First Edition: Friday, Dec. 13, 2024

KFF Health News: Removing A Splinter? Treating A Wart? If A Doctor Does It, It Can Be Billed As Surgery
When George Lai of Portland, Oregon, took his toddler son to a pediatrician last summer for a checkup, the doctor noticed a little splinter in the child’s palm. “He must have gotten it between the front door and the car,” Lai later recalled, and the child wasn’t complaining. The doctor grabbed a pair of forceps — aka tweezers — and pulled out the splinter in “a second,” Lai said. That brief tug was transformed into a surgical billing code: Current Procedural Terminology (CPT) code 10120, “incision and removal of a foreign body, subcutaneous” — at a cost of $414. “This was ridiculous,” Lai said. “There was no scalpel.” He was so angry that he went back to the office to speak with the manager, who told him the coding was correct because tweezers could make an incision to open the skin. (Rosenthal, 12/13)

KFF Health News: More Californians Are Freezing To Death. Experts Point To More Older Homeless People.
A growing number of people — many of them older and homeless — are freezing to death during winter. Hypothermia from exposure to cold temperatures was the underlying or contributing cause of death for 166 Californians last year, more than double the number a decade ago, according to provisional death certificate data from the U.S. Centers for Disease Control and Prevention. The age-adjusted rate of 3.7 deaths per million residents in 2023 was the highest in the state in at least 25 years. (Reese, 12/13)

KFF Health News' 'What The Health?' Podcast: A Killing Touches Off Backlash Against Health Insurers 
The shooting death of UnitedHealthcare CEO Brian Thompson on the streets of New York City prompted a surprising wave of sympathy for the perpetrator, rather than the victim, from Americans who say they have been wronged by their health insurers. It remains to be seen whether backlash from the killing will result in a more serious conversation about what ails the health care system. (12/12)

KFF Health News: Watch: 'Going It Alone' — A Conversation About Growing Old In America 
KFF Health News’ “Navigating Aging” columnist, Judith Graham, spent six months this year talking to older adults who live alone by choice or by circumstance — most commonly, a spouse’s death. They shared their hopes and fears, challenges, and strategies for aging solo. Graham moderated a live event on Dec. 11, hosted by KFF Health News and The John A. Hartford Foundation. She invited five seniors ranging in age from 71 to 102 and from across the country — from Seattle; Chicago; Asheville, North Carolina; New York City; and rural Maine — to talk candidly about the ways they are thriving at this stage of life. (12/12)

Axios: Trump Commits To Protecting Abortion Pill Access
President-elect Trump told Time magazine he will ensure the FDA will not block access to abortion pills on his watch, the first time he has made such a commitment. Medication abortions account for nearly two-thirds of all abortions nationwide. Anti-abortion groups and some Trump allies see limiting access to abortion pill mifepristone as a top priority in the new term — but, for now at least, Trump does not. (Lawler and Bettelheim, 12/12)

CNN: Hardline Activist Who Raised The Idea Of Jailing Women For Abortions Gets Top Policy Job In Trump Administration 
President-elect Donald Trump has chosen Ed Martin, a hardline, socially conservative activist and commentator, to serve as the next chief of staff at the Office of Management and Budget (OMB). As CNN first reported in July, Martin has publicly advocated for a national abortion ban without exceptions for rape or incest and has raised imposing criminal penalties on women and doctors involved in abortions. ... The OMB plays a key role in shaping the president’s economic and legislative agenda by reviewing funding proposals and ensuring they align with the administration’s policy priorities. Martin’s role at OMB could have a potential impact on how federal funds are allocated for programs related to women’s health or reproductive rights. (Kaczynski and Steck, 12/12)

The Guardian: As Funding Dries Up, Private Abortion Clinics Across The US Are Closing
Over the last year, 11 independent abortion clinics closed, bringing the nationwide total of brick-and-mortar indie clinics in the US to 363, according to a report released on Tuesday morning by the Abortion Care Network (ACN), a network of independent providers. That’s down from more than 500 in 2012. (Sherman, 12/11)

Juneau Empire: Planned Parenthood In Juneau Closes, Making Anchorage — 850 Miles Away — The Nearest Location For Abortion Access 
Planned Parenthood’s clinic in Juneau has closed due to what the organization calls a need to consolidate resources in the region to ensure ongoing operations. ... Alix Curtain, a former clinician at the Juneau Planned Parenthood who now owns the nearby Juneau Women’s Health clinic that opened in the fall of 2023, said Thursday the closure means the closest abortion services for people in Southeast Alaska is Anchorage, about 850 miles away. (Sabbatini, 12/12)

