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Deal Would Take Controversial Hospital Pricing Question Off Ballot

It was to be a game of high stakes politics with hundreds of millions of health care dollars on the line. But on Wednesday the players negotiated a truce — with help from unified leaders on Beacon Hill — to prevent a November ballot question on hospital prices.

“It is my hope that this plan will avert a costly and divisive ballot initiative and lend assistance to our community hospitals,” said House Speaker Robert DeLeo in a statement.

The ballot initiative that brought DeLeo, Senate President Stan Rosenberg and Gov. Charlie Baker together aimed to close the gap between high and low cost hospitals. It proposed cutting $463 million in payments to the state’s more expensive hospitals and redistributing that money to struggling community hospitals and to consumers through lower premiums.

The Massachusetts Hospital Association opposed the plan. MHA President Lynn Nicholas is relieved to hear voters won’t be asked to adjust price differences between her members.

“The most important aspect of this resolution is not doing complicated public policy through a blunt instrument at the ballot box,” Nicholas said.

The ballot question was proposed by a health care workers union, 1199SEIU. Estimates showed the state’s largest private employer, Partners Healthcare, would have lost more than $400 million a year.

The influential union and the top employer have been in and out of offices on Beacon Hill for weeks, negotiating roughly a half dozen different plans that would have legislators instead of voters settle the hospital price gap problem.

“The most important aspect of this resolution is not doing complicated public policy through a blunt instrument at the ballot box.”

– Lynn Nicholas

The consensus deal announced Wednesday includes some more money for community hospitals — at least $20 to $25 million a year, divided between several dozen hospitals. Some hospitals would benefit and some would lose if an additional hospital assessment of $250 million is approved and distributed through Medicaid payments. The union says it is pleased.

“This agreement is the first substantive step toward leveling the Massachusetts healthcare playing field,” said 1199SEIU Executive Vice President Tyrék Lee, Sr.

The new payments would offer some short-term relief for struggling community hospitals. For the long-term solution, the agreement revives a “Special Commission to Review Variation in Prices Among Providers.”

“The language that we’re currently polling out of committee addresses immediate needs in terms of financing and at the same time establishes a provider price commission to take a look at the factors that are contributing to price variation,” said state Rep. Jeff Sánchez, a Democrat, on Wednesday night.

A similar commission that met five years ago struggled to see action on its recommendations. But Sánchez, who would co-chair this commission, says it’s time to bring stakeholders together again. Some hospitals that have called the payment gap in Massachusetts unfair say they look forward to participating.

“We are hopeful that the Special Commission will develop fair and transparent proposals to ensure that health care prices reflect consumer value to achieve lasting benefits for everyone,” said Andrew Mastrangelo, director of media relations at Lahey Health.

The ballot question alternative may be on the House floor for a vote Thursday.

There are pieces of the agreement that don’t make sense to the state’s leading health care consumer group.

“I think there’s a flag raised about how some of this compromise will be paid for,” said Amy Whitcomb Slemmer, executive director at Health Care for All. She notes that most of the money for struggling hospitals would come from the state’s Center for Health Information and Analysis (CHIA), the agency whose reports have detailed the wide variation in hospital prices and the effect on rising health care costs.

“We look to CHIA for unbiased, unvarnished information about what the health of our health care delivery system really is,” said Whitcomb Slemmer, “so I hope that funding shift or shortfall is made up in another way.”

The ballot question agreement would cut CHIA’s budget by $5 million, or 17 percent, in the first of five years and then $10 million or 35 percent for the next four years.

That’s the public agreement by which 1199SEIU says it would drop the ballot question. But sources familiar with the public deal say there’s a private arrangement, with Partners, that the union insisted on before it would back away from the ballot campaign.

Under the private agreement, sources say Partners would not interfere with union organizing efforts at some of its community hospitals, such as North Shore Medical Center, for example. But the union would not be welcome at Partners major teaching hospitals, Massachusetts General or Brigham and Women’s.

In a joint statement, 1199SEIU and Partners describe a new strategic alliance: “We have always respected the rights of our workers to choose whether to be represented by a union, or not. Future organizing efforts will be designed to ensure the rights of our workers to make free and fully informed decisions on this question through the process of a secret ballot election.”

Neither Partners nor 1199SEIU would answer questions, referring reporters to their statements.

