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A study by researchers at Johns Hopkins Medicine says medical errors should rank as the third leading cause of death in the United States — and highlights how shortcomings in tracking vital statistics may hinder research and keep the problem out of the public eye. The authors, led by Johns Hopkins surgeon Dr. Martin Makary, call for changes in death certificates to better tabulate fatal lapses in care. In an open letter, they urge the Centers for Disease Control and Prevention to immediately add medical errors to its annual list reporting the top causes of death. (Allen and Pierce, 5/3)

If medical error were considered a disease, a new study has found, it would be the third leading cause of death in the United States, behind only heart disease and cancer. Medical error is not reported as a cause of death on death certificates, and the Centers for Disease Control and Prevention has no “medical error” category in its annual report on deaths and mortality. But in this study, researchers defined medical error as any health care intervention that causes a preventable death. (Bakalar, 5/3)

Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine who led the research, said in an interview that the category includes everything from bad doctors to more systemic issues such as communication breakdowns when patients are handed off from one department to another. "It boils down to people dying from the care that they receive rather than the disease for which they are seeking care," Makary said. (Cha, 5/3)

Fatal medical errors include cases in which patients received medications they were allergic to and instances in which patients died of preventable infections, among many other possibilities. Doctors and nurses are not necessarily involved, experts said — sometimes a faulty computer program may be to blame. “Medical care has become really complex,” said Dr. David Classen, an associate professor of medicine at the University of Utah who was not involved in the study. “It's no longer one single physician taking care of a single person at a hospital. It's these huge groups of people now, and mistakes get made.” (Netburn, 5/3)

The study gives an example of exactly how limited the death certificates are when it comes to recording medical errors. One example involved a patient who had a successful organ transplant and seemed healthy, but had to go back to the hospital for a non-specific complaint. During tests to determine what was wrong, a doctor accidentally cut her liver and hadn't realized it. The hospital sent her home, but she returned with internal bleeding and went into cardiac arrest and later died. It was the cut that led to her death, but her death certificate only listed a cardiovascular issue as the cause. (Christensen and Cohen, 5/3)

This paper builds upon a recent study that found that more than 210,000 deaths per year occur due to medical errors. When adjusting for 2013 hospital admission rates, Makary and his colleague found that the present number is more likely 251,454 deaths per year — surpassing the CDC’s stated third-leading cause of death, respiratory disease, which kills close to 150,000 people per year. The leading cause of death in the US is heart disease, followed by cancer. (Swetlitz, 5/3)

For the study, Makary and his colleagues evaluated four separate studies that analyzed medical death rate data from 2000 to 2008, including one by the U.S. Department of Health and Human Services' Office of the Inspector General and the Agency for Healthcare Research and Quality. Based on 2013 data on hospitalization rates, they found that of 35,416,020 hospitalizations, 251,454 deaths stemmed from a medical error. They said that adds up to 9.5 percent of all deaths a year in the U.S. (Marcus, 5/4)

The Internal Revenue Service correctly determined the allowable amount of the ObamaCare-related premium tax credit on most tax returns, a report made public Tuesday found. The tax credit, created by the Affordable Care Act, is designed to help offset the costs of health insurance for low- and moderate-income people. ... The Treasury Inspector General for Tax Administration (TIGTA) analyzed more than 2.6 million tax returns filed from January to May 2015 that claimed the credit. The watchdog said in its report that it determined that the IRS accurately calculated the allowable credit on 93 percent of the returns. (Jagoda, 5/3)

The desire for autonomy and work-life balance is driving more workers into freelance roles, but at the same time there are growing incentives for companies to employ workers via contracts rather than hire them full-time. Chief among those incentives is the cost of providing (or not providing) health care to workers under the Affordable Care Act. Nearly three-quarters of companies said that they would contract with more freelancers this year because of Obamacare, according to a new survey by online work platform Field Nation and executive development firm Future Workplace. (Braverman, 5/3)

