Friday, December 19, 2014

That Was The Week That Was - Issue 41

A look back at the week's health policy news with a focus on ACA implementation

Expecting a holiday lull?  Sorry but health policy waits for no one. This week in addition to a new Surgeon General (finally!) we have poll results, enrollment numbers and lots of Medicaid news. Also CMS was busy with announcements (see the special section below) and we will talk about a dramatic announcement in a socialist state, as well as what’s going on in Cuba (fooled you). The socialist state I refer to (out of deference to Bernie Sanders) is Vermont, where the Governor announced this week he was giving up the pursuit of a single payer health system.

Please note, there will be no issue next week but I will return with Issue 42 on Friday January 2. I hope everyone enjoys the holidays and has a happy and safe New Year.

Since this is the last issue of the year, we’ll start off with a brief look back at 2014:

Remember Ebola?  It’s still a severe problem in West Africa, but in spite of all the fear mongering many in the US seem to have forgotten all about it. This week Politifact called the false claims about Ebola the Lie of the Year: 2014 Lie of the Year: Exaggerations about Ebola. But it wasn’t alone the only lie, here Vox lays out The 8 most bogus health claims of 2014. And finally, as a tribute to the geek in all of us, the Top Ten Healthcare Charts For 2014. Now on to this week’s news.

ACA: Polls/Opposition
In addition to their Health Policy Tracking Poll (see below), Kaiser looks at what news events people are paying attention to (Kaiser Health Policy News Index: December 2014)  Two interesting piece from this month’s results: First over half the population does not know the marketplace is working better than last year - “When asked how the website’s functionality compares with last year, nearly half of the public (48 percent) say there have been fewer problems, 31 percent say the number of problems is about the same, and only 9 percent say there are more.” And second, concerning the subsidy case that will be heard by SCOTUS in the spring - “A large majority (84 percent) of the public say they have heard “only a little” (29 percent) or “nothing at all” (55 percent) about the case before the Supreme Court.”

This month’s health tracking poll didn't have any real surprises with respect to the raw numbers, but the focus on how changeable people’s opinions are is fascinating (Kaiser Health Policy Tracking Poll: December 2014) “Kaiser found that support (for the employer mandate) and opposition (to the individual mandate) are a lot less firm than one might think” (Obamacare Isn't As Divisive As You Thought) and Public Easily Swayed On Attitudes About Health Law, Poll Finds “The poll also found that a year into full implementation, most Americans, and most of those without insurance, remain unaware about many of the health law’s major features.”

More confirmation of the success of the law in reducing the number of uninsured, as Time magazine reports Number of Uninsured Americans Near Historic Low “The data released Thursday from the National Center for Health Statistics’ National Health Interview Survey found that 11.3 percent of Americans were without coverage in the second quarter of 2014, down from 13.1 percent in the first quarter and 14.4 percent throughout 2013. An analysis by the White House Council of Economic Advisers finds the drop in the uninsured to be the largest in four decades, amounting to roughly 9.7 million Americans getting insurance, consistent with other Affordable Care Act estimates.”

While those newly covered are much better off now, they are not the only ones benefitting. The LA Times takes a look and reports the health care industry isn’t doing too badly either: Uninsured rates fell under Obamacare, but who's reaping the benefit?

Here is an interesting perspective on what Republicans would do if the SCOTUS disallows subsidies in Federal Marketplace states. Remember, states that had set up their own marketplaces would continue as before, potentially setting up a two tier system in the country – would Republican’s really allow that to continue? If the Supreme Court Breaks Obamacare, Will Republicans Fix It?

ACA: Enrollment/Marketplaces
This past week saw the formal deadline for enrolling in coverage effective January 1. Lots of effort went into the last minute rush. Here in Maine: Mainers rush to enroll in health exchange The Federal Health Exchange Sees Enrollment Flurry and in spite of that, HealthCare.gov holds up amid record traffic on deadline day.

The deadline was Monday – unfortunately, the weekly enrollment reports (released each week on Tuesday) run Saturday through Friday, so the numbers we have so far aren’t complete. In spite of that we saw Obamacare’s Best Week Yet Brings 1 Million New Sign-Ups. You can see the HHS release here: Open Enrollment Week 4: December 6 – December 12, 2014. In addition to the million on the Federal Marketplace, we saw More than 700,000 enroll through state insurance exchanges in first month. Putting that all together, a research firm revised its projections: Avalere Analysis - Exchange Enrollment Outlook: 10.5 Million to Sign Up by End of 2015.

Although things went well with this initial deadline, there were some who couldn’t get through to the call center. They will be given extra time to enroll and still have their coverage begin January 1: Call center wait won't stop Jan. 1 insurance coverage. In some states (not Maine) insurers also made special allowances for the deadline: Insurers have pushed back a key Obamacare deadline in 37 states. There were some other circumstances where people will be given extra time, as outlined by Tim Jost: Implementing Health Reform: Enrollment And Reenrollment For 2015 “The FFM has, however, established special enrollment periods for a small group of qualified individuals who should have been passively reenrolled with coverage effective January 1, 2015, but for some reason were not.”

Before continuing, let’s take a minute to review the calendar. The 12/15 deadline was to get coverage beginning January 1. That applies to those who are seeking coverage for the first time and to those who are renewing coverage. Both groups still have two months to select a plan (open enrollment ends 2/15), it’s just that for those who are going to be auto-reenrolled (about 80% of those with marketplace coverage from last year) it will be more complicated to switch plans since their existing coverage will already have been renewed.

With that in mind, the expectation had been that if people were going to alter their reenrollment choice, many will have done so by the 12/15 deadline. The numbers above show that while some of those who had existing coverage have done so, the vast majority have not. Two pieces look at that situation: Obamacare Is Only Human (alternative title, Obamacare Has A Problem: Human Nature) and this one that looks at the impact of inertial on pricing decisions of carriers: Most Obamacare enrollees are ignoring tonight’s deadline, and it will cost them “The ACA exchanges were constructed with that idea that transparent competition would help act as a check on unreasonably large premium hikes. But that could also depend on people wanting to shop around for a better deal on coverage.”

ACA: Employers
After two years of delay, part of the employer mandate takes effect on January 1. Employers with 100 or more employees will need to offer coverage or face penalties – it seems like the delay may have served to ease the impact with the economy (somewhat) improving: ACA employer mandate: Not as bitter in better economy.

