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Maryland passes generic drug anti–price gouging law
Maryland has become the first state to prohibit unreasonable price increases on essential off-patent or generic drugs.
The anti–price gouging law authorizes Maryland’s Attorney General to take legal action against manufacturers or distributors that raise drug prices in noncompetitive drug markets if the firms can’t prove the legitimacy of their price increases. Companies could face a civil penalty of up to $10,000 for each violation, according to the law, which goes into effect in October.
Stephen Rockower, MD, president of MedChi, the Maryland State Medical Society, said the medical society has long supported the bill and hailed its passage as beneficial for doctors and their patients.
“It’s been a long time coming,” Dr. Rockower said in an interview. “There have been lots of problems with the huge rising costs of drugs. Manufacturers and pharmacy benefit managers are completely uncontrolled in terms of their pricing. [With this law], we’ll be able to take care of our patients better. It’s hard to prescribe things if it’s going to cost patients $700 a day [for] a drug that used to cost $5 a day. Patients have to be able to afford their medicine, or they don’t take it.”
Chester “Chip” Davis, Jr. president and CEO of the Association for Accessible Medicines, a trade association for manufacturers and distributors of generic drugs, criticized the law.
“By giving the Attorney General unbounded and unprecedented authority to control pricing in a competitive free market, generic companies will be exposed to a level of risk in Maryland that will require them to evaluate whether they want to continue to market affordable medicines within the state,” Mr. Davis said in a statement. “One day, in the not too distant future, [Maryland lawmakers] should be prepared to defend why Maryland was the first state to lead the nation in creating less market-based competition, higher overall prescription drug costs, while also simultaneously increasing the risk of future drug shortages for Maryland’s patients.”
The law has two provisions. It prevents a generic drug manufacturer or wholesale distributor from engaging in price gouging in the sale of an essential off-patent or generic drug, defined as a prescription drug that no longer has market exclusivity and has been designated as essential for treating a life-threatening or chronic health condition by the Maryland Secretary of Health and Mental Hygiene, is actively marketed in the United States by three or fewer manufacturers, and is available for sale in Maryland.
The law also authorizes the Maryland Medical Assistance Program to notify the Attorney General of a price increase when the wholesale acquisition cost of a prescription drug increases by at least 50% in a given year for medications that cost more than $80 per 30-day course.
This first-of-its-kind law is a way to deter manufacturers from exploiting noncompetitive drug markets for short-term profit through unconscionable behavior that “imperils public health and individual welfare,” according to Jeremy A. Greene, MD, PhD, and William V. Padula, PhD.
“Perhaps, [the law will] help reestablish public trust in U.S. policy’s balancing of innovation and access, by reaffirming that older drugs of proven value should be accessible and subject to competition so that they are priced as the commodities they’ve become,” the authors wrote in a perspective published in the New England Journal of Medicine (doi: 10.1056/NEJMp1704907).
Maryland’s law is part of a growing movement among states to address unreasonable pricing spikes in prescription drugs, noted Dr. Greene and Dr. Padula, both of Johns Hopkins University in Baltimore. In April, Louisiana health officials requested feedback about the possibility of invoking an obscure U.S. patent and copyright law to ensure better affordability of hepatitis drugs. In May, the Nevada Senate passed a bill that would force drug makers to publish the list prices they set and the profits they make on insulin, as well as the amount of insulin discounts they give third parties. Additional pharmaceutical price-transparency laws have been proposed in 16 states and Puerto Rico.
“My first concern relates to the provisions of the legislation which directly regulate interstate commerce and pricing by prohibiting and penalizing manufacturer pricing which may occur outside of Maryland,” Gov. Hogan wrote. “These provisions would likely violate the dormant commerce clause of the Constitution. I am also concerned that the definition of ‘unconscionable increase’ and ‘excessive’ are vague, and would likely not stand a ‘vagueness challenge’ under the procedural due process concepts of the 14th Amendment.”
Gov. Hogan added that he is not convinced that the legislation is a solution to Marylanders having better access to medications and that the law may even have the unintended consequences of harming patients by restricting drug access.
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On Twitter @legal_med
Maryland has become the first state to prohibit unreasonable price increases on essential off-patent or generic drugs.
The anti–price gouging law authorizes Maryland’s Attorney General to take legal action against manufacturers or distributors that raise drug prices in noncompetitive drug markets if the firms can’t prove the legitimacy of their price increases. Companies could face a civil penalty of up to $10,000 for each violation, according to the law, which goes into effect in October.
Stephen Rockower, MD, president of MedChi, the Maryland State Medical Society, said the medical society has long supported the bill and hailed its passage as beneficial for doctors and their patients.
“It’s been a long time coming,” Dr. Rockower said in an interview. “There have been lots of problems with the huge rising costs of drugs. Manufacturers and pharmacy benefit managers are completely uncontrolled in terms of their pricing. [With this law], we’ll be able to take care of our patients better. It’s hard to prescribe things if it’s going to cost patients $700 a day [for] a drug that used to cost $5 a day. Patients have to be able to afford their medicine, or they don’t take it.”
Chester “Chip” Davis, Jr. president and CEO of the Association for Accessible Medicines, a trade association for manufacturers and distributors of generic drugs, criticized the law.
“By giving the Attorney General unbounded and unprecedented authority to control pricing in a competitive free market, generic companies will be exposed to a level of risk in Maryland that will require them to evaluate whether they want to continue to market affordable medicines within the state,” Mr. Davis said in a statement. “One day, in the not too distant future, [Maryland lawmakers] should be prepared to defend why Maryland was the first state to lead the nation in creating less market-based competition, higher overall prescription drug costs, while also simultaneously increasing the risk of future drug shortages for Maryland’s patients.”
The law has two provisions. It prevents a generic drug manufacturer or wholesale distributor from engaging in price gouging in the sale of an essential off-patent or generic drug, defined as a prescription drug that no longer has market exclusivity and has been designated as essential for treating a life-threatening or chronic health condition by the Maryland Secretary of Health and Mental Hygiene, is actively marketed in the United States by three or fewer manufacturers, and is available for sale in Maryland.
The law also authorizes the Maryland Medical Assistance Program to notify the Attorney General of a price increase when the wholesale acquisition cost of a prescription drug increases by at least 50% in a given year for medications that cost more than $80 per 30-day course.
This first-of-its-kind law is a way to deter manufacturers from exploiting noncompetitive drug markets for short-term profit through unconscionable behavior that “imperils public health and individual welfare,” according to Jeremy A. Greene, MD, PhD, and William V. Padula, PhD.
“Perhaps, [the law will] help reestablish public trust in U.S. policy’s balancing of innovation and access, by reaffirming that older drugs of proven value should be accessible and subject to competition so that they are priced as the commodities they’ve become,” the authors wrote in a perspective published in the New England Journal of Medicine (doi: 10.1056/NEJMp1704907).
Maryland’s law is part of a growing movement among states to address unreasonable pricing spikes in prescription drugs, noted Dr. Greene and Dr. Padula, both of Johns Hopkins University in Baltimore. In April, Louisiana health officials requested feedback about the possibility of invoking an obscure U.S. patent and copyright law to ensure better affordability of hepatitis drugs. In May, the Nevada Senate passed a bill that would force drug makers to publish the list prices they set and the profits they make on insulin, as well as the amount of insulin discounts they give third parties. Additional pharmaceutical price-transparency laws have been proposed in 16 states and Puerto Rico.
“My first concern relates to the provisions of the legislation which directly regulate interstate commerce and pricing by prohibiting and penalizing manufacturer pricing which may occur outside of Maryland,” Gov. Hogan wrote. “These provisions would likely violate the dormant commerce clause of the Constitution. I am also concerned that the definition of ‘unconscionable increase’ and ‘excessive’ are vague, and would likely not stand a ‘vagueness challenge’ under the procedural due process concepts of the 14th Amendment.”
Gov. Hogan added that he is not convinced that the legislation is a solution to Marylanders having better access to medications and that the law may even have the unintended consequences of harming patients by restricting drug access.
[email protected]
On Twitter @legal_med
Maryland has become the first state to prohibit unreasonable price increases on essential off-patent or generic drugs.
The anti–price gouging law authorizes Maryland’s Attorney General to take legal action against manufacturers or distributors that raise drug prices in noncompetitive drug markets if the firms can’t prove the legitimacy of their price increases. Companies could face a civil penalty of up to $10,000 for each violation, according to the law, which goes into effect in October.
Stephen Rockower, MD, president of MedChi, the Maryland State Medical Society, said the medical society has long supported the bill and hailed its passage as beneficial for doctors and their patients.
“It’s been a long time coming,” Dr. Rockower said in an interview. “There have been lots of problems with the huge rising costs of drugs. Manufacturers and pharmacy benefit managers are completely uncontrolled in terms of their pricing. [With this law], we’ll be able to take care of our patients better. It’s hard to prescribe things if it’s going to cost patients $700 a day [for] a drug that used to cost $5 a day. Patients have to be able to afford their medicine, or they don’t take it.”
Chester “Chip” Davis, Jr. president and CEO of the Association for Accessible Medicines, a trade association for manufacturers and distributors of generic drugs, criticized the law.
“By giving the Attorney General unbounded and unprecedented authority to control pricing in a competitive free market, generic companies will be exposed to a level of risk in Maryland that will require them to evaluate whether they want to continue to market affordable medicines within the state,” Mr. Davis said in a statement. “One day, in the not too distant future, [Maryland lawmakers] should be prepared to defend why Maryland was the first state to lead the nation in creating less market-based competition, higher overall prescription drug costs, while also simultaneously increasing the risk of future drug shortages for Maryland’s patients.”