Related:

The Promise And Price Of New Addiction Treatment Implant

Amid a raging opioid epidemic, there’s a plea for more treatment options. The Food and Drug Administration expects to have a decision on one by May 27.

It’s an implant. Four rods, each about the size of a match stick, inserted in the upper arm. This new device, called Probuphine, delivers a continuous dose of an existing drug, buprenorphine, but with better results, says implant maker Braeburn Pharmaceuticals.

A graphic shows how the implant is placed inside the skin of a person's upper arm. (Courtesy Braeburn Pharmaceuticals)

A graphic shows how the implant is placed inside the skin of a person’s upper arm. (Courtesy Braeburn Pharmaceuticals)

In clinical trials, 88 percent of patients with the implants abstained from opioids, as compared to 72 percent of those taking buprenorphine as a daily pill. (Buprenorphine is commonly referred to by its brand name, Suboxone.)

“I felt completely normal all the time,” said Dave, a paramedic in a small town outside Boston who was on the implant during a clinical trial. He does not want his last name made public so that coworkers won’t find out he is addicted to opioid pain pills.

Dave, 47, has been in recovery for four years with the help of buprenorphine. Dave said he prefers the implant to the pills for several reasons. With the pills he would sometimes feel the drug wear off. He worried about his 2-year-old granddaughter getting into the bottle. And sometimes Dave would just forget to take his medication, which he’s supposed to do in the morning, 15 minutes before he has anything to eat or drink.

“With the implant you didn’t have to worry about that, you just, it was just there and you felt good all the time,” Dave said.

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Boston Medical Center Launches First Comprehensive Transgender Medical Center In Northeast

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Boston Medical Center CEO Kate Walsh was in a meeting a few years ago when something about gender identity and health came up. She turned to Dr. Joshua Safer, who was treating many of the hospital’s transgender patients.

“I said, ‘So you really believe patients are born in the wrong bodies?’ ” Walsh recalls, looking at Safer across a conference room table as she tells the story. “You said, ‘Yes,’ and that’s how we started on this journey to help people live the lives they were meant to live.”

The journey lead to the creation of the Center for Transgender Medicine and Surgery at BMC, the first such comprehensive service in the Northeast. It brings together services the hospital has been building out for several years: primary care, hormone therapy and mental health support, as well as chest and facial reconstruction procedures. Later this summer, as part of the comprehensive center, the hospital will begin genital surgery for men transitioning to women.

“This is very exciting for me to see us stepping up to do this,” said Safer, who will direct the center. “If you look across North America, there are only a handful of surgeons doing this sort of thing.”

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7 Things To Know About The Nation’s First Penis Transplant

Surgical team members Dr. Dicken Ko, left, and Dr. Curtis Cetrulo address the media during a news conference at Massachusetts General Hospital, Monday. (Elise Amendola/AP)

Surgical team members Dr. Dicken Ko, left, and Dr. Curtis Cetrulo address the media during a news conference at Massachusetts General Hospital, Monday. (Elise Amendola/AP)

From The New York Times to cable TV to here at CommonHealth, the country’s first penis transplant made major headlines Monday.

The patient, 64-year-old Thomas Manning, had part of his penis surgically removed four years ago after doctors found he had penile cancer. The news marked a step forward in transplant medicine, but as a resident physician and future primary care doctor, I wondered whether such an elaborate and expensive “proof-of-concept” operation would mean anything for my future patients.

The facts behind the big story:

What did the operation aim to accomplish?

The goals of this operation, according to Dr. Dicken Ko, who co-led the surgical team, were threefold: to reconstruct natural-appearing genitalia, to allow the patient to urinate normally and, hopefully, to help him regain sexual functioning.

They have achieved the first goal, and they are hopeful that Manning will be able to urinate normally in a few weeks. Finally, they did extensive reconstruction of the nerves as well, and are hopeful that he will have normal sexual function in the future.

How was this patient chosen?

For Manning, the motivation to volunteer for this experimental procedure was straightforward. “Because they cut off my penis. Very simple. Very, very simple,” he said in a phone interview. Manning volunteered for the operation and underwent extensive psychological evaluation, according to his team.

The type of injury he had was also an important factor: Because part of his penis had been surgically removed — rather than injured in an explosion — the rest of the vessels and nerves were preserved, which facilitated the operation. This was important, Dr. Ko said, because they wanted to pick a patient who was very likely to have a successful outcome to be the first to receive the transplant.