For small businesses who are not required to offer coverage, things are still challenging: Round 2 for the ACA Health insurance options still a challenge for small businesses. Small employers face a tough decision on if they should offer coverage or not – remember, some employees are actually better off if their employer doesn’t offer coverage because of the availability of subsidies on the individual marketplace. So it was inevitable that Small Businesses Drop Coverage As Health Law Offers Alternatives. Although, as this story highlights, some small businesses are seeing a benefit: Taking the pulse of SHOP exchanges

ACA: Other
In news that saddened single payer advocates everywhere, After years of effort, Vermont's governor reportedly gives up on single-payer health care. “It became clear that risk of economic shock is too high at this time to offer a plan that I can responsibly support for passage.” Governor Peter Shumlin (Governor Abandons Single-Payer Health Care Plan). While this is unfortunate for those who think single payer has merit, it is important to realize that it isn't working in Vermont because people don't accept the tradeoff of higher taxes vs. no insurance premiums, not because the theory is bad. My take is that optics, not finance is what doomed those efforts.

On a positive note, the Press Herald took a look at one of the predicted benefits of the ACA, that the presence of affordable individual insurance would allow individuals to give up their “day job” and pursue new opportunities: Affordable Care Act swelling ranks of self-employed, report says.

Costs
How does your doctor or hospital decide how much to charge for a test?  “Testing has become to the United States’ medical system what liquor is to the hospitality industry: a profit center with large and often arbitrary markups.” (The Odd Math of Medical Tests: One Scan, Two Prices, Both High) – Sounds like yet another compelling case for price negotiations/controls on the Federal level (like just about every other country does).  

Need more reasons?  How about “nonprofit” hospitals forgetting what it means to be a “nonprofit” or charitable institution: From the E.R. to the Courtroom: How Nonprofit Hospitals Are Seizing Patients’ Wages. In the case discussed, if the charges had been incurred just a few months later, they would have been waived. But instead the hospital is taking full advantage of every legal recourse, seriously harming the family involved.

That is one case at one hospital (although we can imagine it is not an isolated incident). What is going on across the country?  The NY Times asked, here’s a look at How the High Cost of Medical Care Is Affecting Americans.

These examples are important to keep in mind when (if?) we start to discuss changes to the ACA. Some (me!) would say the law needs to do more to help some of these people experiencing affordability issues while others (the bad guys) want to get more “blood from a stone” and increase low-income individuals share of expenses (can you say Copper Plan). Stay tuned!
For those who want to argue that the free market can take care of all this, here are 10 reasons why healthcare isn't a free market Spoiler alert!  My favorite is number one: “Nobody in the middle of a heart attack shouts, “Let's go shopping!”

With all that in mind, there is still a cost (and price) crisis in health care – and we need to be doing things differently if we want to fix it. Unfortunately, in the current environment it’s hard to have open discussion on difficult topics: Forbidden Topic in Health Policy Debate: Cost Effectiveness. We can’t do everything for everyone – but in our current system, we don’t discuss how tradeoffs are made, thus all but guaranteeing that they are made in an arbitrary and inefficient way.

Last week, we talked about an editorial in Health Affairs Why I Oppose Payment Reform. This week, part 2 of the editorial was published: How To Succeed At Payment Reform (By Really Trying) “Given the concerns I raised in my prior post, I believe payment reform will only achieve its intended goals if it occurs in a broader context that includes other strategies — for example, defining spending targets and launching initiatives to improve health outcomes by reallocating resources to the social sector.” Or to put it another way, we need extreme solutions to these extreme problems.

CMS Announcements
As I've complained about before, figuring out a taxonomy for this newsletter is hard. Many items could go in multiple categories, yet I don’t want so many categories that each item ends up in a category of one (kind of defeats the purpose). This week, throwing up my hands I’m including this special category to handle a flurry of year end announcements from CMS.

Medicare Cuts Payments To 721 Hospitals With Highest Rates Of Infections, Injuries “In its toughest crackdown yet on medical errors, the federal government is cutting payments to 721 hospitals for having high rates of infections and other patient injuries, records released Thursday show. Medicare assessed these new penalties against some of the most renowned hospitals in the nation, including the Cleveland Clinic, Brigham and Women’s Hospital in Boston, the Hospital of the University of Pennsylvania in Philadelphia and Geisinger Medical Center in Danville, Pa.”

More hospitals to get bonuses than penalties in 2015 under value-based purchasing “A total of 1,698 hospitals will have their Medicare payments boosted in 2015, 467 more than in 2014, according to a Modern Healthcare analysis of data the CMS posted Wednesday. …  A total of 1,360 U.S. hospitals will have their Medicare payments docked next year.”


But wait, there’s more!

Public reporting of 2013 quality measures on the Physician Compare and Hospital Compare Websites “CMS has added new quality data to the Physician Compare website. Additionally, CMS has updated quality measures on the Hospital Compare website and released data on new measures. These websites are part of an Administration-wide effort to increase the availability and accessibility of information on quality, utilization and costs for effective, informed decision-making.”

And finally: Providers balk as CMS announces penalties for 2013 EHR issues “A CMS announcement that many doctors will see their 2015 Medicare payments cut by 1% for failing to meet federal electronic health-record incentive-payment program standards has provoked strong reactions from physician and hospital groups.”  However, note that this was a voluntary program: “More than $25.7 billion in EHR incentive payments were made between early 2011 and Oct. 1 this year, including about $10.3 billion to physicians and other EPs, and $15.4 billion to hospitals, CMS data show. More than 414,000 physicians and other EPs, and 4,695 hospitals have been paid to date.”

Medicaid
CMS released new Medicaid enrollment data this week: Medicaid and CHIP Enrollment Milestone Achievement: Enrollment Grows by Approximately 9.7 Million Additional Americans “As of October 2014, approximately 9.7 million additional Americans were enrolled in Medicaid and CHIP – a 17 percent increase over the average monthly enrollment for July through September 2013, the months before the Marketplaces first opened.”

The NY Times took a look at the numbers, focusing on states that had not expanded Medicaid: Medicaid Rolls Surge Under Affordable Care Act. We’ve talked before about the “woodwork” or “welcome mat” effect – that just the talk about health coverage will get some to apply for Medicaid who had not applied before even though they were already eligible. These numbers show its impact. A side note, when looking at the chart in the article you’ll see Maine is not included. According to the footnote, Maine did not report enrollment figures to CMS. But while we don’t have exact numbers, we do know that here in Maine, enrollment is now under 300,000 for the first time in many years as people who were terminated earlier this year lose their transitional benefits.

