With help from Rachel Roubein, Sarah Karlin-Smith, Victoria Colliver and Adam Cancryn
HOW HEALTH PROVIDERS ARE PREPPING FOR HURRICANE FLORENCE — The storm is expected to batter the Carolinas, and emergency evacuations are in place in both states.
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“It’s really been a family-like experience the way hospitals have graciously stepped up,” Schipp Ames of the South Carolina Hospital Association told POLITICO’s Rachel Roubein.
As of Wednesday evening:
— South Carolina: At least three hospitals were evacuating all patients, and other hospitals are transferring some patients to the 22 inland hospitals accepting patients from coastal areas, Ames said.
Dozens of nursing homes and assisted living facilities in the evacuation zone also transferred patients, along with medical supplies, staff and — given lack of vacant beds — mattresses for senior citizens, many of whom may be sleeping on the floor.
— North Carolina: Some small facilities are moving patients to flagship hospitals, seeking to consolidate patients and resources, said Julie Henry of the North Carolina Healthcare Association.
About 12 to 15 skilled nursing care centers in coastal and eastern counties are evacuating, with some beginning as early as Monday, the North Carolina Health Care Facilities Association told POLITICO.
The North Carolina Health Information Exchange Authority also has prompted members to ensure that physicians have log-in credentials and can remotely access health care information.
— Meanwhile in Virginia: Six long-term care facilities had evacuated as of early Wednesday afternoon. Multiple Virginia hospitals also said they are prepping for emergency conditions and bringing in extra food, water and medicine.
HOW FLORENCE COULD HIT PHARMA — Multiple companies’ operations could be disrupted by the hurricane, POLITICO’s Sarah Karlin-Smith reports.
— Pfizer is suspending production at its two manufacturing plants in North Carolina. The company declined to say whether the affected products — vaccines and sterile injectable medicines — are among the dozens it currently lists in short supply.
— Merck is shutting four facilities in North Carolina and Virginia and is planning to adjust shipments (and deploy power generators) as needed.
— Baxter is keeping a Marion, N.C.-based plant open as of Wednesday, given that the facility is inland. The plant historically has produced saline, which has been in short supply — and was worsened by Hurricane Maria’s impact on drug manufacturing plants in Puerto Rico in 2017.
— Novo Nordisk also is leaving open a plant in North Carolina that produces diabetes medication.
— But the full impact isn’t clear because pharmaceutical companies don’t have to publicly disclose what products are made at which factories, Sarah writes. FDA also couldn’t provide information on how many facilities are in the storm’s path.
MARK YOUR CALENDAR: OPIOID VOTE ON MONDAY — Senate Majority Leader Mitch McConnell on Wednesday canceled this week’s remaining votes, including a planned vote on the chamber’s long-delayed opioid package, citing the hurricane risk.
The opioids vote is now “locked in” for Monday evening, a McConnell aide told reporters.
… A Republican aide said Senate lawmakers are working with the House to reconcile the two chambers’ policy differences so they can quickly send a final deal to the president’s desk before the midterm elections, POLITICO’s Brianna Ehley reports. More for Pros.
** A message from PhRMA: According to a new analysis, nearly one in five hospitals mark up medicine prices 700% or more. Even worse, 320 hospitals in the study marked up prices more than 1000%. These hospital markups lead to higher costs for everyone — patients, employers and payers. **
FINAL DEAL IS “IMMINENT, IMMINENT” ON LABOR-HHS SPENDING PACKAGE TOO — That’s according to Senate Appropriations Chairman Richard Shelby, who told reporters on Wednesday night that a final compromise was “really close.” Senate leaders are aiming for a floor vote next week, POLITICO’s Jennifer Scholtes and Anthony Adragna report.
The fiscal 2019 package — which includes the Labor-HHS-Education and Defense funding bills — could also get held up by conservatives in the House. More for Pros.
THIS IS THURSDAY PULSE, LIVE FROM KANSAS — Good morning from the Sunflower State, where your author is at a conference convened by the Association of Community Mental Health Centers of Kansas. (He was grilled by Kyle Kessler, ACMHCK chief and PULSE reader, on stage yesterday.)