For as much as Minnesota Republicans despise MNsure, they love to talk about it. They've written letters, legislation and plenty of campaign literature since even before the insurance marketplace went live in a problem-plagued 2013 rollout. This legislative session, they are again taking aim. Republicans have passed measures to slice MNsure's operating allowances, alter its leadership structure and phase out the state exchange altogether. Their goal is to put Minnesota into a federally run marketplace beginning in 2018. (Bakst, 5/4)

Barred from restaurants, banned on airplanes and unwelcome in workplaces across America, smokers have become accustomed to hiding their habits. So it’s no surprise many may now also be denying their habit when they buy health coverage from the federal health law’s insurance exchanges. Insurers -- who can charge higher rates in most states to admitted smokers -- are steamed. (Galewitz, 5/4)

After 33 years as [executive director of Families USA, Ron] Pollack will announce Wednesday that he plans to step down next March. ... Under his direction, Families USA became a major player in almost every big health-care battle of the past several decades. It was at the forefront of pushing for the creation of the Children’s Health Insurance Program in 1997 and in opposing changing Medicaid into a block-grant program. (McGinley, 5/4)

South Dakota's ability to expand Medicaid under Gov. Dennis Daugaard's conditions got a boost from federal policy changes that could help the state cover the costs of expansion, a top adviser to the governor said. Officials examining expansion hope to have a better idea next month whether a federal move to take on more Medicaid costs for Native American enrollees will allow South Dakota to cut spending enough to offset broadening eligibility for the public health coverage program. Daugaard has proposed expanding Medicaid as long as the state's share of the cost is covered by savings contingent on the federal policy changes. (5/3)

The prospects of a special session to address Medicaid expansion in South Dakota are improving. Gov. Dennis Daugaard's administration got good news last month that savings from a federal policy shift could save the state more than it initially expected. Meanwhile continuing conversations around a pair of ailing Indian Health Service (IHS) hospitals in the state has kept the issue in the public eye. (Ferguson, 5/3)

Gov. John Bel Edwards told more than 350 people from northeastern Louisiana they could thank his Medicaid expansion for saving University Health Conway, the state's safety net hospital in Monroe. Without the estimated $184 million savings from the Medicaid expansion, Edwards said, Conway would have suffered the same fate as four other safety net hospitals that are slated for closure because of deep budget cuts. (Hilburn, 5/3)

The chairmen of Arkansas' largest political parties agreed Tuesday that legislators came up with a good Medicaid expansion plan, even if they differed on how they got there. (Kissel, 5/3)

A contract dispute between UnitedHealthcare and a doctors’ group that handles high-risk pregnancies and infants has left thousands of parents unsure whether their medical care will be covered. The contract impasse, which began last summer, affects about 6,000 UnitedHealthcare-insured patients who receive medical services from Obstetrix Medical Group. (Alltucker, 5/3)

U.S. health insurer WellCare Health Plans Inc (WCG.N) reported a bigger-than-expected rise in quarterly profit and raised its profit forecast for the year as medical costs decreased. The amount WellCare spent on medical claims out of the premiums it earned, a key measure of costs known as medical benefits ratio (MBR), decreased in both the company's Medicaid and Medicare businesses. The improvement in the ratio – closely watched by investors and analysts for signs of higher medical costs and usage – was largely as WellCare's new contract with pharmacy benefit manager CVS Health Corp (CVS.N) led to better management of pharmacy costs and drug rebates. (5/3)

In the face of losses in the Affordable Care Act marketplace, Blue Cross and Blue Shield of Illinois is looking for new ways to cut spending. Starting June 1, the Chicago-based health insurer will no longer accept credit cards as a form of payment for members who buy their own health insurance on or off the Illinois marketplace. The company began notifying customers of the change last month. Blue Cross will still accept other forms of payment, including debit cards. (Sachdev, 5/2)

Every Oregon health insurance company but one is proposing double-digit percentage rate hikes for the individual market in 2017, with two of the biggest players -- Moda Health Plans and Providence Health Plans -- both seeking to raise rates by nearly a third. (Manning, 5/3)