That brings up the topic of Medicaid expansion – lots of news this week from states who have not yet expanded, and some from those who have.

We’ll start with some observations from Drew Altman about the increasing number of Republican Governors who opposed the ACA that are now considering expansion: Medicaid Expansion in Red States “These days, momentum in the states lies with pragmatism over conservative ideology and anti-Obamacare sentiment–that is, provided the details of the deal between the administration and these states are just right. But momentum could swing back, depending on developments in Congress and the Supreme Court.”  The Washington Post also observed that Three Republican governors have now endorsed the Medicaid expansion since the midterms.

And talking about swinging back, one of the earliest examples of a “red” state expanding, the original private option state Arkansas, is now considering rolling back its expansion: Arkansas' model Medicaid experiment in jeopardy.

Before continuing, let’s remember that there is a difference between a Governor stating that they will expand under certain conditions, and CMS accepting those conditions by granting a waiver. Secretary Burwell has said she will speak to any Governor that wants to talk, but keep in mind what George Burns had to say about prayers in the movie Oh God: I answer all of them, but sometimes the answer is no.

To date, waivers have been approved in Arkansas, Iowa, Michigan and Pennsylvania. Despite the ongoing conversations, nothing has yet been approved for Alaska, Tennessee, Utah or Wyoming.

Here is some of the state specific coverage:


Medicare
Need another reason to be concerned about the future of Medicare?  Here you go: Paul Ryan's bid to overhaul Medicare to resurface in new Congress. His plan is to replace the program with vouchers for private coverage.

But we see this week yet again, that the benefit of private Medicare plans (Medicare Advantage) often goes to the insurers, not the beneficiaries: How much do beneficiaries gain from higher Medicare Advantage payments “One of the main arguments in favor of Medicare Advantage is that competition provides the greatest value to beneficiaries. Even if one believes that to be the case, according to this study, Medicare Advantage may not achieve levels of competition to come close to fulfilling its potential. Beneficiaries are supposed to be better off under competition. The less competitive the program, the less clear it is that they are.”

Drugs
In 2012 there was a meningitis outbreak that killed 64 people. It was traced to tainted drug injections made by a “compounding pharmacy”. This week, Compound Pharmacy Owners and Employees Arrested for Meningitis Outbreak “The most serious charges were made against Barry Cadden, a co-founder, and Glenn Chin, a supervisory pharmacist who oversaw the sterile room, who were charged with 25 counts of second-degree murder for causing the deaths of patients in seven states. Cadden and Chin face a maximum of up to life in prison if convicted on all counts.”

In light of the charges, Modern Healthcare asked the question: Are compounding pharmacies safer now? The answer is yes, partially due to a law passed by Congress in 2013 as a result of the incident.

Also in legal arena a Judge halts Alzheimer's drug swap until July. There is a common practice whereby a pharmaceutical firm takes a drug who’s patent is about to expire, tweaks the drug (such as taking a two pill a day drug and making it one pill a day), takes out a new patent and then removes the old drug from the market. That means the patient is forced to change the way they use the drug, then when the generic comes out a few months later it is harder to get individuals to switch to it, since it represents another “change”. The ruling could have a sweeping impact on the ability of the drug company to remove the original drug from market (Court Rules on Alzheimer’s Drug: Decision Could Reduce a Common Industry Practice) thus making it easier to switch to the generic when it is available.

System Transformation
Thirteen months after his nomination, this week Vivek Murthy was confirmed as Surgeon General. His nomination was contentious because he had the audacity to say that guns (and the injuries they cause) are a public health issue. In part due to Ted Cruz’s objections to the Cromnibus (see last week’s issue), his nomination was finally brought to a vote by the full Senate and approved (Senate Confirms Gun-Control Advocate as Surgeon General - Vivek Murthy became the nation's top doctor Monday, but only after a protracted fight over firearms). Here are more details on the man and what a Surgeon General actually does: Vivek Murthy is the new surgeon general. Who is he, and what the heck is his job?

Also in the news this week was a historical change in the dynamic of US-Cuban relations. Why am I talking about that in a health policy blog?  Primarily because of something called the Cuban Paradox. That is the term used because while Cuba is considered a poor country, their health system is one of the best in the world when measured by the health of the population. That begs the question, Can Cuba Escape Poverty but Stay Healthy?  Also, this piece takes a look at how both countries health care systems can benefit from improved relations: Renewed U.S.-Cuba relations could impact both nations' healthcare

The Washington Post takes a deep dive into end-of-life care: ‘Warehouses for the dying’: Are we prolonging life or prolonging death? ““I think if someone from Mars came and saw some of these people, they would say, what have they done to deserve this punishment?” said Marik, gesturing to the surrounding rooms. “People might say we are prolonging life, but we end up prolonging death.”” An important piece of the puzzle is palliative and hospice care. Here are some thoughts on each: How to introduce palliative care to patients and Too Little, Too Late For Many New Yorkers Seeking Hospice.


On the technology front, a mind boggling look at the near future: Fantastic Voyage: Tiny Sensors May Soon Monitor Seniors’ Medicines From Inside and a reminder that technology can also help with some of the more mundane tasks: Doctors no match for computers at accurately recording patient symptoms, study finds

A new study out this week looked at Shared Decision Making And The Use Of Patient Decision Aids. It reinforces the point that we still have a long way to go to achieve the goal of providing: “the care patients need and no less; the care they want and no more.”  Handing someone a PDA (no not a public display of affection or a personal digital assistant, a patient decision aid) is NOT shared decision making. After the patient reviews the material there needs to be a two way conversation with the provider if it is truly going to be a shared decision.

And finally, while we've picked on Dr. Oz before, it’s both appropriate and fun. So let’s end the year with a classic and do it one more time: Half of Dr. Oz’s medical advice is baseless or wrong, study says

All comments and suggestions are welcome; please let me know what you think. And as always, thanks for reading!