The law has two provisions. It prevents a generic drug manufacturer or wholesale distributor from engaging in price gouging in the sale of an essential off-patent or generic drug, defined as a prescription drug that no longer has market exclusivity and has been designated as essential for treating a life-threatening or chronic health condition by the Maryland Secretary of Health and Mental Hygiene, is actively marketed in the United States by three or fewer manufacturers, and is available for sale in Maryland.
The law also authorizes the Maryland Medical Assistance Program to notify the Attorney General of a price increase when the wholesale acquisition cost of a prescription drug increases by at least 50% in a given year for medications that cost more than $80 per 30-day course.
This first-of-its-kind law is a way to deter manufacturers from exploiting noncompetitive drug markets for short-term profit through unconscionable behavior that “imperils public health and individual welfare,” according to Jeremy A. Greene, MD, PhD, and William V. Padula, PhD.
“Perhaps, [the law will] help reestablish public trust in U.S. policy’s balancing of innovation and access, by reaffirming that older drugs of proven value should be accessible and subject to competition so that they are priced as the commodities they’ve become,” the authors wrote in a perspective published in the New England Journal of Medicine (doi: 10.1056/NEJMp1704907).
Maryland’s law is part of a growing movement among states to address unreasonable pricing spikes in prescription drugs, noted Dr. Greene and Dr. Padula, both of Johns Hopkins University in Baltimore. In April, Louisiana health officials requested feedback about the possibility of invoking an obscure U.S. patent and copyright law to ensure better affordability of hepatitis drugs. In May, the Nevada Senate passed a bill that would force drug makers to publish the list prices they set and the profits they make on insulin, as well as the amount of insulin discounts they give third parties. Additional pharmaceutical price-transparency laws have been proposed in 16 states and Puerto Rico.
“My first concern relates to the provisions of the legislation which directly regulate interstate commerce and pricing by prohibiting and penalizing manufacturer pricing which may occur outside of Maryland,” Gov. Hogan wrote. “These provisions would likely violate the dormant commerce clause of the Constitution. I am also concerned that the definition of ‘unconscionable increase’ and ‘excessive’ are vague, and would likely not stand a ‘vagueness challenge’ under the procedural due process concepts of the 14th Amendment.”
Gov. Hogan added that he is not convinced that the legislation is a solution to Marylanders having better access to medications and that the law may even have the unintended consequences of harming patients by restricting drug access.
[email protected]
On Twitter @legal_med
Supreme Court rules to speed biosimilar drugs to market
The U.S. Supreme Court has ruled that biosimilar companies can take their versions of biological drugs to the market 6 months sooner in a precedential ruling that could mean quicker access to less expensive medications.
The unanimous ruling overturns an appeals court ruling in favor California-based Amgen that had barred competitor Sandoz from selling its biosimilar of Neupogen (filgrastim) until 6 months after Food and Drug Administration approval. Justices held that the Biologics Price Competition and Innovation Act of 2009 (BPCIA) allows biosimilar applicants to provide notice of commercial marketing prior to obtaining licensure by the FDA.
Carol Lynch, global head of Biopharmaceuticals at Sandoz, said the ruling helps to eliminate unnecessary barriers so that patients can access more affordable medicine in a more timely manner.
“Biosimilars offer significant value to patients, providers, and payers, increasing the number of treatment options available to patients across many disease areas at a reduced cost to the health care system,” Ms. Lynch said in a statement. “The justices’ unanimous ruling on the notice of commercial marketing will help expedite patient access to life-enhancing treatments. We also appreciate the clarity provided on the patent dance, which will help the
In a statement, an Amgen spokeswoman said the company was “disappointed in the court’s decision on the notice of commercial marketing,” but that it will “continue to seek to enforce our intellectual property against those parties that infringe upon our rights.”
The “patent dance” referred to by Ms. Lynch is the often lengthy process by which companies marketing brand name and biosimilar medications spar and undergo legal proceedings before the biosimilar can enter the market.
In this case, Sandoz filed an application with the FDA in May 2014 seeking approval to market Zarxio (filgrastim-sndz) Neupogen as the reference product. Amgen has marketed Neupogen since 1991 and holds patents on methods of manufacturing and using filgrastim. In July 2014, the FDA accepted Sandoz’ application for review. In October 2014, Amgen sued for patent infringement, alleging that Sandoz failed to adhere to the BPCIA by unlawfully providing its notice of commercial marketing before FDA licensure, among other arguments.
The U.S. Court of Appeals for the Federal Circuit in Washington ruled in favor of Amgen, holding that Sandoz must wait for an FDA license before marketing its biosimilar, which meant another 6-month waiting period. The Supreme Court disagreed. Justices based their decision on the plain language of the BPCIA, ruling that the statute allows for applicants to provide marketing notice either before or after receiving FDA approval.
In a statement, the Pharmaceutical Care Management Association said the Supreme Court’s ruling on biosimilars will help create more competition among costly biologic medications, “which is the key to reducing overall prescription drug costs for consumers, employers, government programs, and others.”
[email protected]
On Twitter @legal_med
The U.S. Supreme Court has ruled that biosimilar companies can take their versions of biological drugs to the market 6 months sooner in a precedential ruling that could mean quicker access to less expensive medications.
The unanimous ruling overturns an appeals court ruling in favor California-based Amgen that had barred competitor Sandoz from selling its biosimilar of Neupogen (filgrastim) until 6 months after Food and Drug Administration approval. Justices held that the Biologics Price Competition and Innovation Act of 2009 (BPCIA) allows biosimilar applicants to provide notice of commercial marketing prior to obtaining licensure by the FDA.
Carol Lynch, global head of Biopharmaceuticals at Sandoz, said the ruling helps to eliminate unnecessary barriers so that patients can access more affordable medicine in a more timely manner.
“Biosimilars offer significant value to patients, providers, and payers, increasing the number of treatment options available to patients across many disease areas at a reduced cost to the health care system,” Ms. Lynch said in a statement. “The justices’ unanimous ruling on the notice of commercial marketing will help expedite patient access to life-enhancing treatments. We also appreciate the clarity provided on the patent dance, which will help the
In a statement, an Amgen spokeswoman said the company was “disappointed in the court’s decision on the notice of commercial marketing,” but that it will “continue to seek to enforce our intellectual property against those parties that infringe upon our rights.”
The “patent dance” referred to by Ms. Lynch is the often lengthy process by which companies marketing brand name and biosimilar medications spar and undergo legal proceedings before the biosimilar can enter the market.
In this case, Sandoz filed an application with the FDA in May 2014 seeking approval to market Zarxio (filgrastim-sndz) Neupogen as the reference product. Amgen has marketed Neupogen since 1991 and holds patents on methods of manufacturing and using filgrastim. In July 2014, the FDA accepted Sandoz’ application for review. In October 2014, Amgen sued for patent infringement, alleging that Sandoz failed to adhere to the BPCIA by unlawfully providing its notice of commercial marketing before FDA licensure, among other arguments.
The U.S. Court of Appeals for the Federal Circuit in Washington ruled in favor of Amgen, holding that Sandoz must wait for an FDA license before marketing its biosimilar, which meant another 6-month waiting period. The Supreme Court disagreed. Justices based their decision on the plain language of the BPCIA, ruling that the statute allows for applicants to provide marketing notice either before or after receiving FDA approval.
In a statement, the Pharmaceutical Care Management Association said the Supreme Court’s ruling on biosimilars will help create more competition among costly biologic medications, “which is the key to reducing overall prescription drug costs for consumers, employers, government programs, and others.”
[email protected]
On Twitter @legal_med
The U.S. Supreme Court has ruled that biosimilar companies can take their versions of biological drugs to the market 6 months sooner in a precedential ruling that could mean quicker access to less expensive medications.
The unanimous ruling overturns an appeals court ruling in favor California-based Amgen that had barred competitor Sandoz from selling its biosimilar of Neupogen (filgrastim) until 6 months after Food and Drug Administration approval. Justices held that the Biologics Price Competition and Innovation Act of 2009 (BPCIA) allows biosimilar applicants to provide notice of commercial marketing prior to obtaining licensure by the FDA.
Carol Lynch, global head of Biopharmaceuticals at Sandoz, said the ruling helps to eliminate unnecessary barriers so that patients can access more affordable medicine in a more timely manner.
“Biosimilars offer significant value to patients, providers, and payers, increasing the number of treatment options available to patients across many disease areas at a reduced cost to the health care system,” Ms. Lynch said in a statement. “The justices’ unanimous ruling on the notice of commercial marketing will help expedite patient access to life-enhancing treatments. We also appreciate the clarity provided on the patent dance, which will help the
In a statement, an Amgen spokeswoman said the company was “disappointed in the court’s decision on the notice of commercial marketing,” but that it will “continue to seek to enforce our intellectual property against those parties that infringe upon our rights.”
The “patent dance” referred to by Ms. Lynch is the often lengthy process by which companies marketing brand name and biosimilar medications spar and undergo legal proceedings before the biosimilar can enter the market.
In this case, Sandoz filed an application with the FDA in May 2014 seeking approval to market Zarxio (filgrastim-sndz) Neupogen as the reference product. Amgen has marketed Neupogen since 1991 and holds patents on methods of manufacturing and using filgrastim. In July 2014, the FDA accepted Sandoz’ application for review. In October 2014, Amgen sued for patent infringement, alleging that Sandoz failed to adhere to the BPCIA by unlawfully providing its notice of commercial marketing before FDA licensure, among other arguments.
