance, which could potentially result in eventual premium and/or copay amounts.

This also comes on the heels of the Patient Protection and Affordable Care Act, which among its many provisions included an expansion of Medicaid that would be funded by the federal government, but which states could also choose to opt out. While reports indicate Governor Rauner considered this option, it appears that for the moment it won’t and that Illinois will accept that money. The proposed budget also apparently presumes that many Illinois residents will take advantage of the health care exchange subsidized by the ACA, which will save the state money as well.

Read the entire article by clicking on the following:  Governor Rauner Seeks to Cut Medicaid by $1.5 Billion :: Illinois Nursing Home Abuse Blog

In bid to lower costs, FDA OKs sale of 'biosimilar' knockoff of Amgen drug - LA Times

By Stuart Pfeifer

Stuart Pfeifer is a business reporter for the Los Angeles Times. He covers pharmaceutical companies, hospitals and healthcare. Stuart joined The Times in 2000 as a reporter for the Metro staff, covering courts, county government and law enforcement. Before his career at The Times, Stuart worked as a reporter for the Orange County Register. He is a graduate of Cal State Fullerton

Food and Drug Administration approved the first copycat version of a biologic drug in the United States, allowing a Swiss company to sell a knockoff of Amgen Inc.’s chemotherapy recovery drug Neupogen.

The FDA authorized Novartis' Sandoz unit to sell its version of the Amgen drug in the United States. Sandoz intends to market it under the brand name Zarxio.

The decision is expected to pave the way for other “biosimilar” drugs to hit the U.S. market in coming years, a move that many say will lower drug costs by increasing competition.

Biologic drugs like Neupogen had faced competition from knockoff drugs outside the United States for several years, but not in the United States. Sandoz sells biosimilars in more than 60 foreign countries. It has sold the Neupogen knockoff under the name Zarzio overseas since 2009.

Although pill medications had faced generic competition for years in the United States, the FDA had never before approved a copycat version of a biologic drug.

Things started to change in 2010 when the Affordable Care Act included a clear, concise approval process for knockoff versions of biologics. The move was intended to increase competition and reduce costs of the effective, but often expensive, drugs.

Biologic drugs are made from living cells or tissue and are impossible to replicate exactly. That’s why knockoff versions are called “biosimilars” and not generics.

In its application to the FDA, Sandoz said studies had found its version to be “highly similar” to Neupogen with patients receiving similar medical benefits.

Amgen has fought to delay the sale of Sandoz’s Zarzio. In October, Amgen sued Sandoz in federal court for allegedly infringing on its patent. Last month, Amgen asked a judge to temporarily block Sandoz from selling its Neupogen version, even if it wins FDA approval.

Sandoz has said it followed the law and looks forward to its day in court. A hearing on Amgen’s request is scheduled for March 13 in San Francisco.

Sandoz also is pursuing FDA approval of two other Amgen drugs, Neulasta, which also boosts white blood-cell counts, and Enbrel, which treats rheumatoid arthritis. Another company, Hospira Inc., has applied to the FDA for approval of a biosimilar version of Amgen’s anemia drug Epogen.

The four Amgen drugs targeted by biosimilar competition generated nearly $11 billion in U.S. sales last year.

Outside the United States, biosimilars have typically sold at a 20% to 30% discount to the original drug, while generic pills often sell at up to 90% discounts. Analysts expect roughly the same discounts in the United States.

Still, the price cuts could shave billions of dollars a year from the cost of U.S. healthcare. A RAND study estimated that biosimilars will generate $44 billion of savings in 10 years

In bid to lower costs, FDA OKs sale of 'biosimilar' knockoff of Amgen drug - LA Times

My View: Hospitals abuse drug program meant to help poor - Opinion - Rockford Register Star - Rockford, IL

 

By David Miller
Posted Dec. 12, 2014 @ 5:00 pm

An obscure federal program designed to help poor Americans afford prescription drugs is being used to boost the profits of the nation’s largest hospitals and pharmacies.