This D.C.-based reporter is relishing his trip to the heartland. Got suggestions for things to see or folks to visit in Kansas or Oklahoma? Tips to ddiamond@politico.com.
NAVIGATE THE TWISTS AND TURNS OF THE CANADA-U.S. TRADE RELATIONSHIP. Now live, POLITICO Pro Canada, Pro’s latest subscription-based product, provides news and policy analysis on the deeply integrated Canada-U.S. relationship. Created for business leaders and policy professionals, coverage focuses on federal and state policies that affect bilateral economic interests and government relations. Visit www.politicopro.com/canada to learn more.
Association for Community Affiliated Plans hosts Hill briefing on housing, Medicaid. ACAP members will share lessons from the field in coordination with Sen. Sherrod Brown’s office. (As of Wednesday night, the event was still scheduled, ACAP confirmed.)
Alex Azar, Seema Verma to speak at Financial Times summit on pharma costs. The HHS secretary is scheduled to speak at 9:05 a.m. and the CMS administrator is scheduled for 3:45 p.m. at the New York City-based conference.
PULSE CHECK AT WORK: RADIOLOGIST
Overseas doctors are cheaper. Artificial intelligence could eventually be smarter. Are American radiologists’ days numbered?
That’s what we tried to solve for this week’s episode, speaking with Emory’s Stefan Tigges and UCSF’s Rebecca Bindman-Smith on how their jobs have changed — and what radiologists do all day, when not reading scans.
Listen to a new episode of our popular podcast.
HOT OFF THE PRESSES: MORE CENSUS DATA ON UNINSURED — The percentage of Americans with health insurance decreased in six of the nation’s 25 most populous metropolitan areas between 2016 and 2017. Four large metro areas saw more people with health coverage, among them Philadelphia and Los Angeles.
Other notable nuggets from the American Community Survey: Metropolitan Boston topped the list with 97 percent of residents covered while Houston had the lowest percentage insured, 82 percent. (It’s worth mentioning that Massachusetts has had a mandate that individuals sign up for insurance for over a decade.) More for Pros.
MEET LEANA WEN, THE NEXT PLANNED PARENTHOOD PRESIDENT — The Baltimore health commissioner will be the first physician to lead the reproductive health group in nearly 50 years.
“In the ER, I saw what happens every day when people don’t have access to the basic right of health care,” Wen said in a biographical video shared by Planned Parenthood, tracing her immigration to the United States and her fights with the Trump administration. Watch the video.
— Her record challenging Trump: Wen and the Baltimore City Health Department successfully sued over federal funding cuts to teen pregnancy prevention programs. She also has spoken out against the administration’s changes to Title X family planning grants and the proposed domestic gag rule that would limit information about abortion that providers receiving federal money could share with patients. More here.
— Her record in Baltimore: Wen focused on the opioid epidemic, issuing a blanket prescription to ensure that any city resident could obtain naloxone, the overdose reversal drug. She also highlighted how racial disparities contributed to the city’s health crises and launched new community health initiatives, like providing glasses to schoolchildren.
Where key swing votes stand on Brett Kavanaugh. Sen. Susan Collins said she has a few follow-up questions for the Supreme Court nominee and is planning to speak with him later this week, POLITICO’s Adam Cancryn reports. Collins told Adam she’s still completing her due diligence and reviewing confidential documents shared with the Senate Judiciary Committee. But there’s no indication what she wants to ask Kavanaugh and no indication which way she’s leaning.
Sen. Lisa Murkowski also didn’t give any new indications when — or which way — she’ll decide on Kavanaugh.
House passes PACE bill by voice vote. The bill directs CMS to finalize Obama-era updates to the program’s staffing standards and other rules by the end of the year. Advocates and lawmakers say PACE — the Program for All-Inclusive Care for the Elderly — needs the changes in order to expand the program and keep more seniors out of nursing homes, particularly as the U.S. population ages.
Senate passes PREEMIE act reauthorization. The bill renews funding for a number of federal initiatives related to preterm birth and encourages new federal efforts to lower maternal mortality. More from the March of Dimes.