All kinds of tools are being developed to give consumers the ability to answer how much health care will cost even before they decide where to go, ranging from a primary care doctor's visit to a flu shot. ... Bringing light to health care prices, an area that is famously opaque and hard to navigate, offers for the first time the prospect that patients will truly be able to shop around and save themselves -- and the health care system -- money. But a study published in the Journal of the American Medical Association on Tuesday suggests that transparency tools alone aren't going to lead to much, if any, savings. The study followed health care spending at two large employers that offered a web tool that allowed patients to easily shop around and save on health care costs. (Johnson, 5/3)

If people know how much health care services cost, they’ll shop for the best prices and spend less — or so the theory goes. That’s why the Massachusetts law intended to lower costs included a requirement that doctors, hospitals, and insurers provide cost estimates. But a Harvard Medical School study published Tuesday casts doubt on whether such efforts can curb spending. (Freyer, 5/4)

A Harvard study just out in JAMA finds that when health care consumers use price-comparison tools, they don’t end up spending less. In fact, they may even spend a bit more, perhaps because they think higher prices mean better quality. (Goldberg, 5/3)

Here’s a key theory behind cutting health care costs: If consumers knew how much they'd have to pay for various medical services, they could be savvier shoppers, which would ratchet up competition among doctors and hospitals, to cut prices. So, employers and insurers created online tools to help folks distinguish costly providers from less expensive alternatives. (Gorenstein, 5/3)

Too many preschoolers with ADHD still are being put on drugs right away, before behavior therapy is tried, health officials say. The Centers for Disease Control and Prevention reported Tuesday that three in four young kids diagnosed with attention deficit hyperactivity disorder are put on medicines. New CDC data shows that's continued, even after research found behavior therapy is as effective and doesn't give children stomach aches, sleep problems or other drug side effects. (5/3)

The drugs of choice among most pediatricians, psychiatrists and others treating children with ADHD are stimulants like Adderall and Ritalin — which have earned an almost mythical reputation for their ability to help children do better in school, and which some teens and college students abuse to gain an edge in academics. But the long-term effects of those drugs on a young brain and body have not been well studied, and the side effects can be numerous, including poor appetite, sleeplessness, irritability and slowed growth. "Until we know more the recommendation is to first refer parents of children under 6 years of age who have ADHD for training and behavior therapy," Anne Schuchat, CDC principal deputy director, said in a call with reporters on Tuesday. (Cha, 5/3)

Among the littlest people diagnosed with attention deficit and hyperactivity disorder--ADHD--nearly half get no more help dealing with their distractedness, impulsiveness and hyperactivity than that provided by prescription medication, says a new government report. That's despite the fact that for these patients--children ages 2 to 5 diagnosed with ADHD--behavior therapy can help children develop self-control, organizational skills and coping mechanisms, tools that would help them over the long run. (Healy, 5/3)

On the front lines of America's fight against a drug-abuse epidemic, there have been emotional, sometimes contradictory reactions to news that investigators are looking into whether Prince died of an overdose. Those engaged in the fight say a celebrity's death can help raise awareness of the problems yet also overshadow the other victims dying by the hundreds every week. Others suggest the attention to celebrity deaths is transitory and has limited impact. (5/3)

Purdue Pharma LP, the maker of the prescription pain killer OxyContin, filed its opposition Monday to an effort by STAT to unseal documents related to how the company marketed its powerful opioid medication. The filing in Pike Circuit Court, Kentucky, argues that STAT has no constitutional or common law right to unseal the records, which include a deposition of Dr. Richard Sackler, a Purdue board member and former company president who is a member of the family that controls the closely held company. (Armstrong, 5/3)

The fight against the growing abuse of prescription painkillers and heroin is not robust enough at any level -- not federal and state governments’ efforts or those of doctors and users themselves, according to most Americans in a new poll out Tuesday. Lack of access to care for those with substance abuse issues is a major problem, said 58 percent of those surveyed by the Kaiser Family Foundation. (KHN is an editorially independent program of the Foundation.) The poll found that Americans had somewhat different views of heroin and prescription drug abuse. (Gillespie, 5/3)

