HHS Announces Major Payment Shift from Fee-for-Service to Value or Quality

HHS last week announced a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as ACOs or bundled payment arrangements by the end of 2016, and 50 percent of payments to these models by the end of 2018. HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs. This is the first time HHS has set explicit goals for alternative payment models and value-based payments.

  • Click here for the HHS announcement.
  • Click here for the NY Times story.
  • Click here for a very good HHS backgrounder.


Vascular Procedures Drawing New Scrutiny

A new report is focusing the spotlight on a small number of vascular surgeons, radiologists and cardiologists performing stent procedures in limbs and mostly outside of hospitals. The number of procedures to open blockages in heart vessels fell by about 30 percent from 2005 to 2013, to about 323,000 for patients covered under Medicare. Over the same time, the number of similar procedures for vessels outside the heart soared by almost 70 percent to 853,000, according to the Advisory Board Company. Click here for the NY Times story.


North vs. South: Battle Over Diagnostic Testing

Unnecessary diagnostic testing of senior is getting increasing scrutiny, particularly in Florida as retirees flock to the Sunshine state, according to reports last week. In fact, northern physicians are beginning to warn their elderly snowbird patients about Florida physicians who may be prescribing unnecessary procedures. According to one analysis, more than twice the number of nuclear stress tests, echocardiograms and vascular ultrasounds were ordered per Medicare beneficiary in doctor’s offices in Florida than in Massachusetts. Click here for the NY Times story.


GAO Report Finds Wide Geographic Variations in Hospital Spending

Hospital charges–particularly those incurred just as a patient is admitted–are driving a lot of geographic variation in health care spending, according to a study from the GAO released last week. The GAO examined the cost to private insurers in 2009 and 2010 for three fairly pricey procedures–coronary stent placement, laparoscopic appendectomy and total hip replacement. Its conclusion was no surprise: in some of areas of the country, the cost of those procedures are as much as 94 percent higher than it is in other parts. Click here for the GAO report. Dallas area hospitals were pegged as among the most expensive, according to the Dallas Morning New. Click here for that story and the hospital response.


Commission Recommends Ending TRICARE

The commission created by Congress to develop recommendations to overhaul military pay and benefits is pushing to dissolve the Tricare health care system. The panel is recommending the development of a new health care system in which active-duty family members, members of the Reserves and retirees would pick private-sector insurance from a menu of plans. Active-duty family members would be reimbursed for the cost of these private-sector plans through a new Basic Allowance for Health Care. Click here to review all the recommendations.


Measles Outbreak Largest in Two Decades; CDC Recommends Action

As officials in 14 states grapple with a measles outbreak, the parents at the heart of America’s anti-vaccine movement are being blamed for a public-health crisis. Click here for the story. From January 1 to January 28, 2015, 84 people from 14 states were reported to have measles, according to the CDC. Most of these cases are part of a large, ongoing outbreak linked to an amusement park in California. Click here for the latest update from the CDC.The CDC urged Americans last week to get vaccinated for measles, saying that 2014 saw the highest number of cases in two decades. Click here.


Hep C Drug Battle Underway for State Medicaid Programs

A battle is raging in many states between two major Hep C drug companies as they each try to corner the Medicaid market. Missouri and Connecticut are among the states that are either negotiating or securing discounts on expensive new hepatitis C drugs. The state deals follow a series of high-profile supply contracts that drug makers Gilead Sciences Inc. and AbbVie Inc. have signed in recent weeks with insurance companies and pharmacy-benefit managers, in exchange for undisclosed discounts. Click here for the WSJ story.


Study: Organ Transplants Saved More than 2 Million Years of Life in US

Organ transplants have saved more than 2 million years of life in the United States over 25 years, new research shows. But less than half of the people who needed a transplant in that time period got one, according to a report published last week in JAMA Surgery. The number of years of life saved by type of organ transplant were: kidney, 1.3 million years; liver, more than 460,000; heart, almost 270,000; lung, close to 65,000; pancreas-kidney, almost 80,000; pancreas, just under 15,000; and intestine, about 4,500. Click here for the abstract and to access the report. Click here for the news summary.


Medical Errors a Leading Cause of Death: New Analysis

Medical errors kill more people than car crashes or new disease outbreaks, according to a new report out last week. They kill more people annually than breast cancer, AIDS, plane crashes, or drug overdoses. Depending which estimate you use, medical errors are either the 3rd or 9th leading cause of death in the United States. This Vox report is also collecting patient error information through a survey at the end of the report. Click here.


High Cost Drugs May Be Insurance Plan to Keep Out Sicker Patients: Reports

Patient groups say they’ve spotted an alarming trend of some health insurance plans designing drug benefits to purposefully keep out sicker, costlier patients, according to reports last week. Rather than reject coverage for sick patients altogether, some insurers are placing high-cost medications for chronic conditions into the highest-priced tiers of the drugs they cover, which would force patients to pay potentially thousands of more dollars out of pocket for essential medications. Click here for more. Click here for the New England Journal of Medicine analysis.


GOP Plans to Repeal ACA Coming Together

A growing number of congressional Republicans want to use a contentious budget procedure to dismantle the Affordable Care Act, according to senior lawmakers and aides involved in discussions over the strategy the Wall Street Journal Reported late last week. A final decision could be weeks if not months away, but Republican lawmakers and aides say there is broad support for using the budget reconciliation process to repeal the Act and potentially replace it with a GOP alternative. Click here for the story. How would an Obamacare repeal impact the federal budget? The CBO says it cannot make that determination at this time. Click here for the CBO letter.


