Today's News and Commentary

About the public’s health

Only half of Americans plan to get a flu shot this year. Here's why that's a problem: “While 60% of adults think that the flu vaccine is the best preventive measure against flu-related deaths and hospitalizations, only 52% said they planned to get one this season, according to a survey by the National Foundation for Infectious Diseases (NFID).” If fewer people are immunized the population as a whole will not be protected. What incentives will get people to increase vaccination rates, given that the main reasons they do not get the shots are:

  • 51 percent do not think flu vaccines work

  • 34 percent are concerned with side effects from the vaccine

  • 22 percent are concerned about getting flu from the vaccine

Advisory Committee Supports GSK’s OTC Nicotine Spray: “The Nonprescription Drugs Advisory Committee voted 8-7 for the product’s efficacy, 9-6 for its safety, and 9-6 for its overall risk-benefit profile to reduce withdrawal symptoms associated with quitting smoking for consumers ages 18 years or older.” Is this nicotine delivery mechanism going to replace vaping?

About health insurance

Essential Hospitals Thank Senate for Vote to Delay DSH Cut: As previously reported, the federal government was going to cut $4 billion in Disproportionate Share Hospital payments. The Senate voted to delay that action.

Sam's Club, Humana team up to mitigate high out-of-pocket healthcare costs: “Sam’s Club is teaming up with Humana and telehealth startup 98point6 to pilot a program aimed at helping its members mitigate some out-of-pocket healthcare costs…The program, called Care Accelerator, is not meant to replace a health insurance plan but to make it easier for those with high deductibles and others with high upfront costs for care get access to basic services and prescriptions…Sam’s Club members that opt into the program will be able to purchase service bundles ranging from $50 to 240 per year that include a range of services.  
At the lowest price point, individual members can get certain generic drugs for free at Sam’s Club pharmacies, pay $1 for telehealth primary care visits at 98point6 and save on eye exams and glasses or dental care. 
Humana will manage the provider network…”

Democrats to force vote on Trump health care rule: Democrats wants the Senate to vote on the Trump administration’s policy to relax health plan requirements. Their theory is that that they win either way- A “NO” vote can block the White House plans (once the Democratically controlled House weighs in). A “YES” vote for waivers can be publicized as Republican desire to weaken a health plan that Americans have grown to favor. The catch is that even with 100% Democratic backing, 4 Republican Senators will need to agree to hold the vote.

Association of Bundled Payments for Joint Replacement Surgery and Patient Outcomes With Simultaneous Hospital Participation in Accountable Care Organizations: Are there differences in costs between ACOs that have bundled payments for lower extremity joint replacements and traditional Medicare fee-for-service? Not overall, but the mix of services was more appropriate with bundles. “In a cohort study of 483 008 Medicare fee-for-service beneficiaries, compared with participation in joint replacement bundled payments alone, coparticipation was not associated with differential changes in episode spending. However, coparticipation in accountable care organizations was associated with differentially greater decreases in hospital length of stay and home health care use, greater increases in postdischarge outpatient follow-up, and smaller reductions in unplanned readmissions.”

UnitedHealthcare Consumer Sentiment Survey, 2019 Executive Summary: This survey gathered information by different age segments for three topics: Open Enrollment Preparedness; Technology & Transparency Trends; and Health Literacy & Consumer Preferences. One surprise was that, overall, only “20% said the internet or a mobile app is the first source they usually consult for information about specific health symptoms, conditions or ailments.” Millennials’ use was 30% and Baby Boomers’ use was 14%. One caveat: it is not clear from the methodology if the people surveyed at random were UnitedHealthcare members. The health literacy figures are higher than from other research I have seen.

About healthcare quality and patient safety

CMS’ Discharge Planning Rule Supports Interoperability and Patient Preferences: CMS has issued its final rules regarding hospital discharge procedures. In summary, hospitals must “provide patients access to information about PAC [post-acute care, that is, after-hospital care] provider choices, including performance on important quality measures and resource-use measures – including measures related to the number of pressure ulcers in a given facility, the proportion of falls that lead to injury, and the number of readmissions back to the hospital. The rule also advances CMS’s historic interoperability efforts by requiring the seamless exchange of patient information between healthcare settings, and ensuring that a patient’s healthcare information follows them after discharge from a hospital or PAC provider.”

CMS finalizes hospital antibiotic stewardship requirements (Modern Healthcare, subscription required): The headline speaks for itself. These requirements are now part of the infection control provisions that are in CMS’s conditions of participation for hospitals.

About healthcare information technology

Sen. Rand Paul continues fight against patient identifier, introduces bill to overturn authority under HIPAA: As previously reported, the Senate did not include funding to roll out a national patient identifier. To add to the impediments, Senator Paul introduced legislation “called the National Patient Identifier Repeal Act of 2019, that would repeal the original authority to create the ID under the Health Insurance Portability and Accountability Act of 1996.” His rationale is fear of jeopardizing patient privacy by centralizing sensitive data. He should look to most of the other developed countries that have secure single identifiers that are used for healthcare, drivers licenses, taxes and financial services.

Changes to Existing Medical Software Policies Resulting from Section 3060 of the 21st Century Cures Act: Today the FDA issued its final (non-binding) guidance covering what types of medical software are subject to regulation as devices. To reflect changes in this document over the draft of last December, “the title of the guidance has been revised to ‘Policy for Device Software Functions and Mobile Medical Applications.’” The categories it covers are: Software Function Intended for Administrative Support of a Health Care Facility; Software Function Intended for Maintaining or Encouraging a Healthy Lifestyle; Software Function Intended to Serve as Electronic Patient Records; and Software Function Intended for Transferring Storing, Converting Formats, Displaying Data and Results. In general, if the app helps a patient to maintain a healthy lifestyle, communicate with a practitioner or store data, it is exempt from FDA regulation. But read the details (it is actually written in understandable English).