Many of Illinois’ 188 hospitals are taking part in this abuse. And Washington is finally taking notice, pledging to refocus the 340B program so that it serves those it was intended to help.

When Congress created 340B in 1992, lawmakers hoped that by requiring pharmaceutical firms to discount drugs sold to hospitals serving large numbers of poor and uninsured, they’d help those hospitals without tapping taxpayers.

But the law has morphed considerably over the past 22 years. And today, hospitals aren’t required to pass 340B discounts along to patients. Consequently, hospitals participating in the program receive discounted drugs for all their patients — even the ones that are insured or can afford the cost of care.

Here’s an illustration of how this scheme works. Say a drug normally costs $100, but a hospital can purchase it for $60 directly from the drug manufacturer as part of the 340B program. When the hospital treats an insured patient, it bills the insurer the full $100 price for the drug. In addition, the hospital typically collects a co-pay from the patient, say $10.

The end result is that the hospital makes a $50 profit on a drug that cost the hospital only $60. That’s an 83 percent return that has nothing to do with helping the poor and uninsured.

This hypothetical example may actually understate how much money hospitals are making off 340B. Last year, the North Carolina News & Observer reported “large hospitals (with access to 340B discounts) are dramatically inflating prices on chemotherapy drugs at a time when they are cornering more of the market on cancer care. ... Hospitals routinely mark up prices on cancer drugs two to 10 times or more over cost. In some cases, the markup is far higher.”

With this kind of money to be made, it’s no wonder why almost every hospital in the country is vying to be part of the program. In order to be deemed eligible, hospitals have only to meet certain benchmarks for the number of medically underserved patients they treat. But there’s scant evidence that the method used for determining eligibility corresponds with serving high numbers of the poor and uninsured. In fact, the federal Medicare Payment Advisory Commission itself has expressed skepticism of the methodology.

As a result, 1 in 3 U.S. hospitals now participates in the 340B program. The Berkeley Research Group estimates that expenditures under the program will double from $6 billion in 2010 to $12 billion in 2016.

This is not only fiscally irresponsible and unsustainable, it’s wrong. The 340B program is supposed to help poor patients, not hospitals’ profit margins. Federal lawmakers must get 340B back on track.

 

Read more: http://www.rrstar.com/article/20141212/Opinion/141219749#ixzz3LjMPAUcV

Bionic body parts: what's already here (eyes!) and what's coming soon

 

In June of 2014, the FDA approved the first exoskeleton for medical use: ReWalk. The system consists of motorized leg braces that someone tells to walk, stand up, or sit down using a remote control. The person also wears a backpack housing ReWalk's power supply and computer. The device is specifically approved for people with lower-body paralysis.

Other notable medical exoskeletons include the Ekso Bionics' Ekso, which is approved for use in physical therapy and rehab, and the HAL series by Japanese company Cyberdyne.

The military has also been a big player in this field. Ekso Bionics previously developed the hydraulic powered HULC (Human Universal Load Carrier), which Lockheed Martin is now developing for military and industrial uses. Lockheed's website describes the HULC as something that could help military personnel carry up to 200 pounds of heavy combat gear for extended periods of time without fatigue. And Raytheon also has a suit: the XOS.

Several other programs having also been developing strength suits for military use, including US Special Operations Command's TALOS (Tactical Assault Light Operator Suit), which seeks "an advanced infantry uniform that promises to provide superhuman strength with greater ballistic protection," according to a US Army statement, and Darpa's Warrior Web program, with the goal of a soft, pliable supersuit.

2) Bionic eyes that give sight to the blind

© Provided by Vox.com Second Sight Argus.

There are many researchers working on bionic eyes, but Second Sight's Argus II implant became the first FDA-approved bionic eye in 2013. And it actually does give sight to the blind — it's approved for people with retinitis pigmentosa, a disease that affects more than 2 million people around the world.

The Argus II involves a 60-electrode array that gets implanted in the eye in order to restore its function. A camera mounted on a pair of glasses records visual information about the world. This info then gets parsed by a small video-processing unit. Then this information gets wirelessly transferred to the electrode-array implant, which activates neurons in the back of the eye and sends messages to the brain.

