The combined company will offer a range of virtual care options for markets that include employers, health plans and health systems. The deal also allows Teladoc to develop global expansion plans.
Telehealth platform Teladoc Inc. has finalized its $440 million acquisition of the medical consulting company Best Doctors.
“Today we take a tremendous step forward as we continue to deliver on our promise to transform the healthcare experience; to provide an unprecedented, single-point of access for resolution to the widest spectrum of medical conditions, delivered via a virtual platform,” Teladoc CEO Jason Gorevic said Monday in a media release.
The deal, which was announced last month, was touted by the two companies as a “marriage” of Purchase, NY-based Teladoc’s technology, engagement capabilities, and scalable platform with Best Doctors’ network of medical experts, analytics, patient decision-support, and regional expertise. The combined company will offer virtual care services for markets that include employers, health plans, and health systems. The deal also allows Teladoc to develop global expansion plans.
Under the definitive agreement announced on June 19, Best Doctors shareholders will receive $375 million in cash and $65 million in Teladoc common stock from the issuance of 1.9 million shares.
Best Doctors CEO Peter McClennen will become president of the Best Doctors division under Teladoc. He will also receive a stock option award covering 123,320 shares of Teladoc common stock and a restricted stock unit award covering 58,824 shares of Teladoc common stock. The stock option awards each have an exercise price of $35.45, the company said.
Privately held Best Doctors was founded in 1989 by Harvard Medical School professors and now claims more than 40 million members globally. In 2014, Best Doctors acquired Rise Health to expand of its digital health services. Best Doctors generated $92.2 million in 2016, $23.7 million in the first quarter of 2017, and is expected to generate more than $100 million this year.
The bill is scheduled for a floor vote next week, but it’s not clear if this latest version of the Better Care Reconciliation Act of 2017 has enough support to pass the Senate. It will require near-unanimous support from Republicans because no Democrats support it.
Senate Republicans on Thursday unveiled their revised plan to repeal and replace the Affordable Care Act that now scraps a tax cut for the wealthy, increases subsidies for individual coverage, drops the individual mandate and allows insurers to offer no-frills plans.
The revised bill retains a contentious provision for a per capita cap on Medicaid spending and a decade-long phase out of the ACA’s Medicaid expansion that could mean a loss of coverage for millions of people.
The bill is scheduled for a floor vote next week, but it’s not clear if the latest version of the Better Care Reconciliation Act of 2017 has enough support to pass the Senate. It will require near-unanimous support from the majority 52 Republicans because no Democrats support it.
Republican Sens. Rand Paul of Kentucky and Susan Collins of Maine have already said they will not support the BCRA for completely different reasons. Paul says the BCRA remains too much like Obamacare, which he had pledged to repeal. Collins said she can’t support the Medicaid cuts.
The nonpartisan Congressional Budget Office has yet to score the latest proposal, and it’s not clear if the actuaries will be able to do so before next week’s planned floor vote.
In an effort to address criticism that their plan is primarily a tax cut for the rich while slashing services for the poor, the Republicans’ revision scuttled a plan to eliminate Obamacare’s 3.8% tax on investment income and a 0.9% surtax for Medicare, both of which target high earners with incomes in excess of $200,000. Some smaller taxes were eliminated, such as the tax on tanning salons.
The new bill also includes a modification of a provision pushed by Sen. Ted Cruz, R-TX, that would allow health insurers to offer bare-bones, discount policies that don’t comply with minimum coverage mandates under the ACA for mental health services, maternity and pediatric care, addiction treatment, prescription drugs and emergency medicine. The bill also provides $70 billion to create a high risk pool to help offset the costs of people with pre-existing conditions who buy the bare-bones plans.
The original BCRA provided $2 billion to help states deal with the opioids abuse crisis. That funding was increased to $45 billion in the revised bill in an effort to gain support from Senators in rural states that have been particularly hard hit by the epidemic.
The revised bill adds another $70 billion to a $112 billion state stability fund that was proposed in the original bill, which is designed to help states create and coordinate programs that lower coverage costs for consumers and insurers.
