Week of September 28-October 2, 2015


ACA Implementation
33 million Americans, 10.4 percent of the U.S. population, still went without health insurance for the entirety of 2014. Millions more were uninsured for at least part of the year.  New data released this month shows they were disproportionately poor, black and Hispanic; 4.5 million of them were children. 33 Million Americans Still Don’t Have Health Insurance – Here’s who they are.
Read this report from 538EconomicsNavigators and in-person assisters continue to play a key role in helping consumers get coverage through the insurance Marketplaces.  Navigators and Assisters in the Third Open Enrollment Period.
Read this brief from Health AffairsIn two new Wall Street Journal “Experts” blog posts, Commonwealth Fund President David Blumenthal, M.D., addresses important issues on the health policy horizon—precision medicine and potential changes to the Affordable Care Act (ACA).
Read the WSJ posts: 1 and 2

Health Care Operations and Management
Nursing shortages a decade from now will not be as severe as previously projected, according to new research. A 2000 study in JAMA predicted that rising demand for nurses, coupled with a wave of retirements, would lead to a shortage of as many as 800,000 nurses by 2020.  Overall, the new researchers forecast a shortage in 2025 of about 130,000 nurses.
Read why in this publication from Medical Care

Reducing hospital readmissions for patients with heart failure (HF) is a national priority. A goal has been set to reduce readmissions by 20% or more via national quality improvement campaigns. Despite the increased effort towards reduction in readmission rates, almost no hospitals have reduced HF readmissions by 20% over the last four years.
Read this research report from The Journal of Cardiac Failure 

Hundreds of hospitals are believed to have settled with the government as part of a year’s long, nationwide investigation into the suspected overuse of implantable cardioverter defibrillators.  The U.S. Justice Department may announce in the coming weeks what may be the largest False Claims Act investigation and recovery ever in terms of the number of hospitals involved.
Read this article in Modern Healthcare 

While the U.S. health-care system isn’t evolving as quickly as it needs to, the hospitalist story offers hope, demonstrating the capacity of the system to undergo transformative, even disruptive, change.  How Hospitalists Have Innovated U.S. Health Care.
Read this WSJ blog post from Dr. Robert M. Wachter, Professor and Associate Chairman of the DOM at the UCSF

With a projected shortfall of oncologists and a doubling in the number of cancer survivors in some high-income countries by 2030, primary care clinicians will be increasingly relied upon to play a larger role in cancer care, says a major new commission composed of experts from North America, Europe, and Australia. The document sets out a series of proposals to improve the integration of care and better equip primary care physicians to identify and follow cancer patients.
Read the Lancet Oncology article, “The expanding role of primary care in cancer control

The telehealth boom still faces some big challenges. Many insurance companies have been slow to pay for telemedicine. Medicare is a financial powerhouse and insurance companies often follow its lead on payments. Medicare only pays for telemedicine in rural or medically underserved areas and only when video conferencing is used. But telemedicine has broadened as technology has developed.
Read this report from KHN, Telemedicine Expands Despite Uncertain Financial Prospects

CMS and Medicare/Medicaid
The CMS will begin paying the same as private insurance rates for clinical diagnostic laboratory tests starting January 1, 2017, according to a proposed rule announced Friday. The move could result in a large cuts in payments to laboratories. Medicare paid between 18% and 30% more than other insurers for some lab tests, an HHS Office of Inspector General report found.  CMS proposes $5 billion cut in lab test fees.
Read the article from Modern Healthcare

The CMS Innovation Center is beefing up reporting requirements in a revived Partnership for Patients program whose initial three-year effort fell short of expectations in reducing hospital-acquired conditions that cause patient harm. CMS toughens reporting requirements in revived Partnership for Patients effort.
Read this report from Modern Healthcare

The Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) is announcing a new demonstration model today to test changes to the Medicare Part D program. The goal of the Part D Enhanced Medication Therapy Management (“MTM”) Model is to deliver greater value and better health outcomes for Medicare and its Part D beneficiaries. Realigning Medicare Part D Incentives: A New Model For Medication Therapy Management.
Read this post from Health Affairs

The government reviews less than 1 percent of the information filed annually by provider networks for adequacy and accuracy. It looks only at the networks of plans entering new markets and not at those in existing markets, the GAO said. The General Accountability Office study found the CMS, which administers Medicare Advantage plans, primarily relies on complaints from consumers to determine if they are having trouble getting appointments with providers.
Read this article from KHN, GAO: “More Oversight Needed Over Medicare Advantage Provider Networks”

Medicare’s quality incentive program for hospitals, which provides bonuses and penalties based on performance, has not led to demonstrated improvements in its first three years, according to a federal report released Thursday. The Government Accountability Office examined the Hospital Value-Based Purchasing Program, one of the federal health law’s initiatives to tie payment to quality of care.
Read this article from KHN, Hospital Care Unaffected By Quality Payments, GAO Finds

Population Health
The health sector has a growing need to use modeling to inform policy decisions and for selecting and refining potential strategies (e.g., ranging from interventions to investments) to improve the health of communities and the nation. A growing interest in systems science approaches to population health has led public health researchers, regulators and others to turn to modeling more than ever, and many types of models have been used to forecast health effects associated with current and future risk behaviors.
Read this new report from the IOM, How Modeling Can Inform Strategies to Improve Population Health: Workshop Summary

