First Edition: March 29, 2018

Kaiser Health News: Scrutinizing Medicare Coverage For Physical, Occupational And Speech Therapy
For years, confusion has surrounded the conditions under which older adults can receive physical, occupational and speech therapy covered by Medicare. Services have been terminated for some seniors, such as those with severe cases of multiple sclerosis or Parkinson’s disease, because therapists said they weren’t making sufficient progress. Others, including individuals recovering from strokes or traumatic brain injuries, have been told that they reached an annual limit on services and didn’t qualify for further care. (Graham, 3/29)

California Healthline: Calif. Bill Targets Profiteering In Addiction Treatment, Dialysis Industries
A California lawmaker is seeking to rein in addiction treatment centers and dialysis providers accused of profiteering off vulnerable patients by collecting millions of dollars in inflated medical claims. Supporters of the proposed legislation, scheduled for a key Senate hearing next month, say some providers, industry middlemen and charities with ties to providers are signing up patients for health insurance and paying the premiums only to line their own pockets. They say these arrangements drive up insurance costs industrywide. (Terhune, 3/28)

Kaiser Health News: Omissions On Death Certificates Lead To Undercounting Of Opioid Overdoses
In a refrigerator in the coroner’s office in Marion County, Ind., rows of vials await testing. They contain blood, urine and vitreous, the fluid collected from inside a human eye.In overdose cases, the fluids may contain clues for investigators. “We send that off to a toxicology lab to be tested for what we call drugs of abuse,” said Alfie Ballew, chief deputy coroner. The results often include drugs such as cocaine, heroin, fentanyl or prescription pharmaceuticals. (Harper, 3/29)

The New York Times: Veterans Affairs Secretary Is Latest To Go As Trump Shakes Up Cabinet
After weeks of uncertainty atop the Department of Veterans Affairs, President Trump dismissed its secretary, David J. Shulkin, on Wednesday and announced he would replace him with the White House physician, Dr. Ronny L. Jackson, a rear admiral in the Navy. ... The announcement punctuated what has been a rapid fall from favor for Dr. Shulkin, a politically moderate former hospital executive who delivered Mr. Trump a string of bipartisan legislative victories at a time when he was struggling to find them. But in his final weeks, he struggled to fight off attempts by more conservative administration officials to have him removed and was dogged by an unflattering inspector general report on his overseas travel that undermined his relationship with the president. (Fandos and Haberman, 3/28)

Reuters: Trump Taps Doctor, Decorated Diver To Rescue Veterans Affairs
When a Republican congressman was critically wounded in a shooting at a baseball game last summer, U.S. President Donald Trump dispatched his physician, an Iraq war veteran trained in emergency medicine, to the hospital to check on his condition. Later on that June day, Navy Rear Admiral Ronny Jackson accompanied the Trumps to meet with Representative Steve Scalise's family and medical team. Scalise survived and has returned to Congress. Now Trump is counting on Jackson to take charge at Veterans Affairs, a behemoth of a bureaucracy that has vexed a slew of decorated military officers and corporate managers. (Holland, 3/28)

The Associated Press: VA Pick Impressed Trump When He Gave Glowing Health Report
Ronny Jackson passed his screen test with President Donald Trump before casting even began. Jackson, the president's personal physician and surprise choice to lead the massive Department of Veterans Affairs, stood before the White House press corps in January to announce the results of the president's first physical in a performance that showed he was quick-witted, hard to throw off-kilter and unfailingly complimentary of Trump. Marveling at the 71-year-old president's good health, Jackson opined, "It's just the way God made him." (Colvin, 3/29)

The Washington Post: Trump Taps His Doctor To Replace Shulkin At VA, Choosing Personal Chemistry Over Traditional Qualifications
A biography released by the White House shows Jackson is credentialed and experienced in medicine but has no background in management. He nonetheless will be charged with delivering on one of Trump’s signature campaign promises: to fix the federal government’s second-largest bureaucracy. VA, which employs 360,000 people and has a $186 billion annual budget, serves a growing population of veterans in need and is suffering from a shortage of doctors, nurses and mental health experts. (Rein, Rucker, Wax-Thibodeaux and Dawsey, 3/28)

