Kings, dogs and Burwells: The latest policy posts from the Health Wonk Review #HWR

BHN is hosting this week’s round-up. In anticipation of the King v. Burwell decision, we offer kings and Burwells. The content of the images is not meant as a BHN endorsement for either position. Same goes for the opinions in these posts. Some say the ruling may come down today, others bet on 6/29. SCOTUS Blog is the site to watch. (For actual posts on the pending decision, see the 6/3 edition.)

Finally, our thoughts are with the members of Emanuel African Methodist Episcopal Church and the staff at one more hospital that had to brace for victims of a mass shooting.

The posts:

  • 512px-BBKing07
    By Roland Godefroy

    Joseph Paduda at Managed Care Matters writes:  Health care cost drivers; or, here’s where you’re getting screwed. Two studies published in Health Affairs shed much light on hospital costs and the societal implications of physician practice consolidation.  Both are a bit scary.

  • A post from Health Affairs analyzes the major elements of the final rule recent Medicare Shared Savings Program Final Rule.Lawrence Kocot, of Ross White,
    burwell
    HHS photo

    and Mark McClellan at KPMG  offer alternatives for CMS and the possible future of the program

  •   From David Willams at the Health Business Blog notes: Long term care insurance -narrow framing is not the problem. Why don’t people buy long term care insurance? Because for many it’s not a good value
  •  David Harlow at the HealthBlawg: Outsourced Chronic Care Management Service256px-King_Kong_1933_French_posters Can Help Physicians and Patients. I wrote this post with a client about Chronic Care Management, a newly-reimbursable service under Medicare as of January 2015, and a service that is specifically non-face-to-face. The federales are dedicating significant funds to this service based on the belief that it will reduce expenditures on other services for multiply-chronically-ill elders.
  • From Boston Health News, links to stories on telemedicine and hospitals as step-down units.
  • From Roy Poses at Health Care Renewal: Health Care Professional Societies Whose Leadership Betrays Their Own Members – the APA Alleged to Have Supported Torture, and Deceived its Members to Collect Money. Health care professionals need to be extremely skepticburwellneonal of the leadership and governance of all health care organizations.  True health care reform requires organizational leaders who understand the health care system, uphold its values, and are willing to be accountable.
  •  Tom Lynch of Workers Comp Insider offers “the word of the week: horrendoma. That’s a description he applies to the healthcare system after looking at billed vs paid hospital data and the concept of charges as a “starting point.” See his post: Hospital Medicare Charges: You Don’t Always Get What You Want.
    By Metro-Goldwyn-MayerReproduction Number: LC-USZ6-2067 Location: NYWTS -- BIOG [Public domain], via Wikimedia Commons
    By Metro-Goldwyn-Mayer, Inc.
  • Henry Stern at InsureBlog asks “What carrier in its right mind would cover” sex change surgery? Transjenner Insurance: In case you were wondering: Yes, ObamaPlans *do* cover sex-changes. InsureBlog has the, er, straight scoop.
  • From Health System Ed: Decrying the End of Private Physician Practice? Not so fast!  Experts have been saying that the private physician practice is no longer sustainable under managed care but then along comes ACOs and perhaps that tune is changing when the focus turns from volume to outcomes.
  • This Health Affairs post focuses specifically on the provisions of the rule dealing with benchmarkingBWburwell2 and distribution of shared savings and losses and suggests that CMS consider the possibility of graduated rates of sharing savings and loss distribution.y Carrie Colla, Scott Heiser, Emily Tierney, and Elliott Fisher at Dartmouth
  • Finally, Brad Wright asks : This Father’s Day, Give 1 For Dad
    In honor of his father, he’s donating to “Give 1 For Dad campaign to fund an important clinical trial for prostate cancer at the Duke Cancer Institute. At issue is that the treatment uses a safe generic drug, which is great because it isn’t toxic like other current treatments, but not so great because no major pharmaceutical companies are willing to fund a clinical trial of a generic drug.”

What does your king look like? king-cobra-405623_640(Click on images for credits, rights.)

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Harvard and MIT use clinical trials to study health policy #ACA #HCR

A New York Times story on the feds’ failure to use randomized clinical trials for health delivery research led us to J-Pal, a joint Harvard MIT program. Here’s a link to the group’s health page. 

J-PAL’s Health Program seeks to promote the important contributions that randomized evaluations can make in understanding how improvements in health services and delivery can reduce poverty. J-PAL’s Health Program seeks to promote the important contributions that randomized evaluations can make in understanding how improvements in health services and delivery can reduce poverty. Each year, significant resources are allocated to global health and development initiatives. However, despite substantial investment, improvements in global health indicators have been uneven. For example, according to the World Health Organization’s (WHO) latest data, encouraging declines in child mortality rates have occurred globally, while improvements in maternal mortality, TB, and HIV/AIDS have been slower (World Health Statistics Report 2010). Moreover, the WHO reports worsening of certain key indicators such as prevalence of undernutrition in a number of countries.

The Times story quotes researchers saying that the federal government needs “to to do more randomized trials and fewer demonstration projects. ”

The situation is different in the developing world. There, randomized trials have become common in health care and other areas, sponsored by a variety of groups like J-PAL, a global network of researchers that was organized by M.I.T. and Harvard economists.

So far, J-PAL has conducted over 440 randomized trials in 55 countries, according to Amy Finkelstein, an M.I.T. economist.

Dr. Finkelstein and Lawrence Katz, a Harvard economist, have now started J-PAL North America to spur randomized trials in, among other areas, health care.

Dr. Finkelstein was encouraged by the Medicaid study she and Katherine Baicker of Harvard did in Oregon. The state wanted to expand Medicaid coverage but could not afford to insure all, so it used a lottery.