Funded by support from the Maine Health Access Foundation

*The title is a tribute to the BBC show, the NBC show and the amazing Tom Lehrer album "That Was The Year That Was"

Friday, December 12, 2014

That Was The Week That Was - Issue 40

A look back at the week's health policy news with a focus on ACA implementation

For issue 40 (I have no idea how that happened) we have Grubergate, CRomnibus and the problem with inertia.

With the congressional hearing this past Tuesday, we started the week talking about Grubergate. Once the hearing ended the focus shifted to the efforts to fund the government and what would be slipped into the spending bill. Meanwhile, the deadline for selecting coverage (or updating coverage) for a January 1 effective date gets closer and closer (Monday December 15) and while new enrollment numbers look good, it seems like not enough people are reviewing their current coverage.

We'll talk about all that, disturbing data on breast cancer treatments, questioning payment reform efforts and much much more. Let’s get started.

ACA: Opposition (Grubergate)/ Court Cases
To review, Gruber (Jon not Hans) is an MIT economist who developed an economic model for pricing health reform efforts. He contributed to the discussion that created RomneyCare and helped with the ACA. He also seems as an individual to have no filter and has said many things where he embarrassed himself and supporters of the law (How Conservative Media Turned Gruber Into The Perfect Obama Villain).

On Tuesday, the House held a hearing where Gruber (and Secretary Burwell) were questioned. During the hearing, He squirmed. He dodged. He apologized. But Republicans barely laid a glove on him.


OK, are we done with him now?  The sad answer is no, as later in the week yet another new video appeared with more “stupid” remarks (In a new video, Jon Gruber boasted that he “helped write” Obamacare) and, the Committee issued a new subpoena for yet more information (Issa Subpoenas ObamaCare Architect Jonathan Gruber).

Some have observes that 'Grubergate' shows the sad state of debate on Obamacare “The Gruber video snippets were dug up by opposition researchers who pushed them to cable TV producers, who would rather smear the Affordable Care Act than report on how the law has provided secure, affordable coverage to more than 15 million Americans and significantly reduced the rate of increase in premiums and healthcare costs.” Yet is can also be said that If Obamacare's biggest problem is Jon Gruber, Obamacare is doing great.

How important is this issue?  According to a Kaiser survey, For All the ‘Grubergate’ Talk, Few Americans May Have Listened “Preliminary data from this month’s Kaiser Health News Index shows that just about 2 in 10 Americans say they have been following the story closely (and just 1 in 10 say very closely), which puts Grubergate far behind major news such as the protests that followed the Ferguson, Mo., grand jury’s decision not to indict (closely followed by about 8 in 10) and the conflicts involving ISIS and other militant groups (closely followed by about 7 in 10).”

Another way to think about it is that It doesn’t matter if Congress thinks Jon Gruber is dumb. It matters if the Supreme Court thinks he’s smart. Will his statements have an impact as SCOTUS decides the subsidy case?  Only time will tell.

Also this week regarding the subsidy case, a very well thought out and scary look at what happens if the decision prevents subsidies from being paid in states with a the federal marketplace: Predicting the Fallout from King v. Burwell — Exchanges and the ACA. The basic point is that getting around an adverse SCOTUS decision may not be as easy as originally thought. We’ve always known it will take action by the state – but the action is probably more complicated than just saying the state has a marketplace and is only using healthcare.gov for the technology. More discussion of the same concerns in the NY Times: Many States Will Be Unprepared if Court Weakens Health Law.

More responses this week to Senator Schumer’s remarks re the ACA not helping the middle class. First, here are Six Ways Health Reform Helps the Middle Class.

Next, an economist takes a look at how the subsidies helps lower premiums for those who don’t receive them – spoiler alert, they reduce adverse selection. But for those interested in the details, here you go, but caution, math ahead:  How health insurance subsidies help everyone.

Looking forward to the future of the ACA and health reform in next year’s congress; on the Democrat side of the aisle you have Health care torch passed … to nobody - Next generation of Dems less visionary, more wonky. Meanwhile, on the Republican side of the aisle, Mitch McConnell’s Obamacare gambit: Behind closed doors, Republicans are plotting one last tilt at the Affordable Care Act.

CRomnibus
Let’s start with the basics, CRomnibus is the spending bill passed late Thursday night by the House and to be take up Friday or Monday by the Senate (where it is expected to pass). Why is it called CRomnibus? Because it's a mash-up of an omnibus bill, which is how Congress funds the government when things are working normally, and a continuing resolution (CR), which is how Congress funds the government when it can't come to a deal. In this case, the CR only affects the Department of Homeland Security, which, … will see its funding expire in February.” (From Vox) In case you’re wondering, the reason Homeland Security was singled out has to do with Republican opposition to the President’s action on undocumented residents. But, since this is a health policy blog, I won’t go into detail about that or the bill in general, plenty of sites are doing that today. What I have done below is list items highlighting some of the different pieces hidden in the 1,600 page bill that have an impact on health policy (and ACA implementation):

An attempt to sabotage the risk corridor program: Republicans Dealt A Quiet Blow To O-Care In The CRomnibus and Insurers Say Spending Bill Would Raise Obamacare Rates: The bill would cap spending on a program Republicans call an “insurer bailout.” The program was always meant to be revenue neutral, so it is unclear how much of an impact this will ultimately have. It will depend on the actual claims experience plans end up with.

In a classic bite your own nose to spite your face move, 'Cromnibus' cuts could hamper IRS enforcement of ObamaCare. “… the funding bill's $350 million in budget cuts to the IRS will further burden the already cash-strapped agency.” It’s been estimated that every time the IRS budget is reduced by a dollar, we lose about $7 in tax receipts…

There is a change to the way MLR is calculated for non-profit Blue Cross Blue Shield Plans and how their tax status is determined (note this category does not include Anthem here in Maine). (The CRomnibus shows Democrats, Republicans actually working together on Obamacare) This is a “fix” that has been sought since the day after the bill was passed by some Democrats and Republicans. For the optimists among you this can be interpreted as a sign that there is room to clean up the law. (Given the rest of the items on the list, I’m not so sure).

Regarding the requirement that members of Congress and their staff use the marketplace: GOP approves David Vitter’s Obamacare amendment. This change removes the opportunity to classify some staff members as committee members and thus exempt them from the requirement. Attempts to also remove the employer contribution from Congress and their staff failed.