ProPublica: A Coast Guard Commander Miscarried. She Nearly Died After Being Denied Care.
The night the EMTs carried Elizabeth Nakagawa from her home, bleeding and in pain, the tarp they’d wrapped her in reminded her of a body bag. Nakagawa, 39, is a Coast Guard commander: stoic, methodical, an engineer by trade. But as they maneuvered her past her young daughters’ bedroom, down the narrow steps and into the ambulance, she felt a stab of fear. She might never see her girls again. Then came a blast of anger. She’d been treated for a miscarriage before. She knew her life never should have been in danger. (Edwards and Fields, 12/13)

Politico: Hegseth Walks Back Controversial Comments On Women And Gays In The Military
Pete Hegseth, Donald Trump's nominee for secretary of defense, softened his stance against women in combat and gays in the military after he previously suggested they shouldn’t fill those roles. His evolving rhetoric — which came after meetings with more moderate senators — signals an effort to soothe lingering concerns his leadership might cause upheaval to a diverse, modern military. It could also serve as a guide for Trump’s other would-be nominees who face headwinds in their confirmations. (Gould and O'Brien, 12/13)

Military.com: No More Copays: Defense Bill Set To Sign Off On Free Birth Control For Military Families 
Free birth control will be available to all Tricare users after more than a decade of efforts to eliminate copays for contraception for military families were finally successful in this year's annual defense policy bill. Since the Affordable Care Act, also known as Obamacare, ended copays for birth control for private insurance plans, lawmakers, mostly Democrats, have pushed for military families to have the same benefit in their health insurance. (Kheel, 12/12)

Politico: Congress Nears Deal On Disaster Aid, Funding Patch To Avert Pre-Christmas Shutdown 
Congressional leaders are closing in on a deal to fund the government into early next year, along with tens of billions of dollars in disaster aid, as they work to avoid a holiday shutdown. The burgeoning agreement comes after weeks of House and Senate leadership negotiations, which included top appropriators, ahead of the Dec. 20 deadline. Text of the funding bill is expected over the weekend or early next week to allow both chambers to pass the measure before lawmakers leave town until January. (Carney and Scholtes, 12/12)

MedPage Today: MedPAC Members Supportive Of Upping Medicare Pay Rates Close To The Inflation Rate 
Members of the Medicare Payment Advisory Commission (MedPAC) seemed favorable Thursday to a proposed recommendation to Congress that Medicare should pay physicians based on the rate of medical inflation and give primary care doctors who serve low-income beneficiaries an extra pay bump. "I think the chair's recommendation is directionally correct," said commission member Cheryl Damberg, PhD, MPH, of the RAND Corporation in Santa Monica, California. (Frieden, 12/12)

MedPage Today: Should Hospitals Be Paid The Same As Doctors' Offices For The Same Service? 
The idea of requiring site-neutral payments in Medicare -- in which providers would be reimbursed at the same rate for performing the same service, regardless of where it's performed -- appears to be gaining steam on Capitol Hill. "We are decreasing the out-of-pocket expense for someone receiving the exact same care at the same doctor's office with the same equipment and the same nurse" in cases where the cost of the service increased after the hospital bought the doctor's practice, Sen. Bill Cassidy, MD (R-La.), said Wednesday at a site-neutral payment event sponsored by Politico and the Leukemia & Lymphoma Society. Cassidy, ranking member of the Senate Health, Education, Labor, & Pensions (HELP) Committee, was referring to a bill which he and Sen. Maggie Hassan (D-N.H.) are developing. (Frieden, 12/12)

Stat: Centene Pushes GOP To Avoid Medicaid Cuts, Keep ACA Subsidies 
Executives at the health insurance behemoth Centene on Thursday had a clear message to Republicans who are about to take control of the federal government: Think twice before you cut health care programs. (Herman, 12/12)

The Hill: House Republicans Launch Investigation Into CVS Caremark For Potential Antitrust Violations
House Republicans want to know whether pharmacy benefit manager (PBM) CVS Caremark violated federal antitrust laws by threatening independent pharmacies to keep them from using money-saving tools outside the PBM’s network. In a letter to CVS obtained by The Hill, House Judiciary Committee Chair Jim Jordan (R-Ohio) asked the company for documents and communications about pharmaceutical hubs, a type of digital pharmacy service that can streamline the process of accessing and managing complex, high-cost specialty medications for patients. (Weixel, 12/12)

