Under #ACA and #IRS rules, hospitals to play larger role in public health #NEU

Gary Young, director of the Northeastern University Center for Hstate houseealth Policy and Healthcare Research in Boston spoke to me for my quality column in Health Leaders Media this week.  The column looked at the role social services play in promoting health.

He said the Accountable Care Act’s  Community Health Needs Assessment requirement is intended to integrate hospitals more tightly into the public health Infrastructure. They’re already required to  demonstrate “community benefit” spending to the IRS.  Compliance with that requirement is spotty.

As it is, Young’s research team recently reported wide variation in community benefit spending by hospitals. 

“Hospitals have always been focused on treatment and not prevention and promotion,” Young says. “That’s what they’ve been paid to do. From a cultural standpoint, that’s the orientation of hospitals. “

They do not have the infrastructure—intellectual or material—to deal with community health, he says. However, they are facing a paradigm shift.  

The Health Wonk Review: HIT, LGBT and ACA

No sorting this edition of the Health Wonk Review into categories. They cover the range:  insurance, HIT, report cards, LGBT health and cancer. Along with this collection of health policy blog posts, we offer a little color from the former home of the Hospital de la Santa Creu i Sant Pau in Barcelona.

Find a Twitter list of contributors here.

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Sant Rafael Pavilion

At Workers’ Comp Insider, Tom Lynch talks about Oklahoma, fracking, earthquakes and Obamacare: In Oklahoma, The Times, They Are A’Changin’.

Are Bronze level plans on the chopping block? InsureBlog’s Henry Stern offers evidence that this may soon be the case.

Brookings & Ponemon on Privacy & Security: Meet the Experts: David Harlow shares some highlights from two recent research reports on the state of health data privacy and security, one qualitative and the other quantitative. In all, about 200 covered entities and business associates were surveyed, and with the promise of anonymity offered some candid observations, suggestions and rants.



Sant Rafael Pavillion, old and updated view

From Charles Gaba at ACA Signups: Presenting the ACA Signups 2017 Requested Rate Hike Challenge. Last year I spent gobs of time tracking down the requested 2016 individual market rate hike requests and compiling them into statewide and nationwide weighted averages…This year I’m doing it again, but with some crowdsourcing added.


Roy Poses at Health Care Renewal asks: Who Benefits? – Hospital Profits and Quality May Fall, But Hospital Executives’ Compensation Keeps Rising Here is the latest roundup of cases in which non-profit hospitals’ top executives compensation continued to rise despite their institutions’ financial or clinical setbacks.  As usual, the executives, their boards of trustees, and/or their hired spokespeople defended their ever increasing riches with familiar talking points. 

From Brad Flansbaum of The Hospital Leader: Why he punts on hospital report cards.

Peggy Salvatore at Health System Ed offers: Prompted by an excellent blog last time by Anthony Wright at Health Access on the political realities of implementing single payer, we had a little bit of a discussion last week on the HWR podcast. This week an article by some Harvard physicians keeps the topic alive. 


Images projected on tunnel walls

In a post entitled Obamacare’s anti-discrimination protections fortified, Amy Lynn Smith at healthinsurance.org explains how the HHS-issued final rule on Section 1557 of the Affordable Care Act has removed one more roadblock to full healthcare equity for the LGBT community. 

Is High Prescription Drug Spending Becoming Our New Normal? On Health Affairs Blog, Leigh Purvis and Crystal Kuntz examine the rise of specialty drugs, the lack of meaningful price competition for biologics, and the current research pipeline and market and suggest next steps for addressing these trends.  

David Williams at the Health Business Blog offers: Due diligence in middle market healthcare investing  I share my perspective on the special case of commercial due diligence of mid-sized healthcare firms, where the issues can be complex and information is hard to come by.

Hospital visitor

Sant Jordi Pavilion

Jason Shafrin at The Healthcare Economist provides an overview of 5 different approaches for designing a cancer value framework in the latest issue of JAMA.

Colorado Health Insurance Insider offers: Simple Choice plans in the federally facilitated exchange.  Louise Norris wonders about the “Simple choice plansfrom a CMS blog post and how they differ from what has been finalized about Standardized plans in February in the 2017 Benefit and Payment Parameters.