Looking towards the future, “Buried in the spending deal that congressional negotiators announced on Tuesday are several nuggets that should be of interest to hospitals, home health providers and pharmaceutical companies. They won't have any immediate impact but could lay the groundwork for significant policy changes.“ (Small parts of spending deal could have long-term healthcare impact)

On a positive note, the Spending Bill Includes Abortion Funding for Peace Corps Rape Survivors. Peace Corps staff had been the only remaining group where Federal funds were not permitted to be used for abortions in these extreme cases.

As I am preparing to post, an overview of the topic out from Tim Jost looking at several of the items listed above: Implementing Health Reform: Beneath The Hood Of The ‘Cromnibus’

ACA: Premiums/Affordability
Starting off with good news, first a reminder that Maine's Online Marketplace Insurance Shoppers Likely to See Lower Premiums.

Also, a study showing that Many Obamacare Plans Set Out-Of-Pocket Spending Limits Below The Cap “Seventy-four percent of 2015 silver level plans’ out-of-pocket spending caps are below the $6,600 spending limit allowed for individual plans and $13,200 maximum for family plans, according to Avalere, a consulting firm. The average out-of-pocket maximum for 2015 individual silver plans will be $5,853, says Caroline Pearson, a vice president at Avalere. Silver was the most popular plan type this year, selected by about two-thirds of enrollees.”

In the bad news category, a reminder of the issue of medical debt, as a new survey shows that 42.9 MILLION AMERICANS HAVE UNPAID MEDICAL BILLS  “More than half of all debt on credit reports stems from medical expenses.” I would suggest there is a bimodal distribution, or in other words, we are talking about two distinct populations in the data. First are those who experienced a catastrophic event and racked up thousands upon thousands of dollars of medical debt that they just can’t pay. This is the group the ACA’s out-of-pocket limit is designed to prevent (moving forward, it does nothing to cancel existing debt).

Second, the data seems to indicate another group, those who have more manageable levels of debt: “The report by the federal regulator indicates that much of this trouble could be avoided. About half of consumers who only carry medical debt have no other signs of being under financial distress. But complaints to the CFPB indicate that consumers are routinely baffled by medical bills. Unwieldy insurance and hospital statements leave them uncertain as to how much money they owe, the deadline for payment, and which organization should be paid.”  Figuring out a way to alleviate this confusion is

ACA: Marketplaces/Enrollment
In the third week of open enrollment, 618,548 people selected a plan on healthcare.gov. So as of 12/5 there had been a total of 1,383,683 plan selections: Insurance exchange enrollment spikes as 2015 deadline nears (Open Enrollment Week 3: November 29 – December 5, 2014 – Primary Source). With those numbers, it looks like Obamacare Enrollment Poised to Blow Past 9.1 Million Projection.

While that is all good news, the numbers concerning those who already have coverage are less encouraging. We’ve talked before about the need for those with coverage through the marketplace to go back and update their information and review their plan selections. The NY Times took a look at the issue with two reports: Many Aren’t Seeking Cheaper Health Plans as First Deadline to Switch Nears and Why Most People Won’t Shop Again for Health Insurance “There are currently about 6.7 million people with federal or state marketplace health plans, according to government estimates. As of Dec. 5, only 720,000 people in the 37 states using the federal enrollment website have returned to the site to select a 2015 plan.”

With those numbers, it looks like the debate over if this group will be able to overcome their inherent inertia is settled – inertia continues to rule the day. With this experience, the conversations about how open enrollment will work next year become even more important.

But while many people will not go out and check their plans, it’s not too late so Hurry Up! Big Obamacare Deadline Coming Monday. Let’s take a moment to review the deadline – it’s the last chance to have coverage begin on January 1 – but it’s not the end of open enrollment. So even if you miss this deadline you can still sign up for coverage. You can also still change your plan if you are currently enrolled – it just means that for January you may be reenrolled in your current plan and your new selection won’t start until February (if you make a selection by January 15).

As the first deadline approaches, “The Department of Health and Human Services will promote HealthCare.gov at the bottom of some 7-Eleven receipts in an effort to reach demographics that could be uninsured, the department announced Thursday.” (HHS uses 7-Eleven receipts to remind people to sign up for HealthCare.gov).

And finally, as part of the open enrollment push, the President made an appearance on the Colbert Report. If you haven’t seen it yet, it’s not to be missed: The President on the ACA - as Stephen Colbert!

ACA: Employers
New information on what those covered at work are paying: “A new Commonwealth Fund issue brief out today finds that premiums for employer-sponsored health insurance grew 4.1 percent annually between 2010 and 2013, following passage of the Affordable Care Act, compared to 5.1 percent between 20and 2010, before the law was passed. Deductibles also rose more slowly. But while premiums rose 60 percent overall between 20and 2013, U.S. workers’ incomes rose only 11 percent. The contributions employees make toward their health plan premiums, meanwhile, increased 93 percent over this period.” (Costs for Employer Health Coverage Rise More Slowly But Still Claim Growing Share of Wages)

Thoughts from Dr. Wolf regarding the ACA and small businesses – it’s not yet providing all the help needed: Obamacare’s pros and cons for small businesses: The jury’s still out on the benefits.

Picking up on our discussions last week regarding wellness program costs and benefits, coverage from NPR: Wellness At Work Often Comes With Strings Attached and Kaiser: Wellness At Work: Popular But Unproven.

ACA: Other
In the age of smaller networks, the importance of provider directories is amplified. In the proposed rules for next year’s open enrollment, there are much needed requirements regarding accuracy and availability. That said, carriers are already making excuses: Inaccurate provider directories blamed on weak tech, network churn Although not everyone is buying those excuses: ““These explanations are outrageous,” said Robert Laszewski, president of consultancy Health Policy and Strategy Associates. “Not having accurate consumer-level information about just who is in their provider network—particularly when they are using narrow networks as such a major part of their Obamacare offerings—is inexcusable.””

Also proposed for next year are changes to what plans people are “reenrolled” into. There is a whole industry emerging around decision support tools, trying to answer the question Can technology pick the perfect health plan for you?

One of the reasons picking a plan is hard is due to variation in plan design.  That variation is due both to state differences and plan level differences. Here is a look at the state level differences: Health Care Law Is Not One-Size-Fits-All, and Here’s Why and The future of essential health benefits.

Costs
Another day, another set of cost figures. We have two to discuss this week. On one hand, Expected pickup in healthcare spending may be here – Note this is total expenditures, not rate of inflation. We always knew some of this was suppressed due to the economy, and it would rise due to newly insured. Still way too early to know importance of different factors and how things go from here.