The Wall Street Journal: Donald Trump Ousts VA Secretary David Shulkin
Top veterans groups praised Dr. Shulkin on Wednesday, while some expressed concerns about his replacement. “We’re really surprised at this nominee,” said Joe Chenelly, national executive director of Amvets, a veterans advocacy group. “Looking at his background we don’t see anything that indicates he’s capable of running a $200 billion agency. The VA is a lot more than just a medical system.” (Ballahus and Kesling, 3/28)

Politico: ‘My First Reaction Was OMG’: Trump’s VA Pick Is New To All This
Lawmakers on the Hill were full of praise for Shulkin and muted about Jackson, although many said they looked forward to meeting the president’s pick who has to be confirmed by the Senate. “Dr. Shulkin has made a tremendous impact toward improving the lives of veterans during his time at the U.S. Department of Veterans Affairs. He has been instrumental in all that we have accomplished in the last year,” said Sen Johnny Isakson (R-Ga.), the chairman of the Senate Committee on Veterans Affairs. (Kenen, 3/28)

Los Angeles Times: Embattled Veterans Affairs Secretary David Shulkin Fired In Latest White House Shake-Up
Shulkin ran afoul of some conservatives for his go-slow approach to expanding government-paid private care for military veterans outside the VA system. Shifting more veterans to private care is a top priority for the influential network of conservative groups funded by Charles and David Koch. An effort to expand the existing Veterans Choice program, under which veterans can get government reimbursement for seeing a private doctor in certain circumstances, failed this month when Congress did not include it in the massive government spending bill that Trump signed into law.The Koch-backed Concerned Veterans of America has pushed for the legislation, but most other major veterans organizations opposed it. (Cloud, 3/28)

The Hill: Watchdog: VA Employed Thousands Without Background Checks 
A new watchdog report reveals that the Department of Veterans Affairs (VA) employed thousands of workers at medical facilities without properly performing background checks. The inspector general (IG) report released Monday faults the VA for employing an estimated 6,200 workers over five years through 2016 who did not undergo background checks within the mandated first 14 days of their employment. (Bowden, 3/28)

The New York Times: Critics See Echoes Of ‘Don’t Ask, Don’t Tell’ In Military Transgender Ban
The Trump administration’s latest effort at banning transgender individuals from serving in the military amounts to what legal experts said is essentially a reprise of an all-too-familiar directive at the Pentagon: the 1994 “don’t ask, don’t tell” policy. A slew of medical and legal professionals have already lined up against the newest White House order, issued late Friday night, which experts said may survive only if it is backed by the Supreme Court. (Cooper, 3/28)

The Hill: Iowa Seeks To Allow Insurers To Skirt ObamaCare Rules
Iowa’s governor is poised to sign legislation that would allow insurers to sell cheaper plans that don’t comply with certain ObamaCare consumer protection regulations. According to the Des Moines Register, the state Senate approved the bill Tuesday, and Gov. Kim Reynolds (R) is expected to sign it. (Weixel, 3/28)

The Wall Street Journal: Why Are States So Strapped For Cash? There Are Two Big Reasons
The only speaker standing between state budget officers and the opening cocktail hour at a Washington conference was the U.S. Secretary of Health and Human Services. What he said left no one in a celebratory mood. Medicaid costs, said then-Secretary Michael Leavitt, were projected to grow so fast that within 10 years they would “crowd out virtually every other category of spending.” State spending on higher education, infrastructure and safety, he predicted, would all get squeezed. (Podkul and Gillers, 3/28)

The Hill: Pelosi Urges Dems To Link GOP Tax Law To Medicare Cuts 
House Minority Leader Nancy Pelosi (D-Calif.) is urging colleagues to talk to their constituents during the recess about how the GOP tax law could lead to Medicare cuts. It's the latest effort by Pelosi and Democrats to demonize the tax-cut bill, which they argue will starve the government of funds and result in cuts to Medicare and other entitlements. (Jagoda, 3/28)

