Week of September 21-25, 2015


ACA Implementation
For states now using the federally facilitated exchange, the option to keep the familiar interface—and avoid the costs of building or buying a new one—may mitigate the most significant financial obstacle to the creation of a state-based exchange. 
Read this research report from The Commonwealth Fund, The Experiences of State-Run Marketplaces That Use HealthCare.gov. 

House v. Burwell raises two claims. First: Did the Obama administration violate the law by delaying the effective date of the Affordable Care Act’s (ACA) employer mandate? And second: Did the administration violate the law by using marketplace premium subsidy monies to pay insurers for the cost-sharing assistance they provide to eligible plan members, even though lawmakers never appropriated separate funding to do so? 
Read this Commonwealth Fund post, House of Representatives Sues Secretary Burwell, Round 1

Health Care Operations and Management
The new federal health information technology plan focuses less on the implementation of IT systems and more on patients and their healthcare.
Read this article in Modern Healthcare that links to the Federal Health IT Strategic Plan

Physicians have traditionally been reimbursed for face-to-face visits. A new non–visit-based payment for chronic care management (CCM) of Medicare patients took effect in January 2015. … If nonphysician staff were to deliver CCM services, net revenue to practices would increase despite opportunity and staffing costs. 
Read this research publication from the Annals of Int Medicine, Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices: A Modeling Study

CMS and Medicare/Medicaid
The CMS’ Pioneer accountable care organizations are reducing the number of services they provide to patients that have minimal clinical benefit, a study in JAMA Internal Medicine found. 
Read Changes in Low-Value Services in Year 1 of the Medicare Pioneer Accountable Care Organization Program

The CMS said Monday that the average Medicare Advantage premium for 2016 will be $32.60 a month, a drop of 31 cents a month from this year. Almost 3 in 5 Advantage beneficiaries will not face a premium hike next year, the CMS said. But perhaps more important, experts say, is that 95% of Medicare enrollees will live in an area that offers a private plan with no monthly premium. 
Read this Modern Healthcare report  

Two health policy professors, Jonathan Oberlander at the University of North Carolina and Miriam Laugesen at Columbia University, called Medicare’s new physician payment system a “leap of faith” because it relies on a school of thought that is uncertain of working on a national scale. 
Read the research publication from the NEJM, Leap of Faith — Medicare’s New Physician Payment System

Academic Medicine
The annual panel discussion, called “Life Over 90,” is aimed at nudging students toward choosing geriatric medicine, the primary care field that focuses on the elderly.
Read this report from Kaiser, Seniors Tell Medical Students What They Need From Doctors

Health Care Finance and the Market
The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2015, average annual premiums (employer and worker contributions combined) were $6,251 for single coverage and $17,545 for family coverage. Both premiums rose 4 percent from 2014, continuing several years of modest growth. 
Read this publication from Health Affairs, Health Benefits In 2015: Stable Trends In The Employer Market

 This new website provides information on quality for five common conditions or procedures: childbirth, hip and knee replacement, colon cancer screening, diabetes, and back pain.  And it gives cost information — by California counties for 100 procedures, ranging from treating a broken ankle to cancer chemotherapy. 
Read this article from Kaiser, Attention Shoppers:  New Calif. Website Details Costs, Quality of Medical Procedures

More healthcare organizations view prescription drug use as a critical element of keeping patients healthy and reducing costs, and controlling a pharmacy benefit management firm (PBM) could help with a population health strategy. 
Read this article from Modern Healthcare, How the national drug debate is changing the pharmacy benefit business

Quality in Health Care
The National Committee for Quality Assurance has scrapped its old ranking system for health plans and instituted a new ratings system that’s similar to what the CMS has implemented for providers and Medicare Advantage plans.  NCQA nixes health plan rankings in favor of ratings. 
Read this Modern Healthcare report

Most people will experience at least one diagnostic error — an inaccurate or delayed diagnosis — in their lifetime, sometimes with devastating consequences, states a new report from the IOM, Urgent Change Needed to Improve Diagnosis in Health Care or Diagnostic Errors Will Likely Worsen

The National Committee for Quality Assurance (NCQA) released a new set of ratings for more than 1,000 health plans across the United States. The new rating system is modeled after CMS’s star ratings of Medicare Advantage plans. Visit the NCQA website for more,


Health-Care Providers, Insurers Supersize. (WJS)

Justice Department Delays Ruling on Aetna-Humana Merger. (WSJ)

Medicare’s Proposed Changes on Prosthetics Stirs a Fight.  (WSJ)

After the VA scandal, veterans were told their wait for care would get shorter. But it’s actually getting worse.  (The Washington Post)

Pittsburgh hospital looks for mold source after three deaths.  (Reuters)

New York City’s public hospital system head to reorganize hierarchy emphasize ambulatory care. (Politico NY)

Why Consumer Issues Are Rising on the Health Agenda. (WSJ)

HHS Secretary Says Coming Sign-up Season Will Be Toughest Yet Under Health Law(WSJ)

Audit Finds Deficiencies in New York State’s Health-Insurance Exchange.  (WSJ)

An Aging Population, Without the Doctors to Match (The New York Times, OpEd)

Why Cleveland Clinic Shares Its Outcomes Data with the World(Harvard Business Review)

Obesity Maps Put Racial Differences On Stark Display.  (NPR)



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