Joe Paduda offers a quick review of Sec. Clinton’s proposed health care reforms = Medicare for some, consumer cost caps, and more Medicaid.

Finally, while still blogging here, find my most recent work at Health Leaders Media, where I write a weekly column on quality of care.

Photos © Tinker Ready


Boston surgeons can help patients get a new penis, or lose the old one

CaptureNot at the same place. Both the Globe and WBUR report today on Boston Medical Center’s new male-to-female gender reassignment surgery program. News comes just after MGH’s announcement of the first penis transplant.

From the Globe

Boston Medical Center plans to become the first hospital in Massachusetts — and one of a few in the country —to offer gender reassignment surgery, responding to a growing and unmet demand for treatment in the transgender community.

The hospital said more than 100 patients have already signed on to a waiting list to be evaluated for surgery — even before it has widely publicized the program. Boston Medical Center has long provided primary care, mental health services, and hormone therapy for transgender men and women, and most of the patients considering surgery are from the Boston area. Capture2Across the country, many hospitals have been reluctant to offer male-to-female and female-to-male genital surgeries, but health care providers said that is slowly changing as insurance coverage expands and public acceptance of transgender people grows.


Do we need to learn to live with sponsored health care content?

I was going to scan in the front page of today’s Globe, which features a story on Partners staff complaining about how hard it is to learn the new $1.3 billion HIT system. There was a teaser nestled up to it for a story on the first penis transplant. That juxtaposition made me wonder how a slip of the finger on keyboard might impact the noted surgery. But, I decided to be a grown up.

Instead, I’ll let someone else rag on the Globe, or in this case the sort of Globe. That would be the part of the Globe Media Co. that is hiring new staff, not the newspaper itself, which is offering staff buy-outs.

Over at Health News Review, Trudy Lieberman complains about a “serious and rapidly emerging dilemma for consumers of health news. What’s real journalism and what’s “content” masquerading as journalism as we know it?  Examining stories on The Guardian’s Healthcare Network site and on STAT, the fledgling digital news service that’s making a name for itself with loads of daily content, I discovered a blending of traditional stories with advertising and promotion that simply fools the reader.

She goes on: When I first caught on to what STAT was doing, I felt deceived like I was when I read The Guardian’s breakthrough piece. The pooh-bahs at STAT are making it easy for me to read something I don’t want to read and confusing me with look-alike content prepared by some of the biggest names in the healthcare business— Cigna, CVS Health, Johnson & Johnson, Baxalta, a new biopharmaceutical company, and PhRMA whose contributions to Morning Rounds have included “America’s biopharmaceutical researchers and scientists are tireless in the fight against disease” and “Imagine “smart bombs” that fight cancer and reduce side effects.”

First, my conflicts. I was involved in a major sponsored content project once. And I have a family member who works at the Globe.  And while I’m not a big fan of native advertising, I am a big fan of good journalism and we need to pay for it somehow. Or, the folks at STAT will be getting those buy-out offers.

Plus, it looks pretty well-Capturemarked to me with all that orange.  Also, I’m not sure the idea is so much to hide PR in news-sheep’s clothing. My understanding it that the idea is to get this stuff out on social media where the orange banners and disclosures don’t show up — social marketing. That concerns me, along with all these university and hospital publication that look and sound like news but are PR and marketing. Many will argue — we report these stories just like journalist. The difference is — who do they answer to? Who is the customer? That would be the marketing staff at institution or the hospitals, not the reader. But, that stuff gets tweeted out and no one knows the difference. My journalism students don’t know the difference.

Honestly, I hate this stuff as much as Lieberman does. I want to keep that wall between advertising and editorial up. Are native advertising and social marketing, by nature, deceiving the reader?  You could make that argument.  But, I see the dilemma. Here’s hoping we find a better way to support good journalism.



Docs reject Harvard jobs because of conflict of interest policy?

Well, that’harvard meds  what Dr. Peter Slavin, president of Massachusetts General Hospital, told STAT news in a story about Harvard’s revised conflict of interest policy:

Slavin said the change may help with a recruitment problem: “Some faculty don’t come because they perceive that Harvard Medical School has rules that are much too restrictive.”