In a dramatic sign of the scope of the opioid crisis, a new survey on health shows that 44 percent of Americans personally know someone who has been addicted to prescription painkillers. About a quarter of those people say the person they know is an acquaintance, 21 percent say it’s a “close friend,” 20 percent say it’s a family member and two percent say they themselves are addicts. (Pianin, 5/3)

Some people addicted to oxycodone and other opioids are now turning to widely available diarrhea medications to manage their withdrawal symptoms or get high. The results can be dangerous to the heart — and sometimes fatal — warn toxicologists in a study recently published online in the Annals of Emergency Medicine. The researchers describe two case studies where people who were addicted to opioids tried to ease their withdrawal symptoms by taking many times the recommended dose of loperamide, a drug commonly used treat diarrhea. Both patients died. (Kodjak, 5/3)

William Logan Kennedy, a chronic drug abuser who cycled in and out of Miami jails, died last year slumped over his bed in an Overtown home. Next to him: a syringe and a bag of what was suspected to be heroin. It wasn’t. Instead, toxicologists determined this year, the 49-year-old handyman succumbed to a more dangerous and potent painkiller called fentantyl — a synthetic narcotic often peddled to unknowing users as heroin. (Ovalle and Weaver, 5/3)

People in pain write to Jennifer Doudna. They have a congenital illness. Or they have a sick child. Or they carry the gene for Huntington’s disease or some other dreadful time bomb wired through every cell in their body. They know that Doudna helped invent an extraordinary new gene-editing technology, known as CRISPR. But they don’t all seek her help. One woman, the mother of a child with Down syndrome, explained: “I love my child and wouldn’t change him. There’s something about him that’s so special. He’s so loving in a way that’s unique to him. I wouldn’t change it.” The scientist tears up telling this story. “It makes you think hard about what it means to be human, doesn’t it?” she says. (Achenbach, 5/3)

A bill that could have helped shore up the state's Medicaid program got caught in a fight over road funding Tuesday and suffered a mortal blow. The Senate adjourned Tuesday evening a few hours after a committee failed to vote on the bill. The committee's lack of action meant the bill cannot pass in the current session. The legislation, which would split an estimated $639 million payment over the 2010 oil spill, passed the House Thursday and needed to pass a Senate committee to stay alive. The bill would have split the proceeds between state debt payment and coastal road projects, and freed up money for Medicaid. (Lyman, 5/3)

The disagreement between competing versions of the bill concerned how much money should go to repaying state debts and how much should go to road projects in Mobile and Baldwin counties, the coastal counties on the front lines of the 2010 Deepwater Horizon disaster. Both versions would have made available $70 million for the Alabama Medicaid Agency next year, which would erase most of what the agency says is an $85 million shortfall. (Cason, 5/3)

Seeking to slash the red tape that keeps ex-prisoners with mental illness, drug addiction and other ailments from getting health coverage, Maryland is proposing to give thousands of newly released inmates temporary Medicaid membership with few questions asked. The measure, described as the first of its kind in the nation, would help close a gap occurring when sick inmates leave jail or prison care but have trouble getting coverage and treatment after they get out, sometimes for months, advocates say. (Hancock, 5/4)

The Obama administration has announced efforts to make sure inmates have Medicaid coverage when they are released, including those in halfway houses. ... But it will have little effect on ex-inmates in Idaho. Because Idaho lawmakers have not expanded Medicaid eligibility to low-income adults without dependent children, most former inmates in Idaho likely would fall into the “Medicaid gap,” a spokeswoman for the Idaho Department of Health and Welfare told the Statesman. (Dutton, 5/3)

An eligibility assessment tool in use since 2013 has resulted in arbitrary reductions and terminations of home-based Medicaid services for the elderly and disabled, a federal lawsuit contends. The lawsuit against the Arkansas Department of Human Services was filed late Monday by Jonesboro-based Legal Aid of Arkansas on behalf of Bradley Ledgerwood, 34, of Cash, who has cerebral palsy, and Ethel Jacobs, 90, of Helena-West Helena, who has Alzheimer's disease. (Davis, 5/4)

