Americans Favor Workplace Benefits 4 to 1 over Extra Salary: AICPA Survey American Institute of CPAs’s 2018 employment poll shows that “employed adults estimate, on average, their benefits represent 40 percent of their total compensation;” however, per the Bureau of Labor Statistics, the “benefits actually average 31.7 percent of a total compensation package.” The result of this perception is that Americans “would choose a job with benefits over an identical job that offered 30 percent more salary but no benefits.” Given this preference and the tax deductibility of healthcare benefits, further tax reform that reduces the deductibility of health insurance will be very difficult to implement.
Read more about this study
Management of Hyperglycemia in Type 2 Diabetes, 2018: The management of diabetes has gotten much better in the past decade; however, improvements have introduced a new level of treatment complexity. From a business perspective, this complexity makes it difficult to predict healthcare costs. From a quality review perspective, the complexity likewise makes assessment of appropriateness of care more difficult. This article, from the American Diabetes Association, is the best current review of the subject and will be useful for clinicians and those who pay for and evaluate care.
Read these treatment evaluations and recommendations
Cost-Related Insulin Underuse Among Patients With Diabetes: One quarter of patients on insulin who receive their care at the Yale Diabetes Center reported that they under-dose themselves (take less than recommended dose or decrease the frequency) or do not fill their prescription because of medication costs. This study highlights two principles. First, although out of pocket expenses generally reduce healthcare costs, these expenses can lead to reduced necessary care, resulting in longer term increased costs. Second, proponents for value-based care correctly posit that essential medications (like those for diabetes and hypertension) should be free from out of pocket charges.
Read this study on the effect of cost on insulin compliance
Mississippi Medicaid increasing visits to doctors’ offices: This article is interesting from two perspectives. First, it highlights the variability of Medicaid benefits from state to state. This state is increasing the number of annual physician visits for which Medicaid will pay from 12 to 16. Second, the reason this change was made is that officials believe paying for more visits will result in more preventive care and save money.
Read more about reasons for this Medicaid expansion
About Health Insurance
Health Plans with More Restrictive Provider Networks Continue to Dominate the Exchange Market: This finding by Avalere should not come as a surprise. When exchange plans are increasingly restricted from raising premiums and out of pocket expenses, and need to offer a fixed set of benefits (to comply with ACA requirements), the only tool they have left to control costs is offering more narrow network choices.
Read this study on restrictive networks
AHA, AAMC sue Trump administration over site-neutral payment rule: The American Hospital Association and Association of American Medical Colleges are suing the federal government (CMS) because proposed payment changes would eliminate extra payments to hospitals. Services performed at hospitals (or facilities they own) are paid more than if delivered at other sites, such as a physician-owned office or surgical center. Hospitals claim they need to extra money to overcome inadequate payments from Medicare. However, Medicare beneficiaries end up paying more out of pocket for these higher charges. According to CMS, “site-neutral payments for clinic visits will lower out-of-pocket costs for beneficiaries and save the program as much as $380 million in 2019.”
Read more about this issue
Read the CMS payment rule
Trump administration looks to take Medicaid outside the doctor's office: CMS is allowing medicare Advantage plans to offer extended and non medical benefits starting in 2019. Such benefits can include home-delivered meals and homemakers. Recognizing the health implications of these services, CMS is now looking at allowing Medicaid to offer such services.
Read more about this proposal
Reforming America’s Healthcare System Through Choice and Competition: This report was issued as a result of a presidential executive order a year ago and is intended to spur competition and aid consumer choice and affordability. Among its more than fifty recommendations are proposals that would allow individuals to set up Health Savings Accounts with insurance products other than High Deductible Plans and allow for expanded use to permit payment for insurance premiums from those funds. Other recommendations range from removing restrictions on expansion of doctor-owned hospitals to enhancing cross-state physician licensure.
Read this (114 page) report
Are 'community benefit programs' enough to let nonprofit hospitals off the hook for taxes?: Do hospitals (or any nonprofit) provide enough community benefits to justify their tax exemption? This question has existed for decades and is still being discussed. The ACA requires hospitals conduct community-based research to determine healthcare needs and develop plans to address them. Failure to do so (or if the plan is not acceptable to the HHS secretary), can result in loss of federal tax-exempt status. State and local exemptions are very variable. This article discusses calculation of net community benefit- at least in monetary terms.
Read more about nonprofit hospitals and whether they provide enough community benefit
Virtual Visits Partially Replaced In-Person Visits In An ACO-Based Medical Specialty Practice: This study of telemedicine use at t a Massachusetts-based ACO found that “the use of virtual visits reduced in-person visits by 33 percent but increased total visits (virtual plus in-person visits) by 80 percent over 1.5 years.” This finding has been seen before and questions the hype over telemedicine as one cure for healthcare costs. This increased volume has two implications. First, it can mitigate the cost savings from replacing in-person with virtual visits. Second, if healthcare professionals have to field an increasing volume of encounters, telemedia may make accessibility worse.
Read this telemedicine study
Statement from FDA Commissioner Scott Gottlieb, M.D., on how modern predicates can promote innovation and advance safety and effectiveness of medical devices that use 510(k) pathway: Medical devices are often approved using the so-called 510(k) pathway. This process allows low or medium risk devices to get speedier approval if they can compare themselves to an already-approved similar product (called a predicate). The problem is that many of these newer devices compare themselves to predicates that are more than 10 years old and hence have further developed their technology. In a major revision of approval process, these newer devices must compare themselves to predicates less than 10years old.
Read more about this proposal
About Healthcare IT:
Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs: The healthcare community has come to terms with the fact that electronic health records have added to the time and cost of documenting encounters. In an attempt to remedy these problems, The Office of the National Coordinator (ONC) issued this document to address four issues: (1) Clinical Documentation; (2) Health IT Usability and the User Experience;
(3) EHR Reporting; and (4) Public Health Reporting. The recommendations are open to comment until 1/28/19.
See the document for details and where to send comments.
AHIP, CMS, and NQF partner to promote measure alignment and burden reduction: America’s health Insurance Plans, CMS and National Quality Forum have formalized their commitment to The Core Quality Measures Collaborative (CQMC). The CQMC "is a multi-stakeholder, voluntary effort created to promote measure alignment and harmonization across public and private payers.” In other words, the purpose of this collaborative is to reduce confusion and duplication among measures used by different evaluation entities. Core measures cover ACOs and patient centered medical homes as well as seven clinical areas. However, “It’s important to note that CQMC has not developed any payer’s exact measures, but rather a ‘parsimonious set of measures’ that they can use as a springboard within their individual quality improvement programs, explained Danielle Lloyd, AHIP’s senior vice president of clinical affairs.” What this caveat means is that the general measures will be similar but exact reporting requirements will still be different. Until quality measures are truly harmonized. the cost of gathering and reporting them will remain an impediment to assessment of care.