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HEALTH CARE NEWS

US Congress extends CHIP, funds opioid crisis response following temporary shutdown

Publish date: February 9, 2018

By 

Gregory Twachtman 

Oncology Practice

 

 

 

 

 

 

 

 

 

Congress, despite a second shutdown in less than a month, was able to pass a number of financial extenders to fund key health care programs.

The bipartisan spending bill (H.R. 1892), passed in the early morning hours on Feb. 9 by a 71-28 vote in the Senate (16 Republicans and 12 Democrats voted against it, and Sen. John McCain [R-Ariz.] was not present) and a 240-186 vote in the House (67 Republicans and 119 Democrats voted against and 5 representatives did not vote). President Trump signed the bill later that morning.

 

The spending bill and continuing resolution to fund the government through March 23 includes $6 billion to fund treatment for opioid addiction and other mental health issues, $2 billion in additional funding for the National Institutes of Health, and 4 additional years of funding for the Children’s Health Insurance Program. The additional CHIP funding extends the program for a total of 10 years.

The funding bill also made a technical correction to the Merit-based Incentive Payment System (MIPS) track of the Medicare Quality Payment Program. It removes Part B drug reimbursement from the MIPS payment adjustment, so any positive or negative change to physician payments based on the MIPS score will only be applied to physician fee schedule payments.

The bill also repeals the Independent Payment Advisory Board, a panel created by the Affordable Care Act that would have the power to slash Medicare spending under certain budget circumstances. That board was never convened.

The funding legislation also accelerates closure of the Medicare Part D “donut hole,” the coverage gap in which beneficiaries must pay 100% of medication costs prior to entering catastrophic coverage.

Just over $7 billion was provided for community health centers and Medicare’s therapy caps were repealed.

While the funding bill was written in the Senate with bipartisan input and received bipartisan support, Sen. Rand Paul (R-Ky.) held up votes over objections to the more than $1 trillion it will add to the nation’s debt, as well as for the fact that there was no opportunity to introduce and vote on amendments, leading to an hours-long government shutdown.

There also were concerns about two issues that could have derailed the vote in the House. Democrats wanted to add language to address immigrants brought to this nation illegally as children, while some Republicans did not want to increase the federal debt. However, there were enough votes to pass the funding legislation.

gtwachtman@frontlinemedcom.com

Bariatric Surgery Successes Lead to Type 2 Diabetes Treatment

Drotumdi O

Newswise — Bariatric surgery has long yielded almost immediate health benefits for patients with type 2 diabetes, and new findings on the reasons for remission may be the key to developing drug alternatives to surgery.

“One of the things that bariatric surgery does is cause type 2 diabetes remission,” said Bethany Cummings, assistant professor of biomedical sciences at the Cornell University College of Veterinary Medicine and senior author on the paper in Cell Reports. “This has given rise to a field dedicated to figuring out how exactly it does that.”

There are several types of bariatric surgery, all of which reduce the size of the stomach in some way. Cummings’ research focused on vertical sleeve gastrectomy, in which the stomach is reshaped into a tube. Her paper is the first of its kind to be tissue-specific and inducible, which means her lab’s mouse model contains no genetic variables that could lead to errors in the results.

Type 2 diabetes develops due to two issues: islet dysfunction in the pancreas, and insulin resistance that’s generally associated with obesity. Pancreatic islets produce important hormones for the body, including insulin. If they aren’t functioning correctly, insulin can’t move glucose out of the blood.

“The switch between pre-diabetic to diabetic comes down to the islet,” said Darline Garibay, first author on the paper and a graduate student in Cummings’ lab.

The islets comprise a delicate balance of alpha cells and beta cells. Alpha cells produce the hormone glucagon, which pushes glucose into the blood and promotes type 2 diabetes, and beta cells produce insulin, which pushes glucose out of the blood and protects against type 2 diabetes. When a pancreatic islet functions normally, it secretes both hormones into the blood stream. With type 2 diabetes, the islet functions abnormally and is unable to push enough insulin out, so the blood stream becomes saturated with excess glucose and has nothing to balance it.

Beta cells get help producing insulin from the hormone glucagon-like peptide-1 (GLP-1), which is classically thought to be produced only in the gut, not the pancreas. Alpha cells typically make glucagon, but can make GLP-1 instead, though a way to control this important pathway is unknown.

Since GLP-1 numbers rise dramatically in the blood after bariatric surgery, Cummings’ research group focused on GLP-1 receptor signaling in the improvements observed after surgery. Her investigation showed that bariatric surgery has a surprising effect: increasing the expression of GLP-1 in the alpha cell. They also found that the presence of a GLP-1 receptor in the beta cell increased the occurrence of the GLP-1 hormone in the alpha cell – essentially changing its identity from a cell that promotes diabetes to a cell that can fight diabetes. Cummings’ lab thinks that this is a paracrine process, meaning there is an unknown factor secreted from the beta cell that signals locally to convince the alpha cell to stop producing glucagon and switch to making GLP-1 instead.

No dangerous amounts of glucose in the blood stream means no type 2 diabetes.

“Basically, there’s a way to switch the alpha cell from making a bad hormone into making a good hormone,” said Cummings, though she’s not recommending that people rush to get bariatric surgery, which can be risky and expensive, just for these effects.

To further this research into GLP-1, the U.S. Department of Defense awarded Cummings’ lab a Medical Discovery Award to figure out what factor or factors may act to switch what alpha cells produce.

“The ultimate goal here is to define how the surgery works so we can develop a drug that mimics the effect of surgery. Developing such a drug will bypass the risk and expense of bariatric surgery to make the benefits of this surgery more widely available,” said Cummings.