Search This Blog

Saturday, March 4, 2023

States where residents will pay the biggest share of their income in taxes

 Massachusetts and Oregon residents will pay the largest share of their income in taxes this spring, according to a new study from the personal finance site FinanceBuzz.  

The average American will pay 19.68 percent of their income in taxes this year, but residents in 24 states face a tax burden that is higher than the national average, the study found.  

Massachusetts residents filing as individuals can expect to pay 24.07 percent of their income in taxes this year, while couples filing jointly will pay 23.47 percent.  

This steep tax burden is in part due to the Bay State having the highest individual median income in the country — $72,321.  

“This puts many Massachusetts residents into higher tax brackets where more significant portions of their income are taxed at higher rates,” the study states.  

Meanwhile, Floridians and Tennesseans will pay the smallest percentage of their income in taxes this year, with residents in both states who file as individuals set to part with 15.67 percent of their 2022 income in taxes.  

Florida and Tennessee residents’ lower tax burdens are due in part to neither state charging state-level income tax, the study noted.

There are at least seven states in the U.S. that do not have state-level income tax, including Florida and Tennessee. But those states usually make up for lack of individual income tax by charging higher property or sales tax.  

Here are the 10 states where people will pay the highest share of their income in taxes: 

  1. Massachusetts (24.07%) 
  2. Oregon (23.48%) 
  3. Connecticut (23.37%) 
  4. Maryland (22.85%) 
  5. New York (22.70%) 
  6. Hawaii (22.66%) 
  7. Virginia (22.20%) 
  8. New Jersey (22.10%) 
  9. Minnesota (21.94%) 
  10. Illinois (21.50%) 
Here are the states where people will pay the smallest share of their income in taxes: 
  1. Florida (15.67%) 
  2. Tennessee (15.67%) 
  3. South Dakota (15.80%) 
  4. Nevada (15.93%) 
  5. Wyoming (15.99%) 
  6. Texas (16.01%) 
  7. North Dakota (16.71%) 
  8. Alaska (17.10%) 
  9. New Hampshire (17.51%) 
  10. Arizona (18.01%) 

Bicycle Health, Bureau of Prisons to provide opioid use disorder treatment at reentry centers

 Bicycle Health has teamed up with Wellpath and the Federal Bureau of Prisons to provide opioid use disorder treatment to incarcerated individuals.

Bicycle Health, the telehealth provider for OUD, will provide the care, while services will be reimbursed by Wellpath. Wellpath is one of the country’s largest providers for prisoners and other vulnerable patients. Services will be available to individuals living in halfway houses known as residential reentry centers (RRCs) across 42 states with plans to expand. 

Telemedicine is a great way to provide care to these individuals because it facilitates continuity of care with the same provider during incarceration and after, Bicycle Health founder and CEO Ankit Gupta told Fierce Healthcare. That engagement “is extremely important. I think that’s going to directly reduce the risk of overdose,” he said.

But providing care in this setting is not without its complications. Though individuals in RRCs typically have access to a phone and internet, there is a lot of variation, Gupta noted. That’s why the company has been authorized by the bureau to provide audio-based treatment in cases where video is not an option.

Other nuances run the gamut, from variations in drug testing to the way prescriptions are filled. 

“We’ve actually had to sort of adapt our model to this patient population,” Gupta said. 

For instance, patients cannot go to a pharmacy or use insurance. Bicycle Health must work with RRC case managers to get patients a voucher for each prescription, which must be approved by the bureau. That necessarily means getting prescriptions will take a lot longer and involve a lot more care coordination and patient monitoring, Gupta explained. Bicycle Health clinicians are being trained internally by a staffer with experience in criminal justice healthcare, Gupta said.

Medications for OUD like buprenorphine have been found to be significantly underutilized in criminal justice settings. The goal of the latest partnership is to improve access to and promote clinically appropriate use of this type of treatment, the companies said in an announcement, and improve not only health outcomes but also reduce recidivism.

“Telehealth is now well understood to be a widespread, highly effective treatment delivery option for patients with opioid use disorder, which is why we chose to work with Bicycle Health. In doing so, we’re able to overcome many of the obstacles that prevent formerly incarcerated people from getting the MOUD treatment they need,” Thomas Pangburn, M.D., chief clinical officer at Wellpath, said in a press release. “This collaboration helps streamline the process for re-entry by providing evidence-based and convenient treatment options, which can make a real difference for those struggling with opioid addiction.”

