About health insurance
MedPAC: End 'Incident To' Billing for NPs, PAs: This article summarizes three recommendations in MedPAC’s latest report to Congress for Medicare payments. First is elimination of the “incident to” care for NPs an PAs. Currently, if they are working under direct care plans of a supervising physician, they use the MD’s provider number and can bill at 100% of Medicare eligible charges. If working independently, even if employed by a physician, they can only bill at 80% of allowable charges. Second is the recommendation to closely scrutinize ER bills, which have shown a dramatic upcoding. Finally, there would be no physician payment update for 2020, as per existing law.
Texas hospitals applaud new bill to end surprise billing: As Congress debates what to do with surprise billing, states are taking their own actions. The latest is Texas where a new law, backed by the Texas Hospital Association (THA), " calls for an arbitration system for health plans and hospitals to come to a mutually acceptable payment amount without putting patients in the center of the dispute.”
Performance in the Medicare Shared Savings Program [MSSP] After Accounting for Nonrandom Exit: An Instrumental Variable Analysis: Performance evaluations of the MSSP has been complicated by the variety of participants. This study “compared MSSP ACO participants versus control beneficiaries using adjusted longitudinal models that accounted for secular trends, market factors, and beneficiary characteristics.” The results are that the savings CMS claims are higher than should be reported. The researchers conclude: “After adjustment for clinicians' nonrandom exit, the MSSP was not associated with improvements in spending or quality. Selection effects—including exit of high-cost clinicians—may drive estimates of savings in the MSSP.”
Comparison of Hospitals Affiliated With PPS-Exempt Cancer Centers, Other Hospitals Affiliated With NCI-Designated Cancer Centers, and Other Hospitals That Provide Cancer Care: The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 mandated a phasing-in of DRG payments to hospitals for Medicare inpatient services. However, certain oncology hospitals were specifically named for being exempt from the DRG methodology. The theory was that they had special expertise entitling them to higher payments. This research compares those hospitals to non-exempt institutions and finds “generally similar hospital characteristics, patient comorbidity burden, and cancer surgery outcomes.” The results raise the question “ why some cancer centers are designated as PPS-exempt and why most hospitals are not required to publicly report cancer-specific quality metrics.”
Pelosi: Dems will 'fight relentlessly' against Trump's ObamaCare repeal attempts: Although we don’t yet know what the new Trump healthcare proposal looks like, Speaker Pelosi vowed to fight attempts at repealing the ACA.
U.S. News & World Report Hospital Rankings & Ratings: Just FYI that the latest rankings are out.
About healthcare IT
Health plans to go digital with HEDIS, expert says: NCQA announced that the HEDIS quality data will be “going digital.” The article points out that large health plans who are not used to collecting data in this fashion may be at a significant disadvantage.
Read the article
Robocalls are overwhelming hospitals and patients, threatening a new kind of health crisis: Robocalls are bad enough at home. Now they are clogging phone lines at hospitals, potentially preventing important calls from getting through. For example, at “Tufts Medical Center, administrators registered more than 4,500 calls between about 9:30 and 11:30 a.m. on April 30, 2018…” Congress is considering options but the blocking technology needs to keep up with the spammers. No end in sight.
Read the story (Washington Post, but appears to be open access)
CMS rule would streamline prior authorizations for e-prescribing: One part of e-prescribing that slows down the process is getting prior authorization. Now CMS has issued a proposed rule that would add standards to expedite this task- including completion of prior authorization online as part of the prescribing process. Comments are due by August 16.
Online mental health predictive software: Two articles look at how patterns of online entries can help healthcare professionals predict behavioral crises. The first article from the NY Times discusses a program in California whereby “state and county mental health officials, along with patient representatives, have met regularly with behavioral health companies Mindstrong and 7 Cups…to test smartphone apps for people receiving care through the state’s public mental health system.” The second article is from PLOS ONE and looks at “Evaluating the predictability of medical conditions from social media posts,” especially Facebook. In addition to behavioral health, diabetes was also accurately predicted. Both initiatives have shown success and were implemented with patient permission.
FDA Clears Smartphone-Controlled Medical Device to Treat Migraine: Smartphone apps usually take patient inputs and do something with them. This one takes input from the smartphone and uses it for “remote electrical neuromodulation for the acute treatment of migraine.”
About the public’s health
Vaccine Injury Claims Are Few and Far Between: The National Vaccine Injury Compensation Program was established in 1988 as a no-fault system from which injured parties could obtain compensation. The Program was established because pharma companies were leaving the vaccine business due to real fears about lawsuits in, what was then, a low-margin business. The government intervened as a public health measure to ensure vaccine availability. A portion of each vaccination’s sale goes to fund the Program. This story is relevant now because of the reluctance of some to get their children vaccinated. According to the article, which pulled data from the Program, over “roughly the past dozen years in the United States, people have received about 126 million doses of vaccines against measles… and killed 400 to 500 people each year. During that period, 284 people filed claims of harm from those immunizations through a federal program created to compensate people injured by vaccines. Of those claims, about half were dismissed, while 143 were compensated.” Read the article for information about other vaccines.
Read the article (NY Times but appears to be open access)
Physician and Patient Characteristics Associated With More Intensive End-of-Life Care: Choice of medical surrogacy can influence care patterns. In this study on end of life care, terminally ill patients who delegated decisions to their physicians were more likely to receive aggressive treatments in the weeks before they died. The authors call for greater “research, clinical, and policy attention to patient treatment preferences and physician comfort with medical paternalism might lead to improvements in care of patients with advanced disease.”
Disaggregating Hispanic American cancer mortality burden by detailed ethnicity: Viewing hispanics as a single group is counterproductive in healthcare (and other fields). This article highlights that fact by looking at differences in cancer epidemiology. For example, Mexican American and Puerto Rican American males had twice the mortality rate of non-Hispanic whites from stomach and liver cancers. Cuban-Americans had the same rate of those cancers as non-Hispanic whites but a higher rate of lung cancer than other Hispanic groups.
Pfizer bulks up in oncology with $11.4-billion deal to buy Array BioPharma: This story is FYI. It is newsworthy for the size of the deal and Pfizer’s strategy to enhance its oncology business.