On the other hand, these hospital price numbers look like things are still going well. Note these numbers are price inflation, not expenditures: Lowest hospital price growth in 16 years pushes down health inflation. Confused?  Join the club!

We know that some of the ways money is spent are more impactful than others. Reports of two success stories this week: Government anti-smoking campaign cost just $480 per quitter, study finds and Publicly financed family planning’s return on investment ($7 for every public dollar spent).

Lots more interesting pieces on health care costs this week. With no real theme connecting them, we’ll punt and provide a list with brief descriptions:

Why I Oppose Payment Reform – a provocative editorial in Health Affairs makes some very good points (stay tuned for Part 2 which we’ll cover next week).

Consumers still pay bigger share for healthcare than government and businesses – with all the talk of subsidies and employer contributions, this point is often forgotten. Consumers continue to pay the biggest share of health care costs. (And of course it can be argued, as I often do, that consumers are paying the business share of costs as well through reduced wages.)

Devicemakers explore risk contracts with hospitals “In some deals, manufacturers would return a percentage of the device's price if it doesn't meet performance goals, while in others, hospitals would pay more for a device that fulfills a manufacturer's quality and economic claims.”

How residency programs are training doctors to waste money - “Residents who train in regions with high health care costs (that is, the places that err on the side of more scans and specialists) continue to practice expensive medicine decades beyond graduation — even if they move to low-cost parts of the country.”

Surgeons see end-of-year rush for elective procedures – interesting story but no real data. Note there was no mention of the interest in spending down their FSA accounts (another source of year end rush). Also note the one deductible they mention, $8,000, has to be from a grandfathered plan since it exceeds the ACA out-of-pocket max.

Medicaid
We discussed the issue of provider directories above, but it is relevant for Medicaid as well. A study out this week reports Half of Doctors Listed as Serving Medicaid Patients Are Unavailable.

Also disturbing news with a study showing that Nearly 9 Percent Of Medicaid Births Delivered Early For No Medical Reason

Medicaid programs are facing another potential problem in 2015: Obamacare paradox: Medicaid is expanding, but doctors are facing a huge pay cut The ACA included a provision that raised compensation for Primary Care Physicians for 2 years (2013 and 2014). With that expiring, PCPs may experience a pay cut. Several states are working to continue the enhanced rate with state funds. I can report that efforts continue to retain the increased rates here in Maine but nothing has been finalized.

Medicare
When we think of health care in this country, and all the poor comparisons made with other countries, we like to think that at least our seniors are taken care of through Medicare. But a new study out shows that the U.S. Health Care Lags Worldwide for Those Over 65. Even with Medicare coverage there are still significant coverage gaps and delivery problems.

EBOLA
This week Time magazine named their person of the year:  TIME Person of the Year: The Ebola Fighters - The ones who answered the call. A great tribute to those who put others welfare ahead of their own. Maine’s own (OK, she’s not a native, but I’ve adopted her) Kaci was featured in the coverage: Kaci Hickox among Ebola fighters, survivors named ‘Person of the Year’ by Time. She was also recognized by MTV: Nurse Kaci Hickox named mtvU’s Woman of the Year.

Drugs
NPR did a series looking at overuse of drugs in nursing homes. These two stories outline the problem: Old And Overmedicated: The Real Drug Problem In Nursing Homes and Nursing Homes Rarely Penalized For Oversedating Patients. This story takes a look at how things can be done better: This Nursing Home Calms Troubling Behavior Without Risky Drugs. And finally, this story from the BDN looks at the state of things in Maine: Fewer Maine nursing home residents treated with risky antipsychotic drugs “While Maine was most improved under the initiative, the state ranks in the middle of the pack, at 26th in the nation, for the total number of nursing home residents taking antipsychotic drugs.”

This week in Sovaldi news, a new approach to try and reign in the cost with A new lawsuit claims $84,000 is way too much for this lifesaving drug. Not at all clear if such a suit can be successful, but if it is there will be many to follow.

Also in drug cost news, another look at Avastin and Lucentis. They are two nearly identical drugs with vastly different costs. Here is a review of the data on drug company payments and proscribing patterns: Paid to Promote Eye Drug, and Prescribing It Widely.

Finally, a deeply disturbing look at how much of your data is out there: They Know You Buy Viagra and They Want to Sell You More. Note that all of the data discussed in the piece is outside the scope of existing federal privacy laws.

System Transformation
I cannot overstress the importance of this first story. Several years after incontrovertible proof that fewer radiations treatment are as effective as the “standard treatment”, most patients continue to receive the old method of treatment. The story is important for several reasons: women are undergoing unnecessary extra treatments, the system paying more for care that is no better (and potentially worse for the patient) and for what it says about the ability of providers to keep up with new information. Long Radiation Treatments Called Unnecessary in Many Breast Cancer Cases and How we treat breast cancer exposes a huge systematic issue in American health care.


On a more mundane but equally important topic, contrary to media reports this week, No, The CDC Did Not Apologize And Say The Flu Vaccine Doesn’t Work. The flu shot effectiveness varies from year to year, but that is not a reason not to get vaccinated (How Effective Are Flu Shots?)

It seems every day there is a headline touting the new “superfood” or new way to prevent cancer. The sad truth is, most of these stories are junk – which begs the question Why so many of the health articles you read are junk. Short answer is that press releases regarding study results can be fairly sensational and are not always written with the researchers’ participation. So take it all with a grain of salt (but not too much salt, that’s bad for you).

The results of the healthiest state rankings were released this year. Unfortunately, Maine back at its lowest point – 20th – in ‘healthiest state’ rankings - The slide from 16th last year is blamed in part on fewer immunizations and more infant mortality. Due to lower vaccination rates and a surprising increase in infant mortality, Maine’s ranking fell. While the vaccination issue has received a fair amount of attention, the infant mortality issue was a surprise to many.

One writer take a look at Science bashing: The latest threat to research in America. Sadly at a time when more than ever we need good research there are those who don’t think it’s money well spent.