Bloomberg: Suspect In UnitedHealth Leader’s Killing Wasn’t A Customer
The suspect charged in the killing of UnitedHealth Group Inc. executive Brian Thompson wasn’t a member of its insurance plans, a company spokesperson said. Neither Luigi Mangione nor his mother were UnitedHealthcare members, the company said, dispelling the idea that the alleged shooting was motivated by a grievance from his personal experience with the nation’s largest health insurer. (Tozzi, 12/12)

The New York Times: When a Glock Isn’t a Glock: The History of the Pistol Found With Luigi Mangione
At first glance, the gun in the police photographs — the one the authorities believe Luigi Mangione used to kill the chief executive of UnitedHealthcare — appears to be a Glock-19, a 9-millimeter semiautomatic pistol used by military forces, police officers, civilians and criminals all over the world. But upon closer inspection, it is clear that the weapon was not factory-made, but was at least partially produced by a 3D printer. The giveaways are subtle: The Glock logo is absent from the pistol’s grip, where it would ordinarily be imprinted, and the angle of the grip is peculiar. Indentations on the grip, known as stippling, are patterned in such a way that the gun’s “fingerprint” can be directly linked to a unique free-to-download 3D-printed design known as the FMDA 19.2 Chairmanwon Remix. (Gibbons-Neff and Toler, 12/12)

The Wall Street Journal: Luigi Mangione’s Mother Spent Months Searching For A Son Who Didn’t Want To Be Found 
Before Kathy Mangione became known as the mother of a suspected assassin, she was just a parent looking for her son. She had desperately searched for 26-year-old Luigi Mangione for the better part of a year, according to people close to the family. One said that he “went off the grid six months to a year ago and wasn’t communicating with anybody,” and that his distraught mother was doing all she could to find him. Another said the Ivy League engineering graduate was “MIA for about eight months.” The Mangiones, their relationship with Luigi, their mindset as the manhunt unfolded, and their legal and personal road ahead have spurred intense interest nationwide, especially in Baltimore, according to many residents. (Calvert, Bauerlein and Carlton, 12/12)

NPR: UHC Murder Suspect Railed About U.S. Health Care. Here's What He Missed
It's true that U.S. health care is uniquely costly and often frustrating, but experts say the reasons our life expectancy trails many comparable nations are complex. While problems with health care access cause suffering, health care is not the main factor behind poor life expectancy, says Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. (Simmons-Duffin, 12/12)

The Hill: Florida Woman Accused Of Threatening Insurance Company, Saying, ‘Delay, Deny, Depose’
A Florida woman who is accused of ending a call to an insurance company with the words “delay, deny, depose” was charged Tuesday. Briana Boston, 42, had reportedly placed a call to BlueCross BlueShield regarding recent medical insurance claims she was denied. The entire phone call was recorded, according to the affidavit. Near the end of the call, investigators said Boston could be heard stating, “Delay, deny, depose. You people are next.” (Rains, 12/12)

The Washington Post: Cedar Hill Execs Are Amending Deal With Physicians For New D.C. Hospital
Executives in charge of a hospital set to open in Southeast Washington next spring said Thursday they have not yet finalized an agreement with the large physicians’ group that is set to staff Cedar Hill Regional Medical Center GW Health. The hospital’s corporate parent and the doctors’ practice signed a deal to provide medical and specialty care at the hospital in 2021 but are amending it to ensure that dedicating 160 clinicians to Cedar Hill will not further imperil the cash-strapped practice overall. (Portnoy, 12/12)

Modern Healthcare: Centene Nets $200M In Medicare Advantage Star Ratings Win
Centene will gain $200 million in additional Medicare Advantage Star Ratings bonus payments next year after the Centers for Medicare and Medicaid Services revised its scores, CEO Sarah London told investors Thursday. The updated metrics also awarded Centene its lone four-star contract for 2025. The health insurance company nevertheless continues to pursue its lawsuit challenging the CMS' administration of the quality incentive program. (Tepper, 12/12)

Modern Healthcare: OptumHealth Backs Out Of 'Dummy Code' Settlement With Aetna 
OptumHealth has pulled out of its agreement to settle a class-action lawsuit alleging the company and Aetna used a "dummy code" to inflate workers' medical expenses. The UnitedHealth Group subsidiary withdrew from the agreement after "it became clear that Optum's understanding of one of the negotiated terms was inconsistent with the understand of the Settling Parties," according to a Dec. 6 notice filed with the U.S. District Court for the Western District of North Carolina. Aetna remains in agreement with the settlement made in November, according to the filing.  (DeSilva, 12/12)

