TMC Brief Presented by America’s Health Insurance Plans: WSJ Calls for Unpaid SGR Fix, Obamacare Changes May Include Extension of Risk Corridors

Today’s Washington Read:

Fixing the Doc Fix
from Wall Street Journal by Editorial Board

Still no apparitions of the Lady of Fátima, but health-care leaders in both parties are trying to repeal the phony Medicare payment scheme that has abetted a decade of budget dishonesty. What a pity other precincts in both parties are conspiring to defeat this political miracle. Earlier this month the six Chairmen and Ranking Members of the committees with jurisdiction over Medicare released a bill that would permanently end the “sustainable growth rate,” or SGR, the automatic formula that says doctor payments will be cut by 25% in April. The Senate Finance, House Ways and Means, and Energy and Commerce folks don’t agree on much, but they’re doing a service by agreeing to end this charade. The problem is that Democrats and Republicans on the committees are deadlocked over how to pay for SGR repeal, while many backbench Republicans and even some Democrats are assailing the bill for supposedly adding to the deficit. Welcome to the anti-reality of the sustainable growth rate. What’s adding to the deficit is traditional Medicare on present trend, not how the accountants keep track of the dollars ex ante. Absent reform, one way or another the money is going to be spent, and Congress can either continue to do so in incremental doc-fix slices or admit in advance that it was always going to do it. The latter option is better as truth in entitlement advertising. Here’s a suggestion: Simply pass the bill as is and forgo the pretense of fake-paying for it, if only to destroy a vehicle for even more spending.

Today’s Business Strategy Read:

Obamacare Changes May Include Extension of Risk Corridors
from Washington Examiner by Susan Ferrechio

The Obama Administration may extend beyond 2016 a federal reimbursement program for health insurance companies that lose money by participating in the newly created health care exchanges. Industry insiders told the Washington Examiner a plan to extend the Affordable Care Act’s “risk corridors” are under discussion, but that administration officials have not made a final decision. The risk corridor program was written into the 2,700-page health care bill to help the insurance companies offset losses if they enroll too few healthy customers and sign up too many people with high health care costs. The Obama Administration is now weighing a plan to grant an additional three-year extension for non-complaint plans on the individual market. Such a move would prevent millions of people from losing their policies in the critical weeks and months before the 2014 election.

 

Today’s Chart Review:

RAND Health Reform Opinion Study: Stability Masks Churn in ACA Opinion
from RAND

 

 

Mark Your Calendars (All Times Eastern):
Wednesday: Quarterly earnings: Acadia HealthcareHealth Care REITHealthcare Realty TrustHealthSouthMedboxMedicines CompanyUnited Health Insurance Holdings
Wednesday: Brookings event on payment, delivery reform and social media @830am
Wednesday: Kaiser Family Foundation event on the ACA and California @12pm
Wednesday: FasterCures webinar on risk assesment @1pm
Thursday: Quarterly earnings: ActavisAllscripts, AMN Healthcare ServicesCyberonicsDepomed, eHealth,EpizymeExpress ScriptsIPC The HospitalistKindred HealthcarePharmacyclicsSelect Medical Holdings
Thursday: MACPAC meeting @830am
Thursday: Chamber of Commerce event on healthcare and trasportation @2:45pm
Thursday: Families USA call on state Medicaid enrollment @12pm
Friday: Quarterly earnings: Acceleron Pharmaceutical
Friday:  Institute for Defense and Government Advancement event on military behavioral health @9am
Friday-Sunday: National Governors Association Winter Meeting

NEWS ARTICLES

1-5: General
6-11: Payers
12-16: Providers
17-21: Pharma/Biotech/Device
22-23: Health IT

OPINIONS, EDITORIALS, PERSPECTIVES

24, 25: Wall Street Journal
26: Politico Magazine

27:Bloomberg

28: Washington Times
29: Health Affairs

RESEARCH REPORTS, ISSUE BRIEFS, CASE STUDIES

30: RAND
31, 32: JAMA

NEWS ARTICLES

 