This model could, however, be at risk if the public health emergency ends without changes to the Ryan Haight Online Pharmacy Consumer Protection Act. Last Friday, the Drug Enforcement Administration (DEA) proposed changes to COVID-era telehealth rules mandating in-person appointments for virtual prescriptions of controlled substances. 

“This rulemaking unnecessarily limits access at a time when it’s needed the most and puts thousands of lives at risk,” Gupta said in a statement in response to the proposed rules. “We plan to work with the DEA during the public comment period toward common sense revisions.” 

https://www.fiercehealthcare.com/digital-health/bicycle-health-teams-wellpath-and-bureau-prisons-virtual-oud-treatment

Payers should cover home-based cardiac rehabilitation programs: study

 Insurers need to rethink their coverage policies regarding home-based cardiac rehabilitation programs, according to a study published yesterday in the Journal of the American Heart Association.

In a press release, the study’s senior author Mary A. Whooley, M.D. said that “our biggest challenge in the U.S. is that home-based cardiac rehabilitation is not covered by many health insurers. Currently, Medicare only pays for on-site or facility-based cardiac rehabilitation.”

While problems persist on the supply side for providing these programs, the study also found a lack of demand.

“The biggest surprise of our analysis was how few patients chose to participate in cardiac rehabilitation,” Whooley said, a primary care physician at the San Francisco Veterans Affairs Medical Center and professor of medicine at the University of California, San Francisco.

HBCR programs focus on lifestyle changes. “However, changing behaviors is difficult, and while care facilities may offer on-site cardiac rehabilitation, many patients don’t choose to take advantage of follow-up treatment,” Whooley said.

The study, which authors tout as the first to show that home-based cardiac rehabilitation can help people with heart disease live longer, involved examining data of 1,120 patients eligible for cardiac rehabilitation at the San Francisco Veterans Health Administration between 2013 and 2018.

Excluded from the study were veterans who choose to attend facility-based cardiac rehabilitation programs or those who died within 30 days of hospitalization. Researchers compared outcomes for 490 home-based care participants to 630 patients who did not participate in the program. The patients were monitored through June 30, 2021.

Those in the home-based program had a 36% lower risk of death compared to those who did not participate.  

“Although no observational study can eliminate the possibility that healthier patients were more likely to participate in HBCR, we rigorously adjusted for confounding using an inverse probability weighted Cox regression analysis with the goal of equalizing the samples across all variables other than exposure to HBCR,” the study found. “These results suggest that participation in HBCR contributed to lower mortality among patients referred to [cardiac rehabilitation].”

The home-based rehabilitation program lasted 12 weeks and included nine coaching calls, motivational interviews and a health journal to track diet, exercise and vital signs. Participants were also given a stationary bike and a blood pressure monitor.

Patients were given physical activity goals, after consultation with a nurse or exercise physiologist. Follow-up calls were made to patients at three and six months after the program, and they were monitored an average of 4.2 years after being hospitalized.

Researchers note that cardiac rehabilitation might be more appealing than facility-based programs, which do not seem to be something most cardiac patients participate in. They cite data that say that from 2007 to 2011, 15% of Medicare patients and 10% of veterans opted for cardiac rehabilitation. In 2016, among Medicare beneficiaries cleared for cardiac rehabilitation, only 24% choose to participate in on-site programs.

This might beg the question of whether insurers paying for these programs would make that much of a difference because the demand for the service doesn’t seem to exist.

In the press release, Whooley said that “we don’t know why so many patients opted out of rehabilitation. Even when home-based cardiac rehabilitation was offered at the time and place of their choosing, only 44% of eligible patients chose to participate. Many patients were simply not interested in changing their behaviors.”

https://www.fiercehealthcare.com/payers/payers-should-cover-home-based-cardiac-rehabilitation-programs-researchers-argue

Teladoc-owned BetterHelp to pay $7.8M to online therapy users for alleged data misuse

 The Federal Trade Commission has reached a settlement with online therapy company BetterHelp, which is owned by Teladoc, over allegations that it shared consumers’ health data with companies like Facebook and Snapchat for advertising purposes.