And finally this week, a look at one doctor’s exposure to dying at home: “This is the first time I have visited a patient on his “death bed” at home, even though I had done it many times in the hospital setting. And what a difference it is! Before me is a picture of ultimate serenity — a man completing a long journey in the comfort of his own home, surrounded by friends and family. I contrast this with the alternative scenario — a man dying in the chaos of an ICU, imprisoned by tubes, alarms, CPR, ventilators, and IV drips.” (The last house call: Turning off the defibrillator)

All comments and suggestions are welcome; please let me know what you think. And as always, thanks for reading!

Funded by support from the Maine Health Access Foundation

*The title is a tribute to the BBC show, the NBC show and the amazing Tom Lehrer album "That Was The Year That Was"

Friday, December 5, 2014

That Was The Week That Was - Issue 39

A look back at the week's health policy news with a focus on ACA implementation

3.6%, 12.4%, 50,000, 765,000: Those four numbers represent four different pieces of information released this week that shows the ACA is working. That’s not to say healthcare is fixed and we can all go home, not by any stretch of the imagination. There is still a lot of work to do and people who need help. The law continues to be threatened and undermined and even if it were working perfectly, it would not be enough. But for today, for a few minutes, we can be thankful some things are moving in the right direction.

Oh, you want to know what those numbers represent?  In order listed above they are: the rate health spending grew in 2013 – the lowest recorded since the government started measuring the figure in 1960 (see the Cost section below), the latest figure on the rate of uninsured in this country – a decline of 30% from a year earlier  (see the Enrollment section below), the number of lives saved by the reduction in medical errors over the past 3 years (see the System Transformation section below), and finally, the number of people who have selected a plan in the first two weeks of open enrollment (see Enrollment section below).

This week we have details on those figures, new ACO regulations and as always, much, much more. So let’s get started.

ACA: Opposition/Support
Sometimes Democrats are their own worst enemy – last week Sen Schumer said passing the ACA was a mistake. Here is another look at why he is wrong: On Obamacare, could all Democrats really be as clueless as Sen. Schumer? Since we seem to be living in bizarro-world, this week while Democrats regretted passing the law the former Republican Senate Majority Leader supported it saying that Republicans should fix the ACA, not continue to hope that the courts overturn it: Trent Lott Encourages GOP To Make Fix To Obamacare Before Supreme Court Case

I wasn't the only person this week thinking about good news, The Brookings Institution also asked the question: Is Obamacare Working? Yes.  Vox chimed in: The Obamacare paradox: the law looks terrible but is doing great as did New York Magazine: 4 New Studies Show Obamacare Is Working Incredibly Well

ACA: Court Cases
Developments in two cases this week, the subsidy case and the House GOP suit of the President.
Starting with the subsidy case, for those interested in the legal arguments this is one of the best pieces I’ve seen on why the case should fail Am I unreasonable? And here are some additions to the legal arguments: A couple of overlooked context clues in King and thoughts on why The Latest Challenge to Obamacare Should Embarrass Conservative Judges.

Some think that Mitch McConnell Just Made a Huge Tactical Mistake by Begging the Supreme Court to Gut Obamacare personally, I don’t think it will have an impact, but it’s a nice thought.

USA Today took a look at what would happen if the Court says subsidies can only be offered in State Exchanges: Experts: No easy options if court strikes down ACA. At the same time, in a review of what states are doing to prepare for the Court’s decision, the answer was not much: 32 States Haven't Tried To Establish an Exchange. Are They Making a Huge Mistake?

Regarding the House GOP suit of the President, focus on the part of the suit concerning the out-of-pocket subsidies. These subsidies are paid directly to insurance companies to lower the copays, coinsurance and/or deductibles paid by those with income below 250% of the Federal Poverty Level. The suit says that the Administration paying those out of the same account as the tax credit subsidies is wrong: Obamacare lawsuit tests 'power of the purse' and Suit on Health Law Puts Focus on Funding Powers.

ACA: Enrollment
Unlike last year, HHS has committed to releasing weekly enrollment reports during the open enrollment period. In the first week Healthcare.gov signed up 462,125 customers. And while Health law sign-ups slowed over Thanksgiving by the end of the second week Obamacare Sign-Ups Top 765,000. Things should only get busier from here as we approach December 15 – the deadline for anyone who wants coverage to begin on Jan 1 including those who want to make changes to their coverage before the New Year. Although while it’s not advised, it is possible for those who are automatically reenrolled in their current plan to still make changes after Dec. 15 – they can pick a new plan at any time during the open enrollment period and drop the coverage they were reenrolled in. You can see the full release from HHS here: Open Enrollment Week 2: November 22 – November 28, 2014

What impact did the first open enrollment have (and the first year of coverage)?  12.4% is the latest figure released by the Urban Institute for the percent uninsured in the country. That represents a decline of 30% from a year earlier (Uninsured rate keeps dropping as second open-enrollment period progresses). It’s worth noting that there is a big discrepancy between states that expanded Medicaid and those that did not “In non-expansion states, the uninsured rate has dropped from 20.1% to 15.1% over the last year. In states that have adopted Medicaid expansion, the uninsured rate dropped from 15% to 10.2% since the exchanges were launched.” Here is the full report from the Urban Institute: Taking Stock: Health Insurance Coverage under the ACA as of September 2014.

ACA: Marketplaces
We’ve talked about the reenrollment issue before, the need for those who currently have coverage to review their choices before being automatically enrolled in the same plan for next year. This week HHS issued a report attempting to quantify the benefit of shopping around: HHS: Switching Obamacare Insurance Plans Could Save Consumers More Than $2 Billion. As one report from the Washington Post put it: The administration is begging Obamacare enrollees to shop around for a better deal. You can read the full report here: Report shows more options and savings for consumers who shop in the Health Insurance Marketplace in 2015.

What it comes down to is inertia – the tendency of people to leave things as they are. NY Magazine takes a more detailed look at the problem here: Obamacare’s Inertia Problem

The reason to shop around is not just to check premiums. Sometimes a plan will change certain provisions while still remaining the same plan: “But tucked within the plans' jargon are changes that could markedly affect how much consumers pay for health care. Generic drugs will soon be free, but the cost of expensive specialty medications will increase. Co-payments for visits to primary-care doctors will go down, but those for emergency room trips will be higher.” (Big Changes in Fine Print of Some 2015 Health Plans). How can consumers figure out what’s going on? Propublica has an app for that!  They've created a comparison tool that lets you compare key cost-sharing provisions of any 2014 plan with any 2015 plan. It’s definitely worth taking a look: Will My Obamacare Health Plan Costs Go Up? Compare before you renew your health insurance plan.

