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Last 50 News Postings

 (Click on title to be directed to posting, most recent listed first)

VA Announces Aggressive New Approach to Produce Rapid Improvements
   in VA Medical Centers
Healthcare Payments Under the Budget Deal: Mostly Good News
   for Physicians
Hospitals Plan to Start Their Own Generic Drug Company
Flu Season and Trehalose
MedPAC Votes to Scrap MIPS
CMS Announces New Payment Model
Varenicline (Chantix®) Associated with Increased Cardiovascular Events
Tax Cuts Could Threaten Physicians
Trump Nominates Former Pharmaceutical Executive as HHS Secretary
Arizona Averages Over 25 Opioid Overdoses Per Day
Maryvale Hospital to Close
California Enacts Drug Pricing Transparency Bill
Senate Health Bill Lacks 50 Votes Needed to Proceed
Medi-Cal Blamed for Poor Care in Lawsuit
Senate Republican Leadership Releases Revised ACA Repeal and Replace Bill
Mortality Rate Will Likely Increase Under Senate Healthcare Bill
University of Arizona-Phoenix Receives Full Accreditation
Limited Choice of Obamacare Insurers in Some Parts of the Southwest
Gottlieb, the FDA and Dumbing Down Medicine
Salary Surveys Report Declines in Pulmonologist, Allergist and Nurse 
CDC Releases Ventilator-Associated Events Criteria
Medicare Bundled Payment Initiative Did Not Reduce COPD Readmissions
Younger Smokers Continue to Smoke as Adults: Implications for Raising the
   Smoking Age to 21
Most Drug Overdose Deaths from Nonprescription Opioids
Lawsuits Allege Price Fixing by Generic Drug Makers
Knox Named Phoenix Associate Dean of Faculty Affairs
Rating the VA Hospitals
Garcia Resigns as Arizona University VP
Combination Influenza Therapy with Clarithromycin-Naproxen-Oseltamivir
   Superior to Oseltamivir Alone
VAP Rates Unchanged
ABIM Overhauling MOC
Substitution of Assistants for Nurses Increases Mortality, Decreases Quality
CMS Releases Data on Drug Spending
Trump Proposes Initial Healthcare Agenda
Election Results of Southwest Ballot Measures Affecting Healthcare
Southwest Ballot Measures Affecting Healthcare
ACGME Proposes Dropping the 16 Hour Resident Shift Limit
Non-Small Cell Lung Cancer: RT Out, Pembrolizumab In, and Vaccine
   Hope or Hype
Dental Visits May Prevent Pneumonia
Hospital Employment of Physicians Does Not Improve Quality
Clinton's and Trump's Positions on Major Healthcare Issues
IDSA Releases Updated Coccidioidomycosis Guidelines
Withdraw of Insurers from ACA Markets Leaving Many Southwest 
Patients with Few or No Choices
Another Phoenix VA Director Leaves
Hospital Executive Compensation Act Dropped from Ballot
Banner Hacked-3.7 Million at Risk
Top Medical News Stories 2015


For an excel file with complete news listings click here.

A report from Heartwire described a letter written by Peter Wilmshurst to the AHA asking for full disclosure of conflicts of interest in the MIST trial. Wilmshurst was portrayed in SWJPCC on April 27, 2012 in our Profiles of Medical Courage series. We felt the report of the letter might be of interest to the readership of SWJPCC but there was no good section to pass along the Heartwire article. For this reason, a new Section entitled “News” has been started to report developments outside the usual medical journal purview or from other sources which might interest our readers. We encourage bringing news-worthy articles to our attention and would welcome submission of written reports of such articles.



VA Announces Aggressive New Approach to Produce Rapid Improvements in VA Medical Centers

The U.S. Department of Veterans Affairs (VA) announced steps that it is taking as part of an aggressive new approach to produce rapid improvements at VA’s low-performing medical facilities nationwide (1). VA defines its low-performing facilities as those medical centers that receive the lowest score in its Strategic Analytics for Improvement and Learning (SAIL) star rating system, or a one-star rating out of five. The SAIL star rating was initiated in 2016 and uses a variety of measures including mortality, length of hospital stay, readmission rates, hospital complications, physician productivity and efficiency. A complete listing of the VA facilities, their star ratings and the metrics used to determine the ratings is available through the end of fiscal year 2017 (2). Based on the latest ratings, the VA currently has 15 one-star facilities including Denver, Loma Linda, and Phoenix in the Southwest (Table 1).  

Table 1. VA facilities with one-star ratings (1).