As part of a proposed order announced Thursday, BetterHelp is banned from sharing consumers’ health data, including sensitive information about mental health challenges, with third parties for marketing and ad targeting.

BetterHelp also agreed to pay $7.8 million to consumers to settle charges that it revealed consumers’ sensitive data with third parties for advertising after promising to keep such data private, according to a FTC press release.

In a statement, BetterHelp said it does not share and "have never shared with advertisers, publishers, social media platforms, or any other similar third parties, private information such as members' names or clinical data from therapy sessions."

"We do not receive and have never received any payment from any third party for any kind of information about any of our members," according to the statement posted online about the FTC settlement.

The company said the settlement with the FTC relates to BetterHelp's advertising practices that were in effect between 2017 to 2020.

"The FTC alleged we used limited, encrypted information to optimize the effectiveness of our advertising campaigns so we could deliver more relevant ads and reach people who may be interested in our services. This industry-standard practice is routinely used by some of the largest health providers, health systems, and healthcare brands," the company said.

"We understand the FTC's desire to set new precedents around consumer marketing, and we are happy to settle this matter with the agency," the company said, noting that the settlement is not an admission of wrongdoing.

The Commission voted 4-0 to approve the settlement.

The FTC noted that it's the agency's first action returning funds to consumers whose health data was compromised.

The proposed order also bans BetterHelp from sharing consumers’ personal information with certain third parties for re-targeting—the targeting of advertisements to consumers who previously had visited BetterHelp’s website or used its app, including those who had not signed up for the company’s counseling service.

The case marks the second time that the FTC has taken action against a digital health company for alleged data misuse.

In February, the agency took enforcement action today against online pharmacy GoodRx for failing to notify customers and regulators of unauthorized disclosures of consumers’ personal health information. The action is the first of its kind under the FTC’s Health Breach Notification Rule (HBNR).

GoodRx is now prohibited from sharing user health data with applicable third parties. The telehealth and prescription drug discount provider also agreed to pay a $1.5 million civil penalty. A blog post on the GoodRx website stated that the company admits no wrongdoing but agreed to settle in order to “avoid the time and expense of protracted litigation.”

These moves signal potential increased enforcement by the FTC on the side of protecting consumer privacy.

"When a person struggling with mental health issues reaches out for help, they do so in a moment of vulnerability and with an expectation that professional counseling services will protect their privacy,” said Samuel Levine, director of the FTC's Bureau of Consumer Protection in a statement. "Instead, BetterHelp betrayed consumers’ most personal health information for profit. Let this proposed order be a stout reminder that the FTC will prioritize defending Americans’ sensitive data from illegal exploitation."

California-based BetterHelp offers online counseling services under several names, including BetterHelp Counseling, Faithful Counseling focused on Christians, Teen Counseling, which caters to teens and requires parental consent, and Pride Counseling for the LGBTQ community.

In its complaint, the FTC alleges that BetterHelp used and revealed consumers’ email addresses, IP addresses, and health questionnaire information to Facebook, Snapchat, Criteo, and Pinterest for advertising purposes, despite assurances that it would not use or disclose their personal health data except for limited purposes, such as to provide counseling services. 

https://www.fiercehealthcare.com/health-tech/teladoc-owned-betterhelp-pay-78m-users-alleged-data-misuse-ftc-order

Physicians twice as likely as general population to attempt suicide: Medscape survey

 Nearly a quarter of physicians reported clinical depression in a new Medscape survey, while 9% admitted to suicidal thoughts and 1% shared that they attempted to end their lives.

Medscape surveyed 9,100 physicians across 29 specialties last year. While physicians often address the suicide crisis throughout the U.S., many are struggling with their own mental health. Two-thirds of doctors reported colloquial depression, according to the survey.

Twenty-four percent of doctors reported clinical depression and the survey also found that doctors are more likely to have suicidal thoughts compared to other professions. 

Depression in the medical community has been a serious problem for about as long as it has been measured, Andrea Giedinghagen, assistant professor of psychiatry at the St. Louis Washington University School of Medicine, said in the report.

“Physicians are also still coping with a pandemic – the trauma from COVID-19 didn’t disappear just because the full ICUs did – and with a fractured healthcare system that virtually guarantees moral distress,” Giedinghagen said. “This is beyond individual solutions for individual problems. Systemic change is necessary.”