Non-profit health-care clinics like Planned Parenthood would be limited in how much they can bill the federal government for medications provided to Medicaid recipients, if an amendment to the state budget wins approval. Currently, these non-profits purchase certain prescription drugs at a discount. Some facilities have been accused of giving discounted prescriptions to Medicaid patients and billing Medicaid providers for the full price of the medication. (Beard Rau, 5/3)

The relatively high percentage of American women who die as a result of pregnancy, which exceeds that of other developed nations, is prompting a new national prevention campaign that is relying on the states to take a leading role. The key element in that effort is to encourage all states to go beyond the information provided on a typical death certificate by having mortality review panels investigate the causes behind every maternal death that occurs during pregnancy or in the year after delivery. The hope is the investigations will reveal systemic causes for at least some of the deaths and lead to preventive measures to save the lives of more would-be or new mothers. (Ollove, 5/3)

The Missouri Legislature has voted to override the governor and block a wage hike for home-care attendants. House members voted 119-36 on Tuesday to undo Democratic Gov. Jay Nixon’s veto. Two-thirds of senators voted for the override in April. (5/3)

Georgia’s governor has signed a bill inspired by former President Jimmy Carter’s cancer treatment. The measure signed Tuesday by Republican Gov. Nathan Deal prevents insurance companies from limiting coverage of drugs for stage four cancer patients. Supporters of the bill say patients sometimes cannot get certain drugs unless they first try other treatment options. Carter, now 91, announced in August that he had been diagnosed with skin cancer that had spread to his brain and would begin receiving doses of Keytruda. The newly approved drug helps the immune system seek out cancer cells appearing in a patient’s body. (5/3)

New York City agreed to pay the U.S. government $4.3 million to settle a civil fraud lawsuit accusing the city's fire department of accepting tens of thousands of improper Medicare reimbursements for emergency ambulance services. The accord signed on Tuesday resolves claims that the city cheated the U.S. Department of Health and Human Services out of millions of dollars from October 2008 to October 2012 by submitting claims for services that were not medically necessary, violating the federal False Claims Act. (5/3)

Seven people traveling back to Georgia and diagnosed with the Zika virus have joined a preliminary study at Emory analyzing immune responses to the disease. The seven volunteers are among the 13 people returning to Georgia who have been diagnosed with Zika. None of them were pregnant, Emory officials say. (Miller, 5/3)

StepOne launched in January, part of Franklin County’s CelebrateOne, a multi-layered initiative aimed at reducing infant mortality in the community. Since then, the two care coordinators who answer the StepOne calls have arranged more than 300 appointments and other help for pregnant women who might not have seen a doctor otherwise. (Kurtzman, 5/4)

Lauretta Jackson spent an hour on a recent Friday morning in the home of Bushra, an Iraqi refugee, trying to help Bushra teach her seven-month-old daughter, Sara, how to gain control of her muscles and live a normal child’s life. (Walters, 5/3)

A physician at Evanston NorthShore Hospital has been charged with stealing nearly $200,000 worth of equipment from two of the medical group's facilities, according to prosecutors and Evanston police. (Eltagouri, 5/3)

In the current academic year, 17 water sources at 12 D.C. public schools tested positive for elevated lead levels. And in recent weeks, the school system has come under fire for not communicating to parents when their children’s school tested positive for the elevated levels. Now, the District says it is responding with more lead testing out of an “abundance of caution” and vows to be upfront about any elevated levels. (Stein, 5/3)

Parents of four students filed a federal lawsuit Tuesday against New Jersey's largest school district and other public officials over lead found in drinking water. The parents allege in the suit against Newark's public schools that the district deliberately exposed children to harmful levels of lead, which is known to severely affect a child's development. The district shut off water fountains at half of its buildings in March because of elevated lead levels. (5/3)