The U.S. Court of Appeals for the Federal Circuit in Washington ruled in favor of Amgen, holding that Sandoz must wait for an FDA license before marketing its biosimilar, which meant another 6-month waiting period. The Supreme Court disagreed. Justices based their decision on the plain language of the BPCIA, ruling that the statute allows for applicants to provide marketing notice either before or after receiving FDA approval.
In a statement, the Pharmaceutical Care Management Association said the Supreme Court’s ruling on biosimilars will help create more competition among costly biologic medications, “which is the key to reducing overall prescription drug costs for consumers, employers, government programs, and others.”
[email protected]
On Twitter @legal_med
Supreme Court: Faith-based hospitals are exempt from federal pension requirements
The U.S. Supreme Court has ruled that faith-based hospitals are exempt from federal pension requirements, holding that employees of religious-affiliated entities are not protected under the Employee Retirement Income Security Act (ERISA). The unanimous decision overturns rulings in the three circuit courts of appeals.
The opinion preserves the status quo, so it should not have an immediate effect on the affected employers and employees, said Ronald J. Mann, a law professor at Columbia University in New York who has written about one case, Advocate Health Care Network v. Stapleton, for Scotusblog.com.
The high court’s opinion centers on logic and the plain language of the ERISA statute, which is sensible, said Paul Secunda, a law professor and director of the labor and employment law program at Marquette University in Milwaukee. However, the decision does not address the larger question that matters to physicians and hospitals, he said.
“Some of these church-affiliated hospitals look an awful lot like their secular competitors,” he said. “They have thousands of employees. They make billions of dollars in revenue.”
Associate Justice Sonia Sotomayor raised similar concerns in a concurring opinion to the decision. While she agreed with her fellow justices on the ruling, she said the case outcome was still troubling.
“Despite their relationship to churches, organizations such as petitioners operate for-profit subsidiaries ... and compete in the secular market with companies that must bear the cost of complying with ERISA,” Justice Sotomayor wrote.
The Supreme Court ruling comes after current and former employees of three hospital chains – Dignity Health, Advocate Health Care, and Saint Peter’s Healthcare System – sued their employers in an effort to make them comply with ERISA. The employees argued that pension plans established by the large health care providers should not fall under ERISA’s “church plan” exception because the plans were not established by churches. ERISA requires that all private employers offering pension plans adhere to federal requirements designed to ensure plan solvency and protect plan participants.
The hospitals argued that pension plans do not have to be established by a church for the ERISA exemption to apply because the plans are maintained by qualifying church-affiliated organizations. The defendants based their position on a 1980 ERISA amendment that included the “maintained” exception. Since the amendment, the federal agencies charged with interpreting ERISA – the IRS, the Department of Labor, and the Pension Benefit Guaranty Corporation – have issued opinion after opinion reaffirming that view, the defendants noted.
Courts of appeals for the Third, Seventh, and Ninth circuits agreed with the employees, concluding that ERISA’s “plain text” requires that a pension plan be established by a church to qualify for the church-plan exemption.
The Supreme Court disagreed, however, ruling that a defined-benefit pension plan maintained by a principal-purpose organization – one controlled by or associate
However, the hospital sector has changed dramatically since the 1980 ERISA amendment, Mr. Secunda pointed out. “If you think back to when this reform was passed ... almost 40 years ago, we have a whole different animal [today] with regard to these large church-oriented hospital organizations.”
Justice Sotomayor raised similar concerns. “These organizations thus bear little resemblance to those Congress considered when enacting the 1980 amendment to the church plan definition. This current reality might prompt Congress to take a different path,” she wrote.
The legal battle over whether faith-based hospitals should comply with ERISA is not likely over, according to Mr. Secunda.
“This is not the end of the story,” he said. “This is just the beginning, and now the next big issue to be decided will be, okay, principal purpose organizations come under the church plan exemption, but do these large billion-dollar hospitals qualify? Are they principal purpose organizations? I think that’s a very open question.”
[email protected]
On Twitter @legal_med
The U.S. Supreme Court has ruled that faith-based hospitals are exempt from federal pension requirements, holding that employees of religious-affiliated entities are not protected under the Employee Retirement Income Security Act (ERISA). The unanimous decision overturns rulings in the three circuit courts of appeals.
The opinion preserves the status quo, so it should not have an immediate effect on the affected employers and employees, said Ronald J. Mann, a law professor at Columbia University in New York who has written about one case, Advocate Health Care Network v. Stapleton, for Scotusblog.com.
The high court’s opinion centers on logic and the plain language of the ERISA statute, which is sensible, said Paul Secunda, a law professor and director of the labor and employment law program at Marquette University in Milwaukee. However, the decision does not address the larger question that matters to physicians and hospitals, he said.
“Some of these church-affiliated hospitals look an awful lot like their secular competitors,” he said. “They have thousands of employees. They make billions of dollars in revenue.”
Associate Justice Sonia Sotomayor raised similar concerns in a concurring opinion to the decision. While she agreed with her fellow justices on the ruling, she said the case outcome was still troubling.
“Despite their relationship to churches, organizations such as petitioners operate for-profit subsidiaries ... and compete in the secular market with companies that must bear the cost of complying with ERISA,” Justice Sotomayor wrote.
The Supreme Court ruling comes after current and former employees of three hospital chains – Dignity Health, Advocate Health Care, and Saint Peter’s Healthcare System – sued their employers in an effort to make them comply with ERISA. The employees argued that pension plans established by the large health care providers should not fall under ERISA’s “church plan” exception because the plans were not established by churches. ERISA requires that all private employers offering pension plans adhere to federal requirements designed to ensure plan solvency and protect plan participants.
The hospitals argued that pension plans do not have to be established by a church for the ERISA exemption to apply because the plans are maintained by qualifying church-affiliated organizations. The defendants based their position on a 1980 ERISA amendment that included the “maintained” exception. Since the amendment, the federal agencies charged with interpreting ERISA – the IRS, the Department of Labor, and the Pension Benefit Guaranty Corporation – have issued opinion after opinion reaffirming that view, the defendants noted.
Courts of appeals for the Third, Seventh, and Ninth circuits agreed with the employees, concluding that ERISA’s “plain text” requires that a pension plan be established by a church to qualify for the church-plan exemption.
The Supreme Court disagreed, however, ruling that a defined-benefit pension plan maintained by a principal-purpose organization – one controlled by or associate
However, the hospital sector has changed dramatically since the 1980 ERISA amendment, Mr. Secunda pointed out. “If you think back to when this reform was passed ... almost 40 years ago, we have a whole different animal [today] with regard to these large church-oriented hospital organizations.”
Justice Sotomayor raised similar concerns. “These organizations thus bear little resemblance to those Congress considered when enacting the 1980 amendment to the church plan definition. This current reality might prompt Congress to take a different path,” she wrote.
The legal battle over whether faith-based hospitals should comply with ERISA is not likely over, according to Mr. Secunda.
“This is not the end of the story,” he said. “This is just the beginning, and now the next big issue to be decided will be, okay, principal purpose organizations come under the church plan exemption, but do these large billion-dollar hospitals qualify? Are they principal purpose organizations? I think that’s a very open question.”
[email protected]
On Twitter @legal_med
The U.S. Supreme Court has ruled that faith-based hospitals are exempt from federal pension requirements, holding that employees of religious-affiliated entities are not protected under the Employee Retirement Income Security Act (ERISA). The unanimous decision overturns rulings in the three circuit courts of appeals.
The opinion preserves the status quo, so it should not have an immediate effect on the affected employers and employees, said Ronald J. Mann, a law professor at Columbia University in New York who has written about one case, Advocate Health Care Network v. Stapleton, for Scotusblog.com.
The high court’s opinion centers on logic and the plain language of the ERISA statute, which is sensible, said Paul Secunda, a law professor and director of the labor and employment law program at Marquette University in Milwaukee. However, the decision does not address the larger question that matters to physicians and hospitals, he said.
“Some of these church-affiliated hospitals look an awful lot like their secular competitors,” he said. “They have thousands of employees. They make billions of dollars in revenue.”
Associate Justice Sonia Sotomayor raised similar concerns in a concurring opinion to the decision. While she agreed with her fellow justices on the ruling, she said the case outcome was still troubling.
“Despite their relationship to churches, organizations such as petitioners operate for-profit subsidiaries ... and compete in the secular market with companies that must bear the cost of complying with ERISA,” Justice Sotomayor wrote.
The Supreme Court ruling comes after current and former employees of three hospital chains – Dignity Health, Advocate Health Care, and Saint Peter’s Healthcare System – sued their employers in an effort to make them comply with ERISA. The employees argued that pension plans established by the large health care providers should not fall under ERISA’s “church plan” exception because the plans were not established by churches. ERISA requires that all private employers offering pension plans adhere to federal requirements designed to ensure plan solvency and protect plan participants.
The hospitals argued that pension plans do not have to be established by a church for the ERISA exemption to apply because the plans are maintained by qualifying church-affiliated organizations. The defendants based their position on a 1980 ERISA amendment that included the “maintained” exception. Since the amendment, the federal agencies charged with interpreting ERISA – the IRS, the Department of Labor, and the Pension Benefit Guaranty Corporation – have issued opinion after opinion reaffirming that view, the defendants noted.
Courts of appeals for the Third, Seventh, and Ninth circuits agreed with the employees, concluding that ERISA’s “plain text” requires that a pension plan be established by a church to qualify for the church-plan exemption.