Finally Kaiser took a look at Who Is Getting ACA Insurance – And Who Isn’t.

ACA: Premiums/Affordability
One of the ways the marketplace brings costs down is by fostering competition. In a look at the state of markets in 2013 (before the Marketplaces opened) they found that oligopolies – market domination by just a few large players – was the norm: Health insurance markets dominated by oligopolies before Obamacare: report. This look from Kaiser found that More Competition Helps Restrain Premiums In Federal Health Marketplace.

But even when everything is working as it’s supposed to, Underinsurance Remains Big Problem Under Obama Health Law (and a continuation by the same author Underinsurance, ctd.). For some, even with help, the cost sharing provisions are still too much. This Gallup survey found that Cost Still a Barrier Between Americans and Medical Care. In a different world, instead of continuing to fight for the laws very existence, we would be focusing on how to improve it.

ACA: Employers
The Maine Chamber of Commerce held a business forum to help get the word out to employers about their responsibilities (this was one I actually did not speak at). For a group that has been a steadfast opponent of the law, it’s nice to see them helping their members deal with reality: Maine Businesses Gear Up for Affordable Care Act's 'Employer Mandate'.

Regarding the SHOP, HealthCare.gov’s insurance marketplace for small businesses gets off to a slow start. The issue is that other than for the minority of small businesses that qualify for a premium tax credit, there is no great advantage to utilizing the online marketplace. The may change next year if employers get excited about the ability to offer their employees a choice of plans through the SHOP, instead of just the one option most small employers now offer.

More evidence of something we’ve discussed before: Workplace wellness programs don’t save money. At the same time, the administration is challenging employers who seem to be trying to stretch the rules with what is and is not permitted: EEOC Takes Aim At Wellness Programs Increasingly Offered By Employers. Given that we know they don’t really help the employers, it was surprising to see that U.S. CEOs threaten to pull tacit Obamacare support over 'wellness' spat. It’s not clear to me what their continued allegiance to the concept is given the mounting evidence of their ineffectiveness.

Costs
So much coverage, so little space. The office of the Actuary (OACT) at the Centers for Medicare & Medicaid Services released its annual report on health expenditures. I could fill this blog with reporting and analysis of the report, but in the interests of not putting all of you to sleep I will keep it short.

To start, for those interested, here is the press release: Press release: National Health Expenditures continued slow growth in 2013 and here are the initial results Health Affairs Web First: National Health Spending In 2013 Continued Pattern Of Low Growth (primary source).

The topline story is that in 2013 medical expenditures increased only 3.6% - the lowest percentage increase since they started measuring that statistic in 1960!  (Health costs in 2013 grew at slowest rate since 1960)  While many saw Good News Inside the Health Spending Numbers, the question persists can it last?  (America's Medical Bill Didn't Spike Last Year: More good news, although it's hard to know how long it will last)

Some think that the slowdown is due to the economy, and there is no doubt that is one factor, but is more going on here?  When looking more closely, this slowdown has not mirrored behavior in previous recessions, so it seems probable that The Health-Cost Slowdown Isn’t Just About the Economy.


In other major cost news this week, CMS released new proposed rules for Accountable Care Organizations (Press release: CMS releases new proposal to improve Accountable Care Organizations and Fact sheets: Proposed Changes to the Medicare Shared Savings Program Regulations).

The new rules would make it easier for ACOs to develop without risking their payments (Draft Medicare ACO rules would allow more time with less risk) If you’re asking Why Medicare won't force penalties on ACOs that don't save money, the answer is that CMS continues to believe in the program and wants to give participating providers time to ramp up. It is feared that if the existing penalty structure remained in place organizations would not join the program for fear of losing money before they figured out how to operate.

Medicaid
Medicaid expansion news in many states this week (although alas, Maine is not one of them):



Florida: Yes, even Florida is considering expansion Medicaid Expansion By Any Other Name May Fly For Florida Lawmakers

In Pennsylvania expansion proceeds but under a cloud of confusion: Pennsylvania launches Medicaid expansion, overhaul “Democratic Gov.-elect Tom Wolf has said he opposes what he views as an unnecessarily complicated process and bureaucracy being set up by Corbett, and Wolf could gradually unwind some elements of Corbett's plan after he takes office Jan. 20. Meanwhile, the federal government has not approved the final benefit packages proposed by the Corbett administration for both the overhaul and expansion of Pennsylvania's Medicaid program, injecting more uncertainty into how exactly everything will change.”

Kaiser took a look at all the private option expansion plans: The ACA and Recent Section 1115 Medicaid Demonstration Waivers Note that it doesn’t include several of the ones listed above since they have not yet received final approval from CMS.

In CHIP news, some good signs regarding renewal of funding: “The consensus was apparent at a subcommittee hearing of the House Energy and Commerce panel, where Republicans and Democrats praised CHIP's benefits in equal measure.” (Lawmakers: Kids will lose coverage without CHIP funding) But talk is cheap and none of the statements ruled out changes to the program when the renewed funding was considered. With respect to timing, while it’s being talked about it is not expected that the lame duck session will do anything (Little action expected on CHIP funding by year-end) so stay tuned for more developments next year.

Medicare
This week in Medicare news, many instances of misbehavior on the part of providers, offered with minimal editorial comment:



Medicare is doing more to police Advantage and Part D lapses, but does it matter?  “Medicare Advantage plans among publicly traded insurers usually net a profit margin between 5% and 6%.”   “Critics of the program question whether the five- and six-digit monetary penalties do enough to change behavior. “The revenue (plans) take in from the federal government is just enormous,” said Wendell Potter, a former PR executive at Cigna Corp. who has testified several times to Congress about the health insurance industry. He is now an analyst at the Center for Public Integrity. “That's not a significant fine or monetary punishment if you ask me.””

Were patients really sicker? Lawsuits say Medicare Advantage plans inflated diagnoses to boost payments time once again for my favorite clip… I’m shocked!  Recently I wrote about a growing convergence of interests between insurers and the Administration (and advocates). Here is a case where that’s not yet the case.

EBOLA
Just a few months ago, the country seemed convinced that Ebola was going to destroy us. While it was never going to come to that, the Administration was nonetheless criticized for not doing enough. Well it turns out, the Administration accomplished a lot: This Is How Much the U.S. