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Drug spending driving up Part B premiums and deductibles
Medicare beneficiaries charged the standard premium for Medicare Part B coverage will be paying $144.60 each month in 2020, up $9.10 from 2019.
Deductibles also will increase to $198 next year, up $13 from the current year.
The Centers for Medicare & Medicaid Services said in a statement announcing the hikes that the increases are “largely due to rising spending on physician administered drugs. These higher costs have a ripple effect and result in higher Part B premiums and deductibles.”
The formal details on the premium and deductible increases have been posted online and are scheduled for publication in the Federal Register on Nov. 13.
The CMS and Congress are looking into a number of options to help contain the spending on drugs, including the use of an international pricing index to put U.S. spending more in line with the lower prices offered in foreign countries, automatic rebates when drug prices rise faster than the rate of inflation, and a modern take on the failed competitive acquisition program.
The agency also announced increases in the inpatient hospital deductible that will be paid under Medicare Part A when beneficiaries are admitted into a hospital in 2020. The deductible increases to $1,408 next year, up from $1,364 this year. The daily coinsurance for the 61st-90th day increases to $352 from $341, while the daily coinsurance for lifetime reserve days increases to $704 from $682.
Skilled nursing facility coinsurance also rises during this same time period to $176 from $170.50.
More information on Part A deductibles can be found here, while information on Part A premiums can be found here.
Medicare beneficiaries charged the standard premium for Medicare Part B coverage will be paying $144.60 each month in 2020, up $9.10 from 2019.
Deductibles also will increase to $198 next year, up $13 from the current year.
The Centers for Medicare & Medicaid Services said in a statement announcing the hikes that the increases are “largely due to rising spending on physician administered drugs. These higher costs have a ripple effect and result in higher Part B premiums and deductibles.”
The formal details on the premium and deductible increases have been posted online and are scheduled for publication in the Federal Register on Nov. 13.
The CMS and Congress are looking into a number of options to help contain the spending on drugs, including the use of an international pricing index to put U.S. spending more in line with the lower prices offered in foreign countries, automatic rebates when drug prices rise faster than the rate of inflation, and a modern take on the failed competitive acquisition program.
The agency also announced increases in the inpatient hospital deductible that will be paid under Medicare Part A when beneficiaries are admitted into a hospital in 2020. The deductible increases to $1,408 next year, up from $1,364 this year. The daily coinsurance for the 61st-90th day increases to $352 from $341, while the daily coinsurance for lifetime reserve days increases to $704 from $682.
Skilled nursing facility coinsurance also rises during this same time period to $176 from $170.50.
More information on Part A deductibles can be found here, while information on Part A premiums can be found here.
Medicare beneficiaries charged the standard premium for Medicare Part B coverage will be paying $144.60 each month in 2020, up $9.10 from 2019.
Deductibles also will increase to $198 next year, up $13 from the current year.
The Centers for Medicare & Medicaid Services said in a statement announcing the hikes that the increases are “largely due to rising spending on physician administered drugs. These higher costs have a ripple effect and result in higher Part B premiums and deductibles.”
The formal details on the premium and deductible increases have been posted online and are scheduled for publication in the Federal Register on Nov. 13.
The CMS and Congress are looking into a number of options to help contain the spending on drugs, including the use of an international pricing index to put U.S. spending more in line with the lower prices offered in foreign countries, automatic rebates when drug prices rise faster than the rate of inflation, and a modern take on the failed competitive acquisition program.
The agency also announced increases in the inpatient hospital deductible that will be paid under Medicare Part A when beneficiaries are admitted into a hospital in 2020. The deductible increases to $1,408 next year, up from $1,364 this year. The daily coinsurance for the 61st-90th day increases to $352 from $341, while the daily coinsurance for lifetime reserve days increases to $704 from $682.
Skilled nursing facility coinsurance also rises during this same time period to $176 from $170.50.
More information on Part A deductibles can be found here, while information on Part A premiums can be found here.
DACA lands before Supreme Court
Whether the Trump administration can rescind a safe-haven program for the children of first-generation immigrants will soon be decided by the U.S. Supreme Court.
Justices on Nov. 12, 2019, heard oral arguments in the case of Regents of the University of California v. Department of Homeland Security, which centers on the legality of the Deferred Action for Childhood Arrivals (DACA) policy.
The DACA case before the court, which consolidates three legal challenges, revolves around two primary legal arguments, said Austin, Tex., attorney Faye Kolly, who coauthored a brief in support of DACA. The plaintiffs argue that the decision to rescind the DACA program was arbitrary and capricious under the Administrative Procedure Act (APA) because there was no justification to end the policy. The DHS’s rescission memorandum did not acknowledge, nor weigh, the profound interests and devastating consequences that would be caused by the rescission to hundreds of thousands of DACA recipients and countless stakeholders who rely on the program, attorneys for the University of California wrote in its brief to the Supreme Court.
The DHS contends the DACA policy itself is unlawful because the Obama administration lacked the statutory authority to launch such a program. The government’s decision to revoke the program was based on the legal and practical implications of maintaining DACA in light of concerns about its legality and ongoing litigation challenging similar programs, attorneys for the DHS wrote in a brief to the Supreme Court.
With a conservative majority on the court, analysts say the Trump administration may have an upper hand in the case. However, Ms. Kolly noted that Chief Justice John G. Roberts Jr. is the wild card to watch.
Although Chief Justice Roberts tends to lean more conservatively, he recently sided with the court’s liberal justices last term in a case involving citizenship, said Ms. Kolly. In that case, Department of Commerce v. New York, Chief Justice Roberts voted to block the Department of Commerce from reinstating a citizenship question on the 2020 Census. In the majority ruling, Justice Roberts wrote that the department’s reasons for reinstating the citizenship question were “incongruent with what the record reveals about the agency’s priorities and decision making.”
Considering that the government’s rationale to end DACA is a key piece to the DACA dispute, it’s possible that Chief Justice Roberts could apply a similar line of reasoning to the case, Ms. Kolly said.
“I think the court will look very closely [at whether] the arbitrary and capricious standard has been violated by the government,” she said in an interview. “I do think they will split along [ideological] lines, but the surprise vote may be Roberts.”
A number of physician and health care organizations have weighed in on the DACA case, including the American Medical Association, the Association of American Medical Colleges, and the American College of Obstetricians and Gynecologists. In a joint brief to the Supreme Court, the organizations wrote that an estimated 27,000 health care workers and support staff depend on DACA for their authorization to work in the United States, including nearly 200 medical students, residents, and physicians. If these physicians and trainees retain their work eligibility, each will care for an average of 1,533-4,600 patients a year, according to the brief.
“Together, over the course of their careers, they will touch the lives of 1.7 [million] to 5.1 million U.S. patients,” the groups wrote. “If DACA is rescinded, however, almost none of these people will be able to serve the American public in their chosen fields. This action would therefore nullify the substantial and long-term investments that DACA recipients, educational institutions, and the public have made in educating and training those recipients to provide needed health care services to the nation.”
More than 25 other individuals and organizations have also submitted briefs – either in support or in opposition – regarding the case. In their brief, attorneys for the Immigration Law Reform Institute, wrote that the DACA policy is void because it was issued in violation of APA notice-and-comment requirements “by virtue of its creating rights and cabining discretion in a sufficiently binding manner to exceed its mere enforcement-discretion justification.”
“DACA also violates the [Immigration and Naturalization Act] on both substantive and procedural grounds, and either sort of violation renders DACA a nullity,” the brief states.
In a Nov. 12 tweet, President Trump indicated that, if the Supreme Court strikes down DACA, he will consider working with Democrats on a legislative remedy that would protect current DACA recipients from deportation.
“Many of the people in DACA, no longer very young, are far from ‘angels,’ ” President Trump tweeted. “Some are very tough, hardened criminals, President Obama said he had no legal right to sign order, but would anyway. If Supreme Court remedies with overturn, a deal will be made with Dems for them to stay!”
Whether the Trump administration can rescind a safe-haven program for the children of first-generation immigrants will soon be decided by the U.S. Supreme Court.
Justices on Nov. 12, 2019, heard oral arguments in the case of Regents of the University of California v. Department of Homeland Security, which centers on the legality of the Deferred Action for Childhood Arrivals (DACA) policy.
The DACA case before the court, which consolidates three legal challenges, revolves around two primary legal arguments, said Austin, Tex., attorney Faye Kolly, who coauthored a brief in support of DACA. The plaintiffs argue that the decision to rescind the DACA program was arbitrary and capricious under the Administrative Procedure Act (APA) because there was no justification to end the policy. The DHS’s rescission memorandum did not acknowledge, nor weigh, the profound interests and devastating consequences that would be caused by the rescission to hundreds of thousands of DACA recipients and countless stakeholders who rely on the program, attorneys for the University of California wrote in its brief to the Supreme Court.
The DHS contends the DACA policy itself is unlawful because the Obama administration lacked the statutory authority to launch such a program. The government’s decision to revoke the program was based on the legal and practical implications of maintaining DACA in light of concerns about its legality and ongoing litigation challenging similar programs, attorneys for the DHS wrote in a brief to the Supreme Court.
With a conservative majority on the court, analysts say the Trump administration may have an upper hand in the case. However, Ms. Kolly noted that Chief Justice John G. Roberts Jr. is the wild card to watch.
Although Chief Justice Roberts tends to lean more conservatively, he recently sided with the court’s liberal justices last term in a case involving citizenship, said Ms. Kolly. In that case, Department of Commerce v. New York, Chief Justice Roberts voted to block the Department of Commerce from reinstating a citizenship question on the 2020 Census. In the majority ruling, Justice Roberts wrote that the department’s reasons for reinstating the citizenship question were “incongruent with what the record reveals about the agency’s priorities and decision making.”
Considering that the government’s rationale to end DACA is a key piece to the DACA dispute, it’s possible that Chief Justice Roberts could apply a similar line of reasoning to the case, Ms. Kolly said.
“I think the court will look very closely [at whether] the arbitrary and capricious standard has been violated by the government,” she said in an interview. “I do think they will split along [ideological] lines, but the surprise vote may be Roberts.”
A number of physician and health care organizations have weighed in on the DACA case, including the American Medical Association, the Association of American Medical Colleges, and the American College of Obstetricians and Gynecologists. In a joint brief to the Supreme Court, the organizations wrote that an estimated 27,000 health care workers and support staff depend on DACA for their authorization to work in the United States, including nearly 200 medical students, residents, and physicians. If these physicians and trainees retain their work eligibility, each will care for an average of 1,533-4,600 patients a year, according to the brief.