The Supreme Court disagreed, however, ruling that a defined-benefit pension plan maintained by a principal-purpose organization – one controlled by or associate
However, the hospital sector has changed dramatically since the 1980 ERISA amendment, Mr. Secunda pointed out. “If you think back to when this reform was passed ... almost 40 years ago, we have a whole different animal [today] with regard to these large church-oriented hospital organizations.”
Justice Sotomayor raised similar concerns. “These organizations thus bear little resemblance to those Congress considered when enacting the 1980 amendment to the church plan definition. This current reality might prompt Congress to take a different path,” she wrote.
The legal battle over whether faith-based hospitals should comply with ERISA is not likely over, according to Mr. Secunda.
“This is not the end of the story,” he said. “This is just the beginning, and now the next big issue to be decided will be, okay, principal purpose organizations come under the church plan exemption, but do these large billion-dollar hospitals qualify? Are they principal purpose organizations? I think that’s a very open question.”
[email protected]
On Twitter @legal_med
Travel restrictions bar surgeon from U.S. meeting
A. Pieter Kappetein, MD, PhD, was looking forward to a busy week of meetings and activities at the annual meeting of the American Association for Thoracic Surgeons (AATS) in late April. Dr. Kappetein, a cardiothoracic surgeon at Erasmus MC in Rotterdam, the Netherlands, and secretary general for the European Association for Cardio-Thoracic Surgery, was giving two presentations at the meeting and had a full schedule of committee meetings, board meetings, and the like.
But on his way to the United States, Dr. Kappetein was pulled aside by U.S. immigration officials in Dublin and questioned about his travel background. After a long interrogation, he was informed he could not enter the United States and had to return home. The reason? His passport showed he had traveled to Iran 2 years earlier.
He was forced to give up his ticket to Boston, buy a new ticket home, and miss the work he was scheduled to do.
“I was angry,” Dr. Kappetein said. “They had to go get my luggage off the plane. I lost my ticket to Boston. It [was] a lot of money. I was very busy in Boston. I had meetings from early in the morning until late in the evening, and I had to give lectures as well. There were a lot of obligations that I could not fulfill.”
Restrictions hamper streamlined process
Dr. Kappetein’s ruined travel plans result from recent changes to the Visa Waiver Program (VWP). The program enables most citizens and nationals of participating countries to travel to the United States for tourism or business for 90 days or less without a visa; U.S. citizens and nationals get reciprocal travel access.
But changes to the program starting in 2015 mandated that most people who had traveled to or had been present in Iran, Iraq, Libya, Somalia, Sudan, Syria, or Yemen on March 1, 2011, or later, were no longer eligible to travel to under the VWP. The changes were part of the Visa Waiver Program Improvement and Terrorist Travel Prevention Act of 2015, signed by President Obama, which aimed to prevent travelers with ties to countries that pose terrorist threats from entering the country.
These new restrictions to the VWP have been enforced since January 2016, Jennifer Gabris, a spokesperson for U.S. Customs and Border Protection, said in an interview. She stressed that the eligibility requirements do not bar travel to the United States; rather, travelers who do not meet the requirements must obtain a visa.
Dr. Kappetein, however, said he has traveled to the United States from the Netherlands at least 10 times since his visit to Iran 2 years ago and encountered no problems until this year. He was under the assumption that travelers coming to the United States for business were exempt from the restrictions.
“I never had any issue at the border,” he said. “So the immigration officers, either they hadn’t seen [the passport stamp], or they had ignored it, or they didn’t care about it. I even got this prescreening [approval], so when I was in the States, I didn’t have to go in the line where you have to take off your shoes or your jacket.”
A Department of State spokeswoman referred questions about airport enforcement to the Department of Homeland Security, which declined to comment for this article.
“It takes time to implement, even after it’s signed,” Mr. Cohen said. “I don’t know to what degree it was being enforced, but the limited application means it probably just didn’t raise much attention.”
He noted there was little publicity surrounding the VWP restrictions until President Donald Trump called out the changes to justify his controversial travel ban, Mr. Cohen added. In his revised executive order released in March, the president noted that the countries named in his ban had already been “identified as presenting heightened concerns about terrorism and travel to the United States” through their exclusion from the VWP.
Harm to collaboration?
The VWP restrictions are among a number of increased security measures for foreigners and immigrants entering the country. President Trump’s March 6 Executive Order on immigration expanded uniform screening procedures for all visa classes and nationalities, while another provision suspended the Visa Interview Waiver Program. The interview program suspension means that certain applicants seeking to renew a visa must be interviewed in person by a consular officer. While a number of courts, including the 4th U.S. Circuit Court of Appeals, have blocked much of the Executive Order, the decisions did not halt the additional screening requirements or temporarily suspend the Visa Interview Waiver Program rollback. Both provisions remain in effect.
On May 4, the State Department proposed another regulation that would require more personal information from a subset of visa applicants, including 15 years of biographical information, employment history, addresses, prior passport numbers, information about family members including current and former spouses as well as travel histories and how trips were funded. Visa applicants would be required to provide phone numbers and email addresses used over the previous 5 years, according to the proposed rule. The subset of visa applicants would be determined by Department of State consular officers when resolving an applicant’s identity or when vetting for national security–related visa ineligibilities.
In a May 18 letter to the State Department, the American Association for the Advancement of Science and 17 other associations cautioned that the rule, if approved, would blunt scientific and academic collaborations, discourage foreign students from seeking to study and participate in research projects in the United States, and damage U.S. competitiveness.
“The notice, as proposed, is likely to have a chilling effect not only on those required to submit additional information, but indirectly on all international travelers to the United States,” the letter stated. “The uncertainties and confusion regarding supplemental questions will have a negative impact particularly on U.S. higher education and scientific collaborations.”
Since Dr. Kappetein’s travel mishap, he has obtained the required visa so that he may again travel to the United States. But he noted that entering this country will take at least 2 hours longer because of the visa entry protocols and additional airport screenings. The added restrictions and increased scrutiny of foreign travelers is unfortunate for U.S.-based medical conferences, he said.
“The interchange of information is really happening at those meetings,” he said. “[This] will block the exchange of information and it will block innovation. That’s a pity for [foreign physicians], but also for Americans.”
[email protected]
On Twitter @legal_med
A. Pieter Kappetein, MD, PhD, was looking forward to a busy week of meetings and activities at the annual meeting of the American Association for Thoracic Surgeons (AATS) in late April. Dr. Kappetein, a cardiothoracic surgeon at Erasmus MC in Rotterdam, the Netherlands, and secretary general for the European Association for Cardio-Thoracic Surgery, was giving two presentations at the meeting and had a full schedule of committee meetings, board meetings, and the like.
But on his way to the United States, Dr. Kappetein was pulled aside by U.S. immigration officials in Dublin and questioned about his travel background. After a long interrogation, he was informed he could not enter the United States and had to return home. The reason? His passport showed he had traveled to Iran 2 years earlier.
He was forced to give up his ticket to Boston, buy a new ticket home, and miss the work he was scheduled to do.
“I was angry,” Dr. Kappetein said. “They had to go get my luggage off the plane. I lost my ticket to Boston. It [was] a lot of money. I was very busy in Boston. I had meetings from early in the morning until late in the evening, and I had to give lectures as well. There were a lot of obligations that I could not fulfill.”
Restrictions hamper streamlined process
Dr. Kappetein’s ruined travel plans result from recent changes to the Visa Waiver Program (VWP). The program enables most citizens and nationals of participating countries to travel to the United States for tourism or business for 90 days or less without a visa; U.S. citizens and nationals get reciprocal travel access.
But changes to the program starting in 2015 mandated that most people who had traveled to or had been present in Iran, Iraq, Libya, Somalia, Sudan, Syria, or Yemen on March 1, 2011, or later, were no longer eligible to travel to under the VWP. The changes were part of the Visa Waiver Program Improvement and Terrorist Travel Prevention Act of 2015, signed by President Obama, which aimed to prevent travelers with ties to countries that pose terrorist threats from entering the country.
These new restrictions to the VWP have been enforced since January 2016, Jennifer Gabris, a spokesperson for U.S. Customs and Border Protection, said in an interview. She stressed that the eligibility requirements do not bar travel to the United States; rather, travelers who do not meet the requirements must obtain a visa.
Dr. Kappetein, however, said he has traveled to the United States from the Netherlands at least 10 times since his visit to Iran 2 years ago and encountered no problems until this year. He was under the assumption that travelers coming to the United States for business were exempt from the restrictions.
“I never had any issue at the border,” he said. “So the immigration officers, either they hadn’t seen [the passport stamp], or they had ignored it, or they didn’t care about it. I even got this prescreening [approval], so when I was in the States, I didn’t have to go in the line where you have to take off your shoes or your jacket.”
A Department of State spokeswoman referred questions about airport enforcement to the Department of Homeland Security, which declined to comment for this article.
“It takes time to implement, even after it’s signed,” Mr. Cohen said. “I don’t know to what degree it was being enforced, but the limited application means it probably just didn’t raise much attention.”
He noted there was little publicity surrounding the VWP restrictions until President Donald Trump called out the changes to justify his controversial travel ban, Mr. Cohen added. In his revised executive order released in March, the president noted that the countries named in his ban had already been “identified as presenting heightened concerns about terrorism and travel to the United States” through their exclusion from the VWP.
Harm to collaboration?
