Today's News and Commentary

About healthcare quality

CMS nursing home star ratings overhaul sees 37% of skilled nursing facilities losing 1 or more stars: Ratings of nursing facilities have been rising over the years, so CMS decided to reset its criteria. This revision resulted in a downgrade of one or more “stars” for 37% of these facilities. As the article points out, this change comes at a time when hospitals are choosing their “after care” partners for participation in global payments.

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About health insurance

Anthem’s Social Determinants Benefits Package Boosts Medicare Enrollment: This year CMS started to allow Medicare Advantage plans to offer expanded benefits like transportation to and from medical visits, healthy meals, and personal care at home. This expansion is paying off for Anthem, which reported a 14% jump in Medicare Advantage enrollment.

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Speech: Remarks by Administrator Seema Verma at the National Association of Accountable Care Organizations (NAACOS) Spring 2019 Conference: READ THIS SPEECH! CMS administrator Verma does a great job outlining changes that need to be made to improve our healthcare system.

”… safeguards put in place under the Stark Law limit providers’ ability to make referrals or coordinate care in innovative ways.  Therefore, we are undergoing a top-to-bottom review of Stark Law regulations to ensure that they are encouraging, rather than hindering, the move to value.”

“We are also combing through and pruning our quality measure sets, so that clinicians can focus on a smaller set of more impactful measures – last year we reduced measures by 20%.”

“To encourage adoption, CMS is promoting multi-payer alignment.  Adoption will increase when providers don’t have different models for different payers.  We want to work with private sector groups to synchronize our models with those in private plans where possible. “

“CMS is striving to set consistent and fair benchmarks.  We factor in a number of important questions, including:  How do we create a level playing field so that provider performance is fairly evaluated?  How do we factor in risk adjustment, so there is not an incentive to cherry-pick healthy patients and so we can strengthen the incentive to take on the most complex patients?  And finally, how do we reward good performers without creating a race to the bottom, where your benchmark always gets harder as your performance improves?”

One statement that the media has highlighted above all others is:

“Looking forward, you can expect that some of the models we have under development will be mandatory.”
In other words, CMS will be making some of its value-based programs mandatory.

Read the speech

Humana, Doctor on Demand launch virtual primary care health plan; This program is not your usual telemedicine linkup; it is part of a structured health plan that Humana is offering with Doctor on Demand and is called On Hand. This virtual primary care model will have lower premiums and no “office” copays for calls. Members will get a kit that includes a blood pressure cuff, thermometer and log to help convey data to the physician. Other in-network virtual services will also be available.

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Association insurance pushes on despite court ruling: Despite a court ruling last month that challenges the legality of association health plans, many people are still enrolled in them. This article updates what is happening with this insurance product.

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About the public’s health

Consumption of Alcohol Beverages and Binge Drinking Among Pregnant Women Aged 18–44 Years — United States, 2015–2017:Alcohol consumption during pregnancy can lead to serious problems for the newborn- called fetal alcohol syndrome. Since the occurrence is idiosyncratic, no level of alcohol consumption is “safe” during pregnancy. This CDC report found that: “Analysis of 2015–2017 Behavioral Risk Factor Surveillance System data found that 11.5% of pregnant women reported current drinking, and 3.9% reported binge drinking during the past 30 days.” Clearly we still have a problem.

Read the report

Americans Are Among the Most Stressed People in the World, Poll Finds: Emotions can have a profound effect on health- especially stress. This article summarizes mainly the US results from the 2019 Gallup Global Emotions study. We are not only stressed , but we are more stressed than any time in the past decade. Not surprisingly, stress doesn’t always correlate with politics or wealth. For example the countries that reported the highest “positive feelings” tend to be South/Central American; highest overall were Paraguay and Panama.

Read the summary article(NY Times but appears to be open access)
Read the full report (Click the link)

About pharma

Questions about BMS-Celgene integration plans? Obviously. Answers? Not so much: This interview with Bristol-Myers Squibb CEO Giovanni Caforio explains the company’s strategy after the Celgene acquisition. One overall message is that R&D will still be pursued with each original company’s agenda.

Read the interview

WHO Invites Comments on Drug Shelf Life Policies: Drug shelf life policies are extremely important because many poorer countries cannot afford to throw out costly medications. The WHO is soliciting comments to formulate a policy about this issue.

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About healthcare technology

FDA clears first device treatment for childhood ADHD: A prescribed, external trigeminal nerve (forehead and face) stimulation device has been approved by the FDA for treatment of unmedicated childhood ADHD.

Read about the product

Molecular subtyping reveals immune alterations associated with progression of bronchial premalignant lesions: Researchers have found four molecular subtypes of bronchial pre malignant cells from high risk smokers. These changes can reliably identify those at high risk. But all that can be done now is intensify surveillance; preemptive interventions are not yet available.

Read the research

CMS Plots to Increase Breakthrough Device Payments; Among other criteria for CMS to consider payment for a “breakthrough device” is evidence that it represents a “substantial clinical improvement.” But comparative studies may not be available at the time the innovation is launched. CMS has said it will waive this requirement for two years while the manufacturer gathers more data.

Read the announcement

About healthcare IT

Nearly half of U.S. doctors say they are anxious about using AI-powered software: survey: This article provides a nice summary of an international Medscape survey about physician attitudes toward using Artificial Intelligence in clinical practice. American physicians are more skeptical than their European counterparts and many feel the technology is still too much in its infancy to be reliable.

Read about the survey