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Wednesday, April 19, 2017
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CMS published a final rule last week designed to help stabilize the Obamacare marketplace and keep insurers from leaving. Among other things, it shortens the enrollment period, adds restrictions to special enrollment periods and gives insurers more flexibility in determining the value of coverage. Some experts say the changes could make it harder for some consumers to purchase insurance, and could raise out-of-pocked costs. (
Reuters;
CMS announcement)
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Milliman released profiles of individual health insurance markets organized by state. The information was compiled from the 2017 open enrollment period data. It includes insurer financials, marketplace enrollment and federal assistance provided to households purchasing insurance coverage through the marketplaces. It can be used to inform future policy decisions, wade through 1332 Waiver requirements and understand marketplace enrollment trends. (
Milliman)
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Trade and professional groups representing insurers, doctors and hospitals--and the U.S. Chamber of Commerce--are asking the Trump administration and congressional leaders to fund the Affordable Care Act’s cost-sharing reductions for this year and next, calling it “the most critical action” that could be taken to stabilize health insurance exchanges. (
Morning Consult)
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Innovation & Transformation
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Kaiser Health News tells how 14-bed Lost Rivers Medical Center in Idaho was about to close before transforming itself. It became a model for how rural hospitals can use digital technology--specifically, telemedicine--to remain financially stable and maintain access to care. “We can, in effect, bring the provider to the community without physically doing so. Even in urban areas, people want more and more convenience... Here we are talking more about necessity,” explains Keith Mueller, director of the Center for Rural Health Policy Analysis at the University of Iowa. (Kaiser Health News)
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Hospitals that participated in at least one of three voluntary value-based care initiatives--Meaningful Use, the ACO programs and the Bundled Payment for Care Initiative--reported a greater reduction in readmission rates than those that didn’t participate, according to research published in
JAMA Internal Medicine. Specifically, 2,400 fewer people out of nearly 275,000 returned to the hospital, resulting in $32 million in savings. “Hospital participation in voluntary value-based reforms was associated with greater reductions in readmissions. Our findings lend support for Medicare’s multipronged strategy to improve hospital quality and value,” the researchers concluded. (
Advisory Board Daily Briefing;
JAMA Internal Medicine)
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Ben Southwood, head of research at the Libertarian Adam Smith Institute, doesn’t like those studies that compare U.S. health care to that of other countries; it leads to a misguided analysis, he says. His solution? “Scrap incentives that push people to get too much health care and deregulate the system to increase competition and push down costs.” (
AdamSmith.org blog)
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CMS has updated its payment policies for inpatient and long-term care. Inpatient operating prospective payments are projected to increase 2.9 percent in fiscal year 2018, but payments to long-term care hospitals are projected to decrease by about 3.75 percent. CMS is proposing to relax clinical quality measure reporting requirements for hospitals that have implemented EHR systems. (
Healthcare Finance News
)
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Researchers, using time stamps to analyze primary care physicians’ clinical time, found PCPs logged an average of 3.08 hours on face-to-face office visits and 3.17 hours on desktop medicine each day. Desktop medicine includes communicating with patients through a secure patient portal, responding to online refill requests and reviewing test results. The records indicated a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated to desktop medicine. (
Health Affairs)
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When doctors use a recommended short course of radiation therapy for women with early stage breast cancer, the savings are significant, according to Duke University researchers. Moreover, numerous studies have shown the short course to be as effective as longer, costlier regimens. Still, fewer than half of those eligible for the short course get it. The researchers estimate one year of extra care costs $164 million. (
HealthLeaders Media)
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Focus on AHRQ: AHRQ has a tool kit designed for hospitals that want to reduce readmission rates: “Designing and Delivering Whole-Person Transitional Care: The Hospital Guide to Reducing Medicaid Readmissions: Toolbox.” (
AHRQ)
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Not that good, not that bad: Indiana’s conservative Medicaid experiment, Healthy Indiana Plan 2.0, is neither the shining example for the nation the Trump administration describes, nor is it as frightful as some critics have contended. (
FierceHealthcare)
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Battling fake news: Health care professionals have been dealing with “fake news” a lot longer that it’s been in the headlines.
Vox shares some of their tips and tactics for winning the battle for truth. (
Vox)
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The U.S. Preventive Services Task Force is changing one aspect of its prostate cancer recommendations. It now recommends asymptomatic men ages 55 to 69 discuss potential benefits and harms of prostate cancer screening with their providers rather than avoiding screening outright. It calls for “informed, individualized decision making based on a man’s values and preferences.” The USPSTF has created a
graphic to illustrate its recommendations. (
Scientific American;
graphic)
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MarketVoices...quotes worth reading
In the U.S., “it’s not even obesity, or indeed their greater pre-existing disease burden, that is doing most of the work in dragging their life expectancy down; it's accidental and violent deaths. It is tragic that the U.S. is so dangerous, but it's not the fault of the healthcare system; indeed, it's an extra burden that U.S. healthcare spending must bear.”--Ben Southwood, head of research at the Libertarian Adam Smith Institute in an AdamSmith.org blog post
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Copyright 2009-2017,
H2R Minutes
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