The VWP restrictions are among a number of increased security measures for foreigners and immigrants entering the country. President Trump’s March 6 Executive Order on immigration expanded uniform screening procedures for all visa classes and nationalities, while another provision suspended the Visa Interview Waiver Program. The interview program suspension means that certain applicants seeking to renew a visa must be interviewed in person by a consular officer. While a number of courts, including the 4th U.S. Circuit Court of Appeals, have blocked much of the Executive Order, the decisions did not halt the additional screening requirements or temporarily suspend the Visa Interview Waiver Program rollback. Both provisions remain in effect.
On May 4, the State Department proposed another regulation that would require more personal information from a subset of visa applicants, including 15 years of biographical information, employment history, addresses, prior passport numbers, information about family members including current and former spouses as well as travel histories and how trips were funded. Visa applicants would be required to provide phone numbers and email addresses used over the previous 5 years, according to the proposed rule. The subset of visa applicants would be determined by Department of State consular officers when resolving an applicant’s identity or when vetting for national security–related visa ineligibilities.
In a May 18 letter to the State Department, the American Association for the Advancement of Science and 17 other associations cautioned that the rule, if approved, would blunt scientific and academic collaborations, discourage foreign students from seeking to study and participate in research projects in the United States, and damage U.S. competitiveness.
“The notice, as proposed, is likely to have a chilling effect not only on those required to submit additional information, but indirectly on all international travelers to the United States,” the letter stated. “The uncertainties and confusion regarding supplemental questions will have a negative impact particularly on U.S. higher education and scientific collaborations.”
Since Dr. Kappetein’s travel mishap, he has obtained the required visa so that he may again travel to the United States. But he noted that entering this country will take at least 2 hours longer because of the visa entry protocols and additional airport screenings. The added restrictions and increased scrutiny of foreign travelers is unfortunate for U.S.-based medical conferences, he said.
“The interchange of information is really happening at those meetings,” he said. “[This] will block the exchange of information and it will block innovation. That’s a pity for [foreign physicians], but also for Americans.”
[email protected]
On Twitter @legal_med
A. Pieter Kappetein, MD, PhD, was looking forward to a busy week of meetings and activities at the annual meeting of the American Association for Thoracic Surgeons (AATS) in late April. Dr. Kappetein, a cardiothoracic surgeon at Erasmus MC in Rotterdam, the Netherlands, and secretary general for the European Association for Cardio-Thoracic Surgery, was giving two presentations at the meeting and had a full schedule of committee meetings, board meetings, and the like.
But on his way to the United States, Dr. Kappetein was pulled aside by U.S. immigration officials in Dublin and questioned about his travel background. After a long interrogation, he was informed he could not enter the United States and had to return home. The reason? His passport showed he had traveled to Iran 2 years earlier.
He was forced to give up his ticket to Boston, buy a new ticket home, and miss the work he was scheduled to do.
“I was angry,” Dr. Kappetein said. “They had to go get my luggage off the plane. I lost my ticket to Boston. It [was] a lot of money. I was very busy in Boston. I had meetings from early in the morning until late in the evening, and I had to give lectures as well. There were a lot of obligations that I could not fulfill.”
Restrictions hamper streamlined process
Dr. Kappetein’s ruined travel plans result from recent changes to the Visa Waiver Program (VWP). The program enables most citizens and nationals of participating countries to travel to the United States for tourism or business for 90 days or less without a visa; U.S. citizens and nationals get reciprocal travel access.
But changes to the program starting in 2015 mandated that most people who had traveled to or had been present in Iran, Iraq, Libya, Somalia, Sudan, Syria, or Yemen on March 1, 2011, or later, were no longer eligible to travel to under the VWP. The changes were part of the Visa Waiver Program Improvement and Terrorist Travel Prevention Act of 2015, signed by President Obama, which aimed to prevent travelers with ties to countries that pose terrorist threats from entering the country.
These new restrictions to the VWP have been enforced since January 2016, Jennifer Gabris, a spokesperson for U.S. Customs and Border Protection, said in an interview. She stressed that the eligibility requirements do not bar travel to the United States; rather, travelers who do not meet the requirements must obtain a visa.
Dr. Kappetein, however, said he has traveled to the United States from the Netherlands at least 10 times since his visit to Iran 2 years ago and encountered no problems until this year. He was under the assumption that travelers coming to the United States for business were exempt from the restrictions.
“I never had any issue at the border,” he said. “So the immigration officers, either they hadn’t seen [the passport stamp], or they had ignored it, or they didn’t care about it. I even got this prescreening [approval], so when I was in the States, I didn’t have to go in the line where you have to take off your shoes or your jacket.”
A Department of State spokeswoman referred questions about airport enforcement to the Department of Homeland Security, which declined to comment for this article.
“It takes time to implement, even after it’s signed,” Mr. Cohen said. “I don’t know to what degree it was being enforced, but the limited application means it probably just didn’t raise much attention.”
He noted there was little publicity surrounding the VWP restrictions until President Donald Trump called out the changes to justify his controversial travel ban, Mr. Cohen added. In his revised executive order released in March, the president noted that the countries named in his ban had already been “identified as presenting heightened concerns about terrorism and travel to the United States” through their exclusion from the VWP.
Harm to collaboration?
The VWP restrictions are among a number of increased security measures for foreigners and immigrants entering the country. President Trump’s March 6 Executive Order on immigration expanded uniform screening procedures for all visa classes and nationalities, while another provision suspended the Visa Interview Waiver Program. The interview program suspension means that certain applicants seeking to renew a visa must be interviewed in person by a consular officer. While a number of courts, including the 4th U.S. Circuit Court of Appeals, have blocked much of the Executive Order, the decisions did not halt the additional screening requirements or temporarily suspend the Visa Interview Waiver Program rollback. Both provisions remain in effect.
On May 4, the State Department proposed another regulation that would require more personal information from a subset of visa applicants, including 15 years of biographical information, employment history, addresses, prior passport numbers, information about family members including current and former spouses as well as travel histories and how trips were funded. Visa applicants would be required to provide phone numbers and email addresses used over the previous 5 years, according to the proposed rule. The subset of visa applicants would be determined by Department of State consular officers when resolving an applicant’s identity or when vetting for national security–related visa ineligibilities.
In a May 18 letter to the State Department, the American Association for the Advancement of Science and 17 other associations cautioned that the rule, if approved, would blunt scientific and academic collaborations, discourage foreign students from seeking to study and participate in research projects in the United States, and damage U.S. competitiveness.
“The notice, as proposed, is likely to have a chilling effect not only on those required to submit additional information, but indirectly on all international travelers to the United States,” the letter stated. “The uncertainties and confusion regarding supplemental questions will have a negative impact particularly on U.S. higher education and scientific collaborations.”
Since Dr. Kappetein’s travel mishap, he has obtained the required visa so that he may again travel to the United States. But he noted that entering this country will take at least 2 hours longer because of the visa entry protocols and additional airport screenings. The added restrictions and increased scrutiny of foreign travelers is unfortunate for U.S.-based medical conferences, he said.
“The interchange of information is really happening at those meetings,” he said. “[This] will block the exchange of information and it will block innovation. That’s a pity for [foreign physicians], but also for Americans.”
[email protected]
On Twitter @legal_med
HHS proposal may limit birth control access
The Trump administration has drafted a plan that would allow more employers to opt out of offering no-cost contraception coverage to women based on religious or moral grounds, according to a leaked copy of the interim rule.
The proposed rule, first obtained by the media outlet Vox, would greatly expand the religious exemption under the Affordable Care Act for employers otherwise subject to the ACA’s contraception mandate. If approved, the rule would allow additional entities and employers that object to the mandate for religious or moral reasons to be exempt from providing coverage. The exception would apply to plans sponsored by objecting employers, whether or not they operate as a nonprofit, according to the leaked rule.
The American Congress of Obstetricians and Gynecologists denounced the rule, saying the proposal would wipe away women’s access to care and put women in all insurance plans at risk of losing coverage they have today.
“Contraception is an integral part of preventive care and a medical necessity for women during approximately 30 years of their lives. Access to contraception allows women to achieve, lead, and reach their full potentials, becoming key drivers of our Nation’s economic success,” Haywood L. Brown, MD, ACOG president, said in a statement. “Since the Affordable Care Act increased access to contraceptives, our nation has achieved a 30-year low in its unintended pregnancy rate, including among teens. Any move to decrease access to these vital services would have damaging effects on public health. Women, families, and our nation all benefit from seamless, affordable access to contraception.”
The White House has declined to comment about the leaked proposal. However, in early May, HHS Secretary Tom Price, MD, said he welcomed the chance to reexamine the ACA’s contraception mandate.
Since the ACA’s contraceptive mandate took effect, it has been the subject of multiple court challenges across the country. The mandate requires nearly all employers to provide coverage of birth control to employees, except for group health plans of “religious employers,” which are deemed exempt. Those religious employers are for the most part churches and other houses of worship.
The Obama administration later created a workaround for another group – nonprofit religious employers – to opt out of the mandate, but critics argued the process itself was a violation of their religious freedom. The issue led to the case of Zubik v. Burwell, a legal challenge over the mandate exemption that went before the U.S. Supreme Court in March 2016.
But the issue remained unresolved. In May 2016, the Supreme Court vacated the lower court rulings related to Zubik v. Burwell and remanded the case back to the four appeals courts that had originally ruled on the issue.
[email protected]
On Twitter @legal_med
The Trump administration has drafted a plan that would allow more employers to opt out of offering no-cost contraception coverage to women based on religious or moral grounds, according to a leaked copy of the interim rule.
