The Health Care Blog – Page 344 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

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.

Open Enrollment 2016… Can the Exchanges Be Saved? And Other Trending Questions

Oct 13, 2016• 13

By STEVEN FINDLAY

It’s open enrollment season—the annual period in which tens of millions of consumers wallow in the misery of health insurance choices and costs. So, let’s pause to reflect on the status of things—enrollment-wise—with employer coverage, Medicare, and the exchanges.

In particular, do consumers have better tools these days to help them choose insurance plans?

For people with employer-based coverage—about 150 million Americans—things are okay and stable, but not great. The latest report from the Kaiser Family Foundation, released last month and based on a detailed survey of 1,900 employers (small, mid-size and large), indicates that premiums rose on average a modest 3% in 2016—to just over $18,000 for family coverage. Workers paid 29% of that.

A similarly small increase in premiums has prevailed for several years and is expected again for 2017.

Almost all firms with 50 or more employees offer health benefits and the vast majority claim their coverage meets the ACA’s requirements for value and affordability. Overall, 56% of employers offer health benefits because hundreds of thousands of small firms either choose not to offer it or can’t afford it—especially the smallest Mom and Pop shops.

Peter Orszag’s Obsession with Overuse

Oct 12, 2016• 2

By KIP SULLIVAN, JD

flying cadeucii In May 2009 the New Yorker published an article about Peter Orszag, President Obama’s director of the Office of Management and Budget and his chief health policy advisor. The article said Orszag was “obsessed” with the claim by Elliot Fisher and his colleagues at Dartmouth that unnecessary medical care accounts for 30 percent of all US health care spending. Based on these claims, said the article, Orszag had come to the conclusion “that a government empowered with research on the most effective medical treatments can, using the proper incentives, persuade doctors to become more efficient …, thus saving billions of dollars.” The article then observed: “Obama is in effect betting his Presidency on Orszag’s thesis.”

If you have read the first four installments in this series on President Obama’s article in the August 2 edition of the Journal of the American Medical Association (the first installment is here you will readily understand why I begin this essay on Orszag with that quote from the New Yorker. The New Yorker got it dead right. Because the Affordable Care Act would be regarded as Obama’s main legacy, and because Obama assumed that Orszag’s diagnosis of and solution to the health care crisis was accurate, it is reasonable to say Obama “bet his Presidency on Orszag’s thesis.”

The Impatient Patient Advocates

Oct 12, 2016• 1

By LYGEIA RICCIARDI (@Lygeia)

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At the 10^th Annual Health 2.0 conference in San Diego I had the honor of moderating a session celebrating a group of outstanding patient advocates and activists for their contributions to the field of digital health. They were chosen through a public voting process. The group was inspiring—their stories, sprit, and impact on the crowd was palpable.

In addition to these individuals’ contributions, it’s important to acknowledge the growing impact of patient advocates in aggregate. Thanks in part to the Internet, smartphones, and social media, patients increasingly exchange ideas for diagnosing and managing their health conditions, analyze and contribute data and research, provide social support to each other, and advocate to improve the healthcare system.

I’m an Ex-Health Plan CEO. I Used to be a VA Critic. Then I Became a Patient.

Oct 11, 2016• 5

By JIM PURCELL

In early 1970, I was on reconnaissance in I Corps in Viet Nam as a 1st Lieutenant Team Leader with the 101st Airborne Division Pathfinder Team. No, we did not bite off the heads of ducks to impress the indigenous, but we were in “the bush” and were considered in harm’s way.

On a rather ordinary insertion to inspect potential landing zones, I was moving my team from one area to another when we encountered heavy booby trapping. I stepped on one myself without it exploding. But as I moved up from my usual third spot to my slack man to get us off the trail, he stepped on a rocket propelled grenade booby trap that killed him instantly, and knocked me badly about. Only slightly wounded but with profound hearing loss, I literally picked up the pieces, got us extracted, made my way to the Da Nang 95th Medevac, and was evac’d stateside. I was extremely embarrassed to receive a Purple Heart given my slight impairments.