  1. Big Spring (Texas)
  2. Denver (Colorado)
  3. Dublin (Georgia)
  4. El Paso (Texas)
  5. Jackson, (Mississippi)
  6. Hampton (Virginia)
  7. Harlingen (Texas)
  8. Loma Linda (California)
  9. Memphis (Tennessee)
  10. Murfreesboro (Tennessee)
  11. Nashville (Tennessee)
  12. Phoenix (Arizona)
  13. Roseburg (Oregon)
  14. Walla Walla (Washington).
  15. Washington (DC)

The steps VA is taking to produce rapid improvements at its low-performing facilities include (Table 2):

Table 2. VA steps to produce rapid improvements at low-performing facilities (1).

  1. Central, national accountable leadership – VA has designated Dr. Peter Almenoff, Director of VA’s Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID) Healthcare Improvement Center, to oversee improvement at each of the centers.
  2. Comprehensive analysis and identification of improvement targets – VA is employing a new initiative, known as Strategic Action Transformation (STAT), that uses a rigorous and formal approach based on clinical performance indicators to identify vulnerabilities in each low-performing facility and set specific targets for improvement.
  3. Provision of national resources for improvement – VA’s RAPID team of experts will use sophisticated statistical tools to track the progress of improvement against these targets, and, where warranted, will dispatch a team of expert improvement coaches quickly to the medical centers to assist them in meeting the goals.
  4. Accountability for results –VA’s Central Office will review each of the facilities quarterly, and if the facilities fail to make rapid substantial progress in their improvement plan, VA leadership will take prompt action, including changing the leadership of the medical center.

VA secretary David Shulkin stated that “President Trump has made it clear that our Veterans deserve only the best when it comes to their healthcare, and that’s why we are focusing on improving our lowest performing facilities nationwide” (1). The VA recently removed the Roseburg Oregon VA Medical Center director who was accused of manipulating hospital admissions to improve the hospital’s rating (3). Almenoff, the overseer of improvement, was transferred from his position as the VA Integrated Network 15 director in 2008 when the Marion VA came under fire for substandard care raising concerns from several Illinois legislators, including the then junior senator from Illinois, Barack Obama (4).

A major hurdle will be for the VA to hire sufficient staff to improve care. As of the end of June, the VA reported 35,554 job vacancies system-wide, and VA Secretary David Shulkin has cited challenges with hiring doctors and nurses, particularly mental health care professionals (5). The agency set a goal to hire 1,000 mental health care workers in 2017. The VA hired 900 last year, but lost 945. The Veterans Access, Choice and Accountability Act of 2014 appropriated several billion dollars to the VA but this apparently did not lead to hiring of sufficient healthcare providers.

Richard A. Robbins, MD

Editor, SWJPCC


  1. VA Office of Public and Intergovernmental Affairs. VA announces aggressive new approach for low-performing medical centers. February 1, 2018. Available at: (accessed 2/14/18).
  2. US Department of Veterans Affairs. Quality care. Available at: (accessed 2/14/18).
  3. Phillips D. Director of veterans hospital accused of manipulating ratings is replaced. New York Times. February 1, 2018. Available at: (accessed 2/14/18).
  4. Durbin D, Obama B, Costello J, Shimkus J. Letter to The Honorable James B. Peake, M.D., Secretary of Veterans' Affairs. July 23, 2008. Available at: (accessed 2/14/18).
  5. Wentling N. Federal unions march on VA headquarters to protest staffing shortages. Stars and Stripes. February 13, 2018. Available at: (accessed 2/14/18).

Cite as: Robbins RA. VA announces aggressive new approach to produce rapid improvements in VA medical centers. Southwest J Pulm Crit Care. 2018;16(2):91-3. doi: PDF


Healthcare Payments Under the Budget Deal: Mostly Good News for Physicians

In the early morning hours last Friday (2/9/18) Congress passed and President Trump signed a massive budget agreement (1). The spending package will cost about $320 billion over 10 years, according to the Congressional Budget Office. Payments for healthcare substantially increase under the deal. Most praised the agreement. "Congress made the right choice this morning for patients and communities by voting to halt damaging cuts to hospitals that care for low-income working families and others who face financial challenges," said Dr. Bruce Siegel, CEO of America's Essential Hospitals, which represents the nation's safety-net facilities. Marc Goldwein of the Center for a Responsible Federal Budget called the healthcare provisions the one "beacon of light" in what otherwise is an exorbitantly costly budget bill. Goldwein praised its mix of structural reforms with "reasonable policy” and liked that the bill pays for the increased healthcare spending.

The bill extends Medicare physician fee cuts that provide about $38 billion in offsets to the increased spending (2). The bill preserves the planned physician fee cuts at 0.5% in 2018 but would reduce the cut to 0.25% in 2019. Not all were pleased by the continuation of the cuts. Calling it "contrary to Congress' intent” ACP President Jack Ende called on Congress to enact permanent relief from the physician fee cuts.

