Articles by admin

No Image

Disputes Made Prevention Panel Stronger, Says Former Leader

For its first 25 years, the U.S. Preventive Services Task Force toiled in relative obscurity.

Created by the federal government in 1984, the task force published books and articles in scientific journals that aimed to inform primary care practitioners about which preventive services were effective based on scientific evidence. It assigns preventive services such as screenings, medication and counseling grades from A to D, or an I for insufficient evidence.

In 2010, everything changed.

“It would be disingenuous of me not to suggest that the link between the … recommendations and insurance coverage hasn’t put an additional focus on our work,” says Dr. Michael LeFevre, who chaired the task force for 10 years. Courtesy of Michael LeFevre hide caption

itoggle caption Courtesy of Michael LeFevre

The massive health care bill that came to be called Obamacare included language requiring that preventive services scoring a grade of A or B from the task force had to be covered by health plans without charging consumers anything out of pocket. In one stroke, this volunteer group of nonpartisan medical experts found themselves thrust into the political hurly-burly. Their recommendations, including a controversial 2009 recommendation regarding breast cancer screening, came under intense scrutiny.

Dr. Michael LeFevre, a primary care physician who is vice chairman of the Department of Family and Community Medicine at the University of Missouri, chaired the task force for 10 years. He stepped down from that position in March. We spoke recently about his tenure and how the task force’s role has evolved. The following interview has been edited and condensed.

How did the health law change the role that task force recommendations play in health care?

It would be disingenuous of me not to suggest that the link between the task force A and B recommendations and insurance coverage hasn’t put an additional focus on our work. There are people who think we are making a coverage decision. We’re not. We evaluate the science; we don’t look at the costs. If the science doesn’t make clear there’s at least moderate certainty of net benefit, we don’t recommend it. We know if we give it an A or a B, there will be a link to coverage, but we’re not saying it should be covered.

Let’s talk about the breast cancer screening recommendation. The task force in 2009 and again several months ago in a proposed update did not recommend mammograms for women age 40 to 49. The task force gave it a C rating, which means they should be offered selectively depending on patient preferences and health history in consultation with a physician. Some say this is a big mistake, that women in that age group won’t get mammograms that may help detect breast cancer earlier. How do you respond to critics?

In 2009, when we released our recommendation for breast cancer screening, we were in the middle of the debate in Congress about the Affordable Care Act. And it was already written into the bill being considered that A and B recommendations would be covered without a copayment. So we became the focus of debate about the recommendation and coverage. This created a firestorm of publicity that was, honestly, ultimately good.

We were already working to try to improve our transparency and communication. I’d be dishonest to say that it didn’t influence us. We realized that we have to be faster and clearer. Our audience is beyond primary care physicians, there are payers, government bodies and patients to consider.

But what about the charges of critics such as Rep. Debbie Wasserman Schultz, D-Fla., a breast cancer survivor, who wrote in The Washington Post, “We know that mammograms are not perfect, but we also know that deferring them until after age 50 is dangerous.”

It’s important for us to separate out the issue of coverage from the science itself and the benefits and harms. We are well aware that many payers cover not only C recommendations but also D recommendations. All the ACA really does is set a floor and says that A and B recommendations have to be covered.

How do you decide which preventive services to review?

We try to update existing topics every five years, more or less often depending on events. Occasionally we retire a topic.

Anybody can nominate a new topic at any time. We have a work group that looks at it continuously. We have to decide, is it prevention, and is it something that can be implemented or referred by primary care clinicians? For example, we saw that Vitamin D deficiency screening was being promoted widely. We decided it was an important topic to review.

What other task force recommendations have been publicly controversial?

The 2009 breast cancer screening recommendation was the peak of public scrutiny. But the breast cancer screening recommendation for women 40 to 49 is not negative [since it suggests that mammography can be offered based on the views of the doctor and patient]. In contrast, we recommended against prostate cancer screening. We gave it a D. To my knowledge nobody has stopped covering prostate cancer screening. We got a lot of attention for that. We still get a lot of attention and some advocates still want that to change. I am surprised about the depth of feeling about the recommendations.

In your role as the immediate past chairman of the task force, you’re involved as a consultant until next spring. What’s on the drawing board going forward? How will the task force change and evolve in the next 10 years?

I look for us to continue to try to be transparent in our work. I can’t tell you exactly what shape that will take as we go forward. We’re not the wizard behind the curtain that makes decrees. We want people engaged in our work and to know how we do that work. Did we miss something, did we reach the right conclusions?