“Together, over the course of their careers, they will touch the lives of 1.7 [million] to 5.1 million U.S. patients,” the groups wrote. “If DACA is rescinded, however, almost none of these people will be able to serve the American public in their chosen fields. This action would therefore nullify the substantial and long-term investments that DACA recipients, educational institutions, and the public have made in educating and training those recipients to provide needed health care services to the nation.”
More than 25 other individuals and organizations have also submitted briefs – either in support or in opposition – regarding the case. In their brief, attorneys for the Immigration Law Reform Institute, wrote that the DACA policy is void because it was issued in violation of APA notice-and-comment requirements “by virtue of its creating rights and cabining discretion in a sufficiently binding manner to exceed its mere enforcement-discretion justification.”
“DACA also violates the [Immigration and Naturalization Act] on both substantive and procedural grounds, and either sort of violation renders DACA a nullity,” the brief states.
In a Nov. 12 tweet, President Trump indicated that, if the Supreme Court strikes down DACA, he will consider working with Democrats on a legislative remedy that would protect current DACA recipients from deportation.
“Many of the people in DACA, no longer very young, are far from ‘angels,’ ” President Trump tweeted. “Some are very tough, hardened criminals, President Obama said he had no legal right to sign order, but would anyway. If Supreme Court remedies with overturn, a deal will be made with Dems for them to stay!”
Whether the Trump administration can rescind a safe-haven program for the children of first-generation immigrants will soon be decided by the U.S. Supreme Court.
Justices on Nov. 12, 2019, heard oral arguments in the case of Regents of the University of California v. Department of Homeland Security, which centers on the legality of the Deferred Action for Childhood Arrivals (DACA) policy.
The DACA case before the court, which consolidates three legal challenges, revolves around two primary legal arguments, said Austin, Tex., attorney Faye Kolly, who coauthored a brief in support of DACA. The plaintiffs argue that the decision to rescind the DACA program was arbitrary and capricious under the Administrative Procedure Act (APA) because there was no justification to end the policy. The DHS’s rescission memorandum did not acknowledge, nor weigh, the profound interests and devastating consequences that would be caused by the rescission to hundreds of thousands of DACA recipients and countless stakeholders who rely on the program, attorneys for the University of California wrote in its brief to the Supreme Court.
The DHS contends the DACA policy itself is unlawful because the Obama administration lacked the statutory authority to launch such a program. The government’s decision to revoke the program was based on the legal and practical implications of maintaining DACA in light of concerns about its legality and ongoing litigation challenging similar programs, attorneys for the DHS wrote in a brief to the Supreme Court.
With a conservative majority on the court, analysts say the Trump administration may have an upper hand in the case. However, Ms. Kolly noted that Chief Justice John G. Roberts Jr. is the wild card to watch.
Although Chief Justice Roberts tends to lean more conservatively, he recently sided with the court’s liberal justices last term in a case involving citizenship, said Ms. Kolly. In that case, Department of Commerce v. New York, Chief Justice Roberts voted to block the Department of Commerce from reinstating a citizenship question on the 2020 Census. In the majority ruling, Justice Roberts wrote that the department’s reasons for reinstating the citizenship question were “incongruent with what the record reveals about the agency’s priorities and decision making.”
Considering that the government’s rationale to end DACA is a key piece to the DACA dispute, it’s possible that Chief Justice Roberts could apply a similar line of reasoning to the case, Ms. Kolly said.
“I think the court will look very closely [at whether] the arbitrary and capricious standard has been violated by the government,” she said in an interview. “I do think they will split along [ideological] lines, but the surprise vote may be Roberts.”
A number of physician and health care organizations have weighed in on the DACA case, including the American Medical Association, the Association of American Medical Colleges, and the American College of Obstetricians and Gynecologists. In a joint brief to the Supreme Court, the organizations wrote that an estimated 27,000 health care workers and support staff depend on DACA for their authorization to work in the United States, including nearly 200 medical students, residents, and physicians. If these physicians and trainees retain their work eligibility, each will care for an average of 1,533-4,600 patients a year, according to the brief.
“Together, over the course of their careers, they will touch the lives of 1.7 [million] to 5.1 million U.S. patients,” the groups wrote. “If DACA is rescinded, however, almost none of these people will be able to serve the American public in their chosen fields. This action would therefore nullify the substantial and long-term investments that DACA recipients, educational institutions, and the public have made in educating and training those recipients to provide needed health care services to the nation.”
More than 25 other individuals and organizations have also submitted briefs – either in support or in opposition – regarding the case. In their brief, attorneys for the Immigration Law Reform Institute, wrote that the DACA policy is void because it was issued in violation of APA notice-and-comment requirements “by virtue of its creating rights and cabining discretion in a sufficiently binding manner to exceed its mere enforcement-discretion justification.”
“DACA also violates the [Immigration and Naturalization Act] on both substantive and procedural grounds, and either sort of violation renders DACA a nullity,” the brief states.
In a Nov. 12 tweet, President Trump indicated that, if the Supreme Court strikes down DACA, he will consider working with Democrats on a legislative remedy that would protect current DACA recipients from deportation.
“Many of the people in DACA, no longer very young, are far from ‘angels,’ ” President Trump tweeted. “Some are very tough, hardened criminals, President Obama said he had no legal right to sign order, but would anyway. If Supreme Court remedies with overturn, a deal will be made with Dems for them to stay!”
Low LDL-C and blood pressure can reduce lifetime CVD risk by 80%
PARIS – Over the course of years and decades, lower LDL cholesterol levels and lower systolic blood pressure can reduce the lifetime risk of cardiovascular disease by up to 80%, according to a new study.
“What we found is that lifetime exposure to the combination of lower LDL and lower systolic blood pressure is associated with independent, additive, and dose-dependent effects on the lifetime risk of cardiovascular disease,” said the study’s senior author, Brian Ference, MD, speaking at the annual congress of the European Society of Cardiology. “The data seem to confirm that most cardiovascular events are preventable, and suggest that most cardiovascular events can be prevented, with prolonged exposure to modestly lower LDL cholesterol and systolic blood pressure.”
Any reduction of LDL-C and systolic blood pressure (SBP), in any combination, was associated with a lower lifetime risk of cardiovascular disease (CVD) in the study, which took advantage of the United Kingdom’s large Biobank to identify individuals with genetically lower LDL-C and blood pressure levels. The relationship was dose-dependent and showed a log-linear relationship to the combined absolute LDL-C and SBP differences, said Dr. Ference, professor and executive director of the Centre for Naturally Randomised Trials at the University of Cambridge, England.
The results validate current guidelines that focus on a lifetime approach to cardiovascular risk reduction and support a focus on therapeutic lifestyle interventions for individuals at all levels of risk for cardiovascular events, said Dr. Ference. He foresees the results shaping new risk-estimating algorithms and informing the next round of prevention guidelines.
Previous studies had suggested that long-term exposure to lower levels of LDL-C and lower systolic blood pressure reduced cardiovascular risk, but the association hadn’t been fully quantified. Ideally, said Dr. Ference, the question would be answered by a long-term randomized controlled trial, but it would be decades before meaningful data would accrue, and such a trial is unlikely to be conducted.
Using data from 438,952 Biobank participants, Dr. Ference and coinvestigators sought to quantify the association between LDL-C, systolic blood pressure, and atherosclerotic CVD. Taking advantage of genetic variants known to be associated with both lower LDL-C and lower systolic blood pressure, the researchers constructed a “natural randomization” trial. This trial design is also known as Mendelian randomization.
First, the entire study population was randomized into those with exome variants associated with higher or lower LDL-C, which resulted in a mean 15-mg/dL difference between the arms. Then, each LDL-C arm was randomized into groups with exome variants associated with higher or lower SBP, resulting in a difference of 2.9-3 mm Hg between the blood pressure arms within each LDL arm. This randomization yielded a reference group, a group with lower LDL-C, a group with lower SBP, and a group with lower LDL-C and SBP.
For the total population, the mean LDL-C was 138 mg/dL, and the mean SBP was 137.8 mm Hg.
A total of 24,980 participants had coronary revascularization, a nonfatal myocardial infarction (MI), or coronary death – the composite primary outcome measure of major coronary events.
“What we found is that long-term exposure to the combination of 1 mmol/L [about 39 mg/dL] lower LDL and 10 mm/Hg lower blood pressure is associated with an 80% lifetime reduction in risk of cardiovascular events, a 75% reduction in the risk of MI, and 68% reduction in the long-term risk of cardiovascular death,” said Dr. Ference.
By breaking participants out into separate quartiles of LDL-C and SBP levels, and examining outcomes for each quartile independently, Dr. Ference and collaborators were able to ascertain that the salutary effects of lower LDL-C and SBP were independent of each other.
Looking at individual cardiovascular outcomes, “The effect of combined exposure to both lower LDL and lower systolic blood pressure appear to be quite similar across multiple composite cardiovascular outcomes,” said Dr. Ference; benefit was seen in risk of MI, stroke, and other vascular events.
Plotting out the amount of risk reduction against the genetic scores for LDL-C and SBP reduction showed a proportional relationship that was logarithmically linear. “These large proportional reductions in risk really suggest that, for LDL, systolic blood pressure, and their combination, the benefit really depends both on the magnitude and the duration of the exposure,” said Dr. Ference. The effect was seen regardless of age, gender, body mass index, and diabetes status; being a smoker slightly attenuated the effects of LDL-C and SBP.
The mean participant age was 65 years, and women made up 54% of the study population. Aside from lipid values and systolic blood pressure, there were no significant between-group differences.
From these findings, what message can clinicians take to their patients? “Benefit is a much greater motivator, rather than the nebulous concept of risk,” said Dr. Ference. “So if we begin to crystallize and give an estimate of how much someone can benefit – either from adhering to a healthy lifestyle, with specific goals for LDL and blood pressure reductions, or from encouraging them to remain compliant with their therapies, achieving those corresponding goals – we can quantify their expected clinical benefit and encourage them to invest in their health over the long term.”
Dr. Ference said that the actual mechanism by which lipids and blood pressure are lowered matters less than the amount and duration of lowering: “These data are really agnostic as to the mechanism by which either blood pressure or LDL – or apo-B–containing lipoproteins generally – and blood pressure are reduced. It really suggests that whatever mechanism by which an individual person can most effectively lower their LDL and blood pressure, that’s the best one for that person, if they can maintain that over time.”
