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

Publish date: February 9, 2018


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Just over $7 billion was provided for community health centers and Medicare’s therapy caps were repealed.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

Roux-en-Y Surgery Linked with More Non-Vertebral Fractures Than Adjustable Gastric Banding

Drotumdi O

Roux-en-Y Surgery Linked with More Non-Vertebral Fractures Than Adjustable Gastric Banding

Article ID: 691223

Released: 15-Mar-2018 4:30 PM EDT

Source Newsroom: Endocrine Society

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ENDO 2018, Mar-2018


Obesity, Surgery, Local - DC, Local - DC Metro, Medical Meetings



Newswise — CHICAGO—Patients undergoing Roux-en-Y gastric bypass (RYGB) surgery may be at greater risk for non-vertebral fracture than those having adjustable gastric banding (AGB), a new population-based study reports. The results will be presented on Saturday, March 17 at ENDO 2018, the 100th annual meeting of the Endocrine Society in Chicago, Ill.

"Bariatric surgery procedures, such as RYGB, are highly effective treatments that induce sustained weight loss,” said lead study author Elaine Wei-Yin Yu, M.D. “RYGB leads to greater improvements in metabolic health than AGB, but RYGB also causes accelerated bone loss and may increase fracture risk."

"We found that Medicare patients who received RYGB had more fractures compared to those who received AGB. Importantly, we found that RYGB increased the risk for hip, wrist, and pelvis fractures. RYGB increased fracture risk across all age groups, in men and in women, although the effects were more pronounced among men," said Yu, assistant professor of medicine at Harvard Medical School and director of the Bone Density Center at Massachusetts General Hospital, in Boston, Mass.

Yu and her colleagues investigated the fracture rates among Medicare Parts A, B and D enrollees with severe obesity who underwent either RYGB or AGB surgery between 2006 and 2014.

The researchers analyzed Medicare billing claims data from 50,649 adults (78 percent women). Of these, 35,920 underwent RYGB and 14,729 underwent AGB. The authors compared fracture rates between the two groups, controlling for differences in age, sex, race, geographical location, index date, degree of healthcare utilization, comorbidities, and prescribed medications.

RYGB patients were younger than AGB patients (53 vs 56 years of age), and they were more likely to have diabetes (36 percent vs 32 percent) as well as a shorter average follow-up time (3.1 vs 3.8 years).

A total of 1,109 non-vertebral fractures were reported during follow-up. The estimated incidence rates of non-vertebral fractures per 1,000 person-years were 9.8 in the RYGB group and 7.1 in the AGB group. Age or diabetes status did not affect RYGB-associated fracture risk.

Compared with patients who received banding, those who underwent bypass had a 126 percent increased risk of hip fracture, a 62 percent increased risk of wrist fracture, and a 172 percent increased risk of pelvis fracture. Gastric bypass increased overall fracture risk more dramatically in men (108 percent) than in women (42 percent).

"This research is very relevant given the high prevalence of obesity and increasing utilization of bariatric surgery. Over one-third of adults in the United States are obese, and bariatric surgery procedures have accordingly been increasing in popularity," Yu said. "Long-term skeletal health should be discussed and managed for all patients undergoing bariatric surgery. . . These data also emphasize the importance of devising therapies that can counteract fracture risk after gastric bypass."

The Doris Duke Charitable Foundation funded the study.

Co-author Seoyoung C. Kim has financial relationships with Pfizer, Inc., Roche Pharmaceuticals, Bristol-Myers Squibb and Merck.

# # #

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at Follow us on Twitter at @TheEndoSociety and @EndoMedia.



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