So far, the resolution is limited, and it definitely doesn't bring people anywhere near 20/20 vision. But it provides enough grayscale resolution to let people see the outline of a doorway, the movement of a person or large object, or the lines on a crosswalk. Some have even been able to identify letters of the alphabet that are a few centimeters tall.

Second Sight is currently working to bring the technology to even more people. They announced in September that they'll be starting trials for blind patients with age-related macular degeneration, which affects 20 to 25 million people worldwide.

And if this seems totally nuts to you, keep in mind that bionic ears — cochlear implants — are already worn by some 300,000 people.

3) Robot limbs that can be controlled by the mind

© Provided by Vox.com Braingate 2.

One of the most impressive pieces of bionics research has been the BrainGate project, which uses brain implants in people with paralysis to allow them to physically interact with the world.

The implant has 96 electrodes that read signals from the brain. And with intensive and long training, some patients have been able to use the system to do some impressive things.

In a study published in Nature in 2006, researchers showed that a patient could use the system to move a computer cursor, open simulated email, and operate a television. And in 2012, they followed up with another paper and showed that two people used the system to instruct a robot hand to pick things up. One patient who had the implant for five years was even able to use the robotic hand to drink coffee. The project still continues today, and researchers are currently recruiting for even more trials.

4) Prosthetic limbs that feel like part of your body

© Provided by Vox.com

Touch Bionics i-limb ultra revolution.

Prosthetic limbs have existed for some time — but now they're getting smarter.

For example, Touch Bionics' i-Limb Ultra, a prosthetic hand with motorized joints, can smartly shape itself to an object someone is trying to grasp or read muscle signals from the skin of someone's upper arm to take on a pre-programmed configuration.

More promising still, researchers are now working on experimental bionic limbs that can communicate more intuitively with people's bodies. This can involve sensors on the skin or even sensors implanted into the body, such as the IMES muscle sensors being used with experimental prosthetics on real people. "I still close what I think is my hand," James Sides told Popular Science. "I open my hand, and rotate it up and down; I close my fingers and the hand closes. It’s exactly as if I still had a hand."

Another possibility is to interface with implants that attach directly to people's nerves and brains.

The next step beyond that is getting feedback from the limb back to the person so that people can feel these prosthetics. This research is still in early stages, but people have seen that having a feel for what's actually going on can improve dexterity.

5) Deep-brain stimulation to treat brain ailments

© Provided by Vox.com Deep brain stimulation DBS Medtronic.

The brain sends signals using both chemicals and electricity. And for decades the main way to intervene and fix brain problems was through the chemical side — through drugs.

But recently that has begun to change. Some people now receive implants in their brains that gave off electrical currents to simulate their brain cells. Think of it like a brain pacemaker.

This technique is called deep-brain stimulation. And it's already FDA-approved for treating Parkinson's disease and a movement disorder called dystonia. Medtronic's deep-brain stimulation system, for example, has been implanted in some 110,000 people. The technique has also been tested in people for psychiatric illnesses, including obsessive-compulsive disorder and severe depression.

 

Above is from MCN:  Bionic body parts: what's already here (eyes!) and what's coming soon

Doctor accused of sex assault on Des Plaines woman - chicagotribune.com

By Jonathan BullingtonTribune reporter

Charles S. Dehaan, 59, was arrested Friday morning at his home in Belvidere on charges of aggravated criminal sexual assault and aggravated criminal sexual abuse, according to Des Plaines Police Department Cmdr. Randy Akin. He is expected to appear in bond court on Sunday.

Starting in January of 2009, Dehaan allegedly began making in-home monthly visits to a 59-year old Des Plaines woman recovering from surgery, police said. During the course of those medical examinations, Dehaan allegedly began to fondle the woman's breast and genital area, police said, and also exposed himself while exhibiting "evidence of sexual arousal."