In the last year, the percentage of physicians who reported contemplating suicide decreased from 13% to 9%, according to the 2021 report. Of the total U.S. adult population, 4.9% have thought of suicide and .5% have attempted the act.

Female physicians were 2% more likely than males to consider ending their lives. In the general population, females are two to three times more likely to attempt suicide while males are more likely to be successful in ending their own lives. Nationally, men make up 80% of suicides.

As physicians age, feelings of suicidal desire wane with 12% of those ages 27 to 41 reporting thoughts of suicide compared to 8% of those aged 57 to 75. This is counter to the general population where men over 45 years old experience higher suicidal rates.

Younger physicians were more likely to say that a med school or healthcare organization should be responsible for a student or physician’s suicide. Of those aged 42 to 56 years, 57% were unsure if institutions should bear any responsibility.

“Admitting to having felt suicidal but not attempted suicide does speak to how stressed a certain cohort of today’s doctors are,” Michael Myers, professor of clinical psychiatry at SUNY Downstate Health Sciences University, said in the report. “The fact that only a small percentage of these individuals went on to attempt suicide is a good sign that they perhaps shared with a trusted colleague, friends or family member or sought professional help.”

Myers also said the statistics might indicate less stigma around disclosing a suicide attempt, “that individuals understand this as a part of a serious mental health issue and not a sign of weakness.”

When it comes to specialty, the top five specialist types most likely to report suicidal thoughts were otolaryngology, psychiatry, family medicine, anesthesiology and Ob/Gyn. The five specialist types least likely were orthopedics, nephrology, oncology, rheumatology and pulmonary medicine.

Physicians were 4% more likely to share their feelings with a therapist as compared to 2019 when only 34% reported doing so. In 2022, just over half reported sharing with a family member, friend or colleague while a meager 5% reported to a suicidal hotline.

Still, 40% stated that they had not shared their feelings with anyone.

These numbers were mostly equal between the genders. Although men were more likely to confide in a family member, and women were more likely to confide in a friend or colleague.

Anonymous responses to the report included various reasons for not reaching out for help, including fears that it will put their career on the line. 

According to the survey, 42% of doctors with depression do not want to risk disclosure to the medical board – a 110% increase from Medscape’s 2021 report.

“I was afraid of being put on a 5150 (involuntary detention), losing my job, having an impact on my future job search and credentialing,” an anonymous physician wrote as part of the survey.

Others shared similar reasons for avoiding treatment including the requirement that “meds had to be reported to the state board.”

Another physician wrote that he or she changed their work situation and no longer experience suicidal thoughts.

“I feel this is passive ideation,” another anonymous physician wrote. “I don’t really plan to do it – I just wish I wasn’t here sometimes.”

When asked why physicians had not sought help, 33% were concerned about the report being on their insurance record and 25% were concerned that a colleague would find out. Just over half said they could “deal with suicidal thoughts without help from a professional.”

“Though as physicians we recognize suicidal ideal as an area of high concern and would take what a patient says very seriously, we are less likely to do this ourselves,” said Perry Lin, national co-chair of the American Association of Suicidology’s Physician Suicide Awareness Committee, in the report. “There is a lot of stigma among help-seeking behavior.”

https://www.fiercehealthcare.com/providers/physicians-are-twice-likely-general-population-attempt-suicide-medscape-survey-found

Active Surveillance in Prostate Cancer on the Rise, but 'Suboptimal,' Highly Variable

 While use of active surveillance for the management of low-risk prostate cancer has increased in the U.S., it still varies widely both at the practitioner level and even within urology practices, according to a cohort study.

Looking at over 20,000 patients included in a quality reporting registry, the rate of active surveillance increased "sharply and consistently" from 26.5% in 2014 to 59.6% in 2021, reported Matthew R. Cooperberg, MD, MPH, of the University of California San Francisco Helen Diller Family Comprehensive Cancer Center, and colleagues.

However, use of active surveillance was variable at the urology practice level, ranging from 4% to 78%, and from 0% to 100% at the practitioner level, over this time period, they noted in JAMA Network Open

opens in a new tab or window.