The lottery was essentially randomizing people to have Medicaid or not, so Dr. Finkelstein and Dr. Baicker designed a study to see the effects.

Over 18 months, those who got Medicaid saw doctors and went to emergency rooms more often and got more health care. They were less depressed. But so far, their health is not better and they cost the system more.

“It is getting so much attention not just because it is important and credible,” said Dr. Finkelstein, “but because it is rare.”

 

Data, medicine, insurance reform and a round up of health policy blogs

1950s era analog computer
1950s-era analog computer

Health data is a theme of this edition of the Health Wonk Review because it is also the focus of the current Knight News Challenge. That contest rewards media innovation with seed money. They use the word “challenge” literally, asking for innovative responses to question: How can we harness data and information for the health of communities?

Our definitions of “health data” and “news” are broad, and range from projects in traditional newsrooms to consumer-facing technology to crunching big datasets. We’re hoping to find and accelerate projects that use data and public information in innovative ways to create strong information flows about health in our communities.

Check it out. Health care produces big, big data. Health information technology, surveillance data, electronic medical records, clinical trials, NIH databases.  Payers and providers produce endless streams of data for millions of people.  On the other end of the scale, the quantified selfers keep blood pressure, diet and exercise logs.

US-MapWhat would happen if you had to turn those logs over to your insurer? David E. Williams of the Health Business Blog notes that car insurer Progressive gathers lots of info on drivers through its Snapshot device. Then, the company lowers premiums in return for lower risk behavior. He asks “What will it look like when the same approach is applied to health insurance?” Risk assessment also serves as the basis for public policies and day-to-day individual behaviors. At Workers’ Comp Insider, Julie Ferguson looks at real versus perceived risks in her post about how “Your Daily Shower Can Kill You.”

Former VA research chief Joel Kupersmith writes on the Health Affairs blog about data, privacy and genomic research.  He considers the  challenge of balancing the benefits of widely shared genomic data with privacy concerns, in particular the re-identification of individuals.

The Healthcare Economist reports data about long-term care trends and investigates the systems in Austria, England, France, Germany and the Netherlands. For many disabled elderly individuals, a nursing home is their only option.  How do European countries take care of the long-term disabled?

CDC data suggest 200,000 Americans are needlessly dying every year from preventable heart disease, but over the last decade, that number – on an unadjusted basis – has decreased by about 12%, or that there are 28,000 fewer deaths, notes Jaan Sidorov of the Disease Management Care Blog: That being said, while the greatest jumps in saved lives are among persons of color, they still are the most vulnerable to avoidable cardiovascular conditions.  If we are really going to use this information, that insight is what tells us where the resources are really needed

                  Black men are at highest risk of dying early from heart disease and stroke
Black men are at highest risk of dying early from heart disease and stroke

Moving out of the data world, Health Care Renewal asks:  What Sorts of People are “Most Influential in Healthcare?” The post notes that Modern Healthcare answers this question with with a list of managers from hospital systems and  health care corporations — and very few doctors. The list did include the CEOs of Sutter Health and Advocate Health, two companies known for significant mismanagement of health care technology, HCR notes.

Some of the most influential  run corporations that have been cited time and again for ethical/ legal problems, and some of the corporations have paid hundreds of millions of dollars in legal settlements and sometimes pleaded guilty to criminal charges.  The list included not a single doctor in private practice, very few people with backgrounds in medical or health care academics, and a tiny number who have suggested reforms of the sort we discuss on Health Care Renewal. 

dials

On to the ACA

Anthony Wright of the Health Access Blog notes that the first ads from California’s  insurance  exchange  provide some basic information to Californians, but also “introduce some signposts and open some doors.” Health Insurance Resource Center Blog offers Maggie Mahar, who says that some pundits are claiming that young Americans will have little interest in purchasing health insurance through the ACA’s exchanges. In reality, the subsidies available to about nine million of those young people should actually make the exchanges’ comprehensive coverage attractive to them.

Joe Paduda’s post  discusses the origins of the “idea” of the mandate while positing that repealing the law “won’t do anything to solve the underlying issues inherent in today’s health insurance system.” A post on health and higher education comes in from John Goodman’and the Health Policy Blog. In it, he compares the way the two are funded.

InsureBlog’s Bob Vineyard enthusiastically reports on a new health insurance start-up that leans heavily on transparency and features free telemedicine and generic drugs. Find out why he gets to post a picture of the Oscar Mayer Wienermobile.

Colorado Health Insurance Insider says that the idea of the ACA “ was to make sure that large employers offered good qualify coverage in order to avoid paying a fine, it appears that some large employers will opt for the fine instead.”

Finally:

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Dats graphic by Michael Schieben

The importance of the hospital patient survey and more policy news

Two local bloggers contribute to the new edition of  Health Wonk Review,  a bi-weekly digest of health policy posts.

masthead-hwrHealthBlawg offers a wrap-up post on the health information technology and health care policy conference in DC earlier this month. The Datapaloozers are looking at data streams from the government and beyond in an effort to manage the health and the health care costs of various populations…policy blog posts.

Why are patient experience surveys crucial to gaining clues for improving patient care and comfort? Many hospitals use them, notes David Williams at Health Business Blog, even though providers may not always be enthusiastic about being rated. They’ve become more important since Medicare began using patient experience as a criterion for reimbursement. 

Where can you find the best of #health #policy blogs? On the new Health Wonk Review

Get the views on health reform from the right and the left over at this edition of Health Wonk Review. Take note of the Health News Review entry. That site — which critiques health news coverage — started in Minnesota but features a slew of reviewer from MGH and other Boston hospitals.

This week’s digest is hosted by the Disease Management Blog, which is also responsible for a series of goofy health policy videos, including this one: