The Health Care Blog – Page 341 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Final Rule

Oct 19, 2016• 10

By KIP SULLIVAN, JD

When I read the original MACRA rule that CMS published last April, I was appalled at its complexity, at CMS’s total disinterest in measuring “performance” accurately, and CMS’s willingness to hype the performance of ACOs and “medical homes” (the main prototypes for the “alternative payment models” [APMs] authorized by MACRA). I entertained the faint hope that CMS would come to its senses after hearing the reaction to its original rule and propose something less complex, or maybe even urge Congress to suspend enforcement of the law until it could be rewritten. Foolish me.

I have read a substantial portion of CMS’s final rule, published last Friday. It is clear to me CMS intends to implement its original rule with only minor changes. I predict the implementation process will be a nightmare.

The Privacy Dilemma

Oct 18, 2016• 2

By JOSEPH KVEDAR, MD

Joseph Kvedar I recently had the opportunity to join Boston news media veteran, Dan Rea, on his AM radio program, Nightside with Dan Rea. It was a one-hour call in program, and an eye opening experience for me. Dan and I chatted about connected health and how it can truly disrupt care delivery and put the individual at the center of their own health. Then Dan opened the lines to the fine citizens of New England for questions, and the phones started ringing off the hook.

The overwhelming concern – actual fear — among callers was maintaining their privacy in an increasingly connected world, especially their personal health data. This is a topic I touched upon in my recent book, The Internet of Healthy Things, and one which I will explore further in my upcoming talk at our Connected Health Symposium in a few weeks. But I was so struck by the extent of concern, I thought I’d present a few theories I’ve been contemplating on the subject.Continue reading…

The Trust Gap in Healthcare: Findings from the 2016 Healthcare Trust Index

Oct 18, 2016• 5

BY PAUL KECKLEY

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In Campaign 2016, a recurring theme to date has been the trustworthiness of the leading candidates. As they debate for the third and final time this week, each will attempt to allay voter concern about their trust-gap and widen apprehension about the other’s.

In politics and business, trust is the most valuable asset candidates and companies own. Lacking trust between a candidate and voters or an organization and its customers and trading partners means elections aren’t won and a company’s, long-term sustainability is compromised.

Healthcare is an industry wherein trust is foundational. We trust our physicians to recommend treatments based solely on their effectiveness and appropriateness to our diagnosis. We trust our drugs and technologies are used solely because they work best. We trust our hospitals are safe and our insurance will help pay the bills. When we learn otherwise, we rationalize they’re the exceptions until recurring doubt leads to distrust. Stories about fraud, price gauging, denials of coverage and excessive profit cast doubt on our system and compromise trust in our healthcare system. The frequency of stories about these and social media lend to the growing distrust in healthcare.Continue reading…

The Blockchained Health Record

Oct 17, 2016• 2

BY DAN HOUSMAN

flying cadeucii A couple of weeks ago I was discussing the opportunities for using block chain technology for medical record interoperability with a group of friends who unsurprisingly see their real experience as evidence that we haven’t made it easy to exchange medical records yet. While chatting, one of my friends asked the question – “Isn’t there some sort of security problem with Health Information Exchanges (HIEs), because block chain technology could solve security issues, especially if that is what is holding things back?” I thought about it and my immediate answer was “not really.” The sharing problem is about trust and finding a model that works for sharing records rather than just some underlying security conundrum.

Re-Decentralization of Medicine: The HIE of One

Oct 17, 2016• 1

MICHAEL CHEN, MD and ADRIAN GROPPER, MD

This week, a non-commercial, open source proof of concept called HIE of One becomes the first standards-based patient-centered health record demonstration. It uses the emerging FHIR standard along with established standards for identity and security management to show how a physician-patient relationship can be independent of any particular institution and therefore as de-centralized as your smartphone messages or your Bitcoin payments.

The history of patient-centered health records begins in 1994 with the Guardian Angel Project at MIT and has inspired many of us. Implementations have come and gone over the past 22 years and today’s massively centralized and institutionally controlled EHRs seem to be headed further and further away from a patient-centered vision. Hacking and information blocking are a concern for patients and legislators. EHRs and government meddling are a source of frustration for physicians. Technology, however, is finally catching up with Guardian Angel’s promise.

The Fine Print of MACRA’s Final Rule: Good for Patients?

Oct 16, 2016• 5

By MICHAEL MILLENSON

The Centers for Medicare & Medicaid Services (CMS) just released the final regulations for the most ambitious attempt in U.S. history to transform how medical care is delivered and paid for. But is it good for patients?

The impact of the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program created a colossal chorus of kibitzers after the draft rule came out last spring: CMS received over 4,000 written comments. The gargantuan, 2,204-page final rule both sets out regulations and responds to commenters’ suggestions.

The rule is meant “to create a more modern patient-centered Medicare program by promoting quality patient care while controlling escalating costs,” says Andy Slavitt, CMS acting administrator, in a letter to clinicians posted online. The rule itself proclaims “high-quality, patient-centered care” as “the bedrock of the Quality Payment Program.”

Don’t Surrender

Oct 16, 2016• 31

By NIRAN AL-AGBA, MD

flying cadeucii Independent physicians are at the beginning of a challenging movement as we fight to stay relevant and solvent during the transition of health care from independence to “regulation without representation”. In 1773, British Parliament passed the Tea Act with the objective to help the struggling British East India Company survive. Opposition to the Act resulted in the return of delivered tea back to Britain. Boston left the ships carrying tea in port and on December 16, 1773, colonists in disguise swarmed aboard three tea-laden ships and dumped their cargo into the harbor. The seeds were planted for the Revolutionary War.

Is the ACA Merely a Step Towards Single-Payer “Medicare-for-All?”

Oct 15, 2016• 4

By DEVON HERRICK

A recent commentary in the Wall Street Journal announced, “Obamacare’s meltdown has arrived.” Over the years I’ve heard conspiracy theories that the Affordable Care Act was designed to fail, as a means to nudge a reluctant nation one step closer to a single-payer, Medicare-for-All health care system.

Bernie Sanders famously advocated for single-payer during his campaign. In 2011, the Vermont legislature passed a bill to create a single-payer initiative. Green Mountain Care was abandoned in 2014 by Vermont’s governor — a Democrat — as being too costly. Despite an 11.5 percent payroll and a sliding-scale income tax of up to 9.5 percent, Green Mountain Care was projected to run deficits by 2020.

A similar single-payer initiative is now taking place in Colorado. Amendment 69, known as ColoradoCare, would create a taxpayer-funded health insurer. ColoradoCare would be available to nearly all Colorado residents, including Medicaid enrollees. Federal programs, such as Medicare, TRICARE and the VA would remain in place, however.

A Letter from CMS to Clinicians in the Quality Payment Program: We Heard You and Will Continue Listening

Oct 14, 2016• 21

By ANDY SLAVITT

screen-shot-2016-10-14-at-8-43-48-am Today, we are finalizing policies to implement the new Medicare Quality Payment Program. Part of the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the Quality Payment Program aims to create a more modern, patient-centered Medicare program by promoting quality patient care while controlling escalating costs through the Merit-Based Incentive Payment System (MIPS) and incentive payments for Advanced Alternative Payment Models (Advanced APMs).

After issuing our proposal for how to implement the new program earlier this spring, we held a listening tour across the country to hear your thoughts and concerns first-hand about the Quality Payment Program. Whether you formally submitted one of the over 4,000 comments we received, or were one of the nearly 100,000 attendees at our outreach sessions, there have been record levels of clinician engagement. The interactions reflect the importance you place on serving the more than 55 million individuals that have Medicare coverage.

We found an eagerness to help the Medicare program improve and an interest in being engaged in how we address the challenges and opportunities ahead. We also heard concerns, which is not surprising, given the challenge of changing something as large and important as the Medicare program. But, we found that there is near-universal support for moving towards a future focused on patient care that pays for what works, reduces clinician burden, and better supports and engages the medical community.

The ACA: We Got Quantity but What About Quality?

Oct 14, 2016

By ABRAAR KARAN, MD

flying cadeucii One of the main goals of the Affordable Care Act (ACA), perhaps second only to improving access, was to improve the quality of care in our health system. Now several years out, we are at a point where we can ask some difficult questions as they relate to value and equity. Did the ACA improve quality of care in the ways it intended to? Did it do so for some people, or hospitals, more than others?

How did the ACA Attempt to Improve Quality?

Three particular programs created by the ACA are worthy to note in this regard. The Hospital Acquired Condition Reduction Program (HACRP) took effect on October 1, 2014 and was created to penalize hospitals scoring in the worst quartile for rates of hospital-acquired conditions outlined by the CMS. The Hospital Readmissions Reduction Program (HRRP), which began for patients discharged on October 1, 2012, required CMS to reduce payments to short-term, acute-care hospitals for readmissions within 30 days for specific conditions, including acute myocardial infarction, pneumonia, and heart failure. The Medicare Hospital Value-Based Purchasing Program (HVBP) started in FY2013, was built to improve quality of care for Medicare patients by rewarding acute-care hospitals with incentive payments for improvements on a number of established quality measures related to clinical processes and outcomes, efficiency, safety, and patient experience.