Other major healthcare provisions include (1,2):

  • Continued funding for community health centers for two years.
  • A two-year delay to the already-in-effect payment cuts to Medicaid disproportionate-share hospitals (DSH) which predominately represent safety net hospitals.
  • A two-year delay in the low-volume adjustment program which predominately affects rural hospitals.
  • An additional 4-year extension of the Children's Health Insurance Program (CHIP), which had received a 6-year extension in the continuing resolution that was approved in January.
  • Forcing pharmaceutical companies to pay 75 percent of the cost of drugs for seniors in Medicare’s coverage gap a year earlier than planned.
  • Repeal of the "therapy cap”, a move long pushed by therapy provider groups and the American Association of Retired Persons. This would permanently repeal Medicare's coverage limit on physical therapy, speech-language pathology, and outpatient treatment.
  • $6 billion for the opioid epidemic, which will go toward state grants, public prevention programs, and law enforcement.
  • Funding for the Maternal, Infant, and Early Childhood Home Visiting Program, which helps at-risk pregnant women and families navigate the social safety net.
  • A reduction in Medicare payments to Home health agencies. They're expected to lose $3.5 billion in Medicare payments starting in 2020 due to a change in the way Medicare calculates annual payment updates.
  • Funding the Chronic Care Act, which opens up new flexibilities for Medicare Advantage and care for chronically ill Medicare beneficiaries.
  • A 2-year delay in implementing The Affordable Care Act's high-cost plan tax, popularly known as the “Cadillac tax”. This was a 40 percent excise tax on employer plans exceeding $10,200 in premiums per year for individuals and $27,500 for families. The tax is now scheduled to take effect in 2020.
  • Repeal of Independent Payment Advisory Board (IPAB). Provider groups from the American Medical Association to the American Hospital Association applauded the move, even though Congress has never triggered the panel, which was charged to find and implement Medicare savings.

However, not all were pleased by the repeal of cost containments. IPAB repeal doesn't cost much in the grand scheme of things, said Mark Goldwein from the Center for a Responsible Federal Budget but “the long-term policy implications are huge, and a big mistake” (2). Kaiser Family Foundation Senior Vice President Larry Levitt chided that the bill demonstrates “…healthcare cost containment generally seems better in theory than in practice” (2).

Richard A. Robbins, MD

Editor, SWJPCC


  1. Luthi S. Beacon of light: Healthcare additions in budget law pleasantly surprise providers. Modern Healthcare. February 9, 2018. Available at: (accessed 2/12/18).
  2. Ault A. Trump signs budget deal, cuts Medicare fee in 2019. Medscape. February 9, 2018. Available at: (accessed 2/12/18).

Cite as: Robbins RA. Healthcare payments under the budget deal: mostly good news for physicians. Southwest J Pulm Crit Care. 2018;16(2):88-9. doi: PDF 


Hospitals Plan to Start Their Own Generic Drug Company

The New York Times reports that groups representing more than 450 hospitals plan to form their own generic drug company (1). Intermountain Healthcare is leading the collaboration with several other large hospital groups, Ascension, SSM Health and Trinity Health, in consultation with the U.S. Department of Veterans Affairs, to form a not-for-profit drug company. The new firm is looking to create generic versions of about 20 existing drugs that the group says cost too much now or are in short supply. The article did not name the drugs targeted but expects the first of its pharmaceutical products to become available in 2019. Members of the consortium will contribute funds to finance the new drug company.

Richard A. Robbins, MD

Editor, SWJPCC


  1. Abelson R, Thomas K. Fed up with drug companies, hospitals decide to start their own. New York Times. January 18, 2018. Available at: (accessed 1/19/18).

Cite as: Robbins RA. Hospitals plan to start their own generic drug company. Southwest J Pulm Crit Care. 2018;16(1):48. doi: PDF


Flu Season and Trehalose

Most of us who are practicing medicine know that we are in a very active flu season. This was brought home to me when last week trying to admit a patient to the hospital from the office. She was a bone marrow transplant patient who had severe diarrhea and dehydration probably secondary to C. difficile. Hospital admissions said the patient had to be sent to the Emergency Room because the hospital was full due to the flu epidemic.

Nationwide there has been a dramatic increase in the number of hospitalizations due to influenza over the past week from 13.7 to 22.7 per 100,000 (1). Influenza A(H3N2) has been the most common form of influenza reported this season. These viruses are often linked to more severe illness, especially in children and people age 65 years and older. Fortunately, the CDC also says that the flu cases may be peaking. However, at least 11 to 13 more weeks remain in the influenza season and strains other than A(H3N2) will undoubtedly show up.