The proposed rule, first obtained by the media outlet Vox, would greatly expand the religious exemption under the Affordable Care Act for employers otherwise subject to the ACA’s contraception mandate. If approved, the rule would allow additional entities and employers that object to the mandate for religious or moral reasons to be exempt from providing coverage. The exception would apply to plans sponsored by objecting employers, whether or not they operate as a nonprofit, according to the leaked rule.
The American Congress of Obstetricians and Gynecologists denounced the rule, saying the proposal would wipe away women’s access to care and put women in all insurance plans at risk of losing coverage they have today.
“Contraception is an integral part of preventive care and a medical necessity for women during approximately 30 years of their lives. Access to contraception allows women to achieve, lead, and reach their full potentials, becoming key drivers of our Nation’s economic success,” Haywood L. Brown, MD, ACOG president, said in a statement. “Since the Affordable Care Act increased access to contraceptives, our nation has achieved a 30-year low in its unintended pregnancy rate, including among teens. Any move to decrease access to these vital services would have damaging effects on public health. Women, families, and our nation all benefit from seamless, affordable access to contraception.”
The White House has declined to comment about the leaked proposal. However, in early May, HHS Secretary Tom Price, MD, said he welcomed the chance to reexamine the ACA’s contraception mandate.
Since the ACA’s contraceptive mandate took effect, it has been the subject of multiple court challenges across the country. The mandate requires nearly all employers to provide coverage of birth control to employees, except for group health plans of “religious employers,” which are deemed exempt. Those religious employers are for the most part churches and other houses of worship.
The Obama administration later created a workaround for another group – nonprofit religious employers – to opt out of the mandate, but critics argued the process itself was a violation of their religious freedom. The issue led to the case of Zubik v. Burwell, a legal challenge over the mandate exemption that went before the U.S. Supreme Court in March 2016.
But the issue remained unresolved. In May 2016, the Supreme Court vacated the lower court rulings related to Zubik v. Burwell and remanded the case back to the four appeals courts that had originally ruled on the issue.
[email protected]
On Twitter @legal_med
The Trump administration has drafted a plan that would allow more employers to opt out of offering no-cost contraception coverage to women based on religious or moral grounds, according to a leaked copy of the interim rule.
The proposed rule, first obtained by the media outlet Vox, would greatly expand the religious exemption under the Affordable Care Act for employers otherwise subject to the ACA’s contraception mandate. If approved, the rule would allow additional entities and employers that object to the mandate for religious or moral reasons to be exempt from providing coverage. The exception would apply to plans sponsored by objecting employers, whether or not they operate as a nonprofit, according to the leaked rule.
The American Congress of Obstetricians and Gynecologists denounced the rule, saying the proposal would wipe away women’s access to care and put women in all insurance plans at risk of losing coverage they have today.
“Contraception is an integral part of preventive care and a medical necessity for women during approximately 30 years of their lives. Access to contraception allows women to achieve, lead, and reach their full potentials, becoming key drivers of our Nation’s economic success,” Haywood L. Brown, MD, ACOG president, said in a statement. “Since the Affordable Care Act increased access to contraceptives, our nation has achieved a 30-year low in its unintended pregnancy rate, including among teens. Any move to decrease access to these vital services would have damaging effects on public health. Women, families, and our nation all benefit from seamless, affordable access to contraception.”
The White House has declined to comment about the leaked proposal. However, in early May, HHS Secretary Tom Price, MD, said he welcomed the chance to reexamine the ACA’s contraception mandate.
Since the ACA’s contraceptive mandate took effect, it has been the subject of multiple court challenges across the country. The mandate requires nearly all employers to provide coverage of birth control to employees, except for group health plans of “religious employers,” which are deemed exempt. Those religious employers are for the most part churches and other houses of worship.
The Obama administration later created a workaround for another group – nonprofit religious employers – to opt out of the mandate, but critics argued the process itself was a violation of their religious freedom. The issue led to the case of Zubik v. Burwell, a legal challenge over the mandate exemption that went before the U.S. Supreme Court in March 2016.
But the issue remained unresolved. In May 2016, the Supreme Court vacated the lower court rulings related to Zubik v. Burwell and remanded the case back to the four appeals courts that had originally ruled on the issue.
[email protected]
On Twitter @legal_med
President’s budget: Malpractice reform but deep health care cuts
President Trump’s proposed budget for fiscal 2018 could mean crushing blows for some of the nation’s largest health care programs, if it makes it through Congress.
The proposed budget “clearly reflects the priorities of the Trump administration, which is to cut taxes, to increase defense spending and spending on boarder security, and also to cut domestic spending,” Timothy S. Jost, a health law professor at Washington and Lee University in Lexington, Va., said in an interview*.
The proposed CHIP reduction would eliminate the increased federal match provided by the Affordable Care Act and cap eligibility for federal CHIP funding at 250% of the federal poverty level, according to a summary of the proposal by the Kaiser Family Foundation. States would be able to transfer children in families with incomes below 133% of the poverty line who were moved from CHIP to Medicaid under the ACA back to CHIP.
If the cuts are approved, physicians face the challenge of caring for more uninsured and underinsured patients, said John D. Abramson, MD, a family physician and health policy lecturer at Harvard Medical School in Boston. He notes that the budget’s proposed Medicaid cuts come on top of Medicaid reductions included in the AHCA.
Meanwhile, the Food and Drug Administration stands to lose $850 million for 2018 through the budget, although medical product user fees would increase, resulting in a program increase of about $450 million. The President proposes to cut CDC funds by $1.3 billion and withdraw $252 million in funding from the Substance Abuse and Mental Health Services Administration. The cuts and savings are further outlined in a U.S. Department of Health & Human Services budget summary.
The cuts to mental health care funding would no doubt affect mental health care providers and the patients they seek to treat, Mr. Jost said. “Given the seriousness of the opioid crisis, it doesn’t seem like a great time to be cutting funding for substance abuse treatment.”
Medical research may also suffer under the proposed budget. The President intends to cut funding for the National Institutes of Health by $5.8 billion, while eliminating the Agency for Health Care Research and Quality as a stand alone agency and folding it into the NIH with less funding.
The American Association for the Advancement of Science expressed concern that the research cuts could devastate the country’s science and technology enterprise and weaken the nation’s economic growth.
“Slashing funding of critically important federal agencies threatens our nation’s ability to advance cures for disease, develop new energy technologies, improve public health, train the next generation of scientists and engineers and grow the American economy,” Rush Holt, association CEO said in a statement.
Other proposals in the budget could be positive for health care, experts say.
IPAB “really hasn’t had any impact on health care over the past 7 years,” Dr. Ayanian said. ““That’s potentially one area of compromise as senators and representatives discuss ways in which the Affordable Care Act can be reformed.”
Medical malpractice reforms are also included in the proposed budget. The proposal includes a $250,000 cap on noneconomic damages, a 3-year statute of limitations, and an established safe harbor for clinicians following evidence-based clinical practice guidelines. The changes are estimated to save the federal government $55 billion over 10 years.
“That’s an area of frequent concern for practicing physicians,” Dr. Ayanian said. “To the extent that reforms can be developed that are acceptable to patients and physicians that create the right incentives for improving health care quality and avoiding medical errors, that could be a positive. It’ll depend very much on the reform proposals that are developed. I think there is potential for bipartisan agreement in this area.”
Ms. Carpenter stressed that the President’s budget is only the first step in a lengthy budget process that will include congressional hearings and debate before legislators draft budget resolutions. “I expect Congress to debate some of the cuts to domestic spending, including things like NIH. There seems to be a good bit of alignment in terms of repeal and replace of the [ACA] and potentially some of the Medicaid reforms.”
“Trump’s budget breaks his promise not to touch Social Security, which at its core is lifeline insurance for Americans who can no longer work, not just in retirement, but also due to a disability,” Sen. Wyden said in a statement. “It also slashes Medicaid by over $600 billion beyond the damage done by Trumpcare, further threatening pediatric care, the nursing home benefit, special education programs in schools, and other health care like substance misuse treatment.”
House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) commended the budget proposal as one that demonstrates President Trump’s commitment to balancing the budget and responsibly prioritizing taxpayer dollars.
“The initiatives modernizing our energy infrastructure and promoting our nation’s energy abundance would undoubtedly make positive impacts on our constituents’ lives,” he said in a statement. “The president’s proposals show the difficult choices facing the country as we work to reduce the deficit, protect our security, and grow jobs.”
Additional proposals in the President’s budget include:
• Nearly $70 billion in cuts for Social Security disability benefits over the next 10 years.
• A funding increase for the Veterans Administration, including $29 billion over the next decade for a program that enables veterans to seek outside health services from private doctors.
• A ban on funds for clinics and medical centers that provide abortions, such as Planned Parenthood.
• A $70 million increase for Medicare and Medicaid fraud prevention efforts in 2018.
• A $114 million funding increase for the Center for Medicare and Medicaid Innovation.
[email protected]
On Twitter @legal_med
*This story was updated May 26, 2017
President Trump’s proposed budget for fiscal 2018 could mean crushing blows for some of the nation’s largest health care programs, if it makes it through Congress.
The proposed budget “clearly reflects the priorities of the Trump administration, which is to cut taxes, to increase defense spending and spending on boarder security, and also to cut domestic spending,” Timothy S. Jost, a health law professor at Washington and Lee University in Lexington, Va., said in an interview*.
The proposed CHIP reduction would eliminate the increased federal match provided by the Affordable Care Act and cap eligibility for federal CHIP funding at 250% of the federal poverty level, according to a summary of the proposal by the Kaiser Family Foundation. States would be able to transfer children in families with incomes below 133% of the poverty line who were moved from CHIP to Medicaid under the ACA back to CHIP.
