Third Death Under TX Abortion Ban; Insurer Pays Its Own Docs More; CME Questioned

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Third Woman Dies Under Texas Abortion Ban

A third woman has died under the Texas abortion ban as doctors there avoid dilation and curettage (D&C) procedures and opt for riskier miscarriage treatments, ProPublica reported.

On June 11, 2023, over 6 hours, 35-year-old mother of two Porsha Ngumezi bled so much in the emergency department at Houston Methodist Sugar Land that she needed two transfusions, ProPublica reported.

Her husband Hope called his mother, a former physician, “who was unequivocal” that Porsha needed a D&C,” ProPublica reported. However, the obstetrician on duty told the pair that it was the hospital’s “routine” to give the drug misoprostol to help the body pass the tissue. And three hours later, Porsha’s heart stopped.

Porsha’s death was preventable, more than a dozen doctors who reviewed a detailed summary of her case, told ProPublica.

“Misoprostol at 11 weeks is not going to work fast enough,” Amber Truehart, MD, an ob/gyn at the University of New Mexico Center for Reproductive Health, told ProPublica. “The patient will continue to bleed and have a higher risk of going into hemorrhagic shock.” Ultimately, the medical examiner found Porsha’s cause of death to be hemorrhage, the outlet noted.

Some physicians said Porsha’s case “raises serious questions about how abortion bans are pressuring doctors to diverge from the standard of care and reach for less-effective options that could expose their patients to more risks,” ProPublica reported. And, “[d]octors and patients described similar decisions they’ve witnessed across the state.”

The obstetrician involved in Porsha’s care did not respond to emails, texts, or calls, ProPublica noted. Houston Methodist officials declined to answer a list of questions about Porsha’s treatment, and did not comment when asked whether the obstetrician’s approach was its “routine.”

However, a spokesperson for the hospital told ProPublica that “each patient’s care is unique to that individual.”

“All Houston Methodist hospitals follow all state laws,” the spokesperson further told the outlet, “including the abortion law in place in Texas.”

UnitedHealth Pays Its Own Physician Groups More Than Others

UnitedHealth Group pays many of its physician practices “significantly more” than other groups “in the same markets for similar services,” a STAT investigation found.

The “above-market payments” were discovered in an analysis conducted in partnership with health analytics company Tribunus Health. It looked at data that UnitedHealth reported to the federal government revealing what its commercial insurance unit pays 16 Optum-branded physician groups for common or expensive services.

Ultimately, the analysis found that insurance subsidiary UnitedHealthcare paid 13 of the Optum practices more on average for common services than market price, STAT reported. The finding varied from 3% to 111% above market price.

“The higher prices reward UnitedHealth at the expense of almost everyone else,” STAT wrote. “Patients end up paying more when they see their doctors and struggle to afford recommended follow-up care. Employers counting on the insurance giant to control ever-rising costs get little or no relief. And doctors trying to compete with UnitedHealth’s practices find themselves frozen out of the higher rates the company is paying its own providers, making it more difficult to remain independent and keep their doors open.”

STAT noted that its analysis had limitations and was not comprehensive. UnitedHealth’s data files were “imperfect” and did not include certain information, the outlet noted. And the analysis included just a subset of common services.

Prior to publication, STAT shared its analysis and a list of questions with UnitedHealth. Though the company declined to make a representative available for an interview, spokesperson Eric Hausman provided a statement to STAT that called the analysis “flawed.”

The company further told STAT that it ran its own analyses and asserted that, “UnitedHealthcare pays Optum Health consistent with other payers in the market.” It declined to share its analyses with the outlet.

Experts Call For Removal of Menopause Documentary from CME

A dozen women’s health experts called for the Federation of State Medical Boards (FSMB) to remove a new documentary about menopause from its continuing medical education program, STAT reported.

“The M Factor: Shredding the Silence on Menopause” can be seen on the Public Broadcasting System. But the group of academics and researchers raised concerns that it makes misleading and inaccurate statements about hormone therapies, STAT reported.

“This documentary film makes numerous unsupported claims, including recommendations for off-label uses of menopausal hormone therapy that are unsupported by evidence, and is rife with misinformation, including statements that directly contradict warnings in FDA-approved product labeling,” they wrote in a November letter to the FSMB. “A major concern is that this film could lead to unsafe and ineffective prescribing.”

Specific examples the experts took issue with and rebutted in their letter included statements made in the documentary regarding the use of menopausal hormone therapy for the prevention of cardiovascular disease and to potentially lower the risk of dementia, depression, anxiety, or Parkinson’s disease.

A spokesman for the FSMB told STAT that the “matter is under review.”

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