I look for us to increase communications. We are increasingly putting out tools for consumers on the Web. I’m probably not supposed to tell you this, but what the heck. Part of our method now, after we’ve reviewed the evidence, we actually have somebody from the communications team get up and grill us. A non-clinician. We feel like if we can’t explain it, we haven’t done our job. We appreciate that our language has to go beyond what a clinician understands.

Transparency, methodological rigor and communications. That’s what we’re focusing on.

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.





No Image

Today in Movie Culture: RoboCop Vs. Terminator, Emotional Spider-Man Fan Film and More

Here are a bunch of little bites to satisfy your hunger for movie culture:

Film Face-Off of the day:

Today is the 25th anniversary of the release of RoboCop 2, so it’s fitting that there’s a new video pitting RoboCop vs. The Terminator. In a rap battle (via Geek Tyrant):

[embedded content]

Fan Film of the Day:

Get out your tissues: Parkour athlete Mike Wilson made the following Spider-Man (er, Spider-Dad) short in honor of his Spidey-loving son who died in December (via Geek Tyrant):

[embedded content]

Movie Mash-Up of the Day:

We’ve seen Jurassic World‘s raptor taming scene influence zookeepers and Chris Pratt‘s latest children’s hospital visit. Here we have one with The Avengers, which could be a nod to Pratt being in future Avengers movies or a joke about the box office record. Either way is fine. (via Empire Magazine)

Cosplay of the Day:

There’s no better way to officially ring in the summer solstice than with a guy dressed jokingly as a seasonally appropriate take on Captain America: The Winter Soldier (via Screen Crush)

Short of the Day:

Workprint is a neat new series of short films made entirely out of stock footage from Catch & Release. Here is the first (via Design Taxi):

[embedded content]

Fan Art of the Day:

Imagining other Disney Princesses as mermaids. Look, Belle is still reading books underwater. See more animated images at Design Taxi:

Supercut of the Day:

Yet another great montage of great dance scenes from movies, compiled by editor and dancer Klara Tavakoli Goesche:

[embedded content]

Vintage Image of the Day:

Woody Allen makes his on-screen debut in What’s New Pussycat, which he also wrote. The comedy opened in theaters 50 years ago today.

Toy of the Day:

While not an official product yet, the latest movie-related proposal for Lego is to make a Spaceballs playset. Yes, please (via Geek Tyrant):

Classic Cartoon of the Day:

Rudolph Ising’s The Milky Way, which was the first non-Disney animated short to win the Oscar in that category, was released to theaters 75 years ago today. Watch it in full below.

[embedded content]

Send tips or follow us via Twitter:

and

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.


No Image

Fraud Still Plagues Medicare's Prescription Drug Program

iStockphoto

iStockphoto

Fraud and abuse continue to dog Medicare’s popular prescription drug program, despite a bevy of initiatives launched to prevent them, according to two new reports by the inspector general of Health and Human Services.

Their release follows the arrests of 44 pharmacy owners, doctors and others, who last week were accused of bilking the program, known as Part D.

The two reports issued Tuesday provide more insight into the extent of the fraud, as well as steps federal regulators should take to stop it. The first report, which covers data from last year, found:

  • More than 1,400 pharmacies had questionable billing practices last year in the drug program. Some billed for extremely high numbers of prescriptions per patient and others billed for a high proportion of narcotic controlled substances. Collectively, they billed Part D $2.3 billion in 2014.
  • Prescriptions for commonly abused opioids continue to rise, despite warnings about inappropriate use. Between 2006 and 2014, Medicare’s spending on them grew to $3.9 billion from $1.5 billion, a 156 percent increase. By comparison, spending for all drugs in the program, including expensive specialty medications, grew by 136 percent during the same period. More than 40 percent of Medicare beneficiaries in Alabama, Tennessee, Oklahoma and Alaska filled at least one prescription for a narcotic in 2014, compared to 32 percent for the nation as a whole.
  • New York and Los Angeles remain hot spots for questionable prescribing, with far higher use of expensive drugs associated with fraud than other parts of the country. The New York metropolitan area, for instance, accounted for half of all prescriptions for the expensive topical ointment Solaraze last year, a disproportional rate. The drug is used for lesions formed as a result of overexposure to the sun. New York and Los Angeles also stood out for prescribing of two omega-3 fatty acids, used to help reduce very high triglyceride levels. The two regions accounted for nearly half of all prescriptions for Vascepa and about a third of those for Lovaza.

