Today's News and Commentary

About health insurance

Tennessee becomes first state with a plan to turn Medicaid into a block grant (Washington Post, subscription may be required): Over the past several years, a number of proposals have been floated for changing Medicaid payment methods, including block grant to states. This one is the first to implement such a change. The big implication is not just this program, but what it may portend for all of Medicaid- especially in Republican-controlled states.

About healthcare professionals

Cornell’s Medical School Offers Full Rides in Battle Over Student Debt (NY Times, subscription may be required): Many medical schools have revised their student scholarship policies to make the education tuition-free. This article is an update on those programs as Cornell joins their ranks.

About hospitals and healthcare systems

Healthy Marketplace Index: This research from the Health Care Cost Institute compared “hospital system concentration levels in 112 metro areas across the country from 2012 to 2016. In 2016, 81 metros of the 112 studied (72%) had hospital markets with [measures] that could qualify as a highly concentrated per the Department of Justice (DOJ)… Hospital markets tended to be less concentrated in larger metro areas. For instance, New York City, NY…, Philadelphia, PA …, and Chicago, IL … had three of the five least concentrated hospital markets studied . Conversely, the three most concentrated markets were in metro areas with populations of less than 300,000 in 2016: Springfield, MO…, Peoria, IL…, and Cape Coral, FL ...”
Read the entire report for a really interesting discussion of this issue of hospitals consolidation.

About pharma

Trends in Off-Label Drug Use in Ambulatory Settings: 2006–2015 (Pediatrics- subscription required for entire article): “Physicians ordered ≥1 off-label systemic drug at 18.5%… of visits, usually (74.6%) because of unapproved conditions. Off-label ordering was most common proportionally in neonates (83%) and in absolute terms among adolescents (322 orders out of 1000 visits).” These rates increased over the ten years of study. An accompanying editorial calls for more research and focused treatments for children.

About the public’s health

Patient Perceptions of Diabetes Guideline Frameworks for Individualizing Glycemic Targets: This article highlights the need to assess patient attitudes toward standardized recommendation and craft customized treatment plans.Many older adults do not place high importance on factors recommended by guidelines to individualize diabetes treatment, especially when deciding to stop use of diabetes medications. Moreover, when considering treatment aggressiveness, many older adults weighted several factors in the opposite direction than suggested by the guidelines. Individualizing diabetes care in older adults will require effective communication regarding the benefits and consequences of making changes to treatment plans.”