FHI's Week in Review - 7/22/19 - OD deaths down + Seema Verma reports on latest ACO enrollment

Volume VI, Issue 29

July 22, 2019

U.S. Overdose Deaths Dipped In 2018, But Some States Saw 'Devastating' Increases

Selena Simmons-Duffin reports for NPR via Health News Florida on 7/18/19:

Good news came out from the Centers for Disease Control and Prevention Wednesday: Preliminary data shows reported drug overdoses declined 4.2% in 2018, after rising precipitously for decades...But not everyone was celebrating. Some states actually saw double-digit increases.

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"It is still a nightmare. And the danger in media over-portraying this is actually quite substantial," says Shawn Ryan , MD, an addiction doctor in Ohio and past-president of the Ohio Society of Addiction Medicine. "If we look at just that decrease nationally - which is not that big - we're missing the point. In order to get back to baseline, we have a very long way to go."

More ACOs Taking Accountability Under MSSP Through 'Pathways to Success'

CMS administrator Seema Verma, writes in a Health Affairs post dated 7/17/19:

Today, I am pleased to announce ACO participation data under Pathways to Success for the July 1, 2019 start date. CMS approved a total of 206 ACO applications for this start date, increasing the total number of Medicare fee-for-service beneficiaries who receive care from health care providers in ACOs from 10.5 million to 10.9 million. Forty-one of the 206 ACOs (20 percent) are entirely new; 25 (12 percent) are re-entering after a period of time when they did not participate as an ACO; and the remaining 140 (68 percent) are renewing their agreements. (Eighteen of these 140 ACOs chose to renew early, before their current agreement period ended.)

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According to Ms. Verma:

When CMS launched Pathways to Success, some industry stakeholders suggested that ACOs may not enroll in the new participation options, since they require ACOs to take on accountability for cost increases more quickly. However, today's results show that American providers are ready for the value-based transformation and are willing to accept greater accountability in exchange for more flexibility. The participation rates for July 1, 2019 are in line with what the agency projected when Pathways to Success was launched, putting CMS on track to generate the $2.9 billion in savings over ten years that were projected. This translates to a more sustainable Medicare program.

Medical Malpractice "Shock Loss Claims" are on the rise

Matt Gracey writes in a July 16, 2019 post at FloridaHealthIndustry.com:

Insurance underwriters use simple loss ratios (losses and expenses divided by premiums) as one of the tools with which to gauge a company's suitability for coverage. High loss ratios, in which the losses approach, equal, or exceed the premium, are not good. One factor that has a large effect on loss ratios are "shock loss" claims, catastrophic losses so large that they have a material effect on the underwriting results of an entire insurance company.

He goes on to describe several large malpractice judgements over the last year and a half.

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According to Mr. Gracey:

These awards and settlements are not to be taken lightly; their implications are far reaching. We are already seeing rate increases across the board in Florida and other states. Many doctors are receiving their renewal policies to discover their rates have been increased 30% - 40%.