General

1) Obama’s Vote-Getting Tactics Struggle to Find the Uninsured

from New York Times by Michael Shear

The hunt for the uninsured in Broward County got underway one recent afternoon when 41 canvassers, armed with electronic maps on Samsung tablets, set off through working-class neighborhoods to peddle the Affordable Care Act door to door. Four hours later, they had made contact with 2,623 residents and signed up exactly 25 people. Many of their targets, people identified on sophisticated computer lists generated in Washington as unlikely to have health insurance, had moved away. Some were not home. Many said they already had insurance through Medicare, their parents or a job. A few were hostile at the mere mention of President Obama’s health care law. “We’re going to repeal that,” one man said gruffly as he shut the door in the face of a canvasser, Nancy Morwin, 58, a retired social worker. Such are the limits of microtargeting the uninsured as groups supporting the Obama administration take to the streets on behalf of the president’s most important domestic initiative. The nationwide effort is modeled on Mr. Obama’s successful voter turnout machines in 2008 and 2012, but in this case the task of finding Americans without health insurance and signing them up is a painfully slow grind.

2) Health Law’s Impact Has Only Begun
from Wall Street Journal by Anna Wilde Mathews

On Jan. 1, the key provisions of the Affordable Care Act took effect. Americans gained access to new health plans subsidized by federal dollars. Insurers no longer can turn away people with existing conditions. Millions are now eligible for new Medicaid benefits. But the federal law also upended existing health-insurance arrangements for millions of people. Companies worry about the expense of providing new policies, some hospitals aren’t seeing the influx of new patients they expected to balance new costs and entrepreneurs say they may hire more part-time workers to avoid offering more coverage. The law’s true impact will play out over years. It will depend in part on whether backers overcome serious early setbacks, including crippling glitches in the new online insurance marketplaces and many states’ rejection of the Medicaid expansion. But another obstacle the law faces is pushback from some consumers and industry over the higher costs, complex rules and mandatory requirements it imposes.

3) Kathleen Sebelius: No Job Loss Under Obamacare
from Politico by Lindsay Kalter

 

Health and Human Services Secretary Kathleen Sebelius says there is “absolutely no evidence” that the Affordable Care Act will drive down employment, despite a report from the Congressional Budget Office released Feb. 4 predicting fewer people would be working.

“There is absolutely no evidence, and every economist will tell you this, that there is any job-loss related to the Affordable Care Act,” Sebelius told reporters in Orlando, Fla., on Monday. “Part-time physicians are actually down since 2010, not up. The number of full-time workers continues to increase. I know that’s a popular myth that continues to be repeated but it just is not accurate.”

4) California Cities Strained by Retiree Health

from Bloomberg by James Nash and Edvard Petterson

The Los Angeles Unified School District, the nation’s largest outside New York City, owes so much for retiree health care that paying off its debt would cost $17,500 for each student — and there are 640,000 of them. Local governments typically haven’t been punished by investors for underfunding retiree health care and insurance, unlike pensions. Investors believe that, in a pinch, the governments can walk away from the obligations, said Michael Ginestro, head of fixed-income research for Bel Air Investment Advisors LLC, which manages $2.8 billion in Los Angeles. A group of California state court decisions have upended that assumption, treating “other post-employment benefits,” or OPEB, as vested rights that can be changed only through contract negotiations. The decisions threaten to add to the fiscal strains of cities and counties whose pension obligations are already putting pressure on their creditworthiness. U.S. states have $529 billion in unfunded liabilities for non-pension retirement benefits, down 3 percent in two years, Standard & Poor’s said in a November 2013 report. The states have $833 billion in unfunded pension liabilities and $488 billion in tax-supported debt such as bonds, according to the report.

5) U.S. Stock-Index Futures Decline Before Housing Report
from Bloomberg by Jonathan Morgan

U.S. stock-index futures declined, after the benchmark Standard & Poor’s 500 Index climbed within eight points of a record, as investors awaited data on housing starts in the world’s biggest economy. Futures on the S&P 500 expiring in March slipped 0.3 percent to 1,832.3 at 6:30 a.m. in New York as investors also waited for the Federal Reserve to publish the minutes of its last policy meeting. The equities gauge has rallied 3.3 percent this month, rebounding from a 3.6 percent drop in January, amid optimism the economy will withstand a reduction in the Fed’s bond purchases. Dow Jones Industrial Average contracts lost 34 points, or 0.2 percent, to 16,073 today.

