Today's News and Commentary

About insurance

Judge Vows To Rule On Medicaid Work Requirements By End Of March: The National Health Law Program and other plaintiffs have sued the federal government over its granting of Medicaid waivers that allow states to tie the program’s health benefits to work requirements. The rulings to date have supported the plaintiffs- the reasoning is that the work requirements do not further the health care goals of Medicaid. U.S. District Judge James Boasberg will rule about the specific work requirement in Arkansas. He is the same judge who blocked Kentucky’s waiver last year.

Read the article

Good Ideas Must Be Evaluated: Speaking of waivers, CMS Administrator Verma announced a new set of tools to helps states get and maintain their Medicaid waivers. These waivers would include those with a tie to work requirements (at least until now).

Read the announcement
Read about the Evaluation Resources

Out-of-Network Emergency Physicians Increase Health Care Prices for Consumers by $6 Billion Each Year: This study by UnitedHealthGroup found that:

“Inflated charges by out of network (OON) emergency physicians treating patients at in-network EDs totaled an estimated $6 billion.
OON emergency physicians charged an average of $538 (150 percent) more per ED visit than in-network emergency physicians were paid ($898 vs. $360).
Over one-quarter of visits to in-network EDs resulted in OON physician charges (12 million out of 44 million).”

Since patients often do not have a choice where they go in an emergency, these charges are the worst kind of monopolistic prices. Is it time for nationally- imposed rates- at least for emergency departments?

Read the study

Azar calls out ‘absurdity' in Medicare wage index: The Medicare wage index is an important component in deciding how much hospitals and physicians are paid for their costs of doing business. The formula is a complex blend of like-jobs and does not specifically look at healthcare employees. It is long overdue for reform.

Read the article (Modern Healthcare but appears to be open access)

Measuring progress in improving prior authorization [PA]: In January of last year the AMA issued a report that documented the burden on physicians of prior authorizations. It then called on insurance companies for certain measures to alleviate this problem. The report says there has not been progress in this area. Among the findings: “A strong majority (88% and 86%, respectively) of physicians report that the number of PAs required for prescription medications and medical services has increased over the last five years.” Further, phone and fax reminders by far the most-used methods of obtaining approvals. Time for the insurance industry to come into this century- that is, if they really want to do so.

Read the research

About the public’s health

Poll shows emerging ideological divide over childhood vaccinations: In a poll asking about federal mandates for childhood vaccines, 61 percent of registered voters were in favor and 39 percent were opposed. But the breakdown is strongly along political ideology: Seventy percent of liberal voters said they favor an immunization requirement compared to 54 percent of conservatives; sixty one percent of moderates were in favor.
Do we really need to make the public’s health about politics?

Read the analysis and survey results

Early Release of Selected Estimates Based on Data From January-September 2018 National Health Interview Survey: This CDC survey is a treasure trove of information ranging from access to insurance to health behaviors. Overall, the percentage of people who reported excellent or very good health was 66.3, statistically unchanged from the previous year.

Read the report

About pharma

Updated CMS drug dashboards show prescription price hikes sustained by Medicaid, Medicare: If you thought the federal government was on top of its own pharmaceutical prices, read this article. From 2013-2017, Medicaid prescription drug spending rose by nearly 15% and average spending per unit dose under Medicare Parts B and D rose 10.6% and 10%, respectivelyThese figures come from the
CMS Drug Spending website.

Read the article

Interim report from the Advisory Council on the Implementation of National Pharmacare: This report is from out northern neighbor. It states, in part, that: “Canada’s spending on prescription drugs is unsustainable…In fact, drug spending is now the second largest category of spending in Canadian health care, surpassing spending on physician services – only hospitals cost more. Canadians pay among the highest prices and spend more on prescription drugs than citizens of almost every other country in the world.”  We will have to see how they will address the same problem we have.

Read the brief

About quality

Variation in Surgical Outcomes Across Networks of the Highest-Rated US Hospitals:Popular press surveys are a common source of information for the public to help them make healthcare decisions. This study uses the 2018 US News & World Report Honor Roll hospitals to assess variations in select surgical outcomes of care among hospitals that were parts of the same systems. No surprise, there was a wide variation. The paper calls for systems to more closely monitor member hospitals but what I take away is that system rankings cannot be used as a proxy for individual institutional care- another case of caveat emptor in healthcare.

Read the research (Subscription required by abstract is accessible)