With today’s emphasis on population health strategies to address “upstream” factors affecting health care, such as housing and nutrition deficiencies, there is growing interest in the potential role of hospitals to be effective leaders in tackling upstream factors that influence health, social and economic well being. This paper from the Brookings Institute explores the potential of hospitals to be such hubs by examining the experience of Washington Adventist Hospital (WAH), a community hospital in Maryland. Hospitals as hubs to create health communities: Lessons from Washington Adventist Hospital.
Read the paper

Health Care Finance and the Market
Just as there are many types of medical tests to assess a person’s health, there are numerous measures of economic performance that can be used to evaluate “economic health.” The Health Care Cost Institute (HCCI), with grant funding from the Robert Wood Johnson Foundation (RWJF), has developed a series of metrics, collectively referred to as the Healthy Marketplace Index (HMI), to assess the economic performance of health care markets, both across markets and within markets over time.
Read the 2015 Healthy Marketplace Index Report

Is profit or innovation driving the rising costs of drugs? Judy Woodruff discusses the rising costs of prescriptions drugs with Dr. Peter Bach of Memorial Sloan Kettering Cancer Center and Dr. Thomas Stossel of Harvard Medical School.
Listen to NPR interview or read the transcript

In February the Centers for Medicare and Medicaid (CMS) announced an accelerated goal to transition health care providers from the traditional fee-for-service reimbursement model to a bundled payment model. That means over the next five years, assuming the proposed rule is implemented on the stated timeline, there should be $800,000 in mandated Medicare cost savings required from Nashville providers who are involved in patient care for total hip and knee procedures.
Read this analysis of the impact on the Nashville, Tennessee healthcare marketplace

Quality in Health Care
Despite its deadly and costly toll of $312 billion, cardiovascular disease continues to be perceived as “a man’s disease,” a perception proven wrong again and again by emerging health data analyses, which serve as important reminders of the critical differences between men’s and women’s health. One such analysis is a new report from the Blue Cross Blue Shield Association and Blue Health Intelligence titled “Disparities Identified in Post Heart Attack Treatment between Women and Men.” 
Read this Health Affairs blog which links to the report

The Joint Commission (JC) wants healthcare facilities to pay more attention to falls and fall-related injuries and to implement proven prevention strategies. Falls resulting in injury are a “prevalent patient safety problem,” and not just among the elderly and frail. 
Read this Joint Commission Sentinel Event Alert, “Preventing falls and fall-related injuries in health care facilities

Researchers from the Commonwealth Fund summarize key lessons from their evaluations, highlighting which strategies, and how many, were most effective in helping to lower hospital readmission rates. Only one strategy was consistently associated with reductions in risk-standardized readmission rates: discharging patients with their follow-up appointments already made, which was associated with a 0.63 percentage point reduction in readmission rates. No other single strategy proved significant, however. Yet, hospitals that implemented three or more different strategies had significantly greater reductions in risk-standardized readmission rates than hospitals that implemented less than three strategies.
Read the post, National Campaigns to Reduce Readmissions: What Have We Learned?


A Health-Care Model in Coal Country. David Feinberg leads a data-driven effort to provide better care for lower cost(WSJ)

70,000 Ways to Classify Ailments.  Enormous expansion of codes doctors use will change paperwork, insurance, monitoring(WSJ)

Men and Women Differ in How They Experience Disease, Respond to Treatment.  Alzheimer’s, nicotine addiction and lung cancer are among the areas where big differences have been found.  (WSJ) 

Why Big Pharma’s patient-assistance programs are a sham (Los Angeles Times)

Medicare paid $30 million for ambulance rides for which no record exists that patients got medical care at their destination, the place where they were picked up or other critical information.  Medicare’s $30M ambulance-ride mystery(AP News)

Health-care stocks suffered an ugly tumble on Monday, dragging down the overall Dow Jones Industrial Avera by nearly 2%.   The Biotech Rout-Investors sell as hostility to innovation rises in Washington(WSJ) 

Meet the four hospital and health care innovators who were just named MacArthur Foundation ‘geniuses’. (Advisory Board)

“New York state lags nation in organ donor registrations” as the first Organ Donor Enrollment Day comes up Oct. 6th (Excellus BC/BS) 

Geisinger acquires AtlantiCare this week.  Read how Geisinger Health System will extend its reach eastward into New Jersey as it absorbs the Atlantic City-based integrated health system AtlantiCare into its organization (Modern Healthcare) 

Hillary Clinton to Propose Scrapping Health Law’s ‘Cadillac Tax’.  (The New York Times) 

Nursing Homes Bill for More Therapy Than Patients Need, U.S. Says.  (The New York Times)

Federal health-care plan costs to rise by most in five years.  (The Washington Post) 

Telemedicine Expands, Though Financial Prospects Still Uncertain. (NPR)

4 Ways Companies May Adjust to Looming Employee Benefits Tax.  (AP News)

Millions More Need H.I.V. Treatment, W.H.O. Says.  (The New York Times) 

Mayor’s Initiative Could Boost Immigrant Health-Care Access.  (WSJ)

Millions of Americans Are Getting Lost in Translation During Hospital Visits. (Smithsonian Magazine)

Why Health Care Mergers Can Be Good for Patients(Harvard Business Review)

Health insurers to receive a fraction of what they’re owed under ACA program(The Washington Post) 

Bill Waiving Insurance Rules for Midsize Businesses Clears Senate. (WSJ) 

Will nation follow California on healthcare for immigrants here illegally? (Los Angeles Times)

Two Substantive Sides to Debate Over Obamacare’s ‘Cadillac Tax’.  (WSJ Think Tank)

Johns Hopkins part of $100 million initiative to study the brain.  (Baltimore Sun)



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