Payers

6) Obamacare Changes May Include Extension of Risk Corridors
from Washington Examiner by Susan Ferrechio

 

The Obama Administration may extend beyond 2016 a federal reimbursement program for health insurance companies that lose money by participating in the newly created health care exchanges. Industry insiders told the Washington Examiner a plan to extend the Affordable Care Act’s “risk corridors” are under discussion, but that administration officials have not made a final decision. The risk corridor program was written into the 2,700-page health care bill to help the insurance companies offset losses if they enroll too few healthy customers and sign up too many people with high health care costs. The Obama Administration is now weighing a plan to grant an additional three-year extension for non-complaint plans on the individual market. Such a move would prevent millions of people from losing their policies in the critical weeks and months before the 2014 election.

7) Arkansas House Fails to Pass ‘Private Option’ Health Law
from Wall Street Journal by Ana Campoy and Louise Radnofsky

The Arkansas House of Representatives on Tuesday failed to pass legislation to continue a state program that used Medicaid dollars to enroll low-income residents in private health insurance, throwing the future of the nationally watched program into doubt. Arkansas last fall became the first state to begin offering a “private option” for low-income residents instead of enrolling them in Medicaid—the result of a compromise between state Republicans and Democrats about how to implement a key provision in the Affordable Care Act. The private option was designed to appeal to conservative lawmakers who wanted to cut the number of uninsured people in the state and use federal dollars to do so, but believed the private sector could provide care more efficiently than Medicaid.

8) Bipartisan Group Of Senators Concerned About Medicare Advantage Cuts
from Kaiser Health News by Mary Agnes Carey

Some Democrats have now joined their Republican counterparts in asking the Obama administration to moderate scheduled Medicare Advantage payment cuts for 2015. In a letter to Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner, a bipartisan coalition of 40 senators urged the administration “to maintain payment levels that will allow [Medicare Advantage] beneficiaries to be protected from disruptive changes in 2015.” Cuts to Medicare Advantage plans are part of the $716 billion in Medicare spending reductions the health law calls for over the next decade. Senate Democrats who signed the letter include Charles Schumer of New York, a member of the Senate Democratic leadership team, as well as several who are facing tough re-election campaigns, including Kay Hagan of North Carolina, Mark Pryor of Arkansas and Mary Landrieu of Louisiana. As early as this week, CMS is expected to release preliminary Medicare Advantage payment rates for 2015 that insurers have estimated could reduce payments by as much as 6 percent to 7 percent next year. Insurers and other Medicare Advantage proponents say cuts of that magnitude could cause premium increases and benefit reductions.
9) Groups Press CMS to Pull Part D Rule
from Politico Pro by Brett Norman

More than 200 health care organizations representing a broad swath of the entire industry are asking CMS to withdraw a rule to overhaul the Medicare prescription drug program. The agency’s proposed changes to the Medicare Part D program have drawn a sharp backlash from insurers, the pharmaceutical industry and consumer groups, which say they would undermine key aspects of the program that have made it popular and effective. “We are deeply concerned that the proposed rule is inconsistent with the spirit and purpose of Medicare Part D, represents unnecessary changes to programs that are already extraordinarily effective in containing costs and, most importantly, will severely impede beneficiaries’ access to affordable health plans and medicines,” states a letter led by the Healthcare Leadership Council that will be sent to CMSTuesday evening. “We urge you in the strongest terms to withdraw the proposed rule that would have unintended consequences for seniors and beneficiaries with disabilities.”

10) GOP Bill Would Delay Obamacare’s Individual Mandate Until 2016
from The Hill by Pete Kasperowicz

The chairman of the House Republican Study Committee has introduced new legislation to retroactively delay the individual health insurance mandate under ObamaCare until 2016. The bill from Rep. Steve Scalise (R-La.) is in reaction to last week’s decision by the Obama administration to delay part of the employer mandate for another year. The administration said companies with at least 50 but fewer than 100 employees will have until January 2016 before they are required to offer health insurance to their workers. That move followed its July 2013 announcement that the mandate for all companies would be delayed until January 2015. The Freeing Americans from Inequitable Requirements (FAIR) Act, H.R. 4064, would essentially delay the individual mandate to have insurance until the employer mandate is in full effect, without any exceptions. Scalise said it’s only fair that the health law should be delayed for everyone, not just companies.

