Today's News and Commentary

About health insurance

Judge strikes down Trump administration's site-neutral payments rule: This story is today’s most impactful. “District of Columbia Judge Rosemary Collyer ruled Tuesday that the Centers for Medicare & Medicaid Services (CMS) overstepped its authority when it finalized a plan to extend a site-neutral payment policy to clinic visits with the goal of paying the same in Medicare for evaluation and management services at physician offices and hospitals.

Hospitals have the ability to charge patients and insurers more for the same services because they can add a facility charge that non-hospital-owned practices cannot. In fact, that’s how they financed physician practice acquisitions- charging more for the same services these practitioners provided before the sale. CMS sought to level the playing field and save the Medicare program $150 million a year by eliminating this differential. The American Hospital Association fought back and won.
The site neutrality payment policy can still be implemented with Congressional action.

10 states with the least competitive health insurance markets: According to this AMA study, 63% of state-level markets are “highly concentrated,” meaning very uncompetitive. That figure goes up to 75% when considering 382 metropolitan statistical areas. Of further concern is the concentration is worsening.

House panel delays vote on surprise medical bills legislation: “The dispute is centered on how doctors and hospitals will be paid once patients are protected from these massive bills. The bipartisan Energy and Commerce legislation essentially sets the payment rate that an insurer would pay the doctor. 

Doctors and hospitals are lobbying hard against that approach, including by spending millions of dollars in ads, warning it would lead to damaging cuts to doctors’ pay.”

Four People Charged In $99 Million Scheme To Commit Health Care Fraud And Wire Fraud And Pay Kickbacks To Doctors And Their Employees: This NJ case involved payoffs and kickbacks for steering referrals to pharmacies that supplied high cost pharmaceuticals. How can we redesign the process to eliminate the incentives to commit fraud?

About healthcare IT

The role of medical smartphone apps in clinical decision-support: A literature review: This study concludes that: “Whilst diagnostic accuracy studies are plentiful, clinical trials are scarce.” Further, methods of data collection vary (e.g., cameras, motion sensors, electrical activity), so research approaches need to be individualized for each test.

Millions of Americans’ Medical Images and Data Are Available on the Internet. Anyone Can Take a Peek: “Hundreds of computer servers worldwide that store patient X-rays and MRIs are so insecure that anyone with a web browser or a few lines of computer code can view patient records.” This research from Propublica and German broadcaster Bayerischer Rundfunk identified “187 servers…in the U.S. that were unprotected by passwords or basic security precautions.” This article is definitely worth a read.

HHS wants to give you your health data — do you want it?: As the federal government pushes providers to make patient data more available, recent research shows patients are either not ready to accept/access their data or do not want to download it. The article is a nice summary of the recent studies about this subject.

Israel Prepares to Unleash AI on Health Care (Wall Street Journal, subscription required): This article is a great insight into what can be done with Artificial Intelligence in healthcare when good design meets efficient interoperability.

About the public’s health

The U.S. abortion rate falls to lowest level since Roe v. Wade: “There appears to be no clear pattern between efforts to ban or restrict abortion and the continuing decline in abortion rates, which has been going on for nearly 40 years. The declines were seen across regions and in states that are more supportive of abortion rights as well as those that are more restrictive.” The reasons for this decline are not clear but they do coincide with decreasing birth rates as well.

Yesterday, the Financial Times had a series of articles about dementia. If you are interested in social issues, policy and business aspects of this condition, these articles are worth reading. (Subscription required).

Ambient black carbon particles reach the fetal side of human placenta: Another reason to eliminate particulate pollution: “Particle transfer across the placenta has been suggested but to date, no direct evidence in real-life, human context exists. Here we report the presence of black carbon (BC) particles as part of combustion-derived particulate matter in human placentae…”

How Health Systems Are Meeting the Challenge of Climate Change: This article is a nice summary of what some major healthcare institutions are doing to reduce their carbon footprint over the next ten years.

Survey: What Employees Want Most from Their Workspaces: “The results of a recent Harvard study suggest that wellness programs, offered by 80% of large U.S. companies, yield unimpressive results — and our findings mirror this. Future Workplace and View recently surveyed 1,601 workers across North America to figure out which wellness perks matter to them most and how these perks impact productivity.” Read the article to find out what employees really want. First on the list is air quality.

About hospitals and health systems

Premier Inc. Survey: Health Systems Report that Changes are Needed to Accelerate Adoption of Risk-Based Payment Arrangements: “Across all payer types, most respondents indicate that less than 20 percent of their population was covered in a risk-based arrangement. Twenty-nine percent reported that fee-for-service Medicare relationships are currently managed in a risk-based model, while 22 percent reported that to be the case for Medicare Advantage. Sixty-four percent of respondents reported that less than 20 percent of their patient population was covered by risk-based arrangements with employer-sponsored health plans.” Despite all the talk about risk-based arrangements and how they are growing, the field is nowhere near where it needs to be. The issues are the same as they have been for the past twenty years or so. Read the report for more details.

About healthcare quality and patient safety

WHO: Millions of Patients Die Every Year Seeking Health Care : “The World Health Organization reports one in 10 patients is harmed in high-income countries. It says 134 million patients in low-and-middle-income countries are harmed because of unsafe care leading to 2.6 million deaths annually. WHO notes most of these deaths are avoidable…Besides the avoidable and tragic loss of life, WHO reports patient harm leads to economic losses of trillions of dollars globally each year. It says medication errors alone cost an estimated $42 billion annually.
On the other hand, WHO says a study in the United States finds safety improvement in patient care has resulted in estimated savings of $28 billion in Medicare hospitals between 2010 and 2015.”
One of the major reasons for this problem is lack of a “patient safety culture,” as has been adopted by many highly functioning US healthcare systems.

About pharma

Decision Resources Group 2019 ePharma Physician® Report Finds U.S. Physicians Increasingly Too Busy to See Pharma Sales Reps: It used to be that pharmaceutical company representatives were a major source of information for physicians about established and new products. In recent years, many institutions have banned such contacts, fearing undue influence. Now, a limiting factor for practitioners who want to see reps is time. This study reports, among other findings, that the share of physicians seeing reps in-person declined in the last year from 67% to 54%. Further, the number of physicians that have not communicated with a representative within the last six months increased from 24% to 39%. Clearly, different marketing channels are needed for these companies.