The Health Care Blog – Page 315 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Strange Making of the “Marketplace Stabilization Rule”

Apr 17, 2017• 1

BY DAVID INTROCASO

On April 13 CMS published the agency’s final “market stabilization” rule. The proposed rule was summarized by THCB’s editors on February 15, the day it was published, and on March 22 THCB published my essay in which I noted CMS provided no evidence any of the proposed reforms would actually stabilize the state marketplaces. The final rule, ostensibly a carbon copy of the proposed, finalizes the six proposed changes without, again, providing any evidence these changes will stabilize the markets by increasing enrollment and issuer participation.

Briefly, the final rule will reduce the 2018 enrollment window from three months or to six weeks, or from November 1 to December 15. The rule narrows the definition of guaranteed availability by allowing issuers to apply re-enrollment payments to outstanding debt. The rule will require 100 percent verification for enrollees’ attempting to acquire insurance during a Special Enrollment Period (SEP) and places other payment, eligibility and exceptional circumstances restrictions on SEP enrollment. The rule finalizes an increase in de minimus variation from +/- 2 percent to -4/+2 percent except for bronze plans which increases to -4/+5 percent. The rule will allow states to determine plan network adequacy or make a determination using an issuer’s accreditation status. The rule finalizes a reduction from 30 to 20 percent of plan providers being defined as an Essential Community Provider (ECP). For plans that cannot meet the 20 percent determination, CMS will allow for a narrative explanation.
Continue reading…

Struggling to Get Customers, Revenue and Traction in the Digital Health Market?

Apr 17, 2017

By ELENA LIPSON SPONSORED POST

Imagine the peace of mind and confidence you will feel if you had a quick, proven process to take your solution or concept from its current state to one that generates sustainable revenue, hoards of customers and value to the healthcare ecosystem.

Elena Lipson has been working with organizations and entrepreneurs in the digital health community for more than 15 years to help them successfully bring new products and services to market, identify and engage new customers and partners, and grow their market share.

For the first time, she is offering a free webinar training to the Health 2.0 community to share the three steps you need to create a blueprint for your digital health solution that will get you customers, accelerate your path to revenue, and help you go to market quickly even if:Continue reading…

The 401W: A Wellness Program Even Al Lewis Could Love

Apr 17, 2017• 1

By AL LEWIS

I’ve been quite vocal about supporting only wellness done for employees and not to them…but what if there could be a “conventional” wellness program – even including screening, HRAs etc. – that both you and I could love?

People manage what’s measured and what’s paid for. If employers want people to stay healthy in the long run, why not measure and pay for health in the long run?

Why not give people the incentive to stay healthy during their working years, instead of giving them the incentive to pretend to participate in programs of no interest, just to make a few bucks? Or, worse, give employees the incentive to learn how to cheat on biometrics, and how to lie on health risk assessments. Attempts to create a culture of health often create a culture of resentment and deceit.

Short-term incentives haven’t changed weight, as noted behavioral economist Kevin Volpp has shown. Nor have they changed true health outcomes – it is easily provable that wellness has almost literally never avoided a single risk-sensitive medical event. So-called outcomes-based programs, ironically, are more about distorting short-term outcomes than achieving long-term outcomes. They have more in common with training circus animals to do tricks in exchange for treats than they do with helping employees improve long-term health.

MACRA Is Broken. It Needs to Go Away Now.

Apr 15, 2017• 17

By KIP SULLIVAN

At its January 12, 2017 meeting, the Medicare Payment Advisory Commission (MedPAC) made it clear they had reached the conclusion that the Merit-based Incentive Payment System (MIPS) cannot work (see my last post ). MIPS is the larger of the two programs within MACRA; the Alternative Payment Model (APM) program is the other. The commission’s primary rationale for its conclusion about MIPS is that it’s not possible to measure physician “merit” (cost and quality) at the individual physician level.

But rather than recommend that Congress repeal MACRA (the Medicare Access and CHIP Reauthorization Act), MedPAC decided to try to fix it. At the January and March 2 meetings, the commissioners discussed a staff proposal to amend MIPS substantially and to tweak the APM program. Those discussions went nowhere.

I give MedPAC credit for finally stating unequivocally that MIPS cannot work. But MedPAC should never have volunteered to fix MACRA. It can’t be done. By proposing modest amendments to MACRA and thereby implying it’s fixable, they stepped into an intellectual tar pit. I will illuminate this tar pit by describing the commission’s unproductive discussion about the staff’s proposed amendments to MACRA. To give you a sneak preview of what that discussion was like, I give you two excerpts from the transcript of the January meeting:

Measuring MACRA

Apr 15, 2017• 4

By STEVEN FINDLAY

With all the machinations over ACA repeal and replace, the new law that makes big changes in the way the federal government pays doctors—the Medicare Access and CHIP Reauthorization Act, or MACRA—hasn’t garnered much attention lately.

But doctors nationwide are sure thinking about it. That includes many of the regular commentators on THCB. I think it’s accurate to say that most of them have been highly critical of MACRA since the law was enacted in April 2015, and even after it was significantly amended late last year to address physician complaints. (See, for example, Kip Sullivan’s most recent post here.)

The law’s main provisions kicked in on Jan. 1, 2017, with 2017 being the first performance-reporting year, affecting payment in 2019.

In a policy brief on MACRA for Health Affairs published late last month, I raised a host of questions about MACRA.

As Kip and many others have noted, some parts of MACRA are weakly designed and both the law and regulations implementing it make some big assumptions. Excerpts from one section of the policy brief are below. The whole brief can be had at the link above. If you are well versed in MACRA, you can skip to the section titled “What’s the Debate?