Dr. Ference reported financial relationships, including research contracts, consulting arrangements, receipt of royalties, and being an owner or stockholder of more than a dozen pharmaceutical companies. The study was funded by the United Kingdom’s National Institute of Health Research and Medical Research Council, and by the British Heart Foundation.
SOURCE: Ference B. et al. ESC Congress 2019, Hot Line Session 3.
Jemma Hopewell, PhD, was the assigned discussant for the Mendelian randomization study of LDL-C and SBP’s effects on cardiovascular health. She placed the genetic epidemiological study within the framework of other short- and medium-term studies that have examined the effects of LDL-C and SBP on cardiovascular health.
“Let’s think about this in the context of other studies,” said Dr. Hopewell, asking what the study adds to what’s known about exposure to LDL-C and systolic blood pressure levels. Shorter-term clinical trials that tracked differences in LDL-C over about 5 years have shown a 20%-25% drop in cardiovascular risk, while medium-term observational studies have shown a decrease of about 30%.
Now, she said, Mendelian randomization studies such as this analysis of the UK Biobank data are showing larger effects with the lifelong exposure to lower LDL levels that genetic variants confer. “As you can see, a pattern emerges ... of larger effects on risk than might be anticipated from the short-term clinical trials.”
A similar pattern can be seen with SBP, with shorter-term clinical trials showing smaller reductions in CVD. Observational studies show more reduction in risk when participants are followed for longer periods, and studies such as the present one show the larger effects of a lifetime of lower blood pressure, said Dr. Hopewell.
In terms of the combined effects, “It’s for the first time today that we see these nice results in a Mendelian randomization framework. This is a very well conducted analysis.”
Still, she cited potential limitations that can inform interpretation of the study results. These include the fact that Biobank participants have been followed for just about 10 years at this point, with most participants still alive. “Therefore, it is unclear whether this truly reflects the lifetime risk of coronary events.”
Also, the paucity of ethnic variation in the Biobank cohort means generalization is problematic until studies are conducted across different ethnic groups, she said.
The study design leaves open the possibility for reverse causality given the fact that participant characteristics captured at the time of recruitment may be influenced by prior disease, said Dr. Hopewell.
She also cited the complication of pleiotropy that’s a known limitation of Mendelian randomization studies. Importantly, the study’s reliance on genetic variation means that results may not directly translate to long-term use of lipid-lowering medication and antihypertensives, she said.
Still, the effects seen with the Biobank population bolster the importance of prevention efforts. “This really is quite encouraging,” said Dr. Hopewell. “Small differences over a long period of time have a material impact on risk.”
Dr. Hopewell is associate professor and senior scientist in genetic epidemiology and clinical trials at Oxford Cardiovascular Science, University of Oxford, England. She disclosed research contracts from unspecified pharmaceutical companies, and she has a fellowship from the British Heart Foundation.
Jemma Hopewell, PhD, was the assigned discussant for the Mendelian randomization study of LDL-C and SBP’s effects on cardiovascular health. She placed the genetic epidemiological study within the framework of other short- and medium-term studies that have examined the effects of LDL-C and SBP on cardiovascular health.
“Let’s think about this in the context of other studies,” said Dr. Hopewell, asking what the study adds to what’s known about exposure to LDL-C and systolic blood pressure levels. Shorter-term clinical trials that tracked differences in LDL-C over about 5 years have shown a 20%-25% drop in cardiovascular risk, while medium-term observational studies have shown a decrease of about 30%.
Now, she said, Mendelian randomization studies such as this analysis of the UK Biobank data are showing larger effects with the lifelong exposure to lower LDL levels that genetic variants confer. “As you can see, a pattern emerges ... of larger effects on risk than might be anticipated from the short-term clinical trials.”
A similar pattern can be seen with SBP, with shorter-term clinical trials showing smaller reductions in CVD. Observational studies show more reduction in risk when participants are followed for longer periods, and studies such as the present one show the larger effects of a lifetime of lower blood pressure, said Dr. Hopewell.
In terms of the combined effects, “It’s for the first time today that we see these nice results in a Mendelian randomization framework. This is a very well conducted analysis.”
Still, she cited potential limitations that can inform interpretation of the study results. These include the fact that Biobank participants have been followed for just about 10 years at this point, with most participants still alive. “Therefore, it is unclear whether this truly reflects the lifetime risk of coronary events.”
Also, the paucity of ethnic variation in the Biobank cohort means generalization is problematic until studies are conducted across different ethnic groups, she said.
The study design leaves open the possibility for reverse causality given the fact that participant characteristics captured at the time of recruitment may be influenced by prior disease, said Dr. Hopewell.
She also cited the complication of pleiotropy that’s a known limitation of Mendelian randomization studies. Importantly, the study’s reliance on genetic variation means that results may not directly translate to long-term use of lipid-lowering medication and antihypertensives, she said.
Still, the effects seen with the Biobank population bolster the importance of prevention efforts. “This really is quite encouraging,” said Dr. Hopewell. “Small differences over a long period of time have a material impact on risk.”
Dr. Hopewell is associate professor and senior scientist in genetic epidemiology and clinical trials at Oxford Cardiovascular Science, University of Oxford, England. She disclosed research contracts from unspecified pharmaceutical companies, and she has a fellowship from the British Heart Foundation.
Jemma Hopewell, PhD, was the assigned discussant for the Mendelian randomization study of LDL-C and SBP’s effects on cardiovascular health. She placed the genetic epidemiological study within the framework of other short- and medium-term studies that have examined the effects of LDL-C and SBP on cardiovascular health.
“Let’s think about this in the context of other studies,” said Dr. Hopewell, asking what the study adds to what’s known about exposure to LDL-C and systolic blood pressure levels. Shorter-term clinical trials that tracked differences in LDL-C over about 5 years have shown a 20%-25% drop in cardiovascular risk, while medium-term observational studies have shown a decrease of about 30%.
Now, she said, Mendelian randomization studies such as this analysis of the UK Biobank data are showing larger effects with the lifelong exposure to lower LDL levels that genetic variants confer. “As you can see, a pattern emerges ... of larger effects on risk than might be anticipated from the short-term clinical trials.”
A similar pattern can be seen with SBP, with shorter-term clinical trials showing smaller reductions in CVD. Observational studies show more reduction in risk when participants are followed for longer periods, and studies such as the present one show the larger effects of a lifetime of lower blood pressure, said Dr. Hopewell.
In terms of the combined effects, “It’s for the first time today that we see these nice results in a Mendelian randomization framework. This is a very well conducted analysis.”
Still, she cited potential limitations that can inform interpretation of the study results. These include the fact that Biobank participants have been followed for just about 10 years at this point, with most participants still alive. “Therefore, it is unclear whether this truly reflects the lifetime risk of coronary events.”
Also, the paucity of ethnic variation in the Biobank cohort means generalization is problematic until studies are conducted across different ethnic groups, she said.
The study design leaves open the possibility for reverse causality given the fact that participant characteristics captured at the time of recruitment may be influenced by prior disease, said Dr. Hopewell.
She also cited the complication of pleiotropy that’s a known limitation of Mendelian randomization studies. Importantly, the study’s reliance on genetic variation means that results may not directly translate to long-term use of lipid-lowering medication and antihypertensives, she said.
Still, the effects seen with the Biobank population bolster the importance of prevention efforts. “This really is quite encouraging,” said Dr. Hopewell. “Small differences over a long period of time have a material impact on risk.”
Dr. Hopewell is associate professor and senior scientist in genetic epidemiology and clinical trials at Oxford Cardiovascular Science, University of Oxford, England. She disclosed research contracts from unspecified pharmaceutical companies, and she has a fellowship from the British Heart Foundation.
PARIS – Over the course of years and decades, lower LDL cholesterol levels and lower systolic blood pressure can reduce the lifetime risk of cardiovascular disease by up to 80%, according to a new study.
“What we found is that lifetime exposure to the combination of lower LDL and lower systolic blood pressure is associated with independent, additive, and dose-dependent effects on the lifetime risk of cardiovascular disease,” said the study’s senior author, Brian Ference, MD, speaking at the annual congress of the European Society of Cardiology. “The data seem to confirm that most cardiovascular events are preventable, and suggest that most cardiovascular events can be prevented, with prolonged exposure to modestly lower LDL cholesterol and systolic blood pressure.”
Any reduction of LDL-C and systolic blood pressure (SBP), in any combination, was associated with a lower lifetime risk of cardiovascular disease (CVD) in the study, which took advantage of the United Kingdom’s large Biobank to identify individuals with genetically lower LDL-C and blood pressure levels. The relationship was dose-dependent and showed a log-linear relationship to the combined absolute LDL-C and SBP differences, said Dr. Ference, professor and executive director of the Centre for Naturally Randomised Trials at the University of Cambridge, England.
The results validate current guidelines that focus on a lifetime approach to cardiovascular risk reduction and support a focus on therapeutic lifestyle interventions for individuals at all levels of risk for cardiovascular events, said Dr. Ference. He foresees the results shaping new risk-estimating algorithms and informing the next round of prevention guidelines.
Previous studies had suggested that long-term exposure to lower levels of LDL-C and lower systolic blood pressure reduced cardiovascular risk, but the association hadn’t been fully quantified. Ideally, said Dr. Ference, the question would be answered by a long-term randomized controlled trial, but it would be decades before meaningful data would accrue, and such a trial is unlikely to be conducted.
Using data from 438,952 Biobank participants, Dr. Ference and coinvestigators sought to quantify the association between LDL-C, systolic blood pressure, and atherosclerotic CVD. Taking advantage of genetic variants known to be associated with both lower LDL-C and lower systolic blood pressure, the researchers constructed a “natural randomization” trial. This trial design is also known as Mendelian randomization.
First, the entire study population was randomized into those with exome variants associated with higher or lower LDL-C, which resulted in a mean 15-mg/dL difference between the arms. Then, each LDL-C arm was randomized into groups with exome variants associated with higher or lower SBP, resulting in a difference of 2.9-3 mm Hg between the blood pressure arms within each LDL arm. This randomization yielded a reference group, a group with lower LDL-C, a group with lower SBP, and a group with lower LDL-C and SBP.
For the total population, the mean LDL-C was 138 mg/dL, and the mean SBP was 137.8 mm Hg.