The inspector general’s findings come two years after ProPublica reported on how weak oversight by the Centers for Medicare and Medicaid Services (CMS) allowed abusive prescribing and outright fraud to proliferate in Part D. Medicare promised a more aggressive approach to analyzing its own data.

People can use Prescriber Checkup, a tool created by ProPublica, to look up doctors and see how their prescribing patterns compare to peers in the same specialty and state.

Medicare Part D provides drug coverage for 39 million seniors and disabled people, at a cost of $121 billion in 2014. It is the fastest-growing component of the Medicare program. Part D is administered by health insurers under contract with the federal government, but CMS is responsible for overseeing it.

For years, the inspector general, an internal watchdog that evaluates HHS programs and investigates wrongdoing, has dinged Medicare for its failure to keep a close enough eye on doctors, pharmacies, beneficiaries and even its fraud contractors. That’s beginning to change, officials say.

“CMS has made progress on a number of recommendations we’ve made, as well as on the initiatives that they’ve had,” said Jodi Nudelman, regional inspector general for evaluation and inspections in the New York office. “They’re starting to use data to drive their strategies.”

At the same time, she said, “There are still concerns. More needs to be done. We can’t stop here.”

A second report from the inspector general says that Medicare needs to adopt a number of reforms that it has so far resisted. They include:

  • Requiring health plans to report all potential fraud and abuse to CMS and its fraud monitoring contractors. Right now, the agency encourages plans to voluntarily report suspicions of fraud but it doesn’t mandate it. Last year, the inspector general found that less than half of Part D insurers voluntarily reported data on potential fraud and abuse.
  • Expanding reviews for questionable drug prescribing beyond controlled substances to other commonly abused drugs, including antipsychotic medications, respiratory drugs and those for HIV.
  • Restricting patients suspected of doctor shopping—visiting multiple doctors in search of controlled substance prescriptions—to a limited number of doctors and pharmacies. CMS said it doesn’t have legal authority to do this, but the inspector general said it should seek the authority, which is commonly used by private insurance companies and state Medicaid programs for the poor.

During last week’s Medicare fraud takedown, 243 people total were arrested, including 46 doctors, nurses and other licensed health professionals. Forty-four of the people arrested were charged with fraud related to Part D.

In Miami, for example, a number of pharmacy owners were charged with health care fraud and conspiracy to commit fraud. In one case, the government charged several people with paying Medicare beneficiaries for their personal identification numbers, which they used to file fraudulent claims for drugs that were never dispensed. They worked with a clinic owner, who forged and altered prescriptions and sold them to the pharmacies. This scheme alone defrauded Medicare of $21.2 million, the government alleges.

Last year, CMS announced that it was granting itself potent new authority to expel physicians from Medicare if they are found to prescribe drugs in abusive ways. The agency also said it would compel health providers to enroll in Medicare to order medications for patients covered by Part D. Currently, that isn’t required.

The changes were supposed to take effect on June 1, but have since been delayed twice, most recently until January 1.

CMS spokesman Aaron Albright said Monday in a written statement that Medicare “works diligently with our law enforcement partners to prevent fraud in the first place and to recover payments for wasteful, abusive or fraudulent services.”

In addition to requiring 400,000 prescribers to enroll in Medicare by next year to order to retain the ability to prescribe in Part D, Albright said, officials are helping health plans decrease overuse of dangerous drugs and taking action against providers and pharmacies with potentially fraudulent billing practices.

In April, CMS launched a web-based tool to allow CMS, law enforcemen, and health plans to share information and coordinate actions against pharmacies deemed high risk. CMS also said it is monitoring potentially fraudulent activity in geographic hot spots like the ones identified by the inspector general.

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.


No Image

In The Battle Between Taylor Swift And Apple, Swift Didn't Fight Alone

Taylor Swift accepts the award for top artist at the Billboard Music Awards. Swift's receiving the lion's share of credit for forcing Apple to pay artists to stream their music, even during a free trial period for users.

Taylor Swift accepts the award for top artist at the Billboard Music Awards. Swift’s receiving the lion’s share of credit for forcing Apple to pay artists to stream their music, even during a free trial period for users. Chris Pizzello/Chris Pizzello/Invision/AP hide caption

itoggle caption Chris Pizzello/Chris Pizzello/Invision/AP

Taylor Swift is no stranger to positive, even fawning, press coverage. Just this month, there was the story about light-up bracelets from a Swift concert being used to flag down help after two women were trapped inside of their car after a crash. The headline from MTV read “Taylor Swift Saved Three Teens’ Lives — Literally.”