The new BCRA also includes a provision that allows people to use their tax-exempt health savings accounts to pay for insurance premiums.
Alexis C. Norman is already serving an eight-year prison sentence after pleading guilty in 2015 to one count of Medicaid fraud in connection with a false billing scheme.
A Texas inmate serving time for Medicaid fraud tried to bilk the healthcare program out of an additional $810,000 from inside the prison walls, federal prosecutors allege.
Alexis C. Norman, 46, of Midlothian, TX, was indicted this week on felony charges stemming from a healthcare fraud conspiracy that she allegedly ran from prison, according to the U.S. Attorneys' Office for the Northern District of Texas. Norman will make her initial appearance in federal court on Friday.
Norman is already serving an eight-year prison sentence after pleading guilty in 2015 to one count of healthcare fraud in connection with a false billing scheme she ran using two companies she owned: Greater Southwest Group, Inc. and Ellis County Community Services.
According to the new indictment, Norman ran a similar scheme while she was awaiting sentencing in her earlier case, and continued to direct it after she was imprisoned. The indictment alleges that Norman, who is not licensed as a mental health provider, operated two counseling companies, Janus Children Services, Inc. and Therapeutic Outreach Services.
As part of the scheme, Norman and an unnamed coconspirator -- who presumably was not in prison -- applied for and obtained group Medicaid provider numbers for Janus and Therapeutic. They obtained individual Medicaid provider numbers of licensed mental health professionals by soliciting applications for bogus job opportunities on Craigslist but not hiring the individuals who applied. Norman and her coconspirators used the provider numbers, together with the names, dates of birth, social security numbers, and Medicaid numbers of approximately 156 Medicaid clients—mostly minor children—to submit fake claims for services. Norman and the coconspirator opened a bank account and leased office space in Tyler, TX for Janus and opened a bank account and leased office space in Waco, TX, for Therapeutic to conceal the fraud from inspectors in the Dallas-Fort Worth area who investigated her prior fraud.
To conceal the scheme, Norman gave false testimony at her sentencing hearing on April 8, 2016, when she responded “No, sir.” to the question, “Have you ever submitted any claims to Medicaid or a Medicaid managed care organization under a business other than Greater Southwest Group or Ellis County Community Services?” In fact, Norman had submitted numerous false claims to Medicaid under Janus, including $1,575 in claims she submitted on April 7, 2016 – the day before her sentencing hearing, the indictment stated.
Norman now faces one count of conspiracy to commit healthcare fraud, four counts of healthcare fraud, and four counts of aggravated identity theft. The indictment also includes a forfeiture allegation that would require the defendant, upon conviction, to forfeit to the U.S. any property traceable to the crime. If convicted, each fraud count carries up to 10 years in prison and a $250,000 fine. The aggravated identity theft counts carry a mandatory statutory penalty of two years in federal prison and a $250,000 fine.
In her earlier scam, Norman used the identities of licensed counselors and Medicaid clients without their knowledge to submit claims to Medicaid for psychotherapy services that were not provided. In addition to the prison time, Norman was ordered to pay nearly $3 million in restitution to Medicaid.
The median opioid prescription was equivalent to 50 pills of five-milligram oxycodone, which is almost twice the amount proposed Minnesota state guidelines recommend for a maximum, researchers have found.
Clinicians at Mayo Clinic were routinely writing opioid prescriptions for surgery patients that exceed regulatory guidelines now being drafted by the state of Minnesota, an in-house review has found.
The research, published this week in Annals of Surgery, also found significant differences in opioid prescribing among Mayo Clinic’s Arizona, Florida and Rochester campuses, and within surgical procedures.
“In light of the opioid epidemic, physicians across the country know overprescribing is a problem, and they know there is an opportunity to improve,” said senior author Elizabeth Habermann, scientific director of surgical outcomes research at Mayo. “This is the first step in determining what is optimal for certain surgeries and, eventually, the individual patient.”
Since 2000, the number of Americans receiving an opioid prescription and the number of deaths involving prescription opioid overdoses have roughly quadrupled, according to the Centers for Disease Control and Prevention. More than 90 people each day died from a prescription opioid or heroin overdose in 2015.