His alleged actions continued through July of 2012, Akin said, but the patient’s medical condition prevented her from stopping them…..

Dehaan is also the subject of a federal indictment earlier this year on allegations of Medicare fraud, court documents show.

Read the entire story by clicking on the following:  Doctor accused of sex assault on Des Plaines woman - chicagotribune.com

Rockford doc accused of Medicare fraud OK'd to leave jail - News - Rockford Register Star - Rockford, IL

 

Rockford doctor arrested Friday and charged with Medicare fraud returned today to federal court, where a judge granted several conditions for him to be released from custody.

Dr. Charles DeHaan appeared in court wearing an orange Boone County Jail uniform and is expected to be released from jail later today. He lives in Belvidere.

State officials temporarily suspended DeHaan's physician and surgeon license and his Illinois Controlled Substance license this month, citing a pattern of inappropriate sexual conduct with multiple patients.

The cases intersected in federal court as Magistrate Judge Ian D. Johnston drew up terms for his release.

DeHaan is not allowed to have contact with current or former patients. He's involved with a private practice called Housecall Physicians Group of Rockford.

Any travel he does is restricted to the court districts of northern Illinois, northern Indiana and western Michigan.

DeHaan's mother lives in Michigan, which is why he's allowed to travel there. Johnston denied defense attorney Debra Schafer's request to also allow DeHaan to visit his daughters in Oregon and Texas.

DeHaan also is not allowed to visit assisted-living facilities where former or current patients are. The state's complaint regarding his suspended licenses involves reports of inappropriate sexual conduct with elderly patients at senior residential facilities between 2009 and 2013.

DeHaan is still allowed to visit any assisted-living facility where his mother lives or may live in the near future.

His wife, Mary, will be a third-party custodian responsible for reporting to the court if her husband violates any conditions of his release. DeHaan also was issued a $4,500 unsecured bond, which he doesn't have to pay but would pay if he violated his release terms.

Click on the following for more details:  Rockford doc accused of Medicare fraud OK'd to leave jail - News - Rockford Register Star - Rockford, IL

Touting Obamacare, US says millions could pay less than $100 a month - CSMonitor.com

By Linda Feldmann, Staff writer / September 17, 2013

Under Obamacare, an estimated 21.9 million uninsured Americans will be eligible to purchase subsidized health insurance via online marketplaces, which begin enrollment Oct. 1. Of those, nearly half – 10.8 million – may be able to buy insurance for $100 or less per month, after factoring in tax credits, according to a report issued Tuesday by the Department of Health and Human Services (HHS).

An additional 12.4 million uninsured Americans will be newly eligible for either Medicaid or the Children’s Health Insurance Program, federal-state health-insurance programs for low-income people, the report says. This group will pay either a small premium or nothing.

Click on the following for the whole story:  Touting Obamacare, US says millions could pay less than $100 a month - CSMonitor.com

Feds to Publicize Drug and Device Company Payments to Doctors Next Year - ProPublica

by Charles Ornstein and Tracy Weber
ProPublica, Feb. 1, 2013, 4:25 p.m.

The release of payments data in September 2014 would mark a milestone in the push to bring transparency to medicine. Once posted, patients will be able to see if their physicians receive money from any of the companies whose products they prescribe. Studies have shown that such payments, however small, bias physicians towards companies and their products.

Until now, ProPublica's Dollars for Docs tool [2] has been the only freely available source for the public to search and analyze the payments made since 2009

Click on the following for more details: Feds to Publicize Drug and Device Company Payments to Doctors Next Year - ProPublica

Questions and answers on Illinois insurance exchange plans - DailyHerald.com

By Associated Press

Here are some fast facts about how buying health insurance will change in Illinois as President Barack Obama's health overhaul takes effect and the first insurance exchange starts operating later this year:

Q. How many people are uninsured in Illinois and how many of those are projected to get insurance under the exchange?

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A. Nearly 1.8 million Illinois residents are uninsured. An estimated 486,000 Illinois residents will get coverage from commercial insurers through the exchange in 2014, growing to 1 million customers by 2016.