Charles Smith, a longtime ally of Gov. Greg Abbott, will be the next executive commissioner of the Texas Health and Human Services Commission, the governor announced Tuesday. Smith, the chief deputy executive commissioner at the massive agency, will start his new position on June 1. (Walters, 5/3)

When a man accused of torturing a woman to death broke out of Washington state's largest mental hospital with another patient in early April, officials called it a rare occurrence and cited only two other escapes in the past seven years. But a review of police reports and interviews by The Associated Press reveal 185 instances in which patients escaped or walked away over just the past 3 1/2 years or so. (5/3)

Ohioans could not legally smoke medical marijuana under a revamped proposal being rolled out today by state legislators. Those with a prescription for medical marijuana would be allowed to use vaporization or other inhalant devices. (Rowland, 5/4)

The $10,000-a-month cancer drug has become the new normal, to the dismay of physicians and patients who increasingly face the burden of financial toxicity. A pair of new studies illustrate just how recently that pricing model has come into vogue and pull back the curtain on the strange market forces that push prices steadily higher in the years after the treatments are launched. The first study, published in JAMA Oncology, examined 32 cancer medications given in pill form and found that their initial launch list prices have steadily increased over the years — even after adjusting for inflation. (Johnson, 5/2)

The cost of new oral cancer medicines is rising no matter how you slice it. Between 2007 and 2013, these pills increased in cost 5 percent each year, and rose another 10 percent when regulators approved additional uses for the drugs, according to a new study in the May issue of Health Affairs. Moreover, the introduction of rival treatments had only a modest effect on cost — generating a decline of about 2 percent. In other words, competition did not do very much to keep a lid on costs. (Silverman, 5/2)

Two new studies on the price of cancer drugs add to the mounting pile of bad news for the patients and insurers. Prices aren’t dropping and they also aren’t achieving the health outcomes the prices seem to call for. Both studies appear in the May edition of Health Affairs. The first study shows that the price of oral cancer drugs recently approved by the Food and Drug Administration increased 5 percent each year between 2007 and 2013. This undermines the argument that even though cancer drugs are expensive when they are introduced, competition reduces the price over time. ... The second study examined cancer drug spending and its health impact in the United Stats and eight other advanced countries. (Owens, 5/2)

The cost of prescription painkillers has been gradually decreasing for patients, with a growing share of the costs now covered by insurers, according to new research. That shift over the last decade could be partly responsible for the dramatic increase in the use of the powerful, and increasingly deadly, drugs, according to a study published Monday in the journal Health Affairs. The average out-of-pocket price for 100 milligrams of morphine plummeted to 90 cents in 2012, down from $4.40 in 2001. (Ferris, 5/3)

To patrons of the Rum Boogie Cafe in Memphis, he’s Mick, a skilled guitarist with a bushy white beard who favors fedoras and sings soulful tunes about fishing and drinking. To Americans outraged by pharmaceutical prices, he just might be the guy to blame. (Langreth and Tracer, 5/2)

Stephen Ubl took over reins of the Pharmaceutical Research and Manufacturers of America last September just as public outrage over high drug prices was hitting its peak. A nimble inside-the-Beltway operative, Ubl came to PhRMA from the Advanced Medical Technology Association, the medical-device makers' trade group, where he won a two-year reprieve from the Affordable Care Act's device tax. He recently sat down for an interview with Modern Healthcare editor Merrill Goozner. (4/30)

As Joe Papa begins the difficult task this week of reviving Valeant Pharmaceuticals, he may want to start by repairing relations with hospitals. The drug maker angered many hospital officials early last year by suddenly boosting prices for a pair of important heart drugs for which few good alternatives are available. On the day that Valeant bought the drugs — Nitropress and Isuprel — from another drug maker, prices rose by 525 percent and 212 percent, respectively. (Silverman, 5/2)

The No. 1 health policy challenge facing the next administration — of either party — may well be the cost of drugs, according to a top administration health official. "If we don't address this problem in the next four or five years, and prescription drug costs grow as they've been growing, this will be one of the top three issues for my successor, if not the No. 1 issue," Centers for Medicare & Medicaid Services acting administrator Andy Slavitt said in an exclusive interview. (Diamond, 4/28)