11) Who Will Help the Newly Insured?

from Politico Pro by Natalie Villacorta

Newfound health benefits often come with newfound questions. But most states have either spurned or run out of federal funding for consumer assistance programs aimed at guiding Obamacare’s newly insured through the complexities of using their coverage. Some states with GOP governors never sought Affordable Care Act dollars for these programs. Most states that did have almost used up the federal cash and are struggling to keep programs afloat. Only 12 states and the District of Columbia now have active consumer assistance programs, and they’re basically on their own. People who have never been insured or who have had long gaps in coverage are often bewildered by the jargon and process. “Enrollment is like a pre-step,” said Sarah Davis, associate director and a clinical assistant professor of law at the Center for Patient Partnerships at the University of Wisconsin-Madison. “Having insurance isn’t the goal, having insurance is the precursor to effectively utilizing health insurance, to accessing care. The goal is the care, and there are roadblocks along the way.”

Providers

12) Voters May Decide Medical Malpractice Cap
from LA Times by Melanie Mason

A protracted political battle over California’s medical malpractice law may be coming to a new front: the voting booth. For decades, trial lawyers and consumer groups have railed against limits on certain damages in malpractice cases, arguing that such restrictions deny victims fair compensation for grisly medical mistakes. Insurance companies, doctors and other healthcare providers have been equally vigorous in defending the law, saying it is crucial to controlling costs and maintaining the availability of care. Now, the lawyers’ side has proposed a ballot initiative that would raise the limits on malpractice awards for pain and suffering. The measure would appear on the fall ballot, but both camps are already amassing war chests and firing opening shots in what would certainly be a bruising and costly fight.


13) Most People Say Rating Sites ‘Important’ When Picking Doctors

from Reuters by Andrew Seaman

When picking a new doctor, most people factor the reviews left on rating websites into their decision, according to a new study. Researchers found 59 percent of people said those physician-rating sites were at least “somewhat important” when choosing a doctor. “The numbers were actually substantially higher than just a few years ago,” Dr. David Hanauer said. He is the study’s lead author from the University of Michigan Medical School in Ann Arbor. “The usage is increasing over time,” Hanauer said. “We need to be aware that these sites are being used. I think there are still valid concerns whether these sites are trustworthy.” Most previous research on websites that allow anyone to post reviews of doctors focused on what people say, the researchers write in the Journal of the American Medical Association. Few studies have looked at who is on the receiving end of that information.

 

14) Colorado’s Elusive Goal: A Complete, Useful Health Care Price List
from Kaiser Health News by Eric Whitney

Coffee is important to many of us, but let’s say your coffee maker breaks.  Finding a new one is as easy as typing “shop coffee maker” into your browser.  Voila – you’ve got models, prices and customer reviews at your fingertips. But say you need something less fun than a coffee maker, like a colonoscopy. Shopping for one of those is a lot harder. Actual prices for the procedure are almost impossible to find, and Bob Kershner says there’s huge variation in cost from one clinic to the next. “You see the range is from $2,800 down to just about $400,” he says, pointing to a computer screen displaying some colonoscopy prices in Denver. Kershner works for a nonprofit called CIVHC, which is starting to make health care prices publicly available in Colorado. Colorado is one of eleven states that are starting to make a lot of health care prices public. It’s taken years. An “all payer claims database” is step one in Colorado. It’s basically a giant shoebox that aims to collect a copy of every receipt for a health care service in a given state. Since doctors and hospitals generally don’t tell people how much services cost beforehand, the best way to figure it out is to get receipts from the parties that pay the bills: insurance companies, Medicaid and Medicare, mostly.


15) Hospital Construction Booming Across the Country
from FierceHealthcare by Ilene MacDonald

 

If you build it, they will come. At least that’s what it looks like given the amount of construction projects on tap at hospitals across the country.

After assessing the area’s population and healthcare market needs over the next decade, Englewood Hospital and Medical Center in New Jersey launched a $90 million expansion project that will feature a family birthing center, a new entrance, and a cancer therapy and wellness project when it opens in the winter of 2016, NorthJersey.com reports. In central Ohio, several factors are driving the need for hospital facelifts, hospital executives told Columbus CEO–a growing population, increasing service demand, advancing science and patient satisfaction.