Clinicians are reminded that in addition to the flu vaccine for prevention, to begin neuraminidase inhibitor antivirals early. Patients at high risk for complications (elderly, children, pregnant women, patients with chronic diseases such as diabetes, heart disease and asthma) should have treatment begun before laboratory confirmation (2).

Many clinicians have noted an increase in the incidence and severity of C. difficile infection over the past 15 years. Because the infection occurs after high dose antibiotics or antibiotics prescribed over a long period of time, it was assumed that this was the cause of the rising rates of infection. However, an alternative explanation was offered by an article appearing last week in Nature (3). The authors showed that two epidemic ribotypes of C. difficile (RT027 and RT078) have acquired unique mechanisms to metabolize low concentrations of the disaccharide trehalose increasing virulence. Trehalose is a sugar widely distributed in nature and used mostly a stabilizing agent in processed foods and products (including influenza vaccine). It was introduced about the same time as the upsurge in C. difficile infection began in the early 2000's.

Richard A. Robbins, MD

Editor, SWJPCC


  1. Brooks M. US influenza activity widespread and intense, may be peaking. Medscape. January 12, 2018. Available at: (accessed 1/14/18). 
  2. Campbell A. 2016-2017 influenza antiviral recommendations. Medscape. January 9, 2017. Available at: (accessed 1/14/18).
  3. Collins J, Robinson C, Danhof H, et al. Dietary trehalose enhances virulence of epidemic Clostridium difficile. Nature. 2018 Jan 3. [CrossRef] [PubMed]

Cite as: Robbins RA. Flu season and trehalose. Southwest J Pulm Crit Care. 2018;16(1):44-5. doi: PDF 


MedPAC Votes to Scrap MIPS

The Medicare Payment Advisory Commission (MedPAC) voted 14 to 2 on January 11th in favor of telling Congress to do away with Merit-based Incentive Payment System (MIPS) (1). Instead they favor moving to what the panel termed a voluntary value program (2). Lawmakers mandated MIPS as part of the bipartisan 2015 Medicare Access and CHIP Reauthorization Act (MACRA) ending the sustainable growth rate formula that had repeatedly threatened to cause deep cuts in Medicare payments to doctors.

On a slide presentation before the vote, the MedPAC staff said MIPS cannot succeed. The cited the following reasons for MIPS’ probable failure (3):

  • Replicates flaws of prior value-based purchasing programs
  • Burdensome and complex
  • Much of the reported information is not meaningful
  • Scores not comparable across clinicians
  • MIPS payment adjustments will be minimal in the first two years, large and arbitrary in later years
  • MIPS will not succeed in helping beneficiaries choose clinicians, helping clinicians change practice patters to improve value, or helping the Medicare program to reward clinicians based on value

Supporters of the MedPAC approach argued for fast action. It will be difficult to dismantle MIPS if it becomes entrenched, said MedPAC panelist Rita Redberg MD (1).

One of the four physician members of the committee, Alice Coombs MD, an anesthesiologist and critical care specialist, dissented. "We have not seen one specialty physician group yet say, 'You know what, I like getting rid of MIPS and I like this [Voluntary Value Program], let's go with it.' " The American Medical Association (AMA) protested the MedPAC vote arguing to keep MIPS in place (1). "Where we are is that we'd like to fix it rather than kill it," Sharon McIlrath, assistant director of federal affairs at the AMA, told the MedPAC panelists during the public comment period. The AMA separately issued a statement from its president, David O. Barbe MD (1). "The best remedy is to fix MIPS rather than jumping into another sweeping change that has not been fleshed out and would have many of the same methodological issues as MIPS," Barbe said.

It's unclear how Congress and CMS will greet the MedPAC recommendation on MIPS. Congress in recent months has struggled with healthcare legislation, for example, reauthorization of the Children's Health Insurance Program. Routine appropriations have not yet been completed for fiscal 2018, The AMA's McIlrath told MedPAC that it doesn't appear "politically viable to think that you are going to go up there and think that you are going to get the Hill to kill MIPS (1)."

Richard A. Robbins, MD

Editor, SWJPCC


  1. Young KD. MedPAC backs bid to scrap MIPS Medicare pay system amid dissent. Medscape. January 11, 2018. Available at: (accessed 1/13/18).
  2. Robbins RA. CMS announces new payment model. Southwest J Pulm Crit Care. 2018;16(1):29-30. Available at: (accessed 1/13/18).
  3. Bloniarz K, Winter A, Glass D. Assessing payment adequacy and updating payments. Available at: (accessed 1/13/18).

Cite as: Robbins RA. MedPAC votes to scrap MIPS. Southwest J Pulm Crit Care. 2018;16(1):42-3. doi: PDF