CMS awards $10 million in navigator grants, down from $36 million last year. The agency also pared the number of grantees to 39 organizations, down from 90 organizations last year, the Washington Examiner’s Kimberly Leonard writes. The new crop of navigators are expected to steer shoppers to plans traditionally offered through the Affordable Care Act exchanges — but also the new association and short-term health plans backed by the Trump administration. See list of grantees.
… Pro-ACA groups decried the announcement, calling it further sabotage of the health law. The Trump administration is “coupling further drastic cuts to the individuals who help Americans enroll with a cynical attempt to push Americans into junk plans,” said Brad Woodhouse of Protect Our Care.
FIRST IN PULSE: Seventy-seven percent of Americans say drug prices are ‘unreasonable.’ That’s according to a new poll from West Health, conducted by NORC at the University of Chicago. But only 23 percent of respondents approved of how President Donald Trump was handling prescription drug prices, despite the administration’s high-profile efforts to tackle the issue.
(Congress also was panned; just 20 percent of respondents approved of Democrats’ approach, while 16 percent approved of Republicans’ efforts.) See the poll.
Introducing “ACT for Better Diagnosis.” More than 40 organizations are teaming up to share tactics to improve diagnostic accuracy. As many as 80,000 hospital deaths per year are linked to inaccurate or delayed diagnoses, and 12 million adults in outpatient settings are annually affected by diagnostic errors, the coalition says.
“Nearly everyone will receive an inaccurate diagnosis at some point in their life and for some, the consequences will be grave,” said Paul Epner of the Society to Improve Diagnosis in Medicine, which is steering the initiative. Participants include the American College of Physicians, the Institute for Healthcare Improvement and Johns Hopkins Medicine as well as federal agencies like CMS and CDC.
California: Nancy Pelosi addresses health care climate summit. The House minority leader spoke at UCSF Mission Bay, where health care leaders convened to discuss the industry’s role in creating 10 percent of the nation’s carbon footprint.
Pelosi said the climate crisis was the “challenge of the generation” and applauded Gov. Jerry Brown and Lt. Gov. Gavin Newsom — who’s bidding to replace Brown — for their years-long efforts.
… Kaiser Permanente announced earlier this week that it will buy clean energy and build solar and wind farms as part of the system’s commitment to go carbon neutral by 2020.
Jeff Myers to depart Medicaid Health Plans of America. Myers, who’s served as CEO for five years, will step down on Oct. 1. Francis Rienzo, the organization’s VP of government affairs, will serve as interim CEO.
Atul Gawande’s update on Ariadne Labs. In an email to friends and supporters on Wednesday, Gawande said that he expects Ariadne — the innovation center that he founded five years ago — to have a new leader by the end of 2018. Gawande already has transitioned to running the joint Amazon-Berkshire Hathaway-JPMorgan Chase health venture.
The star researcher, writer and surgeon also signaled that his transition hasn’t affected Ariadne’s work — touting the lab’s recent accomplishments on priorities like maternal mortality and primary care — and even drew new support; philanthropists John and Ann Doerr doubled their contribution to Ariadne.
By Rachel Roubein
In The New York Times, Caitlin Dickerson reports that the number of detained migrant children has hit its highest level ever recorded. More.
The federal government has fewer methods of tackling upcoding in Medicare Advantage after a federal judge’s recent court ruling, Modern Healthcare’s Shelby Livingston reports. More.
The Apple Watch is adding more health care features, such as heart-monitoring and fall-detection applications, The Wall Street Journal reports. More.
Unlike in years past, health care could actually help boost Democratic candidates in the midterms, writes The Washington Post’s Philip Bump. More.
In NEJM, Nick Bagley and Rachel Sachs look at how Massachusetts tried to limit drug prices — and how the Trump administration rejected the plan. More.
A Louisiana abortion clinic wants a state judge to get rid of a 2015 rewrite of clinic regulations, the Associated Press reports. More.
** A message from PhRMA: How much are hospitals marking up the cost of medicines? According to a new analysis, nearly one in five hospitals mark up medicine prices 700% or more. Even worse, 320 hospitals in the study marked up prices more than 1000%. These hospital markups lead to higher costs for everyone — patients, employers and payers. When hospitals mark up the cost of medicines…Patients pay the price. **