16) Kaiser Sees Small Income Growth as it Trims Operations
from Modern Healthcare by Beth Kutscher

Kaiser Permanente, the Oakland, Calif.-based integrated delivery system, reported modest growth (PDF) in income as the group pares down its operations. The system, which is both a payer and provider of healthcare, added 30,000 new members in 2013, bringing its membership to 9.1 million. Its operating margin remained flat at 3.4%, as it earned $1.8 billion in operating income on revenue of $53.1 billion in 2013.

Pharma/Biotech/Device

17) Actavis-Forest Bid Shines Light on Valeant Next

from Bloomberg by Tara Lachapelle

Actavis Plc’s purchase of Forest Laboratories Inc. accelerates a pharmaceutical merger wave that stands to engulf even more drugmakers. The $21 billion transaction, which includes Forest’s net cash, is fueling the busiest 12-month period for acquisitions in the industry since 2009, according to data compiled by Bloomberg. Generic-drug companies such as Actavis and Valeant Pharmaceuticals International Inc. are boosting growth by crossing over into specialty medicines including skin-care treatments, birth control and remedies for digestive diseases. The most active dealmaker among its North American peers, Valeant may make a competing bid for Forest, according to Piper Jaffray Cos., which also sees Mylan Inc. as a target or acquirer after so far having been largely left out of the consolidation. Valeant, the $49 billion company that’s aiming to more than triple its market value by the end of 2016, could merge eventually with the new Actavis-Forest, Stifel Financial Corp. said. Or Valeant may opt to buy Teva Pharmaceutical Industries Ltd., which would be a better fit, said Aegis Capital Corp.

18) Icahn Orchestrates $25 Billion Drug Merger
from New York Times by David Gelles and William Alden

In 2009, Carl C. Icahn bought a stake in Forest Laboratories, then a struggling drug maker. Over the next few years, Mr. Icahn drew from his standard activist playbook. He criticized Forest’s management and ran a proxy contest to shake up its board. It took several rounds of trying, but Mr. Icahn eventually got two of his nominees elected. And last September, Forest hired a new chief executive, Brenton L. Saunders. Now, less than a half-year after taking the helm, Mr. Saunders, at the urging of Mr. Icahn, has agreed to sell Forest for $25 billion in cash and stock. The merger will make Mr. Icahn even richer, while creating a huge pharmaceuticals company with heavy exposure to both branded and generic drugs.

19) Indian Drugmakers Must Know Quality-Control Rules, FDA Says
from Bloomberg by Ketaki Gokhale and Harsha Subramaniam

Indian companies supplying a quarter of the medicines used in the U.S. must take responsibility for the quality-control necessary to export their products, the top U.S. drug regulator said as it ramps up inspections. The comments by Margaret Hamburg, the U.S. Food and Drug Administration commissioner, follow an eight-day trip toIndia to meet with pharmaceutical companies on production quality. The U.S. is increasing scrutiny of generic drugs made in India, and in the past nine months banned imports from four plants belonging to Ranbaxy Laboratories Ltd. and Wockhardt Ltd. The FDA will expand its offices in India, train regulatory officials in the nation and step up inspections of overseas plants, Hamburg said in an interview with Bloomberg TV India in Mumbai yesterday. Until recently, the U.S. wasn’t inspecting manufacturers in other countries at the same frequency as in the U.S., the commissioner said. That’s changing, she said.

20) Ranbaxy, Teva to Settle with New York Attorney General
from Wall Street Journal by Brent Kendall

New York Attorney General Eric Schneiderman plans to announce a settlement Wednesday with U.S. units of Ranbaxy Laboratories andTeva Pharmaceutical over allegations the two rival generic drug makers made an unlawful agreement to restrict competition. Mr. Schneiderman’s office confirmed the settlement. As part of the deal, the companies will terminate an agreement not to challenge each other’s rights to sell certain generic drugs exclusively in the U.S. They also agreed to refrain from entering into similar agreements in the future, and will pay the state $300,000. The companies neither admitted nor denied Mr. Schneiderman’s allegations as part of the settlement.