If the cuts are approved, physicians face the challenge of caring for more uninsured and underinsured patients, said John D. Abramson, MD, a family physician and health policy lecturer at Harvard Medical School in Boston. He notes that the budget’s proposed Medicaid cuts come on top of Medicaid reductions included in the AHCA.
Meanwhile, the Food and Drug Administration stands to lose $850 million for 2018 through the budget, although medical product user fees would increase, resulting in a program increase of about $450 million. The President proposes to cut CDC funds by $1.3 billion and withdraw $252 million in funding from the Substance Abuse and Mental Health Services Administration. The cuts and savings are further outlined in a U.S. Department of Health & Human Services budget summary.
The cuts to mental health care funding would no doubt affect mental health care providers and the patients they seek to treat, Mr. Jost said. “Given the seriousness of the opioid crisis, it doesn’t seem like a great time to be cutting funding for substance abuse treatment.”
Medical research may also suffer under the proposed budget. The President intends to cut funding for the National Institutes of Health by $5.8 billion, while eliminating the Agency for Health Care Research and Quality as a stand alone agency and folding it into the NIH with less funding.
The American Association for the Advancement of Science expressed concern that the research cuts could devastate the country’s science and technology enterprise and weaken the nation’s economic growth.
“Slashing funding of critically important federal agencies threatens our nation’s ability to advance cures for disease, develop new energy technologies, improve public health, train the next generation of scientists and engineers and grow the American economy,” Rush Holt, association CEO said in a statement.
Other proposals in the budget could be positive for health care, experts say.
IPAB “really hasn’t had any impact on health care over the past 7 years,” Dr. Ayanian said. ““That’s potentially one area of compromise as senators and representatives discuss ways in which the Affordable Care Act can be reformed.”
Medical malpractice reforms are also included in the proposed budget. The proposal includes a $250,000 cap on noneconomic damages, a 3-year statute of limitations, and an established safe harbor for clinicians following evidence-based clinical practice guidelines. The changes are estimated to save the federal government $55 billion over 10 years.
“That’s an area of frequent concern for practicing physicians,” Dr. Ayanian said. “To the extent that reforms can be developed that are acceptable to patients and physicians that create the right incentives for improving health care quality and avoiding medical errors, that could be a positive. It’ll depend very much on the reform proposals that are developed. I think there is potential for bipartisan agreement in this area.”
Ms. Carpenter stressed that the President’s budget is only the first step in a lengthy budget process that will include congressional hearings and debate before legislators draft budget resolutions. “I expect Congress to debate some of the cuts to domestic spending, including things like NIH. There seems to be a good bit of alignment in terms of repeal and replace of the [ACA] and potentially some of the Medicaid reforms.”
“Trump’s budget breaks his promise not to touch Social Security, which at its core is lifeline insurance for Americans who can no longer work, not just in retirement, but also due to a disability,” Sen. Wyden said in a statement. “It also slashes Medicaid by over $600 billion beyond the damage done by Trumpcare, further threatening pediatric care, the nursing home benefit, special education programs in schools, and other health care like substance misuse treatment.”
House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) commended the budget proposal as one that demonstrates President Trump’s commitment to balancing the budget and responsibly prioritizing taxpayer dollars.
“The initiatives modernizing our energy infrastructure and promoting our nation’s energy abundance would undoubtedly make positive impacts on our constituents’ lives,” he said in a statement. “The president’s proposals show the difficult choices facing the country as we work to reduce the deficit, protect our security, and grow jobs.”
Additional proposals in the President’s budget include:
• Nearly $70 billion in cuts for Social Security disability benefits over the next 10 years.
• A funding increase for the Veterans Administration, including $29 billion over the next decade for a program that enables veterans to seek outside health services from private doctors.
• A ban on funds for clinics and medical centers that provide abortions, such as Planned Parenthood.
• A $70 million increase for Medicare and Medicaid fraud prevention efforts in 2018.
• A $114 million funding increase for the Center for Medicare and Medicaid Innovation.
[email protected]
On Twitter @legal_med
*This story was updated May 26, 2017
President Trump’s proposed budget for fiscal 2018 could mean crushing blows for some of the nation’s largest health care programs, if it makes it through Congress.
The proposed budget “clearly reflects the priorities of the Trump administration, which is to cut taxes, to increase defense spending and spending on boarder security, and also to cut domestic spending,” Timothy S. Jost, a health law professor at Washington and Lee University in Lexington, Va., said in an interview*.
The proposed CHIP reduction would eliminate the increased federal match provided by the Affordable Care Act and cap eligibility for federal CHIP funding at 250% of the federal poverty level, according to a summary of the proposal by the Kaiser Family Foundation. States would be able to transfer children in families with incomes below 133% of the poverty line who were moved from CHIP to Medicaid under the ACA back to CHIP.
If the cuts are approved, physicians face the challenge of caring for more uninsured and underinsured patients, said John D. Abramson, MD, a family physician and health policy lecturer at Harvard Medical School in Boston. He notes that the budget’s proposed Medicaid cuts come on top of Medicaid reductions included in the AHCA.
Meanwhile, the Food and Drug Administration stands to lose $850 million for 2018 through the budget, although medical product user fees would increase, resulting in a program increase of about $450 million. The President proposes to cut CDC funds by $1.3 billion and withdraw $252 million in funding from the Substance Abuse and Mental Health Services Administration. The cuts and savings are further outlined in a U.S. Department of Health & Human Services budget summary.
The cuts to mental health care funding would no doubt affect mental health care providers and the patients they seek to treat, Mr. Jost said. “Given the seriousness of the opioid crisis, it doesn’t seem like a great time to be cutting funding for substance abuse treatment.”
Medical research may also suffer under the proposed budget. The President intends to cut funding for the National Institutes of Health by $5.8 billion, while eliminating the Agency for Health Care Research and Quality as a stand alone agency and folding it into the NIH with less funding.
The American Association for the Advancement of Science expressed concern that the research cuts could devastate the country’s science and technology enterprise and weaken the nation’s economic growth.
“Slashing funding of critically important federal agencies threatens our nation’s ability to advance cures for disease, develop new energy technologies, improve public health, train the next generation of scientists and engineers and grow the American economy,” Rush Holt, association CEO said in a statement.
Other proposals in the budget could be positive for health care, experts say.
IPAB “really hasn’t had any impact on health care over the past 7 years,” Dr. Ayanian said. ““That’s potentially one area of compromise as senators and representatives discuss ways in which the Affordable Care Act can be reformed.”
Medical malpractice reforms are also included in the proposed budget. The proposal includes a $250,000 cap on noneconomic damages, a 3-year statute of limitations, and an established safe harbor for clinicians following evidence-based clinical practice guidelines. The changes are estimated to save the federal government $55 billion over 10 years.
“That’s an area of frequent concern for practicing physicians,” Dr. Ayanian said. “To the extent that reforms can be developed that are acceptable to patients and physicians that create the right incentives for improving health care quality and avoiding medical errors, that could be a positive. It’ll depend very much on the reform proposals that are developed. I think there is potential for bipartisan agreement in this area.”
Ms. Carpenter stressed that the President’s budget is only the first step in a lengthy budget process that will include congressional hearings and debate before legislators draft budget resolutions. “I expect Congress to debate some of the cuts to domestic spending, including things like NIH. There seems to be a good bit of alignment in terms of repeal and replace of the [ACA] and potentially some of the Medicaid reforms.”
“Trump’s budget breaks his promise not to touch Social Security, which at its core is lifeline insurance for Americans who can no longer work, not just in retirement, but also due to a disability,” Sen. Wyden said in a statement. “It also slashes Medicaid by over $600 billion beyond the damage done by Trumpcare, further threatening pediatric care, the nursing home benefit, special education programs in schools, and other health care like substance misuse treatment.”
House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) commended the budget proposal as one that demonstrates President Trump’s commitment to balancing the budget and responsibly prioritizing taxpayer dollars.
“The initiatives modernizing our energy infrastructure and promoting our nation’s energy abundance would undoubtedly make positive impacts on our constituents’ lives,” he said in a statement. “The president’s proposals show the difficult choices facing the country as we work to reduce the deficit, protect our security, and grow jobs.”
Additional proposals in the President’s budget include:
• Nearly $70 billion in cuts for Social Security disability benefits over the next 10 years.
• A funding increase for the Veterans Administration, including $29 billion over the next decade for a program that enables veterans to seek outside health services from private doctors.
• A ban on funds for clinics and medical centers that provide abortions, such as Planned Parenthood.
• A $70 million increase for Medicare and Medicaid fraud prevention efforts in 2018.
• A $114 million funding increase for the Center for Medicare and Medicaid Innovation.
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*This story was updated May 26, 2017
VIDEO: Wedge resection offers higher survival for NSCLC
BOSTON – High quality wedge resection results in higher survival for patients with early stage non–small cell lung cancer when compared with stereotactic body radiation therapy, according to new research.
The analysis, reported at the annual meeting of the American Association for Thoracic Surgery, evaluated the treatment of 7,337 patients in the National Cancer Database with clinical T1-T2, N0, M0 non–small cell lung cancer who were treated with either wedge resection or stereotactic body radiation therapy from 2005 to 2012.
In this video, Varun Puri, MD, of Washington University, St. Louis, discusses the study and the significance of the findings.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
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On Twitter @legal_med
BOSTON – High quality wedge resection results in higher survival for patients with early stage non–small cell lung cancer when compared with stereotactic body radiation therapy, according to new research.