How difficult was this operation?

The main technical difficulties of the operation had to do with the vascular reconstruction involved, which is when doctors sew together the small blood vessels of the patient to the donor’s vessels.

Before the operation, they had only a vague idea if the vessels were big enough to connect. They also performed a vein graft, which is akin to a heart bypass and allows greater blood flow. That vein graft was the primary difference between the technical aspects of this operation and the first successful transplant, performed earlier this year in South Africa.

Who else could benefit from this surgery?

For now, the surgeons on this team are focusing on cancer and trauma patients, especially veterans returning with combat wounds from Iraq and Afghanistan.

The technical challenges for soldiers injured by explosions are likely to be more daunting, as the injuries are generally more extensive and their own vessels and nerves are less well-preserved. Nonetheless, the surgeons emphasized how motivated they were to work with veterans.

In a statement, Manning himself said he hoped the operation could soon be performed on “service members who put their lives on the line and suffer serious damage as a result.”

When asked about the potential for use with transgender patients, Dr. Curtis Cetrulo, a plastic surgeon and the second team leader, said it could be possible in the future. The approach, however, would have to be completely different and would require “a whole new effort” to be successful, he said. Continue reading

Related:

Cancer Patient Receives Nation’s First Penis Transplant At MGH

In this photo provided by Massachusetts General Hospital, Thomas Manning gives a thumbs up after being asked how he was feeling following the first penis transplant in the United States. (Sam Riley/Mass General Hospital via AP)

In this photo provided by Massachusetts General Hospital, Thomas Manning gives a thumbs up after being asked how he was feeling following the first penis transplant in the United States. (Sam Riley/Mass General Hospital/AP)

Back in 2012, Thomas Manning of Halifax, Massachusetts, suffered a serious groin injury when a heavy cart fell on him at work. As he was being treated for it, his doctors found an aggressive cancer growing in his penis, and amputated most of it.

“He’s really an incredible person that after that surgery, totally unprovoked, said, ‘Doc, if I can have a penile transplant, I’m your patient,’ ” Manning’s doctor, MGH urologic oncologist Adam Feldman, told reporters on Monday. “And then shortly afterward was when the program started and I said, ‘You know … there just might be something here for you.’ “

It took more than three years for all the pieces to come together, but Manning, 64, has now received the country’s first penis transplant. Surgeons in South Africa and China have performed similar operations.

The operation at Mass. General took place overnight on May 8, and lasted more than 15 hours in total. The organ came from a deceased anonymous donor whose family gave special permission for the transplant.

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Related:

MIT Researchers Aim To Create An On-Demand Pharmacy

Students and postdocs at MIT who were part of the pharmacy on demand (a small scale pharmaceutical manufacturing unit) team. (Courtesy of MIT)

Students and postdocs at MIT who were part of the pharmacy on demand (a small scale pharmaceutical manufacturing unit) team. (Courtesy of MIT)

Hundreds of thousands of bright pink, white or blue tablets and capsules in all colors of the rainbow drop into bottles on sleek conveyors every hour in a sprawling building — somewhere. Each batch of pills may take a month or more to make.

But now, in a lab near Kendall Square, a team of MIT researchers can turn out 1,000 pills in 24 hours in a device the size of your kitchen refrigerator. It’s a whole new way of making drugs.

“We’re giving them an alternative to traditional plants, and we’re reducing the time it takes to manufacture a drug,” said Allan Myerson, professor of chemical engineering at MIT.

The Defense Department is funding this project for use in various places like field hospitals serving troops, jungles to help combat a disease outbreak, and strategic spots throughout the U.S.

“These are portable units so you can put them on the back of a truck and take them anywhere,” Myerson said. “If there was an emergency, you could have these little plants located all over. You just turn them on and you start turning out different pharmaceuticals that are needed.”

Sound simple? It’s not. This mini plant represents a sea of change in both size and operation. Continue reading

State’s Opioid Epidemic Is Vividly Seen On Boston’s ‘Methadone Mile’

On “Methadone Mile,” a one-mile stretch of Massachusetts Avenue in Boston, it is not uncommon to witness people using drugs. Here, we’ve digitally blurred this person’s face to prevent identification. (Jesse Costa/WBUR)

On “Methadone Mile,” a one-mile stretch of Massachusetts Avenue in Boston, it is not uncommon to witness people using drugs. Here, we’ve digitally blurred this person’s face to prevent identification. (Jesse Costa/WBUR)

The ravages of the state’s opioid epidemic are perhaps nowhere more visible than in an area of Boston known as “Methadone Mile” — a one-mile stretch of Massachusetts Avenue in the shadow of Boston Medical Center. Continue reading

Related:

Emergency Mental Health Programs Called Into Question After Taunton Attack

Many questions remain about the mental health services Arthur DaRosa received in the day before he went on a deadly stabbing rampage in Taunton Tuesday evening.