“For the last two decades, there had been such a focus at the national level on ensuring patients have no pain,” said co-author Robert Cima, MD, a colorectal surgeon and chair of surgical quality at Mayo Clinic’s Rochester campus. “That causes overprescribing, and, now, we’re seeing the negative effects of that.”
Cima said there aren’t evidence-based guidelines for prescribing opioids after surgery.
“That’s the fundamental issue,” he said. “And because pain is very subjective, it makes it challenging.”
The study looked at 7,181 opioid prescriptions following 25 common surgeries from January 2013 to December 2015 at Mayo Clinic campuses in Arizona, Florida and Rochester. In particular, the researchers examined patients who weren’t taking opioids in the 90 days before surgery.
Within that group of 5,756 patients, they found the median opioid prescription was equivalent to 50 pills of five-milligram oxycodone. That’s almost twice the amount draft Minnesota state guidelines recommend for a maximum, which is roughly a seven-day supply or about 27 pills of five-milligram oxycodone.
Also, the prescriptions varied among the three campuses after adjusting for other factors. The Rochester campus median equaled 40 pills of oxycodone; whereas, the Arizona and Florida campus’ median equaled 50 and 60 pills, respectively.
Because different surgeries require different degrees of pain management, the researchers also compared the opioid prescribing ranges within each of the 25 surgeries. They found a wide variation ─ even after adjusting for individual patients.
The researchers say the results show there is room for improvement at Mayo, but that the draft Minnesota guidelines aren’t appropriate for all cases.
“For some of the procedures, the guideline is probably appropriate and we have an opportunity to reduce the amount prescribed,” Habermann said. “For some of the more painful procedures, in orthopedics, for example, the draft guideline is likely too low.”
Mayo’s Department of Orthopedic Surgery is using the data to improve its opioid prescribing practices, and is developing a tiered approach based on surgical procedure. Other departments plan to follow suit.
Cima said patients must adjust expectations on appropriate levels of pain after surgery.
“We actively support patients, but they also need to be educated that some discomfort is part of the process,” Cima said. “We want patients to be comfortable enough to function, but taking away all the pain isn’t an appropriate part of recovery.”
The Mayo findings are consistent with a study released this spring that found a “prevalence of chronic opioid usage in surgical patients is high with widespread disparity among different sex, age, ethnicity, BMI, and subspecialty groups” at large academic medical centers.
Medicare and other payers urged to consider additional options with less-invasive virtual colonoscopy for screening and prevention of colorectal cancer.
People with health insurance policies that cover CT colonography for colorectal cancer screening are almost 50% more likely to get screened than those whose policies don't cover the procedure, according to a study in Radiology.
Colorectal cancer kills 50,000 people each year, despite screening methods that provide early detection and treatment of the disease. The American Cancer Society recommends CT colonography as one of the screening tests that can find both pre-cancerous polyps and cancer in people age 50 or older. Insurers have been slow to cover it. CT colonography, also known as virtual colonoscopy, uses CT imaging to provide fly-through views of the colon and is a less-invasive option than conventional colonoscopy.
Screening adherence rates have stalled at about two-thirds of the people who need to be screened, according to study lead author Maureen A. Smith, MD, of the University of Wisconsin-Madison School of Medicine and Public Health.
“CT colonography is a newer technology that can detect both pre-cancer and cancer, but because it's relatively new it isn't widely covered by insurance and isn't covered by Medicare,” Smith said.
Smith and her colleagues looked at overall colorectal cancer screening rates for 33,177 patients under age 65 who were eligible and due for colorectal cancer screening. About half of the people in the group were ultimately screened during the study period, and researchers compared screening rates between those with and without insurance coverage for CT colonography.
The people in the study who had insurance coverage for CT colonography had a 48% greater likelihood of being screened by any method compared with those without coverage who were due for screening.
“Our study suggests that when people are offered a greater choice of screening tests for colorectal cancer, including CT colonography, they are more likely to complete screening to prevent colorectal cancer,” Smith said.
