Sunday, February 10, 2019


Over 1 in 4 physicians say prior authorizations lead to serious adverse events, AMA survey finds

Fierce Healthcare (2/6, Finnegan) reports, “In a survey (pdf) by the American Medical Association” conducted online in December, “28% of 1,000 responding physicians said the prior authorization process required by health insurers for certain drugs, tests and treatments have led to serious or life-threatening adverse events for patients.” Physicians were specifically asked “if the prior authorization process ever affected care delivery and led to a serious adverse event, such as a death, hospitalization, disability or permanent bodily damage or other life-threatening event for a patient in their care.” In an announcement that released the result of the survey, AMA Chair Jack Resneck, Jr., M.D., said, “The AMA survey continues to illustrate that poorly designed, opaque prior authorization programs can pose an unreasonable and costly administrative obstacle to patient-centered care.” Dr. Resneck added, “The time is now for insurance companies to work with physicians, not against us, to improve and streamline the prior authorization process so that patients are ensured timely access to the evidence-based, quality healthcare they need.”


FDA issues 2019 update on BIA-ALCL

The American Society of Plastic Surgeons (ASPS)
 would like to make members aware of a Feb. 6
updating the number of adverse event
 reports submitted to the agency related to
 breast implant-associated anaplastic
 large cell lymphoma (BIA-ALCL).

The statement notes that as of September 2018, 
the agency has received 660 total medical
 device reports (MDR) regarding BIA-ALCL 
cases in the United States – an increase of
 246 new MDRs (59 percent) from the
 previous year’s update. Acknowledging
 that the nature of the MAUDE database’s
 reporting system is susceptible to duplicate 
reports, the agency’s analysis suggests
 there are only 457 unique cases,
 including nine deaths, of BIA-ALCL 
reported (since 2010). The FDA 
also notes that while the MDR 
system is a valuable source of information,
 it is a passive surveillance system with
 limitations, including incomplete,
 inaccurate, untimely, unverified or
 biased data in the reports. The
 incidence or prevalence of BIA-ALCL
 cannot be determined from this reporting
 system alone, due to potential under-
reporting, duplicate reporting and lack 
of information about the total number

 of breast implants.

The FDA update calls
 for no changes in recommendations
 regarding breast implants.
 For patients with breast implants, 
the FDA states there is no need to 
change routine medical care and
 follow-up, and there is no need to 
test asymptomatic patients.

BIA-ALCL is a rare condition that occurs
 most frequently in patients who have
 breast implants with textured surfaces.
 Patients should discuss with their
 health-care provider the benefits
 and risks of textured-surface
 versus smooth-surface implants. .

Tuesday, January 29, 2019


Electric scooters behind rash of visits to hospital EDs, study indicates

USA Today (1/25, Woodyard) reported, “Electric scooters are behind a rash of visits to hospital emergency” departments (EDs), researchers concluded. A study published online in JAMA Network Open revealed that “more electric scooter riders showed up with injuries in the emergency” departments “of two hospitals on Los Angeles’ scooter-heavy Westside than either bicyclists or pedestrians.” Among the patients admitted “some 40.2 percent” had “head injuries,” and 31.7 percent had fractures.


Experts debate whether patients benefit when community hospitals join with major institutions

Kaiser Health News (1/28, Boodman) discusses “a much-touted but little understood collaboration in health care: alliances between community hospitals and some of the nation’s biggest and most respected institutions.” Experts warn that “affiliation with a famous name is not a guarantee of quality.” In some instances, “it’s purely branding and in other cases it’s a deep association,” one expert said. He added, “A key question is ‘how often does the community hospital interact with the flagship hospital? If it’s once a week, that’s one thing. If it’s almost never, that’s another.’” The article says it remains to be seen if patients benefit from these affiliations. The piece adds that in order to increase “their reach, flagship hospitals including Mayo, the Cleveland Clinic and Houston’s MD Anderson Cancer Center have signed affiliation agreements with smaller hospitals around the country.”

Saturday, January 26, 2019


A molecule derived from a type of primrose may be a potent inhibitor of metastatic growth for a rare and aggressive cancer, as published in the journal Molecular Cancer Research.
Approximately 2000 adults are diagnosed with melanoma every year, in half of these cases the disease will metastasize to the liver and treatment options are scarce for these patients. Researchers from the Sidney Kimmel Cancer Center and the Icahn School of Medicine have found that a compound extracted from the Christmas berry primrose plant can stop cancer growth in preliminary tests; further testing could lead to new therapeutic options for those with melanoma.
Uveal melanoma accounts for 5% of all melanoma cases and is the most common eye cancer among adults forming in the melanocytes, although differing from skin melanoma both cancers are lethal. Radiation or surgery are the standard treatment for patients with primary UM that has not spread to other parts of the body, however metastases will occur in about half of these cases most often travelling to the liver; once spread patients often have only a year or so to live as no effective therapies have been developed.
FR900359 derived from Ardisia crenata of the primrose family was tested to investigate whether it may be able to fight the disease. FR900359 works by blocking a type of G protein that sits on a cell’s membrane called Gq which is a signalling molecule; a subset of the proteins are mutated in uveal melanoma turning on a molecular pathway that leads to cancer growth.
Three types of uveal melanoma cells were grown in the lab with cancer mutations which were treated with FR, which was found to effectively block the growth of uveal melanoma cells. When uveal melanoma cells were treated with FR they appeared to revert from cancer cells to typical melanocytes; and higher doses of FR killed the cells according to the researchers who suggest the compound could be used to treat uveal melanoma one day.
The team would like to repeat the findings in a mouse model of uveal melanoma as was done in the lab, moving towards testing in humans to develop new strategies for combating uveal melanoma.


Adalimumab therapy can get hidradenitis suppurativa under control in advance of surgery to repair associated scars and fistulas, says Jacek Szepietowski, president of the Conference of the European Hidradenitis Suppurativa Foundation. Adalimumab is the only FDA-approved biologic drug for the condition, but research is underway on monoclonal antibodies as well as adjuvant therapy with methotrexate, Szepietowski says.

Wednesday, January 9, 2019

American Board of Cosmetic Surgery Denied Right to Advertise as "Board Certified" in California

Today, the Medical Board of California (MBC)
 took a major step to protect patients in the
 state when it unanimously voted against
allowing members of the American Board
 of Cosmetic Surgery (ABCS) to advertise
 as “board certified” cosmetic surgeons.
 ASPS is proud to have worked in advance
 of this vote to educate the MBC
 and show that ABCS certifications
 are not backed by a level of
training that puts them on par with
American Board of Medical
 Specialties (ABMS) member boards.

“This is, frankly, a tremendous relief.
 California has a large number
 of cosmetic surgery patients and the
 most ABCS members of any
 state, which means it holds the greatest
 potential for those patients
 to be misled by advertisements that a
 doctor is a ‘board certified
cosmetic surgeon’,” says ASPS
 President Alan Matarasso, MD, FACS.
 “Today’s ruling means those patients
 are less likely to choose a
 particular provider because they
were exposed to a confusing ad.
 That’s going to make patients safer.
 Our specialty owes a huge debt
 of gratitude to all the plastic surgeons
 who invested their time and talents
 to help protect our patients.”

Today’s ruling closes the book on a
 two-decades-long story. In 1996,
California law was changed so that
 the state’s physicians could only
advertise ABMS certifications, unless
 a non-ABMS board was specifically
 reviewed and deemed equivalent to
 an ABMS member board by the MBC.
 ABCS has applied for equivalency
under this process multiple times, and
the MBC has repeatedly found that
 ABCS falls short of the state’s standard
that requires their training programs
 to be equivalent in scope, content,
and duration to training accredited by
 the Accreditation Council for
 Graduate Medical Education (ACGME).

Wednesday, January 2, 2019

WSJ analysis: Referrals driven by desire to keep business in hospital systems

The Wall Street Journal (12/27, A1, Mathews, Evans, Subscription Publication) reports hospitals employ a variety of strategies to encourage physicians to make referrals that keep patients within the hospital system, even when a patient may benefit from seeing a specialist outside the network. Leakage occurs when patients go to competitors for care, threatening the $1.8 million in revenue annually hospitals see from internal-medicine referrals for services like tests, according to a 2016 Merritt Hawkins survey. As hospitals acquire more physician practices, the pressure on new physicians to avoid leakage has mounted. One study found patients pay $90 more out-of-pocket for MRIs when administered in a hospital, while doctors working for the hospital system were 27 percent more likely to steer patients to the hospital for the scan.

Unfortunately, as more and more plastic surgeons are hired by hospitals, the hospital employed internists and family physicians are instructed to refer to these hospital based plastic surgeons, despite the fact that they may not have as much experience in certain cases.   It's all about the money and hospitals want to control patient flow. 
A sad state of affairs!!!