Public Health Experts Detail Human Cost of Supreme Court Decision on Subsidies

A group of public health experts — 19 deans of public health schools and the American Public Health Association — says that if the Supreme Court nullifies subsidies in states with federal health exchanges, it would result in about 9,800 otherwise preventable deaths annually. They looked at a study based on the universal health coverage in Massachusetts, which found that for every 830 adults with new coverage, there was one fewer death. The details are in the brief they filed with the Supreme Court. Click here.


CMS May Reform EHR MU Reporting Period to 90 Days

CMS is looking at scaling back the 2015 requirements set for demonstrating meaningful use of EHRs. Among the proposals being considered by the agency is implementation of a 90-day reporting period instead of a full year. In addition, the CMS is looking at aligning the reporting times for eligible professionals and hospitals with the calendar year. Click here for more. Legislation mandating the 3 month reporting period was introduced by Rep. Renee Elmers (R-NC) and already has 15 cosponsors. Click here for the bill summary.


Empty Beds Plague Illinois Hospitals

Illinois hospitals, like other facilities in rural areas, face an epidemic of empty beds. Nearly 40 percent of the state’s beds went unused in 2013, Crain’s Chicago Business reported last week. The median statewide occupancy rate is only 53 percent, with fairly stark contrasts between the rates in urban centers–which are about 10 points higher than the median–and rural regions. Click here for the story.


Obama Wants $215 Million for Bio Research Plan

President Obama is putting $215 million of his fiscal 2016 budget, due out today, towards a biomedical research initiative that includes collecting the genetic data of one million Americans. Click here for the NY Times report.


PCMH Studies Show Growing Effectiveness

A majority of the studies released over the course of the last year indicate positive trends in cost and utilization for primary care PCMH interventions, with 28 publications highlighting improvements since September, 2013 — according to a new report from the Patient-Centered Primary Care Collaborative. This is a great summary analysis of the growing effectiveness of PCMH and related strategies. Click here.


Medicaid Responsible for Most Growth in Insurance Coverage: Report

During the first nine months of 2014, the number of Americans with health insurance grew by 8.4 million, and Medicaid is responsible for 89 percent of that, according to a Heritage Foundation analysis based on insurers’ quarterly reports. While enrollment in the individual market increased dramatically during the first two quarters of last year, it declined somewhat in in the third quarter, putting the net increase for all three quarters at 5.8 million people. Click here for the report. More states are leaning toward expanding Medicaid. Click here for the update.


Less than Half of Workers Had Employer Health Coverage in 2013

Less than half of workers had health coverage through their employers in 2013 in a trend that began before the last recession and accelerated since then, according to a study released last week. The data suggest that both workers and employers were trending away from workplace coverage even before the Affordable Care Act began offering alternatives through the Medicaid expansion and exchanges in the states. Click here for the study.


Government Releases National Health IT Roadmap

A new report from the federal health IT coordinator calls for most providers to be able to use their EHR systems to send, receive and use “a common set of electronic clinical information … at the nationwide level by the end of 2017.” Click here. HHS is focused on three key areas: (1) improving the way providers are paid, (2) improving and innovating in care delivery, and (3) sharing information more broadly to providers, consumers, and others to support better decisions while maintaining privacy. The draft Roadmap identifies critical actions to achieve success in sharing information and interoperability and outlines a timeframe for implementation. Click here for the Roadmap website.


GOP Senators Release Plan to Reform NIH, FDA

Two leading Senate Republicans, Lamar Alexander (R-TN) and Richard Burr (R-NC) have published a paper on plans to reform the role NIH and FDA play in medical research and product development. The paper identifies broad challenges at the two agencies that might be addressed through legislation. No specific policy recommendations are included. Click here for their detailed report.


House Committee Releases Updated 21st Century Cures Plan

The House Energy and Commerce Committee has released its first set of proposals in the 21st Century Cures Initiative, but without the backing of the Democrats involved in what until now has been a remarkably bipartisan process. The nearly 400-page discussion draft put out last week contains scores of proposals, including some potentially costly and controversial marketing exclusivity periods for drugs. Click here for the discussion draft. Click here for their overview.


Physician Burnout – Blame Computerization: Survey

Physicians listed computerization of their medical practices as the biggest contributor to burnout in a new survey from Medscape. They ranked “too many bureaucratic tasks”—including EHR requirements — 4.7 out of 7 as a frequent cause of burnout, ranking it worse than time spent at work, the ACA or income issues. The survey of nearly 20,000 physicians found the medical specialties most affected by burnout were critical care, emergency medicine, family and internal medicine, and general surgery. Click here.


New Bills: Medicare Should Pay Pharmacists for Basic Health Services

Pharmacists are already licensed in some states to provide basic health care services like wellness screenings, immunizations and diabetes management — but Medicare won’t pay for it. The Pharmacy and Medically Underserved Areas Enhancement Act would change that. Introduced last week by a bipartisan group, Sens. Chuck Grassley (R-IA), Bob Casey (D-PA), Mark Kirk (R-IL) and Sherrod Brown (D-OH), the bill is intended to help rural seniors who might have easier access to pharmacists than doctors. An equivalent bill has already been introduced in the House. Click here for more.


Obesity Rate on the Rise in 2014

The U.S. obesity rate grew to 27.7% in 2014, up from 27.1% in 2013 and 25.5% in 2008, data from a Gallup-Healthways Well-Being Index indicate. Researchers say Americans 65 and older had the greatest increase in obesity since 2008. Click here for the report.