Is the overall design coherent and workable?

Major special-interest groups, including those representing physicians, industry, and consumers and patients, supported MACRA’s intent and the general framework of the regulations through three comment periods.

However, almost all groups sought changes and raised questions. CMS’s final revisions were most responsive to physician groups, which were insistent on an easier path and more flexibility for doctors in the initial years of the program.

Yes, Mr. President. Health Care is Complicated. And Also Hard.

Apr 14, 2017• 3

By ASEEM SHUKLA, MD

“Nobody knew that health care could be so complicated,” President Donald Trump told us a few weeks ago. As the failure of the House Republican bill shows: Healthcare is hard.

The American Healthcare Act failed to clear the House of Representatives despite catering to longstanding conservative demands: rid the ‘individual mandate’ (designed to force able-bodied people to pay insurance so it’s cheaper for sick people), subsidies to individuals, and revamping Medicaid into block grants to states.

Even with the claim it could be deficit-neutral, the act failed to win enough moderate or conservative Republicans.

While Obamacare stays, the progressive wing of the Democrat party still calls for a single-payer Medicare-for-all health care system.

They would offer a dual catharsis: the moral certitude of declaring health care as a right; and the beguiling simplicity that one only need expand an existing entitlement and simply include the 264 million Americans not currently covered.

But leave aside questions of practicality and which option balloons the national debt further (both actually would), no proposed alternative delivers a cure-all.

Protection? Fairness? Hardly.

Apr 14, 2017

By ART CAPLAN and ZACHARY CAPLAN

The American Health Care Act (aka Trumpcare or Ryancare) failed because it was patched together and would have imperiled insurance benefits for millions of the neediest Americans. Two other health care related bills – the Protecting Access to Care Act and the Fairness in Class Action Litigation Act – have made it out of the U.S. House and are currently pending in the U.S. Senate. If passed they will produce the same abysmal result. Like the American Health Care Act, they should be rejected.

Protection and fairness? How could anyone be against that? Unfortunately, the titles hide the motive of these bills: maybe cost savings and damn the public good. These bills appear to have been written by lobbyists to protect corporate bottom lines. Both bills will add to the substantial roadblocks injured patients already face in attempting to vindicate their rights against powerful entities and corporations in the legal system.

The Protecting Access to Care Act (H.R. 1215) is being touted as a way to control the cost of frivolous medical malpractice lawsuits. The Act would limit medical malpractice victims’ ability to have their day in court by making certain providers immune from lawsuits and imposing strict caps on damages for victims of medical malpractice regardless of the degree of injury or the extent of negligence involved. Some variation of this bill has been floating around Republican circles for decades. There is no question this bill would likely reduce costs for medical providers and insurance companies, but there is every reason to believe it will do so by harming ordinary Americans.

[pdf-embedder url=”https://thehealthcareblog.com/wp-content/uploads/2017/04/BILLS-115hr1215rh.pdf”]

Insurers: Getting To Know The New B In B2B2C

Apr 13, 2017• 1

By PASCAL LARDIER PARTNER CONTENT

Startups are increasingly counting on partnerships with payers and insurers to accelerate the commercialization of their solutions.

Health 2.0 was recently invited by AXA and the International Federation of Health Plans (IHFP) to be part of a meeting in Paris with 15+ European/global health insurers. On March 14th, we took this opportunity to organize a Health 2.0 Paris meetup and present several solutions designed to be implemented or reimbursed by health insurers.

The presentations generated a strong interest and fueled a lively discussion. Insurers had a lot of questions for our panel of presenters… but, not necessarily the ones you would expect. We often think of insurers as payer organizations that only care about saving costs. However, the ROI question was not raised once.

This Doctor Says #BoycottUnitedAirlines

Apr 13, 2017• 25

NIRAN AL-AGBA, MD

Watching events unfold at United Airlines over the last few days have filled me with shock, awe, and horror. As a result of this public relations disaster, their motto “flying the friendly skies” has turned into “not enough seating, prepare for a beating.” America stands as a beacon of freedom from oppression. In my opinion, United Airlines was an iconic American company until last Sunday.

That ended Sunday.

Much of the backlash was initially a result of the lackluster attempt at an apology from the CEO of United Airlines, Oscar Munoz. Despite three attempts, he still appears rather oblivious to the real suffering of Dr. Dao. Physicians have been taught that the best thing to do in the face of a medical error is to be honest, forthcoming, and apologize; it must be genuine and from the heart — acknowledge our blunder, take responsibility for our mistake, and convey our sincere regret. Executives at United Airlines would do well to heed these words.

Who’s to Blame For the Shortage of Doctors? Doctors and Politicians

Apr 12, 2017• 10

By CHARLES SILVER and DAVID HYMAN

After missing an appointment with a physician recently, one of us was tongue-lashed by a medical assistant who explained that the practice has a months-long waiting list for new patients. The dressing-down included a threat. Another no-show and the miscreant would be discharged from the doctor’s practice and have all medications cut off.

Wondering if patients really wait months to see this doctor, the delinquent called back, pretended to be a new patient, and asked how quickly he could get in. The first available appointment at the closest location was, in fact, 2 months out. (The wait could have been cut in half by driving to an office that was farther away.)

Two months is a long time to wait to see a doctor. If your auto mechanic or air conditioner repairman told you that it would take a week to fit you in, you’d find someone else to take care of the problem and you’d never go back to the person who told you to wait. Given the transcendent importance of health, why do patients who need medical assistance routinely wait far longer? And if patients with good insurance wait for two months, how long is the queue for those who rely on Medicaid or who have no insurance at all?Continue reading…