21) Medtronic’s Profit Falls After Charge for Blood Pressure Device

from Bloomberg by Michelle Fay Cortez

Medtronic Inc., the world’s biggest maker of heart-rhythm devices, said fiscal third-quarter profit fell 23 percent after it took a charge for the 2010 acquisition of Ardian Inc. and its failed high blood pressure treatment. Net income in the three months ended Jan. 24 fell to $762 million, or 75 cents a share, from $988 million, or 97 cents, a year earlier, the Minneapolis-based company said in a statement. Profit of 91 cents a share, excluding one-time items such as the write-off of Ardian assets, matched the average of 18 analyst estimates compiled by Bloomberg. The company narrowed its earnings forecast for fiscal 2014 to $3.81 to $3.83 a share, from $3.80 to $3.85 a share.

Health IT

22) Healthcare Organizations Under Siege from Cyberattacks, Study Says
from LA Times by Chris O’Brien

 

Add this to the list of things to freak you out: Healthcare organizations of all kinds are being routinely attacked and compromised by increasingly sophisticated cyberattacks. A new study set to be officially released Wednesday found that networks and Internet-connected devices in places such as hospitals, insurance companies and pharmaceutical companies are under siege and in many cases have been infiltrated without their knowledge. The study was conducted by Norse, a Silicon Valley cybersecurity firm, and SANS, a security research institute. In the report, the groups found from September 2012 to October 2013 that 375 healthcare organizations in the U.S. had been compromised, and in many cases are still compromised because they have not yet detected the attacks. In addition to getting access to patient files and information, the attackers managed to infiltrate devices such as radiology imaging software, conferencing systems, printers, firewalls, Web cameras and mail servers. “What’s concerning to us is the sheer lack of basic blocking and tackling within these organizations,” said Sam Glines, chief executive of Norse. “Firewalls were on default settings. They used very simple passwords for devices. In some cases, an organization used the same password for everything.

23) Cloud Technology to Propel Growth in Healthcare IT Market

from FierceHealthIT by Dan Bowman

An increase in healthcare provider use of cloud technology combined with a decrease in the cost of IT implementation could propel big changes for the U.S. healthcare IT market in the next few years, according to a new report. The analysis, by market research consulting firm RNCOS, predicts that between now and 2018, the health IT market will grow at a compound annual growth rate of close to 10 percent. Continued innovation and government suppport for such tools will factor into the market’s success, according to the report’s authors.

AHIP’s National Health Policy Conference: ACA and the Year Ahead, March 5-6 in Washington, D.C., will convene key Administration andstate officials, Members of Congress, and the foremost health care thought leaders and health insurance industry professionals to provide high-level insight, analysis and policy recommendations on health care issues and trends. Don’t miss this timely opportunity to engage andshare ideas with industry experts and vested stakeholders. Register today.

OPINIONS, EDITORIALS, PERSPECTIVES

 

Wall Street Journal


24) Fixing the Doc Fix

from Wall Street Journal by Editorial Board

Still no apparitions of the Lady of Fátima, but health-care leaders in both parties are trying to repeal the phony Medicare payment scheme that has abetted a decade of budget dishonesty. What a pity other precincts in both parties are conspiring to defeat this political miracle.

Earlier this month the six Chairmen and Ranking Members of the committees with jurisdiction over Medicare released a bill that would permanently end the “sustainable growth rate,” or SGR, the automatic formula that says doctor payments will be cut by 25% in April. The Senate Finance, House Ways and Means, and Energy and Commerce folks don’t agree on much, but they’re doing a service by agreeing to end this charade. The problem is that Democrats and Republicans on the committees are deadlocked over how to pay for SGR repeal, while many backbench Republicans and even some Democrats are assailing the bill for supposedly adding to the deficit. Welcome to the anti-reality of the sustainable growth rate. What’s adding to the deficit is traditional Medicare on present trend, not how the accountants keep track of the dollars ex ante. Absent reform, one way or another the money is going to be spent, and Congress can either continue to do so in incremental doc-fix slices or admit in advance that it was always going to do it. The latter option is better as truth in entitlement advertising. Here’s a suggestion: Simply pass the bill as is and forgo the pretense of fake-paying for it, if only to destroy a vehicle for even more spending.

