Thursday, August 23, 2018
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Hospital associations are taking issue with CMS’s proposed Hospital Outpatient Prospective Payment System (OPPS) rule, arguing it will impair patient access to care and increase out-of-pocket costs. The proposed rule includes site-neutral payments. CMS intends this change to encourage patients to receive care where they choose without the potential for high out-of-pocket co-pays. The Community Oncology Alliance says the change would mean lower costs for cancer patients.
(
PatientEngagement HIT
;
CMS Factsheet
)
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Among those with employer coverage, nearly one in five inpatient admissions includes a claim from an out-of-network provider, according to a new Kaiser Family Foundation analysis of medical bills from large employer plans. This means patients face higher cost-sharing and potential additional bills from providers. Another finding: Enrollees using outpatient mental health services are significantly more likely to have a claim from an out-of-network provider.
(
Peterson-Kaiser Health System Tracker
)
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Innovation & Transformation
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Digital manufacturing in the pharmaceutical industry holds tremendous potential. The technology exists today
—
all of it digitally connected via the Internet of Things
—
but no pharmaceutical company has fully leveraged it, according to a paper from McKinsey & Co. The reason: Organizations need visionaries who “understand the impact will come in successive horizons, not all at once in the next budget cycle.” Organizations need to think of digital not as a collection of tools, but “as a means of transformation, requiring technology and people.” (
McKinsey & Co.
)
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ID.me recently announced it’s the first digital identity-verification platform to earn approval as a full credential service provider from the Kantara Initiative. The network will require users to verify their identity only one time in the ID.me ecosystem, opening the door to interoperability. ID.me plans to open its approved, white-label technologies to government and health care next year.
(
Healthcare Analytics News
)
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George Hahn had two echocardiograms, a year apart. Same hospital, same insurance plan, same test. The first cost $170, the second $3,101. The
Philadelphia Inquirer
investigated. The first test was done by an independent cardiology group with offices at Paoli Hospital. The second was performed by the hospital, also in the insurer’s network. It comes down to bargaining, of course. Hahn isn’t giving up. “Hahn recently paid $500 toward the $3,101 he owes. But he's waiting for a better explanation for the charge before paying the rest,” the paper reports.
(
Philadelphia Inquirer
)
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Women suffering a heart attack have the best chance of survival if they are treated by a female physician, according to research published in the
Proceedings of the National Academy of Sciences
. Moreover, male doctors who have treated more women, or who have more female physicians as colleagues, appear to be more effective at treating female heart attacks than their male colleagues without that experience. (
Proceedings of the National Academy of Sciences
;
CBC
)
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OTC allowance
:
Anthem and Walmart are launching a program aimed at increasing access to over-the-counter medications and health products. Anthem beneficiaries can use OTC allowances to buy their medications and health items at Walmart.
Healthcare Dive
describes this as “the latest in industry’s efforts to capitalize on the aging population.” (
Healthcare Dive
)
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Eliminating debt
: NYU School of Medicine announced last week it will provide all current and future students full-tuition scholarships to attend medical school. According to
Modern Healthcare, it’s the first major institution to do so.
(
Modern Healthcare
)
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Pharma fights back
:
States are taking an increasingly hard stance on pharmaceutical companies, forcing them to disclose and justify price increases. However, drugmakers are fighting back, challenging the state laws and framing the issue as one of constitutional rights.
(
The New York Times
)
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NewsHour
explores why some patients pay considerably more for medicine
—
even generics
—
than the actual cost. In one case, a patient paid a $285 copay for a $40 drug. Insurance copays are higher than the cost of the drug about 25 percent of the time, according to research from the University of Southern California’s Schaeffer Center for Health Policy and Economics. (
PBS NewsHour
;
study
)
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MarketVoices...quotes worth reading
“You have insurance because your belief is, you’re paying premiums, so when you need care, a large fraction of that cost is going to be borne by your insurance company. The whole notion that you are paying more for the drug with insurance is just mind boggling, to think that they’re doing this and getting away with it.”
—
Geoffrey Joyce, a USC economist who co-authored a study on drug copays, on
PBS NewsHour
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Editor
Sandy Mau
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H2R Minutes
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