On Thursday, the hospital where DaRosa went for help — Morton Hospital in Taunton — says it has banned the outside contractor that evaluates MassHealth (Medicaid) patients who come in with psychiatric emergencies.

State policy says emergency mental health evaluations of patients with MassHealth must be done by outside behavioral health vendors. They’re known as Emergency Service Programs.

On Wednesday, Morton Hospital called that policy “misguided.” It wants its own clinicians to evaluate all patients.

The Emergency Services Program the hospital is banning, known as Norton Emergency Services or Taunton/Attleboro Emergency Services, is actually run by the state Department of Mental Health.

Megan Wiechnik, the resource helpline director with the National Alliance on Mental Illness Massachusetts chapter, told WBUR’s All Things Considered host Lisa Mullins the system as it stands works — sometimes.

Earlier:

Health Care And Civic Leaders Launch Serious Illness Care Coalition

Dr. Atul Gawande, a co-chair of the Serious Illness Care coalition, is a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard School of Public Health. (Courtesy)

Dr. Atul Gawande, a co-chair of the Serious Illness Care coalition, is a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard School of Public Health. (Courtesy)

A group of health care and civic leaders meets at the Kennedy Library Thursday morning with a mission: ensuring that Massachusetts residents live their final weeks or months as they choose. They’re launching a new statewide effort called the Serious Illness Care coalition.

The aim of the group is to encourage patients, doctors and family members to talk about what type of care they want when facing a serious illness — the kind that could lead to death within a year.

Continue reading

Earlier:

Opinion: Pending Mass. Paid Leave Bill Targets An Issue Of ‘Human Dignity Violated’

Author Kate Mitchell with her newborn son, Mateo (Courtesy)

Author Kate Mitchell with her newborn son, Mateo (Courtesy)

Ten days after giving birth to my son, Mateo, I was able to walk, but not much more than a few careful steps from couch to bathroom.

I was still bleeding. I was fighting mastitis, a breast infection that delivered a high fever and the worst chills I have ever experienced. Did I mention I was breastfeeding nearly every 45 minutes around the clock? I was totally in love, and completely exhausted.

Luckily for me, I didn’t have to go back to work right after Mateo’s birth. But the same is not true for far too many American women. In fact, about one quarter of mothers in the United States have no choice but to return to work within 10 days of having a baby — many of them still bleeding, still trying to establish breastfeeding, completely exhausted, and often traumatized by leaving their newborns at a time when they need their mothers most.

“At times I feel deeply disappointed that I couldn’t manage to fight harder for what every mother, including me, deserves: time and space to heal and to bond with her new baby.”

– Katey Zeh

In an effort to learn more about the issue, I put together an informal survey that I shared on Facebook and Twitter. One respondent, Katey Zeh, a maternal health advocate with the United Methodist Church, shared her story of lacking access to family leave: In 2014, she gave birth on a Monday, returned to work emails on a Friday, and fully returned to work the following Monday.

Paid parental leave is “partially about economic justice, but it’s also about my parenting — and my family — being affirmed by our society,” Zeh said. In a blog post, she describes in a bit more detail what the lack of leave meant to her:

Now that my daughter is six months old I look back on that time with a lot of regret. If I couldn’t advocate for myself, what kind of advocate was I anyway? If I couldn’t advocate for my kid, what kind of mother did that make me? At times I feel deeply disappointed that I couldn’t manage to fight harder for what every mother, including me, deserves: time and space to heal and to bond with her new baby.

Another respondent, a Catholic school teacher from Ohio who asked that her name not be published, said she loved her work but knew she would not be ready to return to its long hours only four weeks after giving birth — the amount of partial pay leave her employer offered. She also knew that her husband’s work would not allow him to share the home responsibilities, as his job required even longer hours and offered no paternity leave benefits. She left the job she loved. Continue reading