A total of 24,980 participants had coronary revascularization, a nonfatal myocardial infarction (MI), or coronary death – the composite primary outcome measure of major coronary events.
“What we found is that long-term exposure to the combination of 1 mmol/L [about 39 mg/dL] lower LDL and 10 mm/Hg lower blood pressure is associated with an 80% lifetime reduction in risk of cardiovascular events, a 75% reduction in the risk of MI, and 68% reduction in the long-term risk of cardiovascular death,” said Dr. Ference.
By breaking participants out into separate quartiles of LDL-C and SBP levels, and examining outcomes for each quartile independently, Dr. Ference and collaborators were able to ascertain that the salutary effects of lower LDL-C and SBP were independent of each other.
Looking at individual cardiovascular outcomes, “The effect of combined exposure to both lower LDL and lower systolic blood pressure appear to be quite similar across multiple composite cardiovascular outcomes,” said Dr. Ference; benefit was seen in risk of MI, stroke, and other vascular events.
Plotting out the amount of risk reduction against the genetic scores for LDL-C and SBP reduction showed a proportional relationship that was logarithmically linear. “These large proportional reductions in risk really suggest that, for LDL, systolic blood pressure, and their combination, the benefit really depends both on the magnitude and the duration of the exposure,” said Dr. Ference. The effect was seen regardless of age, gender, body mass index, and diabetes status; being a smoker slightly attenuated the effects of LDL-C and SBP.
The mean participant age was 65 years, and women made up 54% of the study population. Aside from lipid values and systolic blood pressure, there were no significant between-group differences.
From these findings, what message can clinicians take to their patients? “Benefit is a much greater motivator, rather than the nebulous concept of risk,” said Dr. Ference. “So if we begin to crystallize and give an estimate of how much someone can benefit – either from adhering to a healthy lifestyle, with specific goals for LDL and blood pressure reductions, or from encouraging them to remain compliant with their therapies, achieving those corresponding goals – we can quantify their expected clinical benefit and encourage them to invest in their health over the long term.”
Dr. Ference said that the actual mechanism by which lipids and blood pressure are lowered matters less than the amount and duration of lowering: “These data are really agnostic as to the mechanism by which either blood pressure or LDL – or apo-B–containing lipoproteins generally – and blood pressure are reduced. It really suggests that whatever mechanism by which an individual person can most effectively lower their LDL and blood pressure, that’s the best one for that person, if they can maintain that over time.”
Dr. Ference reported financial relationships, including research contracts, consulting arrangements, receipt of royalties, and being an owner or stockholder of more than a dozen pharmaceutical companies. The study was funded by the United Kingdom’s National Institute of Health Research and Medical Research Council, and by the British Heart Foundation.
SOURCE: Ference B. et al. ESC Congress 2019, Hot Line Session 3.
PARIS – Over the course of years and decades, lower LDL cholesterol levels and lower systolic blood pressure can reduce the lifetime risk of cardiovascular disease by up to 80%, according to a new study.
“What we found is that lifetime exposure to the combination of lower LDL and lower systolic blood pressure is associated with independent, additive, and dose-dependent effects on the lifetime risk of cardiovascular disease,” said the study’s senior author, Brian Ference, MD, speaking at the annual congress of the European Society of Cardiology. “The data seem to confirm that most cardiovascular events are preventable, and suggest that most cardiovascular events can be prevented, with prolonged exposure to modestly lower LDL cholesterol and systolic blood pressure.”
Any reduction of LDL-C and systolic blood pressure (SBP), in any combination, was associated with a lower lifetime risk of cardiovascular disease (CVD) in the study, which took advantage of the United Kingdom’s large Biobank to identify individuals with genetically lower LDL-C and blood pressure levels. The relationship was dose-dependent and showed a log-linear relationship to the combined absolute LDL-C and SBP differences, said Dr. Ference, professor and executive director of the Centre for Naturally Randomised Trials at the University of Cambridge, England.
The results validate current guidelines that focus on a lifetime approach to cardiovascular risk reduction and support a focus on therapeutic lifestyle interventions for individuals at all levels of risk for cardiovascular events, said Dr. Ference. He foresees the results shaping new risk-estimating algorithms and informing the next round of prevention guidelines.
Previous studies had suggested that long-term exposure to lower levels of LDL-C and lower systolic blood pressure reduced cardiovascular risk, but the association hadn’t been fully quantified. Ideally, said Dr. Ference, the question would be answered by a long-term randomized controlled trial, but it would be decades before meaningful data would accrue, and such a trial is unlikely to be conducted.
Using data from 438,952 Biobank participants, Dr. Ference and coinvestigators sought to quantify the association between LDL-C, systolic blood pressure, and atherosclerotic CVD. Taking advantage of genetic variants known to be associated with both lower LDL-C and lower systolic blood pressure, the researchers constructed a “natural randomization” trial. This trial design is also known as Mendelian randomization.
First, the entire study population was randomized into those with exome variants associated with higher or lower LDL-C, which resulted in a mean 15-mg/dL difference between the arms. Then, each LDL-C arm was randomized into groups with exome variants associated with higher or lower SBP, resulting in a difference of 2.9-3 mm Hg between the blood pressure arms within each LDL arm. This randomization yielded a reference group, a group with lower LDL-C, a group with lower SBP, and a group with lower LDL-C and SBP.
For the total population, the mean LDL-C was 138 mg/dL, and the mean SBP was 137.8 mm Hg.
A total of 24,980 participants had coronary revascularization, a nonfatal myocardial infarction (MI), or coronary death – the composite primary outcome measure of major coronary events.
“What we found is that long-term exposure to the combination of 1 mmol/L [about 39 mg/dL] lower LDL and 10 mm/Hg lower blood pressure is associated with an 80% lifetime reduction in risk of cardiovascular events, a 75% reduction in the risk of MI, and 68% reduction in the long-term risk of cardiovascular death,” said Dr. Ference.
By breaking participants out into separate quartiles of LDL-C and SBP levels, and examining outcomes for each quartile independently, Dr. Ference and collaborators were able to ascertain that the salutary effects of lower LDL-C and SBP were independent of each other.
Looking at individual cardiovascular outcomes, “The effect of combined exposure to both lower LDL and lower systolic blood pressure appear to be quite similar across multiple composite cardiovascular outcomes,” said Dr. Ference; benefit was seen in risk of MI, stroke, and other vascular events.
Plotting out the amount of risk reduction against the genetic scores for LDL-C and SBP reduction showed a proportional relationship that was logarithmically linear. “These large proportional reductions in risk really suggest that, for LDL, systolic blood pressure, and their combination, the benefit really depends both on the magnitude and the duration of the exposure,” said Dr. Ference. The effect was seen regardless of age, gender, body mass index, and diabetes status; being a smoker slightly attenuated the effects of LDL-C and SBP.
The mean participant age was 65 years, and women made up 54% of the study population. Aside from lipid values and systolic blood pressure, there were no significant between-group differences.
From these findings, what message can clinicians take to their patients? “Benefit is a much greater motivator, rather than the nebulous concept of risk,” said Dr. Ference. “So if we begin to crystallize and give an estimate of how much someone can benefit – either from adhering to a healthy lifestyle, with specific goals for LDL and blood pressure reductions, or from encouraging them to remain compliant with their therapies, achieving those corresponding goals – we can quantify their expected clinical benefit and encourage them to invest in their health over the long term.”
Dr. Ference said that the actual mechanism by which lipids and blood pressure are lowered matters less than the amount and duration of lowering: “These data are really agnostic as to the mechanism by which either blood pressure or LDL – or apo-B–containing lipoproteins generally – and blood pressure are reduced. It really suggests that whatever mechanism by which an individual person can most effectively lower their LDL and blood pressure, that’s the best one for that person, if they can maintain that over time.”
Dr. Ference reported financial relationships, including research contracts, consulting arrangements, receipt of royalties, and being an owner or stockholder of more than a dozen pharmaceutical companies. The study was funded by the United Kingdom’s National Institute of Health Research and Medical Research Council, and by the British Heart Foundation.
SOURCE: Ference B. et al. ESC Congress 2019, Hot Line Session 3.
REPORTING FROM ESC CONGRESS 2019
VRIC Abstract Submission Site Now Open
The Vascular Research Initiatives Conference emphasizes emerging vascular science and encourages interactive participation of attendees. Scheduled the day before Vascular Discovery Scientific Sessions, VRIC is considered a key event for connecting with vascular researchers. Join us for the 2020 program "VRIC Chicago 2020: From Discovery to Translation." The SVS is now accepting abstracts for the program and will continue through January 7. Submit your abstract now and be a part of this important event for vascular researchers.
The Vascular Research Initiatives Conference emphasizes emerging vascular science and encourages interactive participation of attendees. Scheduled the day before Vascular Discovery Scientific Sessions, VRIC is considered a key event for connecting with vascular researchers. Join us for the 2020 program "VRIC Chicago 2020: From Discovery to Translation." The SVS is now accepting abstracts for the program and will continue through January 7. Submit your abstract now and be a part of this important event for vascular researchers.
The Vascular Research Initiatives Conference emphasizes emerging vascular science and encourages interactive participation of attendees. Scheduled the day before Vascular Discovery Scientific Sessions, VRIC is considered a key event for connecting with vascular researchers. Join us for the 2020 program "VRIC Chicago 2020: From Discovery to Translation." The SVS is now accepting abstracts for the program and will continue through January 7. Submit your abstract now and be a part of this important event for vascular researchers.
Getting high heightens stroke, arrhythmia risks
Stoners, beware: , and people with cannabis use disorder are at a 50% greater risk of being hospitalized for arrhythmias, according to new research presented at the American Heart Association Scientific Sessions 2019.
An analysis of pooled data on nearly 44,000 participants in a cross-sectional survey showed that, among the 13.6% who reported using marijuana within the last 30 days, the adjusted odds ratio for young-onset stroke (aged 18-44 years), compared with non-users, was 2.75, reported Tarang Parekh, MBBS, a health policy researcher of George Mason University in Fairfax, Va., and colleagues.
In a separate study, a retrospective analysis of national inpatient data showed that people diagnosed with cannabis use disorder – a pathological pattern of impaired control, social impairment, risky behavior or physiological adaptation similar in nature to alcoholism – had a 47%-52% increased likelihood of hospitalization for an arrhythmia, reported Rikinkumar S. Patel, MD, a psychiatry resident at Griffin Memorial Hospital in Norman, Okla.
