Breaking News

Academic exodus, UnitedHealth sued over algorithms denying care, & protecting health care workers from violence

November 15, 2023
Reporter, Morning Rounds Writer
Good morning. Here's an update on the impact of Casey Ross and Bob Herman's investigation into UnitedHealth's reliance on algorithms to determine when seriously ill patients should be discharged from rehab. A class-action lawsuit citing STAT's reporting was filed yesterday against UnitedHealth Group and a subsidiary. Read more below.

not in the lab

Spurning a path of 'thorns and glass,' grad students leave holes in academic research labs

STAT23_AcadEx_Fin01Thumy Phan for STAT

Life science researchers are fleeing academic labs after grueling hours and low wages while earning their doctoral degrees or toiling as postdocs. STAT's Jonathan Wosen has tracked this exodus of scientists finding better opportunities in industry than on campus. Here's what Kevin Erazo Castillo, who left Stanford to join a South San Francisco biotech, said recently about a faculty position: "If I thought there was a viable path to making that happen, I totally would have [tried]. The path was just laid with thorns and glass."

Today Jonathan tells us about the empty lab benches left behind and the impact on basic research. Faculty struggling to recruit and retain researchers say promising hypotheses go untested, grant dollars sit unused, and projects languish for months to years. These disruptions could become more common as more scientists leave the ivory tower — even as the biotech job market cools. Read more.


Insurance

UnitedHealth faces class-action lawsuit over algorithmic care denials 

UnitedHealth Group and its subsidiary NaviHealth are facing a class-action lawsuit that alleges they are illegally using an algorithm to deny rehabilitation care to seriously ill patients — even though the companies know the algorithm has a high error rate. The suit, filed Tuesday on behalf of deceased patients who had a UnitedHealthcare Medicare Advantage plan and their families, follows publication of a STAT investigation yesterday. 

The investigation, cited by the lawsuit, found UnitedHealth pressured medical employees to follow an algorithm that predicts a patient's length of stay in order to issue payment denials to people with Medicare Advantage plans. Internal documents revealed that managers within the company set a goal for clinical employees to keep patients rehab stays within 1% of the days projected by the algorithm. 

"The elderly are prematurely kicked out of care facilities nationwide or forced to deplete family savings to continue receiving necessary care, all because an [artificial intelligence] model 'disagrees' with their real live doctors' recommendations,"  the complaint alleges. UnitedHealth Group and NaviHealth did not immediately respond to a request for comment yesterday. STAT's Casey Ross and Bob Herman have more on this latest development.


politics

'Failure': Government trails pharma on clinical trials

New NIH Director Monica Bertagnolli had strong words yesterday about the U.S. government trailing the pharmaceutical industry when it comes to enrollment in clinical trials. "If you just look at the number of patients who go on government-funded trials, it's been completely flat over the last decade," she said yesterday at a meeting of the advocacy group Friends of Cancer Research. "If you go and look at the number of people who go on pharma-sponsored trials, it's just this commitment and this increase."

Bertagnolli praised pharma for producing "amazing results," but emphasized the NIH's role in answering questions "not of central interest to pharma." As STAT's Rachel Cohrs notes, studies have shown that trials funded by the pharmaceutical industry are less likely to be published than research funded by other sources, and are more likely to produce outcomes favorable for the sponsoring company. Read more on what Bertagnolli calls a "failure."



closer look

Using tech tools to thwart violence against health care workers

AdobeStock_231431716Adobe 

Health care workplace violence isn't new. But some of the tools to deal with it are. Violent incidents had been rising steadily before the pandemic, but threats, bullying, and other hostile actions from colleagues and patients surged with Covid, more than doubling in 2022 compared to 2018. "It's a scary place — people are sick, they're oftentimes confused when they're in the hospital and ill, they get frustrated very easily," said Marc Larsen, an emergency medicine physician at St. Luke's, a Kansas City health system with 16 hospitals. 

That's prompted hospitals to boost their physical security, STAT's Mohana Ravindranath reports. For many, that has meant swapping out the standard hospital room distress buttons for higher-tech systems that track incidents in real time. Workers wear panic buttons on badges that allow them to summon security immediately. Mohana has more on how it works.


health

Food as medicine works, according to two new studies

The irony is not lost on Shane Bailey. The 72-year-old U.S. Coast Guard veteran calls Stockton, Calif., home, but her neighborhood is considered a food desert. "I live in the Central Valley with a lot of produce being grown. But in Stockton, it's often either very expensive, or low quality, or both," she said. Her health improved when she joined a pilot program called Food Rx, in which patients with diabetes received biweekly healthy meal kits, including fresh produce, for a year.

Two recent studies showed the power of produce prescription programs to improve diabetes-related health. Blood sugar levels got better, food insecurity dropped, and healthy behaviors increased, including physical activity. "We can provide medical care and dietary counseling, but when patients cannot afford to access healthy foods, they cannot follow advice on diet and nutrition," researcher Claudia Nau told STAT's Anika Nayak. Read more.


health care 

More kids head to a hospital for asthma if their caregiver's preferred language is not English

A child's asthma is one of the top reasons families wind up seeking health care. It's also a condition that disproportionately affects families from historically marginalized groups, reflecting socioeconomic factors including access to care. A new study in Pediatrics looked at more than 14,000 children in Washington, D.C., to see if the preferred language their caregivers indicated on health records was a factor in unscheduled visits to Children's National Hospital.

For the 8% of caregivers who stated a non-English language preference, their children had higher odds of unscheduled asthma-related emergency department visits and hospitalizations. The higher odds of having an asthma-related hospitalization among Hispanic families held true after accounting for the child's age, ethnicity, insurance status, diagnosis of persistent asthma, drugs prescribed, and encounters with primary care. The researchers urge better understanding the "unique barriers that caregivers who speak languages other than English face in caring for their children with asthma."


On the latest episode of The First Opinion Podcast, First Opinion Editor Torie Bosch talks with medical student Amelia Mercado and her professor, J. Wesley Boyd, about the stressors of medical training, privacy concerns within academic institutions, and how high insurance costs affect access to mental health care. Listen here.


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What we're reading

  • A home birth midwife faces scrutiny after a baby dies. It's not the first time, Washington Post
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  • Insurance executives refused to pay for the cancer treatment that could have saved Him. This is how they did it, ProPublica

  • One-quarter of Americans have little to no confidence in scientists to act in public's best interests, per report, STAT
  • 'I never realized what people go through': Doctor and former hospital CEO with Stage 4 cancer calls for greater empathy in medicine, Boston Globe

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