About healthcare quality and safety
New rule on 'bad actors' means more work for practices: “Effective November 4, 2019… CMS will now require Medicare, Medicaid and Children’s Health Insurance Program (CHIP) providers and suppliers to disclose certain affiliations they may have with other providers and suppliers who are ‘bad actors,.’.. [who] may include providers or entities who have had previous negative interactions with CMS, such as having been previously sanctioned, experienced a payment suspension, been excluded from federal programs, had billing privileges denied, revoked, or terminated or an outstanding debt owed to the government (including federal student loans). It does not matter whether these particular issues were corrected by the affiliated person or entity, only that they occurred.”
Access, Quality, And Financial Performance Of Rural Hospitals Following Health System Affiliation [Health Affairs, subscription required] : “Following health system affiliation, rural hospitals experienced a significant reduction in on-site diagnostic imaging technologies, the availability of obstetric and primary care services, and outpatient nonemergency visits, as well as a significant increase in operating margins (by 1.6–3.6 percentage points from a baseline of −1.6 percent). Changes in patient experience scores, readmissions, and emergency department visits were similar for affiliating and nonaffiliating hospitals. While joining health systems may improve rural hospitals’ financial performance, affiliation may reduce access to services for patients in rural areas.”
About healthcare IT
Health system deploys cost calculator to offer patients price transparency: University Health Care System in Augusta, Georgia, has a website calculator that allows patients to enter some demographic data, the procedure code and their insurance policy number. They can then receive an estimate of their out of pocket expenses. The system claims to be 95% accurate.
10 largest data breaches of 2019: The headline speaks for itself. The top three breaches are by labs affecting a combined 21.8 million people.
AR and VR technology may eclipse use of 3D-printed models: While 3D printing has made significant strides in helping to guide treatments, this article explains how augmented and virtual reality may provide more benefits at a low cost.
About pharma
FDA Testing Levels of Carcinogen in Diabetes Drug Metformin: On the heels of the investigation of ranitidine for containing nitrosamines, the FDA is conducting similar studies on metformin. The difference this time around is that there are many substitutes for ranitidine, but metformin is the starting drug of choice for oral treatment of Type 2 diabetes.
What side effects? Problems with medicines may be vastly underreported to the FDA [Stat+, subscription required]: The headline speaks for itself. For some classes of drugs only about 1% of side effects are reported. Project question: How can we increase reporting of these events? Is it an IT issue or something else?
FDA Seeks to Speed Insulin Biosimilar Approvals with New Guidance: “…acting FDA Commissioner Brett Giroir highlighted the upcoming transition on March 23, 2020 of all approved New Drug Applications (NDAs) for biological products to approved Biologicals License Applications (BLAs), noting the change will mean that currently-approved insulin products can be listed as reference products for biosimilars and interchangeables products.
’The availability of approved biosimilar and interchangeable insulin products is expected to increase access and reduce costs of insulin products,’ he said.”
Biotech companies defend prices of one-off gene therapy [Financial Times, subscription required]: Biotech companies are trying to justify the extreme prices for their newer treatments by pointing out that a lifetime of therapy is often given in a short period of time and gene therapy potentially provides a total cure. Further, some costs, like home care and lost wages, are often not included.
About the public’s health
US flu season arrives early, driven by an unexpected virus: “The U.S. winter flu season is off to its earliest start in more than 15 years…There are different types of flu viruses, and the one causing illnesses in most parts of the country is a surprise. It’s a version that normally doesn’t abound until March or April.”
About health insurance
House-Senate fix could break gridlock on 'surprise' medical bills: “Leaders of the House Energy and Commerce Committee and the chairman of the Senate health panel announced a deal Sunday they said would rely on ‘a new system for independent dispute resolution often called arbitration.’ The lawmakers didn't elaborate…
But while there was bipartisan desire to help consumers, nearly every health sector wanted somebody else to foot the bill when a patient inadvertently sees an out-of-network provider.”
Democrats open door to repealing ObamaCare tax in spending talks: Both major parties still need to agree on a permanent appropriations bill for this year. In order to garner bipartisan support for the funding, Democrats say they are open to repealing the ObamaCare's Cadillac tax, which has never gone into effect, but is scheduled to start in 2022. It “was meant to keep health care costs down by discouraging overly-generous ‘Cadillac’ health insurance plans.” This offer is not new, since earlier this year the House voted to repeal the measure (419-6).
Implementing a Statewide Healthcare Cost Benchmark: “Seeking methods to better understand and control healthcare costs, states are assessing how to build on Massachusetts’ benchmarking model, since adopted, in varying forms, by three other states: Delaware, Rhode Island, and Oregon. All four states share common elements of the program: establishing a statewide cost benchmark; collecting data to measure health spending against the benchmark; publishing health spending reports to identify systemic cost drivers; and using a variety of levers, including public hearings and performance improvement plans (PIPs), to enhance transparency and contain spending growth that exceeds the benchmark.”
Medicare Advantage [MA] rebates to hit new highs in 2020: “Medicare pays plans through bids, where plans submit bids that are compared to a benchmark amount. If a bid is lower than the benchmark, the plan gets a rebate. The benchmark is based on a formula that looks at traditional Medicare costs for the geographic area where the plan is based.
Rebates have been steadily increasing for MA plans from 2016 to 2020.” Rebates are also linked to quality performances.
These data speak to the overall strengths of the MA plans.
About medical devices
RightEye’s Parkinson’s Diagnostic Gets Breakthrough Status: “RightEye received a breakthrough designation from the FDA for the RightEye Vision System, a device that helps assess patients for Parkinson’s disease.
The device records and analyzes data on patient eye movement in search of persistent ocular tremors that are caused by the disease. The data can help doctors both diagnose the disease at an earlier stage, the company said.” If this device proves itself in continuous real-world use, it could be a real breakthrough in diagnosis and screening.
About healthcare professionals
Higher physician compensation driven by demand, not productivity: Higher physician compensation is driven by the increasing institutional demand to hire, not by physician productivity or value-based compensation.