25) The FDA Wants You for Sham Surgery
from Wall Street Journal by Scott Gottlieb

 

In a landmark study of a new cardiovascular device unveiled last month, patients received anesthetics, had a large-bore catheter inserted through a cut into one of their major arteries, and had dye injected into their bloodstream. Their surgeons worked on them for about an hour, with unnecessary pokes and prods, while a monitor displayed the false progress using radioactive fluoroscopy. The patients weren’t being treated. They had agreed to undergo the angiogram procedure without knowing if they’d get the real treatment. They were part of a Food and Drug Administration-approved study of a new medical device from Medtronic to treat serious high blood pressure that is resistant to conventional medicines. Some patients were randomly assigned to this sham surgery. They were placebos. Was their sacrifice worth it? That is a question many patients may want to consider as the FDA insists on a new study methodology with uncertain benefits.

Politico


26) Bushcare
from Politico Magazine by Edward Lazear

 

The Congressional Budget Office’s warning that the Affordable Care Act will cause employment to fall by the equivalent of 2.5 million full-time workers is just the latest of Obamacare’s negative surprises. Unfortunately, House Minority Leader Nancy Pelosi’s statement that “we have to pass the bill so that you can find out what is in it” is proving to be depressingly accurate. The law’s defenders legitimately argue that it is not sufficient merely to criticize the Affordable Care Act; responsible action requires proposing an alternative. Fortunately, Republicans have a good one, and it’s been hiding in plain sight for the past seven years. The plan was first described in President George W. Bush’s 2007 State of the Union Address, but it remains timely. This plan would remedy most of the major problems that exist in America’s health care system and cause less destruction with fewer adverse consequences than Obamacare. So what would the ideal alternative to Obamacare look like? It should provide cost-effective care and the quality treatment that Americans deserve. Effective reform should discourage over-insurance that results from the subsidy of so-called Cadillac plans that pay for basic, inexpensive and predictable procedures and have patient co-payments that are too low. Reform should encourage consumers to use America’s scarce health resources efficiently by inducing them to get tests and treatments that are justified instead of those that are selected because they are almost free to the decision-makers. Finally, reform should make health insurance available to the vast majority of Americans, some of whom cannot afford insurance without help. The Bush 2007 plan achieves these goals.

Bloomberg

 

27) Bigger Hospitals Mean Higher Prices, Not Better Care
from Bloomberg by Shannon Brownlee and Vikas Saini

Hospitals are busily merging with other hospitals and buying up groups of doctors. They claim that size brings efficiency and the opportunity to deliver more “value-based” care — and fewer unnecessary services. They argue that they have to get bigger to cut waste. What’s the evidence that bigger hospitals offer better value? Not a lot. If you think of value as some combination of needed services delivered for the right price, large hospitals are no better than small hospitals on both counts. The Dartmouth Atlas of Health Care and other sources have shown time and again that some of the biggest and best-known U.S. hospitals are no less guilty of subjecting patients to useless tests and marginal treatments.

Washington Times

28) Resisting the Medicaid Expansion Temptation
from Washington Times by Gary Alexander

Thanks to the Supreme Court’s 2012 ruling, states are no longer required to liberalize Medicaid eligibility, one of the strategies of Obamacare to improve health care access among lower-income Americans. Yet that doesn’t mean the 25 states that have resisted turning the means-tested welfare program into a default health care plan for working-age, able-bodied Americans face no pressure to do so. Indeed, a phalanx of welfare-advocacy groups, health care consultants, hospital systems, and managed-care organizations continue to lobby the legislatures of the holdout states. The pro-expansion forces are not simply downplaying the costs involved. Citing numerous studies and economic projections funded by the health care industry, these well-connected advocates of Medicaid are actually claiming that its expansion represents a fiscal bonanza. Not only will states gain, we are told, needed federal Medicaid funds, but they will also experience “a more positive net flow of federal dollars” in general, according to a much-touted December report of the Commonwealth Fund. That’s an argument that most states will find difficult to resist, as their escalating Medicaid expenditures long ago — even before Barack Obama decided to run for the presidency — became their largest single budget line-item, according to data of the National Association of State Budget Officers, outpacing K-12 education. In a day when governors and legislatures need more resources for priorities that benefit all citizens, such as education and transportation, the promise of a bigger stream of federal revenue may be too enticing to forgo. Yet a recent economic forecast and risk analysis we conducted for the state of Maine flatly contradicts that glowing assessment, suggesting that the hope of using Medicaid expansion to solve state budget woes is as empty as President Obama’s promise that “if you like your health care plan, you can keep it.”

