Today's News

About safety:
Physical and verbal violence against health care workers: When we talk about healthcare safety we most often refer to error prevention in patient care. But are healthcare workers safe? I came across this article and it has some astounding statistics about this problem, among them: “According to the Occupational Safety and Health Administration (OSHA), approximately 75 percent of nearly 25,000 workplace assaults reported annually occurred in health care and social service settings and workers in health care settings are four times more likely to be victimized than workers in private industry.”
Before we ask healthcare workers to assure patient safety we must make sure they are safe themselves.

Read more about this issue

About quality:

Framework for Effective Board Governance of Health System Quality: As the Institute for Healthcare Improvement (IHI) wraps up its annual meeting, it issued this report outlining how hospitals boards can be more involved with quality efforts. The document IHI issued states:
”Health system leaders and trustees are looking for greater depth and clarity on what they should do to fulfill their oversight of quality.” While the framework provides useful guidelines for what the board should do, its premise is flawed. Quality of care is the only subject that should ultimately matter when all other issues are considered. As such, quality efforts should start with the board; in other words, it should be a top down process with buy-in at all levels of the organization. In addition to board activities, the role of leadership is to create a culture that is conducive to quality improvement activities.

Read the framework

About pharma:

Warning, investors: Way too many drugs will be vying for market share in 15 diseases: Competition in pharma is great for patients and payers, but not so much for pharma companies. Biotech companies understand the large profits from successful drug launches; but what happens if many are coming up with solutions in the same disease categories? According to research by Leerink, “15 disease areas will become dangerously overcrowded over the next five years.” What are companies doing to prospectively target these categories to maximize their chances of coming out with unique products?

Read more about this category crowding issue

FTC Submits Comment on FDA Guidance Aimed at Deterring Abuse of Citizen Petition Process:
One technique pharma companies have used to delay generic competition is soliciting consumer comments against such introductions. The FDA has modified its approach to weighing these complaints and the Federal Trade Commission (FTC) concurs.

Read more about this issue

About insurance:

Social determinants of health pose challenges for most Americans, survey shows: As previous posts have mentioned, the healthcare field is finally realizing that addressing social determinants is necessary to improving health and controlling costs. The classic stereotype of someone whose needs require addressing is a poor or homeless person. But as this article points out, a new Waystar survey reveals “that 68 percent of Americans identified having challenges in at least one SDoH [social determinants of health] risk category. Of all patients in the ‘high risk’ segment, 60 percent have never discussed their issues with a provider or their insurance company.” The magnitude of this issue should now be apparent and represents a business opportunity to “do well by doing good.”

Read more about these findings

Measuring Progress: Adoption of Alternative Payment Models in Commercial, Medicaid, Medicare Advantage, and Fee-for-Service Medicare Programs: Policy makers and insurers tout their support for changing payments from volume-based to value-based. Despite some progress, this transition has been very slow. One way to encourage this change is through Alternative Payment Models (APMs), such as bundled payments or capitation. A recent survey of 226M Americans revealed that about 34% of payments were based on APMs- up from 23% two years previously. But the implementation of these methods is very uneven and range from about half of Medicare Advantage plans to about a quarter of Medicaid plans (commercial plans are at about 28%). What can we do to speed the change when many providers are lobbying against taking on risk arrangements?

Read more about this survey

ObamaCare sign-ups surge in final weeks but lag last year's numbers:
Updating yesterday’s post on this topic, enrollment is now down 12% from last year with two more days to sign up. There are many reasons for this decrease- some good (like many more people are employed and getting insurance from employers or are covered by expanded Medicaid programs) others not so good (like people opting out entirely because the penalty for not being insured was eliminated or choosing a “short term” policy instead).

Read more about the update on this issue

Study highlights long wait times in Canada under single-payer system. Does that make it a bad idea for U.S.?
The first comment about this article is that CANADA DOES NOT HAVE A SINGLE PAYER SYSTEM! This misconception is probably the single greatest mistake people make when comparing the US to our northern neighbor. Medicare is a single payer system- the federal government comes up with the money to pay for beneficiaries no matter where they reside. Canada’s system (called medicare- not capitalized) is structured closer to our Medicaid. Canadian provinces and territories receive, on average, only about 25% of their budgets from federal support. Further, those entities operate their own healthcare systems with coverage parameters set according to loose guidelines mandated by the federal law under Health Canada.

Now that this error has been corrected, we can move to the subject of the article. Each year the Fraser Institute conducts a survey on, among other items, health-related waiting times for Canadians. Results: they are longer than desired and longer than in the U.S. Why?
Recall that cost, quality and access are the three levers we can use to structure healthcare systems. Canadian provinces and territories, like other governments around the world, have budgets to which they adhere. Canada also has a culture of equity, e.g., the rich cannot buy their way to faster care in the Canadian system (though they can travel to the US and pay). Limits on cost and maintenance of quality mean access suffers; in this case, longer waits. In the US, we have mainly rationed care by presence, absence, or type of insurance coverage.
Now the big question: Are American’s ready, from a cultural standpoint, to adopt an egalitarian system with cost controls- regardless of how many payers there are?

Read more about this analysis

About information technology:

Draft Guidance Document - Pre-market Requirements for Medical Device Cybersecurity: Health Canada just issued this draft guidance on cybersecurity for medical devices. In view of many recent international “hacks” (such as the alleged Chinese action against Marriott) this problem has global dimensions. The problem is nicely framed in the announcement: “Medical devices have evolved from largely analogue, non-networked and isolated hardware to networked devices incorporating remote access, wireless technology and complex software. Increasing levels of interconnectedness and data exchange between medical devices can have significant benefits to both patients and the healthcare system but can also leave devices vulnerable to unauthorized access. These vulnerabilities can negatively impact safety by causing diagnostic or therapeutic errors, or by affecting clinical operations.” A multi-national approach to cyber safety will be required for connected devices to be truly safe.

Read the draft guidance

Trump administration seeks public feedback on how to fix HIPAA privacy rules: The Health Insurance Portability and Accountability Act (HIPAA) IT provisions deal with data standardization, privacy and security. The first aids interoperability while the latter two present potential obstacles. Further, healthcare providers claim (often incorrectly) that they cannot release information to aid care because of HIPAA concerns. In order to address these issues, the Office of Civil Rights (the federal agency responsible for enforcing HIPAA provisions) is now seeking public comments about problems that HIPAA is causing.

Read about this initiative