To read more Q &A click on the following: :  Questions and answers on Illinois insurance exchange plans - DailyHerald.com

Daily Chronicle | With Illinois Cares Rx gone, elderly struggle with drug costs

 

Illinois Cares Rx program ended just weeks after Gov. Pat Quinn signed legislation axing it in an effort to save $72 million and help fill a $2.7 billion hole in the Illinois Medicaid budget – giving seniors and the disabled, who also qualified for the program, little time to plan.

At the time, some agencies advised worried seniors to get a 90-day supply of their prescription drugs.

Now they’re bracing for another surge of calls when seniors need medication refills they can no longer afford.

. About 168,000 seniors and disabled people were enrolled in the program when it ended. Of those, about 143,000 are 65 and older and about 25,000 are disabled people younger than 65.

They include individuals who make less than $22,340 a year and couples who make less than $30,260 a year.

Because the program had no restrictions on assets, people could have large bank accounts and still be eligible.

Click on the following to read all of the story:  Daily Chronicle | With Illinois Cares Rx gone, elderly struggle with drug costs

Northwest Herald | Board approves Centegra Hospital – Huntley

 

– Centegra Health System officials celebrated with a mix of relief and joy Tuesday after a state panel approved their plans for a $233 million project by a 6-3 vote.

Held at the Bolingbrook Golf Club, the Illinois Health Facilities and Services Review Board hearing reconsidered Centegra's application for a permit to proceed with its 128-bed hospital in Huntley.

Floyd and other officials from surrounding health care providers, including Advocate Good Shepherd in Barrington, expressed disappointment with the board's 6-3 vote in favor of Centegra Hospital - Huntley.

"It is unfortunate that board members chose to reverse their decision from December to deny this project. Nothing has changed related to this application,” said Karen Lambert, president of Advocate Good Shepherd Hospital. “This hospital is not needed. It would duplicate services, and it could reduce the quality of care in the area by pulling patients from other health care providers.”

Read the entire article by clicking on the following:  http://www.nwherald.com/2012/07/24/board-approves-centegra-hospital-huntley/agybb7h/?page=2

Komen Foundation VP resigns after funding controversy - CNN.com

 

Handel, the foundation's senior vice president for policy, opposes abortion. She was the driving force behind the foundation's decision not to renew parts of its long-standing partnership with Planned Parenthood, the Huffington Post reported earlier this week after reviewing internal e-mails at the foundation. Planned Parenthood operates hundreds of family clinics where abortions are performed

Click on the following to read the entire story:  Komen Foundation VP resigns after funding controversy - CNN.com

Medicare: How Paul Ryan's budget would change it - CSMonitor.com

 

Medicare is a fee-for-service program which itself pays for health care procedures for most beneficiaries. Under the GOP plan, drafted largely by Budget Committee chairman Rep. Paul Ryan of Wisconsin, it would be changed into a program which subsidizes the purchase of health insurance by individuals.

Current Medicare beneficiaries, and those approaching retirement age, would not be affected by the GOP’s proposed changes. Instead they would apply to people currently 54 years of age and younger

Making health care something seniors purchase from their own pockets would unleash the power of free market competition, according to Ryan. Customers would gravitate to programs that offered higher value or greater quality, he said.

Critics counter that the Medicare subsidy inevitably would shrink relative to health-care costs due to the high rate of medical inflation

Click on the following for more details:  Medicare: How Paul Ryan's budget would change it - CSMonitor.com

SwedishAmerican Hospital seeks hearing on OSF acquisition - Rockford, IL - Rockford Register Star

 

Attorney Daniel Lawler filed a public hearing request on behalf of SwedishAmerican Hospital to the Illinois Health Facilities and Services Review Board.  
The public hearing be at 10 a.m. April 15 at Rockford City Hall, 425 E. State St., in the second-floor City Council chambers.

state certificate of exemption, as well as federal approval, is needed to complete the transaction. The fair market value of the deal is listed as $212.6 million.