Stat: Vermont Transparency Pricing Law May Show Big Price Hikes, But Disappoints Lawmakers 
Nearly two years ago, Vermont became the first state in the country to adopt a law requiring drug makers to justify price hikes for medicines. The move was greeted with cautious enthusiasm by consumer advocates and lawmakers who hoped the effort might be the first step toward forcing the pharmaceutical industry to constrain its pricing. But the latest progress report has dashed those hopes and state lawmakers are working on a fix. (Silverman, 3/28)

The Hill: Dems Seek To Flank Trump On Drug Prices
Democrats are seeking to co-opt President Trump's message on pharmaceuticals against him, and capitalize on voter anger at drug companies in the midterm elections this November. They see attacking high drug prices as a populist message, and one that Trump himself showed can work in his campaign in 2016. (Sullivan, 3/29)

The Wall Street Journal: Hospital Giants Halt Merger Talks
Two major hospital systems have halted talks about a possible merger, shelving for now the prospect of a combination that would have created the nation’s largest owner of hospitals, according to people familiar with the discussions. Ascension, the largest U.S. nonprofit hospital system, and Providence St. Joseph Health, also a major nonprofit hospital owner, put talks on hold to restructure as more medical care moves outside of hospitals, putting pressure on their core operations, according to the people. A big, complex merger would split attention between restructuring and combining the two giants, the people said. (Evans, 2/28)

Stat: The Government Wants To Free Health Data. Will That Unleash Innovation?
In health care, breakthrough cures are no longer just hidden in the innumerable mysteries of biology and chemistry. Increasingly, they are locked away in a place even harder to access: electronic patient records. These files could help establish which patients, with which backgrounds and disease characteristics, respond best to certain therapies — secrets that are often carefully guarded in service of patient privacy, and private profit. (Ross, 3/29)

The Washington Post: Genetics May Make Some Babies Vulnerable To SIDS Or ‘Crib Death,’ Study Says
Sally Clark lost both her infant sons shortly after their births. In 1996, 11-week-old Christopher fell unconscious after being put to bed and never woke up. Two years later, 8-week-old Harry was found dead slumped forward in his bouncy chair. Doctors initially concluded the first boy had died of sudden infant death syndrome (SIDS) — in which a seemingly healthy baby dies without warning and without an obvious cause. But after Clark's second child died, prosecutors in the United Kingdom charged her with murder and put her on trial. According to scholars analyzing the widely publicized case, Clark was wrongly convicted based on a statistic. An expert witness for the prosecution claimed the chance of two cases of SIDS, in an affluent family like hers, was astronomically high — 1 in 73 million. (Cha, 3/28)

Stat: Scientists Find Mini Gastrointestinal Tract Growing Inside Tumor
Embedded in a lung cancer tumor, scientists have found a gastrointestinal tract in miniature. Duke University researchers have observed rudimentary, but functional, stomachs, small intestines, and duodenums growing inside cancerous lungs — illustrating how varied and plastic these metastatic cells can be. (Keshavan, 3/29)

Los Angeles Times: After Weight-Loss Surgery, Singles Were More Likely To Start A Relationship And Couples Were More Likely To Split
Surgical reduction of the stomach may do more than change signals of hunger and appetite, improve metabolic function and induce substantial weight loss. New research suggests it may change some hearts as well. A large Swedish study has found that obese people who had a spouse or live-in partner and then underwent weight loss surgery were 28% more likely to become separated or divorced compared with those in a comparison group who didn't have surgery. (Healy, 3/28)