Coverage of Taylor Swift’s latest move has been just as glowing. Over the weekend, Swift took to Tumblr to criticize Apple’s decision to not compensate artists as they get their new streaming service off the ground. Apple’s going to offer free three-month trial periods for new users, and the company said it would only start paying artists once those free trial periods are over.

In her open letter posted to Tumblr, Swift wrote: “We know how astronomically successful Apple has been and we know that this incredible company has the money to pay artists, writers and producers for the 3 month trial period… even if it is free for the fans trying it out.” She continued later in the letter, “Three months is a long time to go unpaid, and it is unfair to ask anyone to work for nothing.”

Soon after the letter was published online, Apple changed it’s mind, and Apple’s Senior Vice President Eddy Cue even called Swift to let her know. The company says it will now compensate artists even through those free three-month trial periods.

TV Guide said of Swift’s open letter and Apple’s shift, “Taylor Swift Saves The Day!”

But, as The Future of Music Coalition reports, independent music labels deserve some of the credit for Apple’s reversal as well. “It wasn’t just Taylor Swift,” Casey Rae of the Future of Music Coalition told NPR. “There was a huge chunk of the indie label community that was simply not willing to let Apple have a free pass.”

Earlier this month, the American Association of Independent Music said, “It is surprising that Apple feels the need to give a free trial as Apple is a well-known entity, not a new entrant into the marketplace … we are struggling to understand why rights holders would authorize their content on the service before October 1.”

And Beggars Group, a collection of independent music labels said Apple’s decision to not compensate artists for three months could have ripple effects in the entire streaming industry. “…given the natural response of competing digital services to offer comparable terms, we fear that the free trial aspect, far from moving the industry away from freemium services – a model we support – is only resulting in taking the “mium” out of freemium.”

Futureofmusic.org also reports the Worldwide Independent Music Industry Network was heavily involved in helping reverse Apple’s decision.

But even if Swift is the major recipient of all the positive headlines in the aftermath of Apple’s decision, not everyone is pleased. Time reported on comments from Pandora’s former Chief Technology Officer Tom Conrad on Twitter. He pointed out a possible hypocrisy in her strategy. “Swift’s career was built on terrestrial radio play, which is a free service AND doesn’t pay recording artists a dime.”

He continued in further tweets, “Apple isn’t getting rid of its long free trial, but is now going to pay artists. This simply puts it at parity with all other players.” And those other players are continuously criticized for not compensating artists enough for their work.

Then Conrad wrote, “Swift’s letter and Apple’s response is mostly theater. Nothing here to suggest Apple treats artists more fairly than anyone else … we shouldn’t herald this move as progress. It’s status quo.”

The Verge agreed. In one of the few anti-Swift pieces on the issue, the outlet said in their headline, “Taylor Swift vs Apple: nobody wins.”

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.


No Image

Marvel Round-up: Who Owns the Hulk, a Potential Spider-Man Shows Off, and Chris Pratt's Charm Assault Continues

Who owns the Hulk

A lot of fans have been wondering when we’d be getting a new Hulk movie, and while the answer isn’t any more definitive today than it was last week, we at least know a few more details about who would actually be releasing the movie, if it were ever made.

We already knew that Universal, who put out both the Eric Bana and Edward Norton Hulk movies, still held a claim to the character, but now Forbes is reporting that Universal only has the distribution rights to any hypothetical movies. Or, more specifically, Universal has the rights of first refusal, meaning that if Marvel does ever make another one, Universal gets to decide if they want to release it. And since Marvel movies make approximately a quadrillion dollars each, it’s a pretty safe bet that Universal wouldn’t turn down a Hulk movie.

So, once again, the hold up on a Hulk movie is on Marvel’s end.

Chris Pratt, breaking your heart again and again

Chris Pratt has become — seemingly overnight thanks to Marvel’s Guardians of the Galaxy — the most charming person in America. And now his onslaught on the hearts of everyone, everywhere continues with a visit to Our Lady of the Lake Children’s Hospital, where Pratt recreated his own Jurassic World raptor-taming meme with some of the patients in the hospital.

Is this Spidey showing off?

The clock is ticking on when Marvel and Sony will need to launch their new live-action Spider-Man series, but they still haven’t actually cast Spider-Man. One of the big contenders is Ender’s Game star Asa Butterfield, but despite some persistent rumors, he has not been officially cast.

Another one of the rumored actors is Tom Holland. He hasn’t been as persistently buzzed-about as Butterfield, but his name has also been in the mix, and now he’s having fun with his fans by showing off some of his own stunt work. Is he toying with fans or just, as his Instagram says, bored? Probably the latter, but hey — let the speculation continue!