Americans frequently rail against the soaring costs of prescription drugs and demand that drug costs somehow be reined in. Just last week, members of the Senate Special Committee on Aging berated several top executives of the Valeant Pharmaceutical company for driving up the prices of two blood pressure and heart drugs, Nitropress and Isuprel, by 212 percent and 525 percent, respectively. (Pianin, 5/1)

Ramona Sequeira was explaining why she reorganized divisions within her company when she said, "The functional organization that we had was suboptimizing our business and our ability to adapt and respond." (Sachdev, 4/29)

Mylan NV anticipates lower prices this year on the generic drugs that make up the majority of its revenue, even as it shifts its business to be less reliant on the inexpensive copycat medicines by buying Swedish drugmaker Meda AB. “We continue to see nothing out of the ordinary to change our generic pricing assumptions of low- to mid-single digit erosion for the full year,” Chief Executive Officer Heather Bresch said in a statement as the company reported first-quarter earnings Tuesday. (Fourcade, 5/3)

In his final full year as Celgene CEO, Bob Hugin took a bit of a pay cut from 2014. But his compensation still racked up to $22.5 million, among the highest in biopharma, as the cancer-focused company continued to outclass its bigger rivals on revenue and earnings growth. Hugin’s base salary inched up in 2015 to just over $1.4 million, after Hugin nabbed a raise in March, but his cash bonus dropped a bit. (Staton, 5/2)

Everyone complains about the high cost of prescription drugs, but not many people try to do anything about it. An admirable exception is the Department of Health and Human Services (HHS), which recently proposed a pilot program to change the way Medicare reimburses doctors for medications they administer directly to patients, as opposed to those distributed through pharmacies or hospitals. At present, the doctor gets the average price of a drug plus 6 percent, a clear incentive to use higher priced drugs instead of lower priced equivalents. (5/1)

Biogen’s twice-a-day pill for multiple sclerosis was a smash hit out of the gate in 2013, with one of the most successful drug launches in US history, even at a price of nearly $55,000 a year. But by late last year, sales growth had slowed. So the biotech company went big with its first TV ad blitz for the teal pill, sold as Tecfidera. It has bought nearly $39 million worth of TV airtime over the past seven months, vaulting Tecfidera into the top 20 most advertised drugs on US television for that period, according to the media research firm iSpot.tv. (Rebecca Robbins, 4/28)

Who says bipartisanship is dead? The Republican and Democratic winners of South Carolina's primary both favor letting the government dictate Medicare drug prices. Too bad it's such a dangerous idea. Donald Trump and Hillary Clinton want Washington to negotiate prices with drug makers under Medicare Part D, the prescription drug benefit for seniors. Both say their objective is to make prescription drugs more affordable. But should their proposals become law, they will bring the same problems price controls always create: shortages and economic distortions. (Ellen Weaver, 5/3)

A battle is heating up over an effort to impose price controls on prescription drugs in California. While proponents of a ballot measure, known as the “California Drug Price Relief Act,” argue that their proposal will reduce health care costs, they ignore the many negative consequences it will have on patients’ health and economic freedom. The initiative, which will be considered by voters in the November election, would mandate that state agencies pay no more for drugs than the lowest prices paid by the U.S. Department of Veterans Affairs for the same products. The pharmaceutical industry, naturally, is not happy about this threat to its business model and profitability, and has reportedly amassed a $100 million war chest to fight the measure. The industry contends that the VA receives discounted prices by limiting the amount of prescriptions it covers, and that applying these preferential prices to a larger population would be unsustainable for pharmaceutical companies. (5/1)

Ohio voters won't just pick a president this fall. They could also determine the future of medicine in this state. Ohioans likely will consider a problematic ballot initiative that proposes tying the prices that state agencies pay for prescription drugs to the prices paid by the U.S. Department of Veterans Affairs. Proponents of the proposal say emulating the VA will save the state billions and improve healthcare for ordinary Ohio residents. (William Upton, 5/4)