“As these [cannabis] products become increasingly used across the country, getting clearer, scientifically rigorous data is going to be important as we try to understand the overall health effects of cannabis,” said AHA President Robert Harrington, MD, of Stanford (Calif.) University in a statement.
Currently, use of both medical and recreational marijuana is fully legal in 11 U.S. states and the District of Columbia. Medical marijuana is legal with recreational use decriminalized (or penalties reduced) in 28 other states, and totally illegal in 11 other states, according to employee screening firm DISA Global Solutions.
Stroke study
In an oral presentation with simultaneous publication in the AHA journal Stroke, Dr. Parekh and colleagues presented an analysis of pooled data from the Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative cross-sectional survey collected by the Centers for Disease Control and Prevention in 2016 and 2017.
They looked at baseline sociodemographic data and created multivariable logistic regression models with state fixed effects to determine whether marijuana use within the last 30 days was associated with young-onset stroke.
They identified 43,860 participants representing a weighted sample of 35.5 million Americans. Of the sample, 63.3% were male, and 13.6 % of all participants reported using marijuana in the last 30 days.
They found in an unadjusted model that marijuana users had an odds ratio for stroke, compared with nonusers, of 1.59 (P less than.1), and in a model adjusted for demographic factors (gender, race, ethnicity, and education) the OR increased to 1.76 (P less than .05).
When they threw risk behavior into the model (physical activity, body mass index, heavy drinking, and cigarette smoking), they saw that the OR for stroke shot up to 2.75 (P less than .01).
“Physicians should ask patients if they use cannabis and counsel them about its potential stroke risk as part of regular doctor visits,” Dr. Parekh said in a statement.
Arrhythmias study
Based on recent studies suggesting that cannabis use may trigger cardiovascular events, Dr. Patel and colleagues studied whether cannabis use disorder may be related to arrhythmias, approaching the question through hospital records.
“The effects of using cannabis are seen within 15 minutes and last for around 3 hours. At lower doses, it is linked to a rapid heartbeat. At higher doses, it is linked to a too-slow heartbeat,” he said in a statement.
Dr. Patel and colleagues conducted a retrospective analysis of the Nationwide Inpatient Sample from 2010-2014, a period during which medical marijuana became legal in several states and recreational marijuana became legal in Colorado and Washington. The sample is a database maintained by the Healthcare Cost and Utilization Project of the U.S. Office of Disease Prevention and Health Promotion.
They identified 570,557 patients aged 15-54 years with a primary diagnosis of arrhythmia, and compared them with a sample of 67,662,082 patients hospitalized with no arrhythmia diagnosed during the same period.
They found a 2.6% incidence of cannabis use disorder among patients hospitalized for arrhythmias. Patients with cannabis use disorder tended to be younger (15- to 24-years-old; OR, 4.23), male (OR, 1.70) and African American (OR, 2.70).
In regression analysis adjusted for demographics and comorbidities, cannabis use disorder was associated with higher odds of arrhythmia hospitalization in young patients, at 1.28 times among 15- to 24-year-olds (95% confidence interval, 1.229-1.346) and 1.52 times for 25- to 34-year-olds (95% CI, 1.469-1.578).
“As medical and recreational cannabis is legalized in many states, it is important to know the difference between therapeutic cannabis dosing for medical purposes and the consequences of cannabis abuse. We urgently need additional research to understand these issues,” Dr. Patel said.
“It’s not proving that there’s a direct link, but it’s raising a suggestion in an observational analysis that [this] indeed might be the case. What that means for clinicians is that, if you’re seeing a patient who is presenting with a symptomatic arrhythmia, adding cannabis usage to your list of questions as you begin to try to understand possible precipitating factors for this arrhythmia seems to be a reasonable thing to do,” Dr. Harrington commented.
Stoners, beware: , and people with cannabis use disorder are at a 50% greater risk of being hospitalized for arrhythmias, according to new research presented at the American Heart Association Scientific Sessions 2019.
An analysis of pooled data on nearly 44,000 participants in a cross-sectional survey showed that, among the 13.6% who reported using marijuana within the last 30 days, the adjusted odds ratio for young-onset stroke (aged 18-44 years), compared with non-users, was 2.75, reported Tarang Parekh, MBBS, a health policy researcher of George Mason University in Fairfax, Va., and colleagues.
In a separate study, a retrospective analysis of national inpatient data showed that people diagnosed with cannabis use disorder – a pathological pattern of impaired control, social impairment, risky behavior or physiological adaptation similar in nature to alcoholism – had a 47%-52% increased likelihood of hospitalization for an arrhythmia, reported Rikinkumar S. Patel, MD, a psychiatry resident at Griffin Memorial Hospital in Norman, Okla.
“As these [cannabis] products become increasingly used across the country, getting clearer, scientifically rigorous data is going to be important as we try to understand the overall health effects of cannabis,” said AHA President Robert Harrington, MD, of Stanford (Calif.) University in a statement.
Currently, use of both medical and recreational marijuana is fully legal in 11 U.S. states and the District of Columbia. Medical marijuana is legal with recreational use decriminalized (or penalties reduced) in 28 other states, and totally illegal in 11 other states, according to employee screening firm DISA Global Solutions.
Stroke study
In an oral presentation with simultaneous publication in the AHA journal Stroke, Dr. Parekh and colleagues presented an analysis of pooled data from the Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative cross-sectional survey collected by the Centers for Disease Control and Prevention in 2016 and 2017.
They looked at baseline sociodemographic data and created multivariable logistic regression models with state fixed effects to determine whether marijuana use within the last 30 days was associated with young-onset stroke.
They identified 43,860 participants representing a weighted sample of 35.5 million Americans. Of the sample, 63.3% were male, and 13.6 % of all participants reported using marijuana in the last 30 days.
They found in an unadjusted model that marijuana users had an odds ratio for stroke, compared with nonusers, of 1.59 (P less than.1), and in a model adjusted for demographic factors (gender, race, ethnicity, and education) the OR increased to 1.76 (P less than .05).
When they threw risk behavior into the model (physical activity, body mass index, heavy drinking, and cigarette smoking), they saw that the OR for stroke shot up to 2.75 (P less than .01).
“Physicians should ask patients if they use cannabis and counsel them about its potential stroke risk as part of regular doctor visits,” Dr. Parekh said in a statement.
Arrhythmias study
Based on recent studies suggesting that cannabis use may trigger cardiovascular events, Dr. Patel and colleagues studied whether cannabis use disorder may be related to arrhythmias, approaching the question through hospital records.
“The effects of using cannabis are seen within 15 minutes and last for around 3 hours. At lower doses, it is linked to a rapid heartbeat. At higher doses, it is linked to a too-slow heartbeat,” he said in a statement.
Dr. Patel and colleagues conducted a retrospective analysis of the Nationwide Inpatient Sample from 2010-2014, a period during which medical marijuana became legal in several states and recreational marijuana became legal in Colorado and Washington. The sample is a database maintained by the Healthcare Cost and Utilization Project of the U.S. Office of Disease Prevention and Health Promotion.
They identified 570,557 patients aged 15-54 years with a primary diagnosis of arrhythmia, and compared them with a sample of 67,662,082 patients hospitalized with no arrhythmia diagnosed during the same period.
They found a 2.6% incidence of cannabis use disorder among patients hospitalized for arrhythmias. Patients with cannabis use disorder tended to be younger (15- to 24-years-old; OR, 4.23), male (OR, 1.70) and African American (OR, 2.70).
In regression analysis adjusted for demographics and comorbidities, cannabis use disorder was associated with higher odds of arrhythmia hospitalization in young patients, at 1.28 times among 15- to 24-year-olds (95% confidence interval, 1.229-1.346) and 1.52 times for 25- to 34-year-olds (95% CI, 1.469-1.578).
“As medical and recreational cannabis is legalized in many states, it is important to know the difference between therapeutic cannabis dosing for medical purposes and the consequences of cannabis abuse. We urgently need additional research to understand these issues,” Dr. Patel said.
“It’s not proving that there’s a direct link, but it’s raising a suggestion in an observational analysis that [this] indeed might be the case. What that means for clinicians is that, if you’re seeing a patient who is presenting with a symptomatic arrhythmia, adding cannabis usage to your list of questions as you begin to try to understand possible precipitating factors for this arrhythmia seems to be a reasonable thing to do,” Dr. Harrington commented.
Stoners, beware: , and people with cannabis use disorder are at a 50% greater risk of being hospitalized for arrhythmias, according to new research presented at the American Heart Association Scientific Sessions 2019.
An analysis of pooled data on nearly 44,000 participants in a cross-sectional survey showed that, among the 13.6% who reported using marijuana within the last 30 days, the adjusted odds ratio for young-onset stroke (aged 18-44 years), compared with non-users, was 2.75, reported Tarang Parekh, MBBS, a health policy researcher of George Mason University in Fairfax, Va., and colleagues.
In a separate study, a retrospective analysis of national inpatient data showed that people diagnosed with cannabis use disorder – a pathological pattern of impaired control, social impairment, risky behavior or physiological adaptation similar in nature to alcoholism – had a 47%-52% increased likelihood of hospitalization for an arrhythmia, reported Rikinkumar S. Patel, MD, a psychiatry resident at Griffin Memorial Hospital in Norman, Okla.
“As these [cannabis] products become increasingly used across the country, getting clearer, scientifically rigorous data is going to be important as we try to understand the overall health effects of cannabis,” said AHA President Robert Harrington, MD, of Stanford (Calif.) University in a statement.
Currently, use of both medical and recreational marijuana is fully legal in 11 U.S. states and the District of Columbia. Medical marijuana is legal with recreational use decriminalized (or penalties reduced) in 28 other states, and totally illegal in 11 other states, according to employee screening firm DISA Global Solutions.
Stroke study
In an oral presentation with simultaneous publication in the AHA journal Stroke, Dr. Parekh and colleagues presented an analysis of pooled data from the Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative cross-sectional survey collected by the Centers for Disease Control and Prevention in 2016 and 2017.
They looked at baseline sociodemographic data and created multivariable logistic regression models with state fixed effects to determine whether marijuana use within the last 30 days was associated with young-onset stroke.
They identified 43,860 participants representing a weighted sample of 35.5 million Americans. Of the sample, 63.3% were male, and 13.6 % of all participants reported using marijuana in the last 30 days.