Or they leave, according to Gretchen Brodnicki, dean for faculty and research integrity.

 Brodnicki said she has heard anecdotes of faculty leaving, or being unable to conduct specific studies, because of the rule, though she said the impact is hard to measure.

Here’s the new rule:

First, the school is raising the thresholds: Faculty will have to receive at least $25,000 in income (up from $10,000), or hold $50,000 in equity of a publicly traded company (up from $30,000) to trigger the prohibition on clinical research. Faculty still cannot hold any equity in a privately held company if they want to do clinical trials on that company’s product.

Second, the school will now allow faculty to petition for an exemption if they’re over those thresholds and still want to do the research.


Another reason we need The Boston Globe – nursing home coverage

CaptureAs The Globe heads for another round of buyouts,  consider one of many reasons we so need a robust news operation in town: your parents.

Or maybe your grandparents. Or anyone who lives or works in a nursing home in the state. Kay Lazar has been doing some great reporting on conditions in and regulation of nursing homes.

I covered this beat in NC in the 1990s,  so I know the kind of dark places she’s had to go to get these stories. (I count the state Department of Public Health — super uncooperative about public records — among them.) I started reporting on the low fines North Carolina was issuing serious violations of are rules.  After a couple months of this, a county inspector told me this: one home owner said: I don’t care how much you fine me, just keep me out of the paper. When our news operations are diminished, she’ll get her wish.

A small sample of Lazar’s work:

A pattern of profit and subpar care at Mass. nursing homes

The Globe scrutinized the 2014 financial reports, the latest available, from 396 Massachusetts nursing homes and examined the money spent on nursing care, patient food, management, rent, and fees for therapy, office support, and other services. Also examined were health and safety violations for each nursing home.

For-profit nursing homes, which constitute three-quarters of those in the state, frequently devote less money to nursing care, compared to nonprofit homes, the analysis showed.

From Tuesday’s paper

Nursing homes are being bought and sold in the United States at a rapid clip, raising questions about the quality of care, according to a Harvard University-led study published Monday.

Corporate owners appear to target nursing homes beset with problems, and the difficulties — notably health and safety violations — often persist after the transactions, the researchers found.

Nursing home owners profited as complaints rose

Over the past year, a portrait has emerged of substandard care in many of the nursing homes run by Braemoor’s owner, Synergy Health Centers. Poor treatment of patients’ festering pressure sores. Medication errors. Inadequate staff training.

Now, a Globe investigation shows that as father and son were paying themselves handsomely, Synergy apparently provided false information when applying for nursing home licenses. The Globe’s review also found that Synergy and its affiliated companies assembled a string of 11 nursing homes with little state scrutiny of the backgrounds of top executives, including Larry Lipschutz, who faces tens of thousands of dollars in fines because of previous business dealings.



April 26: Boston health news round up

Health writers on both ends of 135 Morrissey Boulevard have been busy — main Globe newsrofenway__1282224095_4483 (2)om to STAT down the hall:  From Stat;  from the Globe business desk. 

Stat shared this story with the print edition of Globe today: Lam, a 22-year-old aspiring doctor, is part of the fast-growing industry of medical scribes working in hospitals and clinics across the country. These scribes, often premed college students, help doctors with a dreaded task — checking boxes and typing words into electronic health records.

And both outlet covered yesterday’s disturbing FDA meeting. This is an ongoing story — desperate patients insist on FDA approval treatments despite lack of solid evidence of efficacy.

Video up soon: What are the public health implications of terrorism? This (Harvard School of Public Health) Forum — which took place a week after the 3rd anniversary of the Boston Marathon bombings — asked what makes a society resilient in the face of attacks or perceived threats. Experts in homeland security, psychological resiliency, crisis leadership, and disaster preparedness and response participated. 

 Dumb question award: Boston Magazine: Should the Media Report on Health Research?  A good topic, but a bit too much to bite off in a blog post. For a more thorough analysis, see Health News Review, which this week looks at what happens when the media doesn’t report on Research

Health Wonk Review: Lots of blog commentary and an invitation you to this afternoon’s “blab” on health policy.


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