Despite the increase, active surveillance rates remain "suboptimal," suggested Cooperberg and colleagues, adding that while the optimal rate hasn't been defined, it is likely greater than 80% based on reports from the U.S. Veterans Affairs system and other health systems.

On multivariable analysis, year of diagnosis was most strongly associated with active surveillance use, with an odds ratio (OR) per year of 1.25 (95% CI 1.24-1.27). The ORs for individual years increased progressively to 4.48 (95% CI 4.31-4.65) for 2021 relative to 2014, the authors said.

In addition, older patient age and lower prostate-specific antigen (PSA) level were associated with active surveillance. Black men were less likely to receive active surveillance than white men (OR 0.87, 95% CI 0.75-1.00).

Neither practice volume nor indicators of practitioner density affected the odds of active surveillance. However, higher urologist density per capita was associated with slightly lower odds of active surveillance (OR 0.92, 95% CI 0.81-1.03), Cooperberg and team reported, "suggesting that more competition in a given area tends to create more opportunities for overtreatment."

They said that variation in the use of active surveillance has been identified previously, but within smaller sets of practices. Moreover, the variation in the use of active surveillance "is not unique to [active surveillance] for prostate cancer," and variations in practice exist in every area of clinical medicine for which multiple clinical options are available.

Nevertheless, "continued progress on this critical quality indicator is essential to minimize overtreatment of low-risk prostate cancer and by extension to improve the benefit-to-harm ratio of national prostate cancer early detection efforts," they concluded.

For this study, Cooperberg and colleagues used data collected from the American Urological Association Quality (AQUA) Registry, a quality reporting registry that collects data from 349 practices across the U.S., representing 1,945 urology practitioners, and including more than 8.5 million patients.

Among 298,801 patients newly diagnosed with prostate cancer from 2014 to 2021, 27,289 were diagnosed with low-risk disease (defined as a PSA level less than 10 ng/mL, Gleason grade group 1, and clinical stage T1c or T2a).

Of these patients, 20,809 had known primary treatment. Median age was 65 years, 40.1% were white, and 8.9% were Black; 49.3% were missing information on race or ethnicity.

Cooperberg and colleagues noted that electronic health record data are often incomplete, and race data are self-reported, which were limitations of their study. Furthermore, access to data on social determinants for patients in the AQUA Registry are limited, and findings on racial disparities in active surveillance use should be interpreted with caution.

Disclosures

Cooperberg reported receiving personal fees from Astellas, AstraZeneca, Pfizer, Bayer, Merck, Dendreon, Janssen, Foundation Medicine, Veracyte, Exact Sciences, Verana Health, and ConcertAI outside the submitted work.

Co-author Gaylis reported receiving personal fees from Janssen Pharmaceuticals outside the submitted work.

Primary Source

JAMA Network Open

Source Reference: opens in a new tab or windowCooperberg MR, et al "Time trends and variation in the use of active surveillance for management of low-risk prostate cancer in the U.S." JAMA Netw Open 2023; DOI: 10.1001/jamanetworkopen.2023.1439.


https://www.medpagetoday.com/urology/prostatecancer/103383

BridgeBio to Discuss Phase 2 Cohort 5 Data for Achondroplasia on March 6

 BridgeBio Pharma, Inc. (Nasdaq: BBIO) (BridgeBio), a commercial-stage biopharmaceutical company focused on genetic diseases and cancers, today announced that members of its management team will host an investor call on Monday, March 6 at 7:30 am ET to discuss Phase 2 Cohort 5 data from its PROPEL2 clinical trial of the investigational therapy infigratinib in children with achondroplasia. Infigratinib is an oral small molecule designed to inhibit fibroblast growth factor receptor 3 (FGFR3) and target achondroplasia at its source.

Achondroplasia is the most common cause of disproportionate short stature, affecting approximately 55,000 people in the United States (US) and European Union (EU), including up to 10,000 children and adolescents with open growth plates. Achondroplasia impacts overall health and quality of life, leading to medical complications such as obstructive sleep apnea, middle ear dysfunction, kyphosis, and spinal stenosis. The condition is uniformly caused by an activating mutation in FGFR3.

To access the live webcast, please visit the “Events” page within the Investors section of the BridgeBio website at http://investor.bridgebio.com. A replay of the webcast will be available on the BridgeBio website for 90 days following the event.