They found in an unadjusted model that marijuana users had an odds ratio for stroke, compared with nonusers, of 1.59 (P less than.1), and in a model adjusted for demographic factors (gender, race, ethnicity, and education) the OR increased to 1.76 (P less than .05).
When they threw risk behavior into the model (physical activity, body mass index, heavy drinking, and cigarette smoking), they saw that the OR for stroke shot up to 2.75 (P less than .01).
“Physicians should ask patients if they use cannabis and counsel them about its potential stroke risk as part of regular doctor visits,” Dr. Parekh said in a statement.
Arrhythmias study
Based on recent studies suggesting that cannabis use may trigger cardiovascular events, Dr. Patel and colleagues studied whether cannabis use disorder may be related to arrhythmias, approaching the question through hospital records.
“The effects of using cannabis are seen within 15 minutes and last for around 3 hours. At lower doses, it is linked to a rapid heartbeat. At higher doses, it is linked to a too-slow heartbeat,” he said in a statement.
Dr. Patel and colleagues conducted a retrospective analysis of the Nationwide Inpatient Sample from 2010-2014, a period during which medical marijuana became legal in several states and recreational marijuana became legal in Colorado and Washington. The sample is a database maintained by the Healthcare Cost and Utilization Project of the U.S. Office of Disease Prevention and Health Promotion.
They identified 570,557 patients aged 15-54 years with a primary diagnosis of arrhythmia, and compared them with a sample of 67,662,082 patients hospitalized with no arrhythmia diagnosed during the same period.
They found a 2.6% incidence of cannabis use disorder among patients hospitalized for arrhythmias. Patients with cannabis use disorder tended to be younger (15- to 24-years-old; OR, 4.23), male (OR, 1.70) and African American (OR, 2.70).
In regression analysis adjusted for demographics and comorbidities, cannabis use disorder was associated with higher odds of arrhythmia hospitalization in young patients, at 1.28 times among 15- to 24-year-olds (95% confidence interval, 1.229-1.346) and 1.52 times for 25- to 34-year-olds (95% CI, 1.469-1.578).
“As medical and recreational cannabis is legalized in many states, it is important to know the difference between therapeutic cannabis dosing for medical purposes and the consequences of cannabis abuse. We urgently need additional research to understand these issues,” Dr. Patel said.
“It’s not proving that there’s a direct link, but it’s raising a suggestion in an observational analysis that [this] indeed might be the case. What that means for clinicians is that, if you’re seeing a patient who is presenting with a symptomatic arrhythmia, adding cannabis usage to your list of questions as you begin to try to understand possible precipitating factors for this arrhythmia seems to be a reasonable thing to do,” Dr. Harrington commented.
REPORTING FROM AHA 2019
MIPS, E/M changes highlight 2020 Medicare fee schedule
A Merit-based Incentive Payment System (MIPS) overhaul and evaluation and management changes to support the care of complex patients highlight the final Medicare physician fee schedule for 2020.
The new MIPS Value Pathways (MVPs) framework “aims to align and connect measures and activities across the quality, cost, promoting interoperability, and improvement activities performance categories of MIPS for different specialties or conditions,” the Centers for Medicare & Medicaid Services said in a fact sheet outlining the updates to the Quality Payment Program.
CMS noted that the framework will have measures aimed at population health and public health priorities, as well as reducing the reporting burden of the MIPS program and providing enhanced data and feedback to clinicians.
“We also intend to analyze existing Medicare information so that we can provide clinicians and patients with more information to improve health outcomes,” the agency wrote. “We believe the MVPs framework will help simplify MIPS, create a more cohesive and meaningful participation experience, improve value, reduce clinician burden, and better align with APMs [advanced alternative payment models] to help ease transition between the two tracks.
While the specifics of how the pathways will work are yet to be determined, the goal is to reduce the reporting burden while increasing its clinical applicability
Under the current MIPS structure, clinicians report on a specific number of measures chosen from a menu that may or may not be relevant to the care of patients with a specific disease, such as diabetes.
The MVPs framework will have some “foundation” measures in the first 2 years linked to promoting interoperability and population health that all clinicians will use. These, however, will be coupled with additional measures across the other MIPS categories (quality, cost, and improvement) that are specifically related to diabetes treatment. The expectation is that disease-specific measures plus foundation measures will add up to fewer measures than clinicians currently report, according to CMS.
Over the next 3-5 years, disease-specific measures will be refined and foundation measures expanded to include enhanced performance feedback and patient-reported outcomes.
“We recognize that this will be a significant shift in the way clinicians may potentially participate in MIPS, therefore we want to work closely with clinicians, patients, specialty societies, third parties, and others to establish the MVPs,” CMS officials said.
In the meantime, there are changes to the current MIPS program. Category weighting remains unchanged for the 2020 performance year (payable in 2022), with the performance threshold being 45 points and the exceptional performance threshold being 85 points.
In the quality performance category, the data completeness threshold is increased to 70%, while the agency continues to remove low-bar, standard-of-care process measures and adding new specialty sets, such as audiology, chiropractic medicine, pulmonology, and endocrinology.
In the cost category, 10 new episode-based measures were added to help expand access to this category. In the improvement activities category, CMS reduced barriers to obtaining a patient-centered medical home designation and increased the participation threshold for a practice from a single clinician to 50% of the clinicians in the practice. In the promoting interoperability category, the agency included queries to a prescription drug–monitoring program as an option measure, removed the verify opioid treatment–agreement measure, and reduced the threshold for a group to be considered hospital based from 100% to 75% being hospital based in order for a group to be excluded from reporting measures in this category.
One change not made in the MIPS update is threshold for exclusion from participating in the MIPS program, which has generated continued criticism over the years from the American Medical Group Association, which represents multispecialty practices.
“Overall, CMS expects Part B payment adjustments of 1.4% for those providers who participate in the program,” AMGA officials said in a statement. “However, Congress authorized up to a 9% payment adjustment for the 2020 performance year. While not every provider will achieve the highest possible adjustment, CMS’ continued policy of excluding otherwise eligible providers from participating in MIPS makes it impossible to achieve sustainable payments to cover the cost of participation. Thus, AMGA members have expressed that the program is no longer a viable tool for transitioning to value-based care.”
The physician fee schedule also finalized a number of provisions aimed at reducing administrative burden and increasing the time physicians have with patients. The changes will save clinicians 2.3 million hours per year in burden reduction, according to CMS.
New evaluation and management services (E/M) codes will allow clinicians to choose the appropriate level of coding based on either the medical decision making or time spent with the patient. In 2021, an add-on code will be implemented for prolonged service times for when clinicians spend more time treating complex patients, according to a CMS fact sheet.
Beginning in 2020, clinicians will be paid for care management services for patients with one serious and high-risk condition. Previously, a patient would need at least two serious and high-risk conditions for clinicians to get paid for care management services. For those with multiple chronic conditions, a Medicare-specific code has been added that covers patient visits that last beyond 20 minutes allowed in the current coding for chronic care management services.
The E/M changes are “a significant step in reducing administrative burden that gets in the way of patient care. Now it’s time for vendors and payors to take the necessary steps to align their systems with the E/M office visit code changes by the time the revisions are deployed on Jan. 1, 2021,” Patrice Harris, MD, president of the American Medical Association, said in a statement.
The American College of Physicians also applauded the change.
“Medicare has long undervalued E/M codes by internal medicine physicians, family physicians, and other cognitive and primary care physicians,” ACP said in a statement, adding that it is “extremely pleased that CMS’s final payment rules will strengthen primary and cognitive care by improving E/M codes and payment levels and reducing administrative burdens.”
The changes also will help address physician shortages, according to ACP officials.
“Fewer physicians are going into office-based internal medicine and other primary care disciplines in large part because Medicare and other payers have long undervalued their services and imposed unreasonable documentation requirements,” they wrote. “CMS’s new rule can help reverse this trend at a time when an aging population will need more primary care physicians, especially internal medicine specialists, to care for them.”
Opioid use disorder treatment programs will be covered by Medicare beginning in 2020. Enrolled opioid treatment programs will receive a bundled payment based on weekly episodes of care that cover Food and Drug Administration–approved medications that treat opioid use disorder, the dispensing and administering those medications, counseling, individual and group therapy, and toxicology testing.
The physician fee schedule also includes codes for telehealth services related to the opioid treatment bundle.
CMS also is finalizing updates on physician supervision of physician assistants to give physician assistants “greater flexibility to practice more broadly in the current health care system in accordance with state law and state scope of practice,” the fact sheet notes.
SOURCE: CMS Medicare Physician Fee Schedule for calendar year 2020.
A Merit-based Incentive Payment System (MIPS) overhaul and evaluation and management changes to support the care of complex patients highlight the final Medicare physician fee schedule for 2020.
The new MIPS Value Pathways (MVPs) framework “aims to align and connect measures and activities across the quality, cost, promoting interoperability, and improvement activities performance categories of MIPS for different specialties or conditions,” the Centers for Medicare & Medicaid Services said in a fact sheet outlining the updates to the Quality Payment Program.
CMS noted that the framework will have measures aimed at population health and public health priorities, as well as reducing the reporting burden of the MIPS program and providing enhanced data and feedback to clinicians.
“We also intend to analyze existing Medicare information so that we can provide clinicians and patients with more information to improve health outcomes,” the agency wrote. “We believe the MVPs framework will help simplify MIPS, create a more cohesive and meaningful participation experience, improve value, reduce clinician burden, and better align with APMs [advanced alternative payment models] to help ease transition between the two tracks.
While the specifics of how the pathways will work are yet to be determined, the goal is to reduce the reporting burden while increasing its clinical applicability
Under the current MIPS structure, clinicians report on a specific number of measures chosen from a menu that may or may not be relevant to the care of patients with a specific disease, such as diabetes.
The MVPs framework will have some “foundation” measures in the first 2 years linked to promoting interoperability and population health that all clinicians will use. These, however, will be coupled with additional measures across the other MIPS categories (quality, cost, and improvement) that are specifically related to diabetes treatment. The expectation is that disease-specific measures plus foundation measures will add up to fewer measures than clinicians currently report, according to CMS.
Over the next 3-5 years, disease-specific measures will be refined and foundation measures expanded to include enhanced performance feedback and patient-reported outcomes.
“We recognize that this will be a significant shift in the way clinicians may potentially participate in MIPS, therefore we want to work closely with clinicians, patients, specialty societies, third parties, and others to establish the MVPs,” CMS officials said.
