Capital Health Care: Prime Healthcare looks at LICH; GNYHA’s concerns over budget

Tweet Share on Facebook Print

Dan Goldberg

Follow: feed

Welcome to Capital Health Care, an early-morning email full of scoops and storylines that will inform the daily conversation in New York among health-industry insiders and high-information consumers. Sign up for our morning newsletters here.

SHAMELESS PLUG -- Follow @dangoldbergcny and @nahmias for more breaking health news throughout the day. And please share this newsletter with your friends and colleagues.

HEALTH SCOOP –- Prime Healthcare Services, a controversial hospital chain under investigation by the U.S. attorney, met with members of the Cobble Hill community on Thursday to express interest in Long Island College Hospital. Prime, if it were to take over LICH, would be the only for-profit hospital operating in New York. The company has been accused of canceling insurance contracts and upcoding, though those charges have never been substantiated and there is no proof Prime has ever broken a law. Last year, a Prime Healthcare senior VP told me that “optimizing reimbursement is an important part of our model. Aggressive, yes. Appropriate, yes. It’s not cheating. It’s optimizing reimbursement.”

CONCERN OVER CAUTION -- GNYHA expressed concern that State Senate and Assembly proposals to give lawmakers a say in the distribution of Medicaid waiver funds could slow or prevent institutions from getting timely aid. The trade group questioned proposals in the Senate’s budget resolution that would give lawmakers a greater say in how waiver money is spent, creating a review council to make recommendations for which facilities should receive funds. Their concern isn’t hard to understand. Hospitals swallowed deep cuts to help produce those savings that turned into the Medicaid waiver, and they desperately want to see some of that money come back to their coffers. Any intimation of delay is bound to make hospital executives cringe.



MAKE SURE YOU CHECK OUT -- Capital’s City Council tracker, a weekly guide to what's happening at the City Council. Every week on Monday we'll post about some of the upcoming hearings and track the progress of some of the more important pieces of legislation.

NOW WE KNOW -– Your mother was right. A new study shows that doing dangerous things leads to serious injuries. Research presented at the 2014 annual meeting of the American Academy of Orthopedic Surgeons demonstrated that the growth of extreme sports such as skateboarding, surfing and snowboarding has correlated with an increase in head and neck injuries.

WE'D LOVE TO HEAR FROM YOU: This roundup is for you so please tell us how we can make it even better. Send tips, news, ideas, calendar items, releases, promotions, job postings, birthdays, congratulations, criticisms and corrections to

WANT MORE HEALTH CARE INFO THROUGHOUT THE DAY? Get bite-size “whiteboard" alerts that focus specifically on health care issues sent directly to your inbox. Please contact Lauren Englander at to learn more.

FACT CHECK -– Gov. George Pataki was on the radio Sunday morning with John Catsimatidis, and said that President Obama had delayed the individual mandate for two years. This is incorrect. The individual mandate is still in place. What the former governor might have been referring to is the Obama administration’s decision to allow plans that do not meet the minimum benefits to exist for another two years, in an attempt to keep the “if you like your plan you can keep it” promise. Pataki's decrying of mandates was interesting. The lack of a mandate in New York coupled with the state’s highly regulated insurance market was one reason premiums on the individual market in the state were so high before the ACA took effect. Once the ACA put in place a mandate, which made for a more diversified risk pool, premiums in the state fell by half. Sarah Kliff wrote a great explainer last July:

BILL TRACKER –- Assemblyman John McDonald III has sponsored a bill that would require stores with pharmacies to keep tobacco products covered and out of view of the public. Anti-smoking groups have been advocating a ban on pharmacy cigarette sales for years—a pharmacy being defined as any store that has one, so it would include most grocery chains. McDonald, a Democrat, owns Marra’s Health Pharmacy in Cohoes. McDonald’s bill was referred to the health committee.
…Assemblywoman Crystal Peoples-Stokes introduced a bill that would provide “patients with better access to eye care medication by ensuring that a medical provider shall be allowed to prescribe up to a 90-day prescription.” The bill was referred to the Higher Education committee.
Check out Capital's bill tracker, a daily guide to the flow of the New York state Legislature.

WHAT WE’RE READING -– William Broad’s piece in The New York Times on how billionaires are taking over the funding of scientific research. From Bloomberg to Koch, the world’s richest men and women are building new hospital wings, funding new research and eradicating diseases.The donors are impatient with the deliberate, and often politicized, pace of public science, they say, and willing to take risks that government cannot or simply will not consider. Yet that personal setting of priorities is precisely what troubles some in the science establishment.”

DOC FIX IS BROKEN -- The House passed a “doc fix” but paid for it by repealing the individual mandate for five years. So, a problem that both parties want to fix, that doctors and economists say needs to be fixed, won’t be fixed because the individual mandate provision is going nowhere in the Senate, and Obama won’t sign it in to law.

PAY ATTENTION -- Use of ADHD medications among Americans rose 35.5 percent between 2008 and 2012, increasing the number of privately insured individuals on these drug therapies to more than 4.8 million, according to a report from Express Scripts. Among the report’s findings: Women aged 26 to 34-years old accounted for the greatest surge in use — an 85 percent increase. And in 2012, South Carolina experienced the highest prevalence of ADHD medication use: 5 percent overall and 14.1 percent for boys 12 to 18-years old.

RYAN WHITE -- C.M.S. ruled Obamacare plans must accept premium and cost-sharing payments from government programs like the Ryan White HIV/AIDS program, Politico reports.