Modern Healthcare: Masimo Layoffs To Hit 75 Employees In 2025 
Patient monitoring company Masimo is laying off 75 employees next month at its Irvine, California, location. The company filed a Worker Adjustment and Retraining Notification in November, which said the layoffs would take effect by Jan. 13. (Dubinsky, 12/12)

Modern Healthcare: Why Private Equity Investment In Healthcare May Rise In 2025
Private equity investment in healthcare is expected to pick up in 2025 but still fall short of the highs of 2021, merger and acquisition advisers said. Private equity-linked healthcare transaction volume is poised to rebound after a sluggish 2024 as interest rates cool, state-led oversight bills lose momentum and a new presidential administration begins. Corporate investors will likely prioritize deals that involve healthcare information technology and other administrative support services over physician practices, industry observers said. (Kacik, 12/12)

Stat: AbbVie Drug Offers Hope Against A Persistent Form Of Leukemia 
Brian Koffman found himself in a situation a couple years ago that most chronic lymphocytic leukemia patients eventually do: relapse. The expectation in CLL is that, no matter what therapy or how many therapies patients have been on, the cancer will eventually recur if the patient lives long enough. The hope is that by that time, there will be yet another treatment to try. But Koffman, after relapsing or refracting from targeted therapies, immunotherapies, and bone marrow transplant, had just about run through all the options. (Chen, 12/13)

AP: Some Breast Cancer Patients Can Avoid Certain Surgeries, Studies Suggest 
Some early breast cancer patients can safely avoid specific surgeries, according to two studies exploring ways to lessen treatment burdens. One new study, published in the New England Journal of Medicine, examines whether removing lymph nodes is always necessary in early breast cancer. Another in the Journal of the American Medical Association suggests a new approach to a type of breast cancer called ductal carcinoma in situ, or DCIS. The research was discussed Thursday at the San Antonio Breast Cancer Symposium. (Johnson, 12/12)

Stat: Editas Medicine Lays Off 65% Of Staff And Drops A Sickle Cell Program
Editas Medicine said Thursday afternoon it will lay off 65% of its staff — around 180 employees — as it shelves its lead gene-editing program for sickle cell disease and shifts focus. (Mast, 12/12)

Stat: Tuberculosis R&D Funding Is Up, But Still Falls Short Of Goals, New Report Finds
Although research and development funding for tuberculosis reached new heights last year, the total fell substantially short of goals set by the United Nations and most of the increase came from just two organizations, according to a new report. (Silverman, 12/13)

The (Cleveland) Plain Dealer: Bill Forcing Hospitals To Administer Ivermectin, Other Requested Treatments Nears Finish Line
Senate Republicans on Wednesday passed legislation that would enable patients to force hospitals into administering drugs for off-label use if the hospital’s own physicians refuse. The legislation comes after a COVID-19 pandemic when conservatives came to believe that drugs like hydroxychloroquine or ivermectin, neither of which have been proven to benefit COVID-19 patients, would cure, treat or prevent their infections. (Zuckerman, 12/11)

Minnesota Public Radio: FBI Agents Raid Autism Treatment Centers In Minneapolis, St. Cloud
FBI agents Thursday morning searched the offices of two Minnesota autism treatment centers as part of a major investigation into alleged Medicaid fraud. A search warrant application unsealed by a federal judge Thursday alleges that Smart Therapy in Minneapolis received nearly $14 million in reimbursement from Medicaid between 2020 and last month. Star Autism Center in St. Cloud — which opened in August 2020 — received $6 million. Investigators say the clinics made fraudulent Medicaid claims for services that they never provided, and claimed to pay employees who had little or no training or purported to work unusual schedules. (Sepic, 12/12)

New Hampshire Public Radio: They Needed Psychiatric Care. Instead, They Died After Confrontations With NH Corrections Officers.
Since 2017, at least two men with serious mental illness have died in the psychiatric unit of the New Hampshire State Prison, after being restrained face down by corrections officers. The state maintains the cases are fundamentally different. But advocates say they reflect long-running problems with how the state cares for people in its custody. (Cuno-Booth, 12/13)

CIDRAP: Avian Flu Suspected In Cats That Drank Raw Milk As Virus Kills Animals At Arizona Zoo 
The Los Angeles County Department of Health today announced that it is investigating two suspected avian flu illnesses in indoor pet cats that drank recalled raw milk, fueling more concerns about wider spread in other animals, which includes zoo animals infected in Arizona's Maricopa County. Also today, the US Department of Agriculture (USDA) confirmed several more outbreaks in dairy cattle in California and in poultry flocks in three states. And two states reported rises in wild-bird detections. (Schnirring, 12/12)