By JIM  PURCELL

An article this week in Politico entitled “Obamacare’s November Surprise” observes that premium announcements for Obamacare’s exchanges should be published around November 1, and that the news will be offputting, to say the least.  Double digit increases from beleaguered insurers are likely, reflecting substantial structural and financial flaws within the exchanges as currently designed.  The article suggests that this might be problematic for Democrats.

I’m doubtful whether, even if there is November rate shock, that it will substantially derail the then Democratic candidate, which absent some stunning intervening event will be Hillary Clinton.  While the ACA is a natural extension of what Ms. Clinton has advocated for decades, she did not design the exchanges, and to hold her responsible for their design flaws seems a tad unfair.  Likewise, she always has taken the position that rather than repeal the ACA, its flaws should be rectified.  Easily said, a very safe position to take, and fair enough as it goes.

But what IS going on with the exchanges and the many co-ops that have failed?  What happened?

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By THE EDITORS

 A special webinar for THCB readers.

By KIP SULLIVAN

In my last post  here, I reported that the Medicare Payment Advisory Commission (MedPAC) believes Medicare ACOs and “medical homes” are unlikely to qualify as “alternative payment models” under MACRA (the Medicare Access and CHIP Reauthorization Act).

In this article I review the evidence supporting MedPAC’s pessimistic assessment of “patient-centered medical homes” (PCMHs). I will review evidence that PCMHs are not cutting Medicare costs but are probably inflicting financial and emotional stress on many PCMH clinics. In a future post I will review the evidence on Medicare ACOs. Down the road I hope to comment on bundled payments. PCMHs, ACOs, and bundled payments are the three templates available to CMS to fashion APMs.

“Medical homes” may be raising Medicare’s costs

Within five years after the PCMH fad appeared, CMS had begun three demonstrations to test the ability of PCMHs to lower Medicare costs while simultaneously improving quality. The first of these demos, the FQHC Advanced Primary Care Practice Demonstration , ended in October 2014. The other two, the Comprehensive Primary Care (CPC) Initiative and the Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration, will end this year. [1]

CMS has released evaluations of the first two years of the FQHC and CPC demos , and an evaluation of the first year of the MAPCP demo . CMS has delayed the second-year evaluation of the MAPCP demo. [2]

The findings presented in these evaluations are not good news for PCMH supporters. In a recent report , the Kaiser Family Foundation (KFF) offered this summary of the results of the three PCMH demos: “Among the office-based multi-payer models (MAPCP and CPC) and the FQHC/APCP model, little to no savings have been generated after accounting for the outgoing Medicare expenditures in care management fees” (see Table 2 of the report).

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By JOHN HALAMKA

As promised last week, I’ve read and taken detailed notes on the entire 962 page MACRA NPRM so that you will not have to.

Although this post is long, it is better than the 20 hours of reading I had to do!Here is everything you need to know from an IT perspective about the MACRA NPRM.

1.  What is the MACRA NPRM trying to achieve with regard to healthcare IT?

The MACRA NPRM proposes to consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for eligible professionals (EPs), creating a single set of reporting requirements.  The rule would sunset payment adjustments under the current PQRS, VM, and the Medicare EHR Incentive Program for eligible professionals.

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By TOM FRIEDEN, MD

Few appreciate the threat of antibiotic resistance to human medicine more than readers of this blog. You know antibiotics as lifesaving “miracle” drugs that treat sepsis, save victims of burns and trauma, and are crucial to survival of patients receiving transplants and cancer treatment.  At the same time, you understand the devastating consequences when these drugs don’t work anymore—when infections become resistant.

The overuse of antibiotics breeds antibiotic-resistant infections that threaten patients, hospitals, and our entire health care system.  Resistant infections mean more and longer hospitalizations, increased hospital costs, and higher mortality.  As clinicians, it is our job to help our colleagues in the medical community and the American public better understand the risk posed by inappropriate use of antibiotics.  Patients and the community benefit from more appropriate antibiotic use, which reduces risks for the individual patient as well as the entire community.

A new, first-of-its-kind analysis of antibiotic use in US doctor’s offices and emergency departments, published in the Journal of the American Medical Association (JAMA), highlights how common inappropriate antibiotic prescribing is.  CDC, in collaboration with The PEW Charitable Trusts and other public health and medical experts, found at least a third of antibiotics are given when the patient does not need them. This overuse, largely due to overprescribing for relatively minor illnesses including common colds, sore throats, and ear infections – for which antibiotics are not effective – amounts to 47 million excess antibiotic prescriptions each year.

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By PAUL KECKLEY

Opinions about the U.S. health system vary widely based largely on our individual experiences as users from time to time. And most Americans don’t think of it as a system at all. Rather, it’s a collection of doctors, hospitals, insurers, drug and device manufacturers and others that operate in a complicated, disconnected, expensive industry that’s increasingly difficult to navigate and afford.

Little wonder that opinions about health reform and the Affordable Care Act divide our nation: half see it as over-reach by the federal government that threatens a system best left alone, and half see it as a remedy for systemic flaws. Both argue their positions fervently, and neither is inclined to consider the view of the other. And in both camps, there are widely held misconceptions that run counter to what’s actually known.

For those who oppose health reform and the ACA and are predisposed toward its undoing, the biggest misconceptions are…Continue reading…