In the meantime, there are changes to the current MIPS program. Category weighting remains unchanged for the 2020 performance year (payable in 2022), with the performance threshold being 45 points and the exceptional performance threshold being 85 points.
In the quality performance category, the data completeness threshold is increased to 70%, while the agency continues to remove low-bar, standard-of-care process measures and adding new specialty sets, such as audiology, chiropractic medicine, pulmonology, and endocrinology.
In the cost category, 10 new episode-based measures were added to help expand access to this category. In the improvement activities category, CMS reduced barriers to obtaining a patient-centered medical home designation and increased the participation threshold for a practice from a single clinician to 50% of the clinicians in the practice. In the promoting interoperability category, the agency included queries to a prescription drug–monitoring program as an option measure, removed the verify opioid treatment–agreement measure, and reduced the threshold for a group to be considered hospital based from 100% to 75% being hospital based in order for a group to be excluded from reporting measures in this category.
One change not made in the MIPS update is threshold for exclusion from participating in the MIPS program, which has generated continued criticism over the years from the American Medical Group Association, which represents multispecialty practices.
“Overall, CMS expects Part B payment adjustments of 1.4% for those providers who participate in the program,” AMGA officials said in a statement. “However, Congress authorized up to a 9% payment adjustment for the 2020 performance year. While not every provider will achieve the highest possible adjustment, CMS’ continued policy of excluding otherwise eligible providers from participating in MIPS makes it impossible to achieve sustainable payments to cover the cost of participation. Thus, AMGA members have expressed that the program is no longer a viable tool for transitioning to value-based care.”
The physician fee schedule also finalized a number of provisions aimed at reducing administrative burden and increasing the time physicians have with patients. The changes will save clinicians 2.3 million hours per year in burden reduction, according to CMS.
New evaluation and management services (E/M) codes will allow clinicians to choose the appropriate level of coding based on either the medical decision making or time spent with the patient. In 2021, an add-on code will be implemented for prolonged service times for when clinicians spend more time treating complex patients, according to a CMS fact sheet.
Beginning in 2020, clinicians will be paid for care management services for patients with one serious and high-risk condition. Previously, a patient would need at least two serious and high-risk conditions for clinicians to get paid for care management services. For those with multiple chronic conditions, a Medicare-specific code has been added that covers patient visits that last beyond 20 minutes allowed in the current coding for chronic care management services.
The E/M changes are “a significant step in reducing administrative burden that gets in the way of patient care. Now it’s time for vendors and payors to take the necessary steps to align their systems with the E/M office visit code changes by the time the revisions are deployed on Jan. 1, 2021,” Patrice Harris, MD, president of the American Medical Association, said in a statement.
The American College of Physicians also applauded the change.
“Medicare has long undervalued E/M codes by internal medicine physicians, family physicians, and other cognitive and primary care physicians,” ACP said in a statement, adding that it is “extremely pleased that CMS’s final payment rules will strengthen primary and cognitive care by improving E/M codes and payment levels and reducing administrative burdens.”
The changes also will help address physician shortages, according to ACP officials.
“Fewer physicians are going into office-based internal medicine and other primary care disciplines in large part because Medicare and other payers have long undervalued their services and imposed unreasonable documentation requirements,” they wrote. “CMS’s new rule can help reverse this trend at a time when an aging population will need more primary care physicians, especially internal medicine specialists, to care for them.”
Opioid use disorder treatment programs will be covered by Medicare beginning in 2020. Enrolled opioid treatment programs will receive a bundled payment based on weekly episodes of care that cover Food and Drug Administration–approved medications that treat opioid use disorder, the dispensing and administering those medications, counseling, individual and group therapy, and toxicology testing.
The physician fee schedule also includes codes for telehealth services related to the opioid treatment bundle.
CMS also is finalizing updates on physician supervision of physician assistants to give physician assistants “greater flexibility to practice more broadly in the current health care system in accordance with state law and state scope of practice,” the fact sheet notes.
SOURCE: CMS Medicare Physician Fee Schedule for calendar year 2020.
A Merit-based Incentive Payment System (MIPS) overhaul and evaluation and management changes to support the care of complex patients highlight the final Medicare physician fee schedule for 2020.
The new MIPS Value Pathways (MVPs) framework “aims to align and connect measures and activities across the quality, cost, promoting interoperability, and improvement activities performance categories of MIPS for different specialties or conditions,” the Centers for Medicare & Medicaid Services said in a fact sheet outlining the updates to the Quality Payment Program.
CMS noted that the framework will have measures aimed at population health and public health priorities, as well as reducing the reporting burden of the MIPS program and providing enhanced data and feedback to clinicians.
“We also intend to analyze existing Medicare information so that we can provide clinicians and patients with more information to improve health outcomes,” the agency wrote. “We believe the MVPs framework will help simplify MIPS, create a more cohesive and meaningful participation experience, improve value, reduce clinician burden, and better align with APMs [advanced alternative payment models] to help ease transition between the two tracks.
While the specifics of how the pathways will work are yet to be determined, the goal is to reduce the reporting burden while increasing its clinical applicability
Under the current MIPS structure, clinicians report on a specific number of measures chosen from a menu that may or may not be relevant to the care of patients with a specific disease, such as diabetes.
The MVPs framework will have some “foundation” measures in the first 2 years linked to promoting interoperability and population health that all clinicians will use. These, however, will be coupled with additional measures across the other MIPS categories (quality, cost, and improvement) that are specifically related to diabetes treatment. The expectation is that disease-specific measures plus foundation measures will add up to fewer measures than clinicians currently report, according to CMS.
Over the next 3-5 years, disease-specific measures will be refined and foundation measures expanded to include enhanced performance feedback and patient-reported outcomes.
“We recognize that this will be a significant shift in the way clinicians may potentially participate in MIPS, therefore we want to work closely with clinicians, patients, specialty societies, third parties, and others to establish the MVPs,” CMS officials said.
In the meantime, there are changes to the current MIPS program. Category weighting remains unchanged for the 2020 performance year (payable in 2022), with the performance threshold being 45 points and the exceptional performance threshold being 85 points.
In the quality performance category, the data completeness threshold is increased to 70%, while the agency continues to remove low-bar, standard-of-care process measures and adding new specialty sets, such as audiology, chiropractic medicine, pulmonology, and endocrinology.
In the cost category, 10 new episode-based measures were added to help expand access to this category. In the improvement activities category, CMS reduced barriers to obtaining a patient-centered medical home designation and increased the participation threshold for a practice from a single clinician to 50% of the clinicians in the practice. In the promoting interoperability category, the agency included queries to a prescription drug–monitoring program as an option measure, removed the verify opioid treatment–agreement measure, and reduced the threshold for a group to be considered hospital based from 100% to 75% being hospital based in order for a group to be excluded from reporting measures in this category.
One change not made in the MIPS update is threshold for exclusion from participating in the MIPS program, which has generated continued criticism over the years from the American Medical Group Association, which represents multispecialty practices.
“Overall, CMS expects Part B payment adjustments of 1.4% for those providers who participate in the program,” AMGA officials said in a statement. “However, Congress authorized up to a 9% payment adjustment for the 2020 performance year. While not every provider will achieve the highest possible adjustment, CMS’ continued policy of excluding otherwise eligible providers from participating in MIPS makes it impossible to achieve sustainable payments to cover the cost of participation. Thus, AMGA members have expressed that the program is no longer a viable tool for transitioning to value-based care.”
The physician fee schedule also finalized a number of provisions aimed at reducing administrative burden and increasing the time physicians have with patients. The changes will save clinicians 2.3 million hours per year in burden reduction, according to CMS.
New evaluation and management services (E/M) codes will allow clinicians to choose the appropriate level of coding based on either the medical decision making or time spent with the patient. In 2021, an add-on code will be implemented for prolonged service times for when clinicians spend more time treating complex patients, according to a CMS fact sheet.
Beginning in 2020, clinicians will be paid for care management services for patients with one serious and high-risk condition. Previously, a patient would need at least two serious and high-risk conditions for clinicians to get paid for care management services. For those with multiple chronic conditions, a Medicare-specific code has been added that covers patient visits that last beyond 20 minutes allowed in the current coding for chronic care management services.
The E/M changes are “a significant step in reducing administrative burden that gets in the way of patient care. Now it’s time for vendors and payors to take the necessary steps to align their systems with the E/M office visit code changes by the time the revisions are deployed on Jan. 1, 2021,” Patrice Harris, MD, president of the American Medical Association, said in a statement.
The American College of Physicians also applauded the change.
“Medicare has long undervalued E/M codes by internal medicine physicians, family physicians, and other cognitive and primary care physicians,” ACP said in a statement, adding that it is “extremely pleased that CMS’s final payment rules will strengthen primary and cognitive care by improving E/M codes and payment levels and reducing administrative burdens.”
The changes also will help address physician shortages, according to ACP officials.
“Fewer physicians are going into office-based internal medicine and other primary care disciplines in large part because Medicare and other payers have long undervalued their services and imposed unreasonable documentation requirements,” they wrote. “CMS’s new rule can help reverse this trend at a time when an aging population will need more primary care physicians, especially internal medicine specialists, to care for them.”
Opioid use disorder treatment programs will be covered by Medicare beginning in 2020. Enrolled opioid treatment programs will receive a bundled payment based on weekly episodes of care that cover Food and Drug Administration–approved medications that treat opioid use disorder, the dispensing and administering those medications, counseling, individual and group therapy, and toxicology testing.
The physician fee schedule also includes codes for telehealth services related to the opioid treatment bundle.
CMS also is finalizing updates on physician supervision of physician assistants to give physician assistants “greater flexibility to practice more broadly in the current health care system in accordance with state law and state scope of practice,” the fact sheet notes.
SOURCE: CMS Medicare Physician Fee Schedule for calendar year 2020.
Court blocks immigration health insurance rule
A district judge has temporarily blocked an order by President Trump that would make having health insurance or the ability to pay for medical care a requirement for immigrants seeking U.S. visas.
There are serious questions about whether President Trump’s immigration rule was arbitrary and capricious and thus, a violation of the Administrative Procedure Act, Judge Michael H. Simon of the U.S. District Court of the District of Oregon wrote in a Nov. 2, 2019, decision.
Further, the plaintiffs had demonstrated they were likely to suffer irreparable harm in the absence of temporary relief, that the balance of hardships tipped sharply toward the plaintiffs, and that temporary relief was in the public interest, Judge Simon wrote in his 18-page order. The new requirement, announced in a proclamation on Oct. 4., was scheduled to take effect on Nov. 3.
