By CAMPBELLSVILLE UNIVERSITY                                        SPONSORED CONTENT

Since its second enrollment period ended in March, Kentucky’s health benefit exchange has been celebrated by state government leaders as a success story of the Affordable Care Act. Known as Kynect, the exchange has provided thousands of uninsured citizens with health insurance coverage. It has also drawn its share of controversy.

Although much of the discussion surrounding Kynect and the Affordable Care Act has focused on their political implications and other debates, little has been said about how the changes to Kentucky’s healthcare system have affected patients, nurses, doctors and hospitals. With two enrollment periods complete, how has Kynect worked and what benefits has it provided the state?

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By THCBist

In a 6-3 ruling, the Supreme Court ruled that the federal health law may provide subsidies to help Americans buy insurance on the state exchanges, officially putting a stop to one of the slowest-moving and arguably most mind-numbingly boring — if important — news stories in recent history (with all due apologies to tax credit enthusiasts and the American Academy of Actuaries).

More importantly, the ruling means that 30 million Americans will continue to be eligible for health insurance through the exchanges. Practically speaking, the decision eliminates the last major challenge to the Affordable Care Act.

Health stocks rose on the news, as the uncertainty that has been shadowing hospital and health plan stocks for months was eliminated.

The dissenting opinion in King, authored by Justice Scalia, is already being called an “instant classic*,” is replete with memorable zingers such as:

“Words no longer have meaning if an Exchange that is not established by a State is “established by the State” and “..It is bad enough for a court to cross out “by the State” once. But seven times?

Dissenting opinions in important cases, of course, are almost always hailed as “instant classics” by supporters, just as they are thrashed as “incoherent judge-babble” by critics.

So to be taken with a grain of salt. Or not.

The line that is likely to be remembered, and quoted most widely by opponents of the Affordable Care Act, however, is this one:

“The Act that Congress passed makes tax credits available only on an ‘Exchange established by the State.’ This Court, however, concludes that this limitation would prevent the rest of the Act from working as well as hoped. So it rewrites the law to make tax credits available everywhere. We should start calling this law SCOTUScare.”

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By MARTIN SAMUELS, MD

In 1970 I had the opportunity to spend time at the Royal Free Hospital in London.  One of my professors at The University of Cincinnati College of Medicine, the late Leon Schiff, a renowned liver expert, arranged for me to work under Professor Sheila Sherlock.  I was placed in a laboratory that was investigating the presumed immune basis of primary biliary cirrhosis.  Roy Fox and Frank Dudley, the faculty in the lab, warmly welcomed me and taught me the basics of immunology research.  My first scientific paper in Gut, was based on this work.  But, I was a budding clinician and I was drawn to the charismatic Professor Sherlock, so I took every opportunity to attend her rounds and teaching conferences.  In many ways a fearsome figure, The Prof dazzled me with her clinical acumen, rhetorical skills, sense of humor and drive.  Though only a lowly visiting medical student, she including me in the exercises and even turned to me as a local “expert” on American culture.  The entire experience is remarkably memorable.  The Prof was filled with pearls, anecdotes, stories and caveats.  Here are a few.

The “outpatient” consisted of the Prof seeing patients while the students watched.  The room was arranged with six cubicles, three on each side of her desk, each guarded by a watchful nurse (sister) with a neat uniform and starched hat.  In front of The Prof’s desk were several rows of chairs; perhaps a total of 16, for students who were to sit quietly unless specifically ask to speak or to feel the liver of one of the patients.

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By MARTIN SAMUELS, MD

1. Be a real expert (have something real about which to mentor)

2. Don’t avoid being a mentor because you are not “like” the mentee (e.g. gender, age, field, ethnicity)

3. Give negative feedback when necessary but don’t hold a grudge

4. Use your power to substantively help the mentee

5. Be proud of your mentees and tell them so (take real pleasure in their accomplishments)

By BOB WACHTER, MD

Natural language processing might seem a bit arcane andtechnical – the type of thing that software engineers talk about deep into the night, but of limited usefulness for practicing docs and their patients.

Yet software that can “read” physicians’ and nurses’ notes may prove to be one of the seminal breakthroughs in digital medicine. Exhibit A, from the world of medical research: a recent studylinked the use of proton pump inhibitors to subsequent heart attacks. It did this by plowing through 16 million notes in electronic health records. While legitimate epidemiologic questions can be raised about the association (more on this later), the technique may well be a game-changer.

Let’s start with a little background.

One of the great tensions in health information technology centers on how to record data about patients. This used to be simple. At the time of Hippocrates, the doctor chronicled the
patient’s symptoms in prose. The chart was, in essence, the physician’s journal. Medical historian Stanley Reiser describes the case of a gentleman named Apollonius of Abdera, who lived in the 5^th century BCE. The physician’s note read:

There were exacerbations of the fever; the bowels passed practically nothing of the food taken; the urine was thin and scanty. No sleep. . . . About the fourteenth day from his taking to bed, after a rigor, he grew hot; wildly delirious, shouting, distress, much rambling, followed by calm; the coma came on at this time.

The cases often ended with a grim coda. In the case of Apollonius, it read: “Thirty-fourth day. Death.”

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By JEFF GOLDSMITH and NATHAN KAUFMAN

On May 4, 2015 Department of Health and Human Services (HHS) Secretary Burwell announced that the Pioneer ACO program had saved the federal government $384 million and improved quality in its first two years and would therefore be expanded. HHS also released a 130 page independent program evaluation by L&M Policy Research that served as the basis for the Centers for Medicare and Medicaid Services (CMS) Actuary’s certification of the Pioneer program.

Burwell’s triumphant announceand ment was an intended shot in the arm for the troubled Pioneer ACO program, 40 percent of whose initial 32 members dropped out in the first two years. It also illustrated the yawning reality gap between DC policymakers and the provider-based managed care community. In reality, the Pioneer program badly damaged CMS’s credibility with the provider-based managed care community and sharply reduced the likelihood that the ACO will be broadly adopted.

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