Bored

A video posted by ?? (@tomholland2013) on Jun 21, 2015 at 7:44am PDT

Follow @PeterSHall Follow @MoviesDotCom

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.


No Image

Pete Rose Bet On Baseball Games As A Player, ESPN Reports

Former Cincinnati Reds' player and manager Pete Rose watches a baseball game between the Reds and Washington Nationals on May 31 in Cincinnati.

Former Cincinnati Reds’ player and manager Pete Rose watches a baseball game between the Reds and Washington Nationals on May 31 in Cincinnati. John Minchillo/AP hide caption

itoggle caption John Minchillo/AP

Pete Rose, baseball’s all-time hits leader, bet on Cincinnati Reds games in 1986, during his last season as an active player, ESPN’s Outside the Lines reports.

After years of denial, Rose admitted in his 2004 autobiography that he bet on games, but only while he was manager. And as recently as April, he told a radio show he “never bet as a player: That’s a fact.” But ESPN has obtained documents that show the betting began as Rose “racked up the last hits of a record-smashing career in 1986.” Here’s more:

“The documents are copies of pages from a notebook seized from the home of former Rose associate Michael Bertolini during a raid by the U.S. Postal Inspection Service in October 1989, nearly two months after Rose was declared permanently ineligible by Major League Baseball. Their authenticity has been verified by two people who took part in the raid, which was part of a mail fraud investigation and unrelated to gambling. For 26 years, the notebook has remained under court-ordered seal and is currently stored in the National Archives’ New York office, where officials have declined requests to release it publicly.”

Rose was banned for life from baseball in 1989 for gambling. He first applied for reinstatement in 1997, and applied again this year upon the retirement of Bud Selig as baseball commissioner. As ESPN says, the timing of the latest revelation “isn’t great.

“In March of this year, he applied to [Commissioner Rob] Manfred for reinstatement. Dowd recently met with MLB CIO and executive vice president of administration John McHale Jr., who is leading Manfred’s review of Rose’s reinstatement request, to walk McHale through his investigation. On Monday morning, MLB officials declined to comment about the notebook.”

In a statement to ESPN through his lawyer Rose said: “Since we submitted the application earlier this year, we committed to MLB that we would not comment on specific matters relating to reinstatement. I need to maintain that. To be sure, I’m eager to sit down with [MLB commissioner Rob] Manfred to address my entire history — the good and the bad — and my long personal journey since baseball. That meeting likely will come sometime after the All-Star break. Therefore at this point, it’s not appropriate to comment on any specifics.”

Rose’s permanent suspension from baseball makes him ineligible for the Hall of Fame despite his status as the game’s career hits leader.

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.


No Image

Back In Ghana, Pat Thomas Gives New Life To Highlife

Pat Thomas' new album, Kwashibu Area Band, brings the West African genre of highlife into the 21st century.
3:53

Download

Pat Thomas’ new album, Kwashibu Area Band, brings the West African genre of highlife into the 21st century. Courtesy of the artist hide caption

itoggle caption Courtesy of the artist

Pat Thomas, a singer and bandleader from Ghana, is nearly 70. He’s lived in England, Germany, Canada and the U.S. But these days he’s back home, once again making the music that enshrined him in the hearts of his countrymen: highlife.

In the 1960s, highlife out of Ghana and Nigeria ruled the dance floors of West Africa. The music’s blend of African rhythm, jazzy brass lines, tangling electric guitars and folkloric vocals proudly projected African modernity. Independence fever was sweeping the continent, and highlife was the soundtrack to countless celebrations. For Pat Thomas, that celebration has never stopped — in fact, it continues on his new album Kwashibu Area Band.

Thomas recorded the album in Accra with a young Ghanaian producer, so it’s a multi-generational effort. The session reunites Taylor with another highlife veteran, Ebo Taylor. The two first worked together in 1968, and they’ve remained close all these years.

These eight songs unfold in beautifully paced arrangements that are unhurried, but also packed with ideas. Some songs nod to music styles that highlife has influenced, like Afrobeat out of Nigeria. Drummer Tony Allen started out in highlife and went on to become an architect of Afrobeat with his unmistakable brilliance on trap drums, and Allen’s presence in two of Kwashibu Area Band‘s tracks is a special treat.

No one would argue that highlife is poised to make a serious comeback in the era of hip-hop and electronica. But iconic dance sounds — whether big-band swing, soul or ska — never really die. Highlife belongs on that list, and we’re lucky Pat Thomas is still around to remind us what the fuss was about.

This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.