Breaking News

Internal dissent over an algorithm denying care, NIH research fellows organizing for a raise, & a big health care data breach

July 11, 2023
Reporter, Morning Rounds Writer
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a stat investigation

How a Medicare Advantage algorithm sparked internal dissent over denied care

AI_Healthcare_Final-2Eros Dervishi for STAT

Back in March, STAT's Bob Herman and Casey Ross revealed that algorithmic denials from NaviHealth cut off insurance payments for Medicare Advantage patients struggling to recover from severe diseases and injuries, forcing them to either forgo care or pay thousands of dollars out of pocket. Now, their new investigation shows even clinical staffers within NaviHealth became increasingly distressed by the way their bosses were letting an algorithm override their discretion.

"It was very much about following the algorithms and basically not using your clinical judgment," one former NaviHealth medical reviewer said. "That was very different from before we were owned by Optum." NaviHealth was acquired by Optum, a division of UnitedHealth Group. The company's adherence to its algorithm, even when clinicians disagreed, is a powerful example of the potential dark side of AI's incursion into health care. Read more.


business

Hackers hit HCA Healthcare in massive data breach

HCA Healthcare has experienced what is likely the largest data breach ever reported by a health care provider, with approximately 11 million patients affected. Hackers stole the data from an external storage location that's used to automate emails and then posted the data to an online forum, the for-profit hospital giant disclosed yesterday. The compromised information includes patients' names, email addresses, and service locations, but the company does not believe that includes clinical or payment information. The affected sites include about 1,400 hospitals and physician offices in 20 states.

HCA, which did not respond to a request for comment, did not disclose when the information was stolen, nor what time period it covered. Patients who visited the affected facilities should be especially wary of calls and texts they might receive from hackers trying to build credibility based on knowledge about their appointments, Forrester analyst Allie Mellen told STAT's Tara Bannow. Read more.


addiction

Taking aim at 'tranq' and its role in overdoses 

The White House unveiled a new plan today to stem the rising tide of xylazine, a veterinary tranquilizer known as "tranq," in the country's illicit drug supply. Increasingly mixed into illicit opioids like fentanyl, the drug is contributing to overdose spikes across the country, particularly in northeastern cities like Philadelphia and New York. The combination is especially deadly because the overdose remedy naloxone has no effect on xylazine

"[W]e are launching coordinated efforts across all of government to ensure we are using every lever we have to protect public health and public safety, and save lives," Rahul Gupta, the director of the White House Office of National Drug Control Policy, said in a statement. The plan relies on testing, research, data collection, disrupting the xylazine supply, and developing evidence-based treatment and harm-reduction practices. Overall, the goal is to reduce deaths involving xylazine by 15% in the next two years. STAT's Lev Facher has more.



Closer Look

Collecting data on maternal mortality is in jeopardy

The numbers are horrifying: U.S. maternal deaths during pregnancy or in the year after childbirth are on average 10 times higher than in similar countries. The rate is more than 20 times higher for Black and Native people. And a recent JAMA study said maternal mortality more than doubled from 1999 to 2019. So it's alarming to see that data collection is inconsistent and under political attack, experts told STAT's Annalisa Merelli.

"Maternal mortality review committees run by states [...] are able to review far more data, including hospital records and other information to correctly adjudicate a death as a maternal death, and more importantly, understand what were the drivers," said Greg Roth, a co-author of the JAMA study. But not all states have maternal mortality review committees. "Increasingly, the reporting of those findings have become a political issue, and there have been efforts to suppress their findings." Read more.


science

NIH fellows are seeking a union and a raise. Where will the money come from?

Several thousand research fellows at the country's leading scientific agency are mobilizing to form a union, mirroring discontent among postbacs and postdocs at the beginning of their careers who've chosen academia over industry. Working at agency headquarters in Bethesda, Md., likely means a struggle to make ends meet: In 2022, NIH postbacs made between $34,750 and $40,700 — up to 25% less than the $46,405 that living wage calculators said is required to live there. 

Federal agencies like NIH can't just give raises. Congress sets the agency's budget, most of which goes out in external grants. If the union is voted in and negotiates a raise, more money for salaries means less money for something else, unless the NIH can convince Congress to raise its budget. That seems unlikely in the current climate of suspicion over the NIH's research and a debt ceiling deal. STAT's Brittany Trang tells us more.


in the lab

Not the rainbow, but a glow: Colorblind patients perceive some color after gene therapy

Did you know people who are completely colorblind are called achromats? Neither did I until reading this study in Current Biology about what four patients could see after gene therapy for congenital achromatopsia, in which patients are born with just rod vision so can see only shades of gray. After gene therapy in one eye, these patients could perceive color attributes, like lightness, but in a different, more limited way than people with both rods and cones.

After receiving a copy of a gene that promotes a certain cone-specific protein in just one of their eyes, the patients noticed color in linens, traffic lights, and flags, but, no, they couldn't suddenly see all colors of the rainbow, the researchers report. They could distinguish red from a black background, for example, saying it glows differently. This falls short of completely restored color vision, but the authors call it "a necessary first step."


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What we're reading

  • Europe is probing whether Ozempic use raises risk of suicidal thoughts, Wall Street Journal
  • Silence is a 'sound' you hear, study suggests, New York Times
  • Opinion: A bipartisan opportunity to strengthen America's pandemic security, STAT
  • Heat wave last summer killed 61,000 people in Europe, research finds, The Guardian
  • Opinion: What does it mean to be 'in recovery?' We need a better federal definition, STAT

Thanks for reading! More tomorrow,


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