CONGRATULATIONS -- The United Hospital Fund hosted its 21st annual Hospital Auxilian and Volunteer Achievement Awards ceremony on Friday at the Waldorf-Astoria, honoring 91 volunteers and auxilians who provide exceptional service. The honorees averaged more than 10 years of voluntary service in hospital settings ranging from gift shops and fundraising departments, to emergency rooms and clinics. “This event is one of the highlights for me each year, as we get to celebrate the contributions of these everyday heroes,” Jim Tallon, president of the United Hospital Fund, said in a press release. “In meeting many of today’s honorees, I see the diversity that makes New York the great city that it is. But I also see an important commonality—the drive of remarkable individuals to give of their time, unselfishly, to improve health care and the lives of patients and their families.”

CALENDAR –- Memorial Sloan Kettering is hosting a panel discussion today on how to talk to your kids about your cancer diagnosis.

TODAY’S TIP -– Comes to us from Catherine Abate, the head of Community Healthcare Network, who reminds us that “the foods you grab-and-go at corner bodegas could be killing you, but there are healthier options on the same shelves if you just take a moment when stopping-and-shopping.” Here’s a list of the top-10 unhealthy items and healthier options:

-ICD-10 WATCH –- A study in the Journal of Oncology Practice found that health providers may experience information and financial loss because of the ICD-10 conversion. The study looked at coding for hematology-oncology because prior research had shown it was a field that would have a simpler time converting from ICD-9. Researchers used 2010 Illinois Medicaid data to identify ICD-9 outpatient codes with the highest reimbursement. They then used a computer program to translate those into ICD-10 and found that the transition led to significant information loss, affecting 8 percent of the Medicaid codes, and about a 3 percent loss in Medicaid reimbursement.

-GLUTEN FREE -- The growing gluten-free market could soon get some company from a hemp cracker. The Journal of Food Science published a paper showing how the cracker can be made from hemp flour, a by-product of cold-pressed hemp oil, in combination with decaffeinated green tea leaves. Yummy! Hemp flour is rich in proteins, fibers, phytochemicals, minerals, omega-6 and omega-3 essential fatty acids, the article said. Green tea leaves contain compounds that have been shown to have health benefits including cancer prevention of many types as well as decreasing LDL cholesterol levels.

-MUSCLE MEMORY -- Columbia University researchers had the March 13 cover story in Cell. They report on the discovery of a new type of mechanical memory that adjusts muscle elasticity to their history of stretching. The discovery, according to the authors, could lead to new treatments of muscle disorders. "We discovered an effective way of tuning muscle elasticity," Pallav Kosuri, a lead author, said in a press release. "We first observed the effect on a molecular level, and then tested it all the way up to human tissue." The study focused on how titin is impacted by oxidation, which increases during muscle activity. The researchers found that titin contains several locations prone to oxidation, but most are inside muscular folds. Stretching the muscle forces titin to unfold causing it to become increasingly sensitive to oxidation.

-SECOND LIFE -- A protein that normally protects cells can also interact with the Marburg virus VP24, allowing the deadly virus to live longer and replicate better, according to a report from the Icahn School of Medicine at Mount Sinai published in Cell Reports. "Marburg virus has been essentially untreatable," the study's senior author Dr. Christopher Basler, a professor of microbiology at the Icahn School, said in a press release. "Our study shows that Marburg virus VP24 interacts with the host protein Keap1." Keap1 regulates the antioxidant response, normally protecting cells from harm. "If we can develop inhibitors, the virus will die and replicate more slowly – that's the hypothesis that we have now," Basler said.

-LOCATION, LOCATION, LOCATION –- People who live or work near takeout places are more likely to be obese, according to an article published on This was a study done in the UK and showed that as eating outside the home grew more prevalent so did obesity. Not sure how this same study would fare in New York City.

-WHEN SECONDS COUNT –- A new study shows that injured patients who live near closed trauma centers have higher odds of dying. The article published in The Journal of Trauma and Acute Care Surgery looked at more than a quarter of a million patients and analyzed the impact of closures of three centers in California. It demonstrated that when injured patients must travel farther to a trauma center they had a 21 percent higher chance of in-hospital death. The odds of death were even higher – 29 percent - during the first two years after a closure, the study found.

-BLOW YOUR MIND -- Americans spend about $100 billion each year on cocaine, heroin, marijuana and methamphetamines. That roughly equates to the total spending by the federal government on education. Americans are using less cocaine but far more marijuana, according to a report from the RAND Drug Policy Research Center. Researchers looked at drug use between 2000 and 2010 and found marijuana use rose 30 percent from 2006 to 2010, while cocaine consumption fell by half. Heroin use was fairly stable throughout the decade, the report found, but there have been several other reports showing a spike in heroin use since 2010.

-COPY CAT –- It takes children until about the age of 5 or 6 before they understand why it’s bad to steal an idea without proper attribution, according to a study in the Journal of Experimental Child Psychology. This holds true even though younger kids understand stealing a physical object is wrong. The results were the same regardless of cultural differences.

-BRAIN MATTERS – A study in JAMA Psychiatry demonstrates why smokers have such trouble giving up cigarettes. The brain imaging found that smokers who abstained from cigarettes showed weakened interconnectivity between certain networks in the brains: the default mode network, the executive control network, and the salience network. Researchers believe that the weakened connectivity makes it harder to reduce cravings. The authors believe that a better understanding of these networks could help predict people's ability to quit and stay quit.

MISSED A ROUNDUP? Get caught up here: 3/14, 3/13, 3/12, 3/11, 3/10