Stay in the know with Becker's Hospital Review's weekly roundup of the nation's biggest healthcare news. Here's what you need to know this week.
1. Healthcare providers accuse Blue Cross and Blue Shield of acting as a cartel
Two federal lawsuits have claimed Blue Cross and Blue Shield insurers are engaging in cartel-like behavior by divvying up markets to avoid competing with one another, according to the Wall Street Journal. One lawsuit was brought on behalf of healthcare providers and the other on behalf of individual and small-employer customers. Both name all 37 BCBS companies, which cover about a third of Americans, and the BCBS Association as defendants. In their lawsuit, customers claim they are paying inflated premiums due to the illegal market division the BCBS companies have implemented, as well as other actions taken by the association, such as placing limitations on the amount of non-Blue-brands business insurers can do. The providers claim the Blue association's agreements reduce competition in their regions, causing them to be paid much less. Scott Nehs, general counsel of the Blue association, denies those claims. The defendants attempted to get the lawsuits thrown out, but U.S. District Judge R. David Proctor denied defendants' motion to dismiss.
2. CMS unveils overhaul to Medicaid managed care
CMS unveiled a regulatory package Wednesday containing the first major update to Medicaid managed care regulations in more than 10 years. CMS' proposed rule updates regulations "to reflect the changes in delivery systems, strengthen the system's ability to serve diverse populations and promote greater alignment of Medicaid managed care policies with those of the payers," according to the agency. The proposed rule aims to improve the beneficiary experiences by improving the enrollment process, the communication they receive from the state and managed care plans and care coordination. To provide better care coordination, the proposed rule would strengthen the role of assigned care coordinators and require transition of care standards for all Medicaid beneficiaries transitioning from one delivery system to another within Medicaid.
The proposed rule also incorporates the medical loss ratio — a financial measurement that sets the minimum amount of premium dollars health plans must spend on actual healthcare costs, with the intention of cutting overhead spending by insurers. The proposed rule would set the MLR at 85 percent, meaning 85 cents out of every premium dollar would be used on actual healthcare costs. Insurers have already begun voicing opposition to this element of the proposed rule. Jeff Meyers, president and CEO of Medicaid Health Plans, told The Hill he "strongly encouraged CMS not to go down this route" because every state already uses some form of the MLR, and the proposed rule could "destabilize the programs that are developed on a state level." America's Health Insurance Plans CEO Dan Durham also disagrees with the MLR. "An arbitrary cap on health plans' administrative costs could undermine many of the critical services — beyond medical care — that make a difference in improving health outcomes for beneficiaries, such as transportation to and from appointments, social services, and more," he told The Hill.
3. U.S. military accidentally ships anthrax, possibly exposes lab workers
The U.S. military inadvertently sent 22 shipments of live anthrax, some via FedEx, to labs in nine states and to a U.S. base in South Korea, which resulted in four lab workers in the U.S. and up to 22 overseas being put in post-exposure treatment, CNN reported. The anthrax samples were believed to be dead and were shipped under less rigorous conditions than the live agent protocol, but a Maryland lab received live samples, and samples in a lab in Dubway, Utah, were determined to contain live agent. Currently, there is no risk to the public. "All personnel were provided appropriate medical precautionary measures to include examinations, antibiotics and in some instances, vaccinations," a statement from the base said. "None of the personnel have shown any signs of possible exposure."
4. Study identifies 'Achilles heel' of Ebola
An international team of scientists — including scientists from Albert Einstein College of Medicine of Yeshiva University in New York City and the U.S. Army Medical Research Institute of Infectious Diseases in Frederick, Md. — identified the molecular "Achilles' heel" of the deadly Ebola virus. Using mice, the researchers found that the Ebola virus can't infect cells unless it first attaches to a host protein called Niemann-Pick C1, or NPC1, in membrane compartments called lysosomes deep within cells. One of the co-study leaders called NPC1 Ebola's "Achilles heel." The study found mice deficient in NPC1 were completely resistant to infection, suggesting that drugs blocking virus entry to the NPC1 protein could protect against Ebola infection. Such a treatment may also block the cholesterol transport pathway in humans, but the researchers claim the treatment could be tolerated.
5. NYC nurses could authorize strike
The New York State Nurses Association union, which has been negotiating a contract with the city's major hospitals, is moving to vote to authorize a strike, according to Crain's New York Business. The strike could include thousands of registered nurses. Nurses from New York-Presbyterian Hospital, Mount Sinai Hospital, Mount Sinai St. Luke's Hospital and Montefiore Medical Center, who are members of the bargaining group NYC Hospital Alliance, are moving toward a vote on the strike and have requested rooms to stage the strike. Nurses at Staten Island University Hospital and Maimonides Medical Center, which are not part of the NYC Hospital Alliance, have also requested rooms for a strike vote. The New York nurses are considering striking rather than accepting the hospitals' 10 percent wage hike offer. The NYSNA has pushed the hospitals to include language regarding set staffing ratios for RNs in their contracts, to which the hospitals refused. Instead, they offered to enhance the use of existing collaborative committees that would set up regular meetings to review staffing levels with nurses and nursing management.
6. FBI investigates J&J and its hysterectomy device found to spread cancer
The FBI launched an investigation into Johnson & Johnson, the manufacturer of laparoscopic power morcellators that were pulled off the market last summer, according to The Wall Street Journal. The U.S. Food and Drug Administration had previously warned the device has a serious risk of spreading cancerous tissue. The FBI is looking into what J&J knew about the risks the device posed, which is used to perform hysterectomies. However, a J&J spokesman told the newspaper that he wasn't aware of an investigation into the device. Several hospitals, like Massachusetts General and Brigham and Women's in Boston, have limited their use of the devices in recent years.
7. Man dies from Lassa fever in New Jersey
A man who returned to New Jersey after traveling to Liberia died from Lassa fever, a viral disease with similar symptoms to Ebola. The man returned to the U.S. May 17. He was screened for illnesses at the airport but did not have a fever at that time. However, on May 18, he went to the hospital in New Jersey with a sore throat, fever and tiredness, but was sent home. He returned to the same hospital May 21 with worse symptoms and was transported to a second hospital that was prepared to treat Ebola and other viral hemorrhagic diseases. The patient tested negative for Ebola and positive for Lassa fever before dying May 25. The CDC is working with public health officials to find people who had close contact with the man and they will be monitored for 21 days for symptoms.