Stat: Lawmakers Hope To Bring Opioid Legislation To Vote Before Memorial Day
A key House committee will hold the last of three major hearings to address the opioid crisis on April 11, and hopes to bring a legislative package to the floor before the House breaks for Memorial Day on May 24, according to GOP aides on Capitol Hill. The third hearing of the House Energy & Commerce health subcommittee will focus on insurance coverage, payment issues, and prescription regulations for Medicaid beneficiaries. An initial session focused on enforcement issues and a second discussed public health, treatment, and prevention strategies. (Facher, 3/29)

NPR: Opioid Treatment Program Helps Parents Get And Stay Sober To Get Their Kids Back
Velva Poole has spent about 20 years as a social worker, mostly in Louisville, Ky. She's seen people ravaged by methamphetamines and cocaine; now it's mostly opioids. Most of her clients are parents who have lost custody of their children because of drug use. Poole remembers one mom in particular. "She had her kids removed the first time for cocaine. And then she had actually gotten them back," she says. But three months later, the mother relapsed and overdosed on heroin. (Gillespie, 3/28)

NPR: Fentanyl-Laced Cocaine Becoming A Deadly Problem Among Drug Users
A pipe was the only sign of drug use found near Chris Bennett's body in November. But it looked like the 32-year-old Taunton, Mass. native had stopped breathing and died of an opioid overdose. Bennett's mother Liisa couldn't understand what happened. Then she saw the toxicology report. "I'm convinced he was smoking cocaine that was laced," she says. "That's what he had in his system, [it] was cocaine and fentanyl." (Bebinger, 3/29)

The Associated Press: Delaware House Would Require Taking Guns From Mentally Ill
The Delaware House has unanimously approved a "red flag" bill requiring efforts to temporarily seize guns from people with mental health issues who make an "explicit or imminent threat" to kill or injure someone. House Bill 302 imposes a series of "duties to warn." (3/28)

The Washington Post: Virginia Democrats Pressure Counties To Ban Loaded Shotguns, Rifles On Roads
A group of Northern Virginia lawmakers, frustrated over a failure to pass gun-safety measures in Richmond, is pushing the state’s two largest jurisdictions to use an existing law that allows local governments to bar people from driving with a loaded shotgun or rifle. Seeking to capi­tal­ize on momentum from last week’s March for Our Lives, 10 Democratic state legislators sent a letter to Prince William County’s Board of Supervisors on Wednesday that urged them to adopt an ordinance regulating the transport of loaded weapons. (Olivo, 3/28)

The New York Times: 4,000 Eggs And Embryos Are Lost In Tank Failure, Ohio Fertility Clinic Says
The “catastrophic” failure of a storage tank this month at an Ohio fertility clinic caused the apparent loss of more than 4,000 frozen embryos and eggs, the clinic said this week. About 950 patients were affected by the failure, in which the tank’s temperature rose and an alarm did not go off, the University Hospitals Cleveland Medical Center, which oversees the clinic, said in a letter that was sent to patients on Monday and posted on its website. (Hauser, 3/28)

The Associated Press: Kansas Regulators Seek To Take Over 15 Nursing Homes
"Our most pressing concern at this point is stability," KDADS Secretary Tim Keck said in a news release. "We want to ensure the residents of these facilities continue to receive the care they need, and to make sure the staff, which provides that care, continues to be paid." (3/28)

The Associated Press: Maryland Senate Votes To Ban 'Gay Conversion Therapy'
A measure to prohibit health professionals from practicing "gay conversion therapy" on minors cleared the Maryland Senate on Wednesday — the same day the governor of Washington signed a bill into law to ban the practice. The Maryland Senate voted 34-12 for the bill, which now goes to the House. The measure would classify the practice as unprofessional conduct and subject providers to discipline by the state licensing board. (3/28)

The Associated Press: Nebraska On Pace To Pass Budget Targeting Abortion Providers
Nebraska inched closer Wednesday to passing a budget that could deny federal money to Planned Parenthood of the Heartland, at least temporarily, despite furious opposition from a handful of lawmakers. Lawmakers advanced a budget measure that would prevent health clinics from getting family-planning dollars if they perform, counsel in favor of or refer patients to abortion services. (Schulte, 3/28)