An $18 billion merger of medical firms suffers from a lack of logic. Healthcare data miner IMS is uniting with Quintiles, a manager of drug trials. Each will own about half the combined company, and other than some cost savings, the reasons for combining are a bit hazy. The presence of buyout shop TPG on both sides may offer some clues. (Robert Cyran, 5/3)

With its estimate that between 44 000 and 98 000 patients die in hospitals each year as the result of medical errors, the National Academy of Medicine’s (NAM’s; formerly the Institute of Medicine’s) report To Err Is Human: Building a Safer Health System propelled a wave of activity. Health care professionals, professional societies, large employer groups, patient advocacy organizations, and researchers voiced the need to reduce the estimated high toll of medical errors and adverse events. (Tejal K. Gandhi, Donald M. Berwick and Kaveh G. Shojania, 5/3)

Mosquitoes were not a concern in Kentucky in February, when the World Health Organization declared the mosquito-borne Zika virus a global public health emergency and President Barack Obama asked Congress for $1.9 billion to combat the disease. For the past two months, the Republicans who control Congress — prominent among them, Kentuckians Hal Rogers in the key role of House Appropriations chairman and Mitch McConnell, the majority leader of the Senate — have responded to the Zika threat by doing nothing — except blame the White House. (5/2)

It was a field day last week for health wonks in Washington. The CMS issued two major rules—one final, one proposed—that will shape how nearly half the nation's healthcare tab gets spent over the next decade. A few weeks ago, I wrote glowingly about burgeoning state Medicaid experiments aimed at delivering better care to the nation's poor and long-term disabled. Many of those programs are run by private managed-care organizations (MCOs), which now oversee spending for a majority of state Medicaid budgets. (Merrill Goozner, 4/30)

It has been more than 15 years since To Err Is Human, the landmark report by the Institute of Medicine (IOM), revealed the substantial morbidity and mortality related to medical errors in the United States. Two recent developments have refocused policy makers on getting patient safety right. The first are data suggesting that deaths associated with medical errors may exceed 400 000 annually, although this number is controversial, with questions about the degree to which medical errors truly caused each of these deaths and how many deaths were attributable to a medical error when death was inevitable. Regardless, medical error is likely a major cause of death and disability in the United States. The second is the Affordable Care Act, which has, through programs like Value-Based Purchasing and Hospital-Acquired Conditions penalties, made patient safety a financial priority for hospitals. While greater focus on safety is a welcome development, there is little reason to believe that added attention alone will lead to safer care. (Ashish Jha and Peter Pronovost, 5/3)

The term “provider” first appeared in the modern health care lexicon as a shorthand referring to delivery entities such as group practices, hospitals, and networks. More recently, its use has expanded to encompass physicians, nurse practitioners (NPs), physician assistants (PAs), and perhaps others, especially those engaged in delivery of primary care. On one level, this expansion is both logical and convenient, as it reflects the importance of a multidisciplinary approach to modern primary care delivery, extending beyond the traditional dyad of patient and physician. Being designated as a “primary care provider” also denotes qualifying for payment of services rendered, a designation long sought and highly valued by advanced-practice nurses and PAs. Although useful in these contexts, the term “provider” has the potential for adverse consequences for primary care, calling into question the wisdom of its expanded use. (Allan H. Goroll, 5/3)

In a stunningly reckless move, the Obama Food and Drug Administration recently relaxed standards for administering the abortion pill RU-486, allowing it to be used to abort children who are more developed in the womb and, shockingly, requiring even less physician supervision of a drug that has hospitalized and even killed women. (Lila Rose, 5/4)

Every spring, major breast cancer charities like Susan G. Komen and the Avon Foundation encourage people to raise money by walking. Each year, multiple organizations put on hundreds of walks, raising tens of millions of dollars. Since the 1980s, they’ve argued that these efforts are key to ending a devastating disease. About their three-day event, Komen proclaims: “This isn’t just a walk. It’s the journey to the end of breast cancer.” (Karuna Jagger, 5/4)