all allegations or assertions should be supported with two copies of documentation or materials that are printed or typed

Click on the following for more details:  SwedishAmerican Hospital seeks hearing on OSF acquisition - Rockford, IL - Rockford Register Star

Their Own Private Europe - NYTimes.com

Economist Krugman replies to Representative Ryan’s  dubious assertions about employment, health care” and its relationship to the Republican view of Europe

Mr. Ryan made highly dubious assertions about employment, health care and moreAmerican conservatives have long had their own private Europe of the imagination — a place of economic stagnation and terrible health care, a collapsing society groaning under the weight of Big Government. The fact that Europe isn’t actually like that — did you know that adults in their prime working years are more likely to be employed in Europe than they are in the United States? —

truth was that in 2006-2007 Ireland was running a budget surplus, and had one of the lowest debt levels in the advanced world. So what went wrong? The answer is: out-of-control banks….

balanced budgets won’t protect you from crisis if you don’t effectively regulate your banks — a point made in the newly released report of the Financial Crisis Inquiry Commission, which concludes that “30 years of deregulation and reliance on self-regulation” helped create our own catastrophe

Click on the following for Mr. Krugman’s editorial:  Their Own Private Europe - NYTimes.com

Justice Dept. Sues Michigan Blue Cross Over Pricing Deals - NYTimes.com

 

Blue Cross, in effect, bought protection from competition — by agreeing to increase the amounts it would pay to certain hospitals to induce the hospitals to agree to the “most favored nation” clauses.

Blue Cross Blue Shield of Michigan, a nonprofit company, is by far the largest provider of commercial health insurance in Michigan, with revenue of more than $10 billion in 2009. It insures more than nine times as many Michigan residents as its next largest

Justice Dept. Sues Michigan Blue Cross Over Pricing Deals - NYTimes.com

McHenry Dentist shutters office

The McHenry office [of orthodontist Daryl Ashbeck] was closed early Friday afternoon, with the lights out and the shades half-drawn.

Illinois Department of Financial and Professional Regulation show that Ashbeck’s dental license was suspended March 9, because Ashbeck failed an alcohol test he agreed to take as a condition of getting his license back in November 2008.

Ashbeck also is facing a felony forgery charge in McHenry County for allegedly forging a prescription for Tussionex, which includes an antihistamine and hydrocodone. He allegedly presented the fake prescription on a Rockford dentist’s pad at a Crystal Lake drug store in February, local court records show.

A failure to notify patients could be viewed as patient abandonment and could cause a new case to be brought against a dentist, Hofer said. That new case ultimately could lead to a fine or losing the license altogether.

Click on the following for more details:  Northwest Herald | Dentist shutters office

Out of State Dentists to Help Illinois Families

State Representative David E. Miller, who himself is a dentist and the House sponsor of the bill. "They can give their services weather it's a church or a clinic � so instead of going through a whole licensure process they can be able to practice here and provide care for those who need it."

10 day temporary permit is issued by the Department of Financial and Professional Regulation and is for dentists who are providing voluntary care. The bill was also sponsored by State Senator Pamela Althoff.

Click on the following for more details:  Galesburg Radio 14...WGIL

Opponents take last stand against health care bill - Yahoo! News

Experts say none of it is likely to work, but it will keep the issue, and the outrage, alive until Election Day.

"I am surprised by the mobilization of the states. It does strike me as a kind of civil disobedience, a declaration that we're not going to follow the law of the land," said Mark Hall, a professor of law and public health at Wake Forest University.

Because the individual mandate does not take effect until 2014, the states challenging that have time to work on legislation.

Click on the following for more details:  Opponents take last stand against health care bill - Yahoo! News

Walgreens starts free diabetes tests today

free diabetes tests will be available at Walgreens stores in thousands of communities nationwide through Feb. 18.

Nearly 24 million Americans have diabetes, and an estimated 6 million or so are undiagnosed.

Click on the following for more details:  Walgreens starts free diabetes tests today | Crain's Chicago Business