The analysis, reported at the annual meeting of the American Association for Thoracic Surgery, evaluated the treatment of 7,337 patients in the National Cancer Database with clinical T1-T2, N0, M0 non–small cell lung cancer who were treated with either wedge resection or stereotactic body radiation therapy from 2005 to 2012.
In this video, Varun Puri, MD, of Washington University, St. Louis, discusses the study and the significance of the findings.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
[email protected]
On Twitter @legal_med
BOSTON – High quality wedge resection results in higher survival for patients with early stage non–small cell lung cancer when compared with stereotactic body radiation therapy, according to new research.
The analysis, reported at the annual meeting of the American Association for Thoracic Surgery, evaluated the treatment of 7,337 patients in the National Cancer Database with clinical T1-T2, N0, M0 non–small cell lung cancer who were treated with either wedge resection or stereotactic body radiation therapy from 2005 to 2012.
In this video, Varun Puri, MD, of Washington University, St. Louis, discusses the study and the significance of the findings.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
[email protected]
On Twitter @legal_med
AT THE AATS ANNUAL MEETING
VIDEO: Lack of heart teams impact prevalence of PCI
BOSTON – Data show a marked bias in referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team.
More patients underwent percutaneous coronary intervention (PCI) in hospitals without on-site cardiac surgery than patients at hospitals with on-site cardiac surgery, according to the analysis presented at the annual meeting of the American Association for Thoracic Surgery. The multivariate logistic regression analysis showed that the absence of on-site cardiac surgery and a heart team was an independent predictor for PCI.
In this video, Ehud Raanani, MD, of Tel Aviv University in Israel discusses referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team and how this phenomenon could affect patients.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
[email protected]
On Twitter @legal_med
BOSTON – Data show a marked bias in referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team.
More patients underwent percutaneous coronary intervention (PCI) in hospitals without on-site cardiac surgery than patients at hospitals with on-site cardiac surgery, according to the analysis presented at the annual meeting of the American Association for Thoracic Surgery. The multivariate logistic regression analysis showed that the absence of on-site cardiac surgery and a heart team was an independent predictor for PCI.
In this video, Ehud Raanani, MD, of Tel Aviv University in Israel discusses referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team and how this phenomenon could affect patients.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
[email protected]
On Twitter @legal_med
BOSTON – Data show a marked bias in referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team.
More patients underwent percutaneous coronary intervention (PCI) in hospitals without on-site cardiac surgery than patients at hospitals with on-site cardiac surgery, according to the analysis presented at the annual meeting of the American Association for Thoracic Surgery. The multivariate logistic regression analysis showed that the absence of on-site cardiac surgery and a heart team was an independent predictor for PCI.
In this video, Ehud Raanani, MD, of Tel Aviv University in Israel discusses referral patterns for coronary revascularization in stand-alone interventional cardiology units lacking a heart team and how this phenomenon could affect patients.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
[email protected]
On Twitter @legal_med
AT THE AATS ANNUAL MEETING
More telemedicine shifts to system-wide models
As telemedicine gains momentum, more health providers are moving from stand-alone programs to system-wide approaches.
In a survey of 436 U.S. health care executives, physicians, nurses, hospitals, and other health professionals, 25% of respondents with a telemedicine program began with a departmental approach but are now shifting to an enterprise system, 39% had an established enterprise system, and 36% remain with a departmental basis.
The survey of health care professionals’ priorities, objectives, challenges, and telemedicine models of care was conducted between December 2016 and January 2017 for REACH Health, a telemedicine software company.
Fifty-one percent of respondents reported that telemedicine is a top priority or high priority, a decrease from last year’s survey in which 66% of respondents said so. This shift could be linked to a continuing evolution and maturation of telemedicine as more programs move from ad-hoc project status to mainstream service, according to the report.
The telemedicine features most valuable to health providers were clinical documentation, the ability to send documentation to/from the electronic medical record, and the ability to analyze consult data. For the second year, health providers rated their top three telemedicine objectives as: improving patient outcomes, improving patient convenience, and increasing patient engagement.
Overall, health providers responded that the possible repeal and replacement of the Affordable Care Act would be positive for telemedicine. Forty-one percent of respondents said that patient adoption and the use of telemedicine would increase with ACA repeal/replace and 40% of health providers said that internal adoption and use of telemedicine would rise with replacement of the health law.
Just under half (47%) said they were uncertain how health care law changes would impact telemedicine parity laws, and 45% were unsure how repeal and replace would affect Medicare and Medicaid reimbursement for telemedicine services.
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On Twitter @legal_med
As telemedicine gains momentum, more health providers are moving from stand-alone programs to system-wide approaches.
In a survey of 436 U.S. health care executives, physicians, nurses, hospitals, and other health professionals, 25% of respondents with a telemedicine program began with a departmental approach but are now shifting to an enterprise system, 39% had an established enterprise system, and 36% remain with a departmental basis.
The survey of health care professionals’ priorities, objectives, challenges, and telemedicine models of care was conducted between December 2016 and January 2017 for REACH Health, a telemedicine software company.
Fifty-one percent of respondents reported that telemedicine is a top priority or high priority, a decrease from last year’s survey in which 66% of respondents said so. This shift could be linked to a continuing evolution and maturation of telemedicine as more programs move from ad-hoc project status to mainstream service, according to the report.
The telemedicine features most valuable to health providers were clinical documentation, the ability to send documentation to/from the electronic medical record, and the ability to analyze consult data. For the second year, health providers rated their top three telemedicine objectives as: improving patient outcomes, improving patient convenience, and increasing patient engagement.
Overall, health providers responded that the possible repeal and replacement of the Affordable Care Act would be positive for telemedicine. Forty-one percent of respondents said that patient adoption and the use of telemedicine would increase with ACA repeal/replace and 40% of health providers said that internal adoption and use of telemedicine would rise with replacement of the health law.
Just under half (47%) said they were uncertain how health care law changes would impact telemedicine parity laws, and 45% were unsure how repeal and replace would affect Medicare and Medicaid reimbursement for telemedicine services.
[email protected]
On Twitter @legal_med
As telemedicine gains momentum, more health providers are moving from stand-alone programs to system-wide approaches.
In a survey of 436 U.S. health care executives, physicians, nurses, hospitals, and other health professionals, 25% of respondents with a telemedicine program began with a departmental approach but are now shifting to an enterprise system, 39% had an established enterprise system, and 36% remain with a departmental basis.
The survey of health care professionals’ priorities, objectives, challenges, and telemedicine models of care was conducted between December 2016 and January 2017 for REACH Health, a telemedicine software company.
Fifty-one percent of respondents reported that telemedicine is a top priority or high priority, a decrease from last year’s survey in which 66% of respondents said so. This shift could be linked to a continuing evolution and maturation of telemedicine as more programs move from ad-hoc project status to mainstream service, according to the report.
The telemedicine features most valuable to health providers were clinical documentation, the ability to send documentation to/from the electronic medical record, and the ability to analyze consult data. For the second year, health providers rated their top three telemedicine objectives as: improving patient outcomes, improving patient convenience, and increasing patient engagement.
Overall, health providers responded that the possible repeal and replacement of the Affordable Care Act would be positive for telemedicine. Forty-one percent of respondents said that patient adoption and the use of telemedicine would increase with ACA repeal/replace and 40% of health providers said that internal adoption and use of telemedicine would rise with replacement of the health law.
Just under half (47%) said they were uncertain how health care law changes would impact telemedicine parity laws, and 45% were unsure how repeal and replace would affect Medicare and Medicaid reimbursement for telemedicine services.
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On Twitter @legal_med
VIDEO: Surgeon case volume linked to mitral valve repair outcomes
BOSTON – Individual surgeon case volume is a significant factor in degenerative mitral valve repair rates and overall patient survival, according to a study presented at the annual meeting of the American Association for Thoracic Surgery.
The analysis, which reviewed the outcomes of 38,128 adult patients, found that higher surgeon volume of mitral cases is associated with better degenerative mitral repair rates and higher survival. In this video, Ralph Damiano Jr., MD, of Washington University, St. Louis, discusses the threshold of mitral cases that led to better repair rates and how further cardiac surgical subspecialization could improve outcomes in patients with degenerative mitral disease.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
[email protected]
On Twitter @legal_med
BOSTON – Individual surgeon case volume is a significant factor in degenerative mitral valve repair rates and overall patient survival, according to a study presented at the annual meeting of the American Association for Thoracic Surgery.
The analysis, which reviewed the outcomes of 38,128 adult patients, found that higher surgeon volume of mitral cases is associated with better degenerative mitral repair rates and higher survival. In this video, Ralph Damiano Jr., MD, of Washington University, St. Louis, discusses the threshold of mitral cases that led to better repair rates and how further cardiac surgical subspecialization could improve outcomes in patients with degenerative mitral disease.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
[email protected]
On Twitter @legal_med
BOSTON – Individual surgeon case volume is a significant factor in degenerative mitral valve repair rates and overall patient survival, according to a study presented at the annual meeting of the American Association for Thoracic Surgery.
The analysis, which reviewed the outcomes of 38,128 adult patients, found that higher surgeon volume of mitral cases is associated with better degenerative mitral repair rates and higher survival. In this video, Ralph Damiano Jr., MD, of Washington University, St. Louis, discusses the threshold of mitral cases that led to better repair rates and how further cardiac surgical subspecialization could improve outcomes in patients with degenerative mitral disease.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
[email protected]
On Twitter @legal_med
AT THE AATS ANNUAL MEETING