White House press secretary Stephanie Grisham said the administration strongly disagreed with the district court’s decision to impose the nationwide injunction against the policy without even affording the government an opportunity to provide a written defense.
“It is wrong and unfair for a single district court judge to thwart the policies that the President determined would best protect the United States health care system – and for the United States taxpayers to suffer the grave consequences of the immense strain inflicted on the health care system from subsidizing uncompensated care for those seeking admission,” Ms. Grisham said in a statement. “The administration looks forward to the opportunity to make its defense in court, and it will continue to vigorously defend the President’s policies to protect the interests of the American people.”
Jesse Bless, director of federal litigation for the American Immigration Lawyers Association, which represented the plaintiffs in the case, said he applauded the court’s ruling for protecting countless families.
“Thousands across the country can breathe a sigh of relief today because the court recognized the urgent and irreparable harm that would have been inflicted in the absence of a [temporary retraining order],” Mr. Bless said in a statement. “This proclamation would permanently separate families and damage employers; it is a clear violation of the constitution. The president simply does not have the authority to rewrite the law by proclamation.”
The Oct. 4 proclamation calls on visa applicants to demonstrate to immigration authorities that they can obtain coverage by an approved health insurer within 30 days of entering the United States or show evidence they possess the financial resources to pay for foreseeable medical costs. Approved coverage would include, but not be limited to, an employer-sponsored plan, an unsubsidized health plan offered in the individual market, a family member’s plan, or a visitor health insurance with at least 364 days of coverage. President Trump said that the restriction would protect Americans from bearing the burden of uncompensated health care costs generated by immigrants.
The nonpartisan Migration Policy Institute estimates the new requirement may restrict up to 375,000 prospective legal immigrants from moving to the United States annually.
A district judge has temporarily blocked an order by President Trump that would make having health insurance or the ability to pay for medical care a requirement for immigrants seeking U.S. visas.
There are serious questions about whether President Trump’s immigration rule was arbitrary and capricious and thus, a violation of the Administrative Procedure Act, Judge Michael H. Simon of the U.S. District Court of the District of Oregon wrote in a Nov. 2, 2019, decision.
Further, the plaintiffs had demonstrated they were likely to suffer irreparable harm in the absence of temporary relief, that the balance of hardships tipped sharply toward the plaintiffs, and that temporary relief was in the public interest, Judge Simon wrote in his 18-page order. The new requirement, announced in a proclamation on Oct. 4., was scheduled to take effect on Nov. 3.
White House press secretary Stephanie Grisham said the administration strongly disagreed with the district court’s decision to impose the nationwide injunction against the policy without even affording the government an opportunity to provide a written defense.
“It is wrong and unfair for a single district court judge to thwart the policies that the President determined would best protect the United States health care system – and for the United States taxpayers to suffer the grave consequences of the immense strain inflicted on the health care system from subsidizing uncompensated care for those seeking admission,” Ms. Grisham said in a statement. “The administration looks forward to the opportunity to make its defense in court, and it will continue to vigorously defend the President’s policies to protect the interests of the American people.”
Jesse Bless, director of federal litigation for the American Immigration Lawyers Association, which represented the plaintiffs in the case, said he applauded the court’s ruling for protecting countless families.
“Thousands across the country can breathe a sigh of relief today because the court recognized the urgent and irreparable harm that would have been inflicted in the absence of a [temporary retraining order],” Mr. Bless said in a statement. “This proclamation would permanently separate families and damage employers; it is a clear violation of the constitution. The president simply does not have the authority to rewrite the law by proclamation.”
The Oct. 4 proclamation calls on visa applicants to demonstrate to immigration authorities that they can obtain coverage by an approved health insurer within 30 days of entering the United States or show evidence they possess the financial resources to pay for foreseeable medical costs. Approved coverage would include, but not be limited to, an employer-sponsored plan, an unsubsidized health plan offered in the individual market, a family member’s plan, or a visitor health insurance with at least 364 days of coverage. President Trump said that the restriction would protect Americans from bearing the burden of uncompensated health care costs generated by immigrants.
The nonpartisan Migration Policy Institute estimates the new requirement may restrict up to 375,000 prospective legal immigrants from moving to the United States annually.
A district judge has temporarily blocked an order by President Trump that would make having health insurance or the ability to pay for medical care a requirement for immigrants seeking U.S. visas.
There are serious questions about whether President Trump’s immigration rule was arbitrary and capricious and thus, a violation of the Administrative Procedure Act, Judge Michael H. Simon of the U.S. District Court of the District of Oregon wrote in a Nov. 2, 2019, decision.
Further, the plaintiffs had demonstrated they were likely to suffer irreparable harm in the absence of temporary relief, that the balance of hardships tipped sharply toward the plaintiffs, and that temporary relief was in the public interest, Judge Simon wrote in his 18-page order. The new requirement, announced in a proclamation on Oct. 4., was scheduled to take effect on Nov. 3.
White House press secretary Stephanie Grisham said the administration strongly disagreed with the district court’s decision to impose the nationwide injunction against the policy without even affording the government an opportunity to provide a written defense.
“It is wrong and unfair for a single district court judge to thwart the policies that the President determined would best protect the United States health care system – and for the United States taxpayers to suffer the grave consequences of the immense strain inflicted on the health care system from subsidizing uncompensated care for those seeking admission,” Ms. Grisham said in a statement. “The administration looks forward to the opportunity to make its defense in court, and it will continue to vigorously defend the President’s policies to protect the interests of the American people.”
Jesse Bless, director of federal litigation for the American Immigration Lawyers Association, which represented the plaintiffs in the case, said he applauded the court’s ruling for protecting countless families.
“Thousands across the country can breathe a sigh of relief today because the court recognized the urgent and irreparable harm that would have been inflicted in the absence of a [temporary retraining order],” Mr. Bless said in a statement. “This proclamation would permanently separate families and damage employers; it is a clear violation of the constitution. The president simply does not have the authority to rewrite the law by proclamation.”
The Oct. 4 proclamation calls on visa applicants to demonstrate to immigration authorities that they can obtain coverage by an approved health insurer within 30 days of entering the United States or show evidence they possess the financial resources to pay for foreseeable medical costs. Approved coverage would include, but not be limited to, an employer-sponsored plan, an unsubsidized health plan offered in the individual market, a family member’s plan, or a visitor health insurance with at least 364 days of coverage. President Trump said that the restriction would protect Americans from bearing the burden of uncompensated health care costs generated by immigrants.
The nonpartisan Migration Policy Institute estimates the new requirement may restrict up to 375,000 prospective legal immigrants from moving to the United States annually.
Register for Community Practice Committee Webinar
The SVS' Community Practice Committee will hold a webinar, Credentialing and Privileging for New Procedures and Technologies, on Tuesday, November 12th from 7-8pm CT. The webinar will focus on critical elements for obtaining privileging, the definition of a new procedure, a proposed process for credentialing and privileging and implementing the proposed process. Dr. Thomas Forbes is presenting the webinar and there will be time for questions. Dr. Forbes will also be joined by several vascular surgeons to answer your privileging and credentialing questions. Register today.
The SVS' Community Practice Committee will hold a webinar, Credentialing and Privileging for New Procedures and Technologies, on Tuesday, November 12th from 7-8pm CT. The webinar will focus on critical elements for obtaining privileging, the definition of a new procedure, a proposed process for credentialing and privileging and implementing the proposed process. Dr. Thomas Forbes is presenting the webinar and there will be time for questions. Dr. Forbes will also be joined by several vascular surgeons to answer your privileging and credentialing questions. Register today.
The SVS' Community Practice Committee will hold a webinar, Credentialing and Privileging for New Procedures and Technologies, on Tuesday, November 12th from 7-8pm CT. The webinar will focus on critical elements for obtaining privileging, the definition of a new procedure, a proposed process for credentialing and privileging and implementing the proposed process. Dr. Thomas Forbes is presenting the webinar and there will be time for questions. Dr. Forbes will also be joined by several vascular surgeons to answer your privileging and credentialing questions. Register today.
New Program Focuses on Surgeon Wellness Through Peer Support
With physician distress a top concern of vascular surgeons, the SVS and its Wellness Task Force are launching a member support component of its wellness program, designed to help vascular surgeons enhance their personal resilience/wellness, and continue development of a compassionate and accountable peer community. Beginning in November, an article and a self-awareness exercise will be posted on SVSConnect each month and the group will encourage discussion on the topic. In February, a second phase of the program will offer members the opportunity to join peer support conference calls guided by wellness experts.
With physician distress a top concern of vascular surgeons, the SVS and its Wellness Task Force are launching a member support component of its wellness program, designed to help vascular surgeons enhance their personal resilience/wellness, and continue development of a compassionate and accountable peer community. Beginning in November, an article and a self-awareness exercise will be posted on SVSConnect each month and the group will encourage discussion on the topic. In February, a second phase of the program will offer members the opportunity to join peer support conference calls guided by wellness experts.
With physician distress a top concern of vascular surgeons, the SVS and its Wellness Task Force are launching a member support component of its wellness program, designed to help vascular surgeons enhance their personal resilience/wellness, and continue development of a compassionate and accountable peer community. Beginning in November, an article and a self-awareness exercise will be posted on SVSConnect each month and the group will encourage discussion on the topic. In February, a second phase of the program will offer members the opportunity to join peer support conference calls guided by wellness experts.
The 2019 SVS Foundation Annual Report is Ready
The SVS Foundation has just published its 2019 Annual Report. This year, the report focuses on how past award recipients have used their grants to impact and improve patient care. More than $13 million in grants over the past three decades have given recipients the support they need to impact the lives of patients and those who provide care. Read about the stories, see the numbers and consider giving to the SVS Foundation in their 2019 Annual Report.
The SVS Foundation has just published its 2019 Annual Report. This year, the report focuses on how past award recipients have used their grants to impact and improve patient care. More than $13 million in grants over the past three decades have given recipients the support they need to impact the lives of patients and those who provide care. Read about the stories, see the numbers and consider giving to the SVS Foundation in their 2019 Annual Report.
The SVS Foundation has just published its 2019 Annual Report. This year, the report focuses on how past award recipients have used their grants to impact and improve patient care. More than $13 million in grants over the past three decades have given recipients the support they need to impact the lives of patients and those who provide care. Read about the stories, see the numbers and consider giving to the SVS Foundation in their 2019 Annual Report.