Health Affairs

 

29) Doctors Without State Borders: Practicing Across State Lines
from Health Affairs by Robert Kocher

In the United States, a tangled web of federal and state regulations controls physician licensing.  Although federal standards govern medical training and testing, each state has its own licensing board, and doctors must procure a license for every state in which they practice medicine (with some limited exceptions for physicians from bordering states, for consultations, and during emergencies). This bifurcated system makes it difficult for physicians to care for patients in other states, and in particular impedes the practice of telemedicine. The status quo creates excessive administrative burdens and like contributes to worse health outcomes, higher costs, and reduced access to health care. We believe that, short of the federal government implementing a single national licensing scheme, states should adopt mutual recognition agreements in which they honor each other’s physician licenses.  To encourage states to adopt such a system, we suggest that the federal Center for Medicare and Medicaid Innovation (CMMI) create an Innovation Model to pilot the use of telemedicine to provide access to underserved communities by offering funding to states that sign mutual recognition agreements.

 

ACA’sFuture: The Good, the Bad and the Ugly. Avik Roy of the Manhattan Institute for Policy Research, and Jonathan Cohn of the NewRepublic, will discuss the politics and fiscal implications surrounding the ACA’s full implementation and certain future. You’ll find this andmore valuable sessions and engaging speakers at AHIP’s National Health Policy Conference: ACA and the Year Ahead, March 5-6 in Washington, D.C. Register today.

RESEARCH REPORTS, ISSUE BRIEFS, CASE STUDIES

 

RAND

 

30) RAND Health Reform Opinion Study: Stability Masks Churn in ACA Opinion
from RAND by Katherine Grace Carman

This week, the percentage of respondents reporting a favorable opinion of the ACA remained stable, while unfavorable opinion dropped. Over the past month, we’ve seen weekly fluctuations in the percentages of respondents reporting unfavorable opinions and those saying “don’t know.”

However, these fluctuations have been, for the most part, within the margin of error. This implies that opinion has actually remained remarkably stable. Part of what makes our approach unique is that we survey the same respondents repeatedly over time. We split our 5,500-member panel into four groups and survey the first group during the first week of each month, the second group during the second week, and so on. So when we look at changes in opinion from one month prior, we compare responses of the same group of people at two points in time. Doing so for this past week shows that 10 to 15 percent of respondents continue to change their response each month. Thus, while we see remarkable stability in responses over time, this continues to mask churning of individual opinions.

JAMA

 

31) Beyond ACOs and Bundled Payments
from JAMA by Christopher Chen and Clay Ackerly

For all the attention paid to accountable care models, few observers have recognized that Medicare is rolling out the core framework of bundled payments within the hospital fee-for-service payment system. Under its hospital value-based purchasing (HVBP) program, Medicare has established the Medicare Spending Per Beneficiary (MSPB) metric, defined as the average Medicare Part A and Part B spending per patient (eg, all traditional Medicare fee-for-service spending outside of prescription drug coverage) from 3 days prior to admission to 30 days after discharge. Hospital value-based purchasing adjusts each hospital’s fee-for-service Medicare reimbursement based on various performance benchmarks, such as MSPB; more than 1400 hospitals will receive reductions in their Medicare payment rates this year.1 Although Medicare has created a number of pay-for-performance programs over the past decade, MSPB represents the first pay-for-efficiency measure embedded within the fee-for-service system to penalize or reward hospitals not just for readmission rates or efficiency within an inpatient stay but for the value of care delivered across the entire continuum.

 

32) IOM Outlines Framework for Clinical Data Sharing, Solicits Input

from JAMA by Bridget Kuehn

 

The global clinical research enterprise generates reams of data, but much of it never sees the light of day. Although some study findings are published in journals, in other cases, summary results may be submitted to a clinical trial registry, or data may be submitted to regulators as a condition of marketing approval. Some data never leave the hands of the researchers who generate it. This patchy access to data means that clinicians and patients are unaware of information that may be important. It may lead to a skewed portrayal of the efficacy or safety of an intervention. It may also violate researchers’ ethical obligations to study participants. These concerns have led to a growing movement to expand access to clinical trial data. To help guide this effort, the Institute of Medicine (IOM) convened a committee to create a framework for how such data should be shared. In January 2014, a draft of the framework was released for public comment.

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