"Policymakers should consider additional options for screening and prevention of colorectal cancer," Smith said. "CT colonography is potentially a powerful option, because there are people who will prefer it."
Some insurers have begun increasing coverage to include CT colonography, Smith said, but the lack of coverage by Medicare is unlikely to change soon.
"Locally, insurers have been open to including CT colonography in their coverage," she said. "Nationally, any change will probably rely on Medicare's decision-making process, which can take substantially more time."
The average additional cost in the six months following a fall for transfemoral amputee patients requiring an emergency department visit was $18,000. For patients who had to be hospitalized, this extra expense was more than $25,000.
Medicare and other insurers that pay for only basic mechanical artificial knees and legs instead of more sophisticated prosthetics with microprocessors could pay more in the long run because of falls associated with the low-tech appendages, a Mayo Clinic study has found.
In a new study published in Prosthetics and Orthotics International, Mayo researchers examined the direct medical costs of falls in adults with amputations above the knee in an effort to “provide a comparison for policymakers when evaluating the value of more expensive … technologies.”
Of the 185,000 transfemoral amputee patients each year, only 25%-30% receive a prosthetic leg and knee, and insurance policies for most only cover basic mechanical knees. Despite growing data that newer technology reduces falls and improves physical capabilities, only high-functioning patients are deemed eligible for a knee with microprocessor technology.
Mayo researchers said they are challenging that standard.
“We want to help provide the best quality of life and prosthesis for each individual,” said study lead author Benjamin Mundell, a health economist and a student at Mayo Clinic School of Medicine. “It is important to look beyond the initial cost differences of a microprocessor knee compared to a mechanical knee and understand what downstream costs might be avoided with a better prosthesis.”
“Microprocessor knees are designed to help improve balance and reduce falls,” he said. “The fear of falling for those with mechanical knees likely reduces their overall physical activity and if they do fall and require hospitalization, the cost of care is almost as expensive as a microprocessor knee.”
The team examined the medical records of 77 patients in Wisconsin and Minnesota who received a transfemoral amputation between 2000 and 2014. They found that 46 of these patients had received a prosthetic knee. Of these, 22 patients logged 31 falls that resulted in an ED visit or hospitalization.
Using standardized Medicare cost data, the researchers found that the average additional cost in the six months following a fall for patients requiring an ED visit was $18,000. For patients who had to be hospitalized, this extra cost was more than $25,000.
“Understanding the costs is part of basic health economics,” said study senior author Kenton Kaufman, a biomedical engineer and orthopedics researcher at Mayo. “This study quantifies the cost of falls that require medical attention – providing evidence that it may not be economical to withhold microprocessor knees from patients with moderate ambulatory capabilities.”
Kaufman said the costs to patients are much higher than the study shows because the study doesn’t reflect indirect costs such as lost wages, and transportation and caregiving expenses.
Medicare K levels are used to determine which prosthetic device is medically necessary for a patient. To be considered eligible for the microprocessor knee, a patient needs extensive documentation that he would use the leg more than the normal day-to-day walking, stairs, etc.
“For many, the default may be a mechanical knee, because it is easier to prove basic necessity than to ensure the rigorous documentation requirements for one with advanced – and more costly – technology,” Kaufman said. “One of the reasons we work on improving technology in prosthetic knees is to help individuals become more agile, more balanced and less likely to fall, but if people aren’t able to access this technology, they may become more vulnerable and less active than their condition would normally indicate.”
The most common errors were taking or giving the wrong medication or incorrect dosage, and inadvertently taking or giving a medication twice, researchers have found.
The frequency of serious medication errors by patients or their caregivers outside of a healthcare setting more than doubled from 2000 to 2012, according to a study in Clinical Toxicology.
Researchers from the Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children’s Hospital analyzed calls to poison control centers across the country over the 13-year period about medication errors that resulted in serious medical problems.
The rate of serious medication errors per 100,000 people more than doubled from 1.09 in 2000 to 2.28 in 2012. These errors occurred mostly in the home, affected people of all ages, and were associated with a wide variety of medications.
“Drug manufacturers and pharmacists have a role to play when it comes to reducing medication errors,” said Henry Spiller, a co-author of the study, and director of the Central Ohio Poison Center at Nationwide Children’s. “There is room for improvement in product packaging and labeling. Dosing instructions could be made clearer, especially for patients and caregivers with limited literacy or numeracy.”
The most common errors were taking or giving the wrong medication or incorrect dosage, and inadvertently taking or giving the medication twice. Among children, dosing errors and inadvertently taking or giving someone else’s medication were also common errors. One-third of medication errors resulted in hospital admission.
The medication categories most frequently associated with serious outcomes were cardiovascular drugs (21%), analgesics (12%), and hormones/hormone antagonists (11%). Most analgesic exposures were related to products containing acetaminophen (44%) or opioids (34%), and nearly two-thirds of hormone/hormone antagonist exposures were associated with insulin. Cardiovascular and analgesic medications combined accounted for 66% of all fatalities in this study.
Among children younger than six years, the rate of medication errors increased early in the study and then decreased after 2005, which was associated with a decrease in the use of cough and cold medicines attributable to the Food and Drug Administration’s 2007 warning against giving these drugs to children.
“Managing medications is an important skill for everyone, but parents and caregivers have the additional responsibility of managing others’ medications,” said study lead author Nichole Hodges, a researcher at the Center for Injury Research and Policy at Nationwide Children’s.
“When a child needs medication, one of the best things to do is keep a written log of the day and time each medication is given to ensure the child stays on schedule and does not get extra doses.”
Data for the study were obtained from the National Poison Data System, which is maintained by the American Association of Poison Control Centers.
The sector’s 37,000 new jobs accounted for nearly 17% of all new jobs in the economy in June. Despite the strong growth, healthcare job creation is trending about 20% slower than in 2016, a record year.
Halfway through 2017, healthcare job growth remains strong, but it’s running nearly 20% below last year’s record pace, according to the Bureau of Labor Statistics
In June, healthcare added 37,000 jobs, including 26,000 in ambulatory services and 12,000 in hospitals. So far this year, healthcare has created an average of 24,000 jobs each month, compared with a monthly average of 32,000 jobs in 2016, BLS data show.
In the larger economy, total nonfarm payroll employment increased by 222,000 in June, and the healthcare sector accounted for nearly 17% of those new jobs. The unemployment rate was little changed at 4.4%, BLS data show.
The latest Conference Board Help Wanted OnLinedata series for May shows that healthcare job growth is robust, with nearly five job openings for every clinician and healthcare technologist searching for a job, with an average hourly wage of $38.06. The news is not so good for healthcare support workers, of whom there are 1.4 people searching for every advertised job, paying an average hourly wage of $14.65.
Healthcare job growth has continued at a torrid pace for most of the new century. The sector set a record pace for job growth in 2016, which broke the record set in 2015. However, 2017 is trending slower.Nicole Smith, chief economist at Georgetown University Center on Education and the Workforce, told HealthLeaders Media that the slowdown could be linked to churn and uncertainty around the Affordable Care Act.
"Maybe hospitals are being pre-emptive and not hiring workers at the same pace as in the past in anticipation that this repeal and replace is actually going to go through,” Smith said. “We can expect hospital hiring to really slow down until people get a handle on what is going to happen.”
This ongoing robust job growth in healthcare was not unforeseen. In 2009, the President’s Council of Economic Advisors correctly predicted that healthcare would be the largest source of job growth in the decade ahead, with 3.5 million new jobs expected by 2016.
"Healthcare practitioners and technicians, which include physicians, registered nurses, and other health professionals and technicians, are expected to be in increasing demand," the report stated. “Investments in health information technology will bolster job growth in that area, while the healthcare support sector–including physical therapists, medical social workers, and home healthcare aides–is projected to see even faster job growth as the nation's population ages.”
Risk factors associated with adverse events within six months of an emergency department visit for a fall included diabetes, polypharmacy (five or more medications), and psychiatric and/or sedative medications.
More than half patients age 65 and older who visited an emergency department for injuries sustained in a fall suffered adverse events – including additional falls, hospitalization and death – within six months, according to a small sample study this week in the Annals of Emergency Medicine.
“Our study shows an even higher rate of adverse events than previous studies have,” said lead author Jiraporn Sri-on, MD, of Navamindradhiraj University in Bangkok, Thailand. “Patients taking psychiatric and/or sedative medications had even more adverse events. This is concerning because these types of drugs are commonly prescribed for elderly patients in community and residential care settings.”
The findings rely upon an analysis of 350 elderly fall patients who presented to the ED at one urban teaching hospital in 2012. Of patients who visited the ED for injuries sustained in a fall, 7.7% developed adverse events within 7 days, 21.4% developed adverse events within 30 days and 50.3% developed adverse events within six months. Within six months, 22.6% had at least one additional fall, 42.6% revisited the emergency department, 31% had subsequent hospitalization and 2.6% had died.
Risk factors associated with adverse events within six months of an emergency department visit for a fall included diabetes, polypharmacy (five or more medications), and psychiatric and/or sedative medications.
"Emergency physicians have a tremendous opportunity to reduce the very high adverse event rate among older emergency patients who have fallen,” Sri-on said. "Fall guidelines exist and work needs to be done to increase their implementation in emergency departments so patients can be educated on how not to fall again once they have been discharged from the emergency department."
The American College of Emergency Physicians recently produced a public education video to help prevent falls.
Across all patient subgroups and payers, hospital stays decreased or held stable between 2005 and 2014, while the inflation-adjusted mean cost per inpatient stay increased by 12.7%, from $9,500 to $10,900.
Hospital inpatient stays dropped from 37.8 million in 2005, to 35.4 million in 2014, a decrease of 6.6%, according to a statistical brief from the Healthcare Cost and Utilization Project.
And the demographic trends show that more affluent people are spending 15%-20% less time in the hospital, while people living in poorer communities experienced the smallest decrease in hospitalization rates. Medicaid-covered inpatient stays increased by 15.7%, while the proportion paid by private insurance and that were uninsured decreased by 12.5% and 13%, respectively.
The decreased held for several patient demographic subgroups, including patients younger than 45 years and older than 74 years, patients with private insurance or no insurance, and patients in the two highest income quartiles. For patients aged 45-64 and 65-74 years, the number of hospital stays did not change substantially during the 10-year time period, HCUP’s analysis found.
The only hospitalization type that changed substantially from 2005 to 2014 was mental health/substance use. Between 2005 and 2014, the proportion of inpatient stays for mental health/substance use increased from 4.9% to 5.9% of all hospital stays, a 20% increase. The proportion of stays for other hospitalization types held steady.
The HCUP analysis also found that:
The overall average cost per hospital stay increased by 12.7% from 2005 to 2014, adjusting for inflation. Inflation-adjusted cost per stay for patients covered by private insurance or Medicaid increased 16%-18%. Cost per stay for Medicare-covered patients and the uninsured changed minimally. Other subgroups with large increases in mean cost per stay were patients aged 0-17 years (up 15.3%) and patients hospitalized for neonatal care (up 19.2%), injuries (up 17%), and surgery (up 16.4%).
In both 2005 and 2014, medical hospitalizations constituted the highest proportion of stays (46%), followed by surgical (20%), maternal (12%), neonatal (11%), mental health/substance use (6%), and injury (5%).
Medicare was the most common expected payer for hospital care and together with Medicaid paid for 61.6% of all hospital stays in 2014.
The proportion of Medicaid-covered inpatient stays increased by 15.7%, whereas the proportion paid by private insurance and that were uninsured decreased by 12.5% and 13%, respectively.
Between 2005 and 2014, septicemia and osteoarthritis became two of the five most common reasons for inpatient stays. Septicemia hospital stays almost tripled. Septicemia and complication of device/implant/graft rose to top 10 conditions in 2014 but were not on the top 10 list a decade earlier. Nonspecific chest pain and coronary atherosclerosis decreased by more than 60% from 2005 to 2014, falling off the list of top 10 reasons for hospitalization.
