Today's News and Commentary

About health insurance

Prior Authorization Bill Expected in Congress This Summer: Prior authorizations for services, tests and pharmaceuticals add a large time and cost burden to practitioners and inconvenience for patients. This forthcoming bill has bipartisan support and is expected out this summer.

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Next Generation ACO participants for 2019 drop to 41: Since March 2018 the number of these ACO participants dropped from 58 to 41. Some may have shifted to the less risky shared savings program, but will be required to eventually assume more risk.

Read the announcement (Modern Healthcare, so there is some limited access)

CBO changes how it estimates insurance coverage: The Congressional Budget office will change its methodology for determining the impact of such insurance changes as repeal of the ACA.
“The updated insurance model changes how individuals and families are projected to choose among coverage options and how an employer is projected to take a worker's preference into account when deciding whether to offer employment-based coverage.”

Read the article (Modern Healthcare, so there is some limited access)

US Emergency Department Visits and Hospital Discharges Among Uninsured Patients Before and After Implementation of the Affordable Care Act: We still have a long way to go covering the uninsured, who use the ED for much of their care. “Proportions of ED visits and hospital discharges by uninsured patients decreased considerably after the implementation of the 2014 ACA insurance provisions. Despite these changes, approximately 1 in 10 ED visits and 1 in 20 hospital discharges were made by uninsured individuals in 2014 to 2016.”

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The Return of Churn:State Paperwork Barriers Caused More Than 1.5 Million Low-Income People to Lose Their Medicaid Coverage in 2018: This paper looks into the reason for the huge drop in Medicaid coverage in 2018. Reasons were not previously clear. For example, one could speculate that the country’s increased employment took many off the roles. This study claims that the vast majority of the loss was due to “enrollment churn”- or eligibility redetermination enrollment losses. The losses varied dramatically among the states. We need more uniform criteria, processes and enforcement; if for no other reason then 744,000 of the 1.5million loss were children

Read the research.

About healthcare IT

Senators move to ramp up oversight of VA's $16B EHR project: Integration of VA and Department of Defense IT systems was announced in 2017. It still has a long way to go. Because of the cost and slow pace, bipartisan action in the senate will “ramp up oversight” of this project.

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About pharma

Innovative drug delivery improves effectiveness of cancer immunotherapy: “…a new method has been developed that targets collagen to deliver immunotherapies directly to tumours, helping to both reduce side effects and make the therapies more effective in treating cancer.” The collagen complex sees blood leakage in cancers as a breach in blood vessels and seals them up, delivering the immunotherapy.

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Almost Half of Young Asthma Patients Misuse Inhalers: This article highlights the difference between efficacy (ideal circumstance use) and effectiveness (use in real world conditions). Asthma treatments are mostly efficacious but more needs to be done to make them effective.

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On-chip drug screening for identifying antibiotic interactions in eight hours: A problem using antibiotics in a timely fashion is the long time it takes to assess the the sensitivity of the bacteria. This technology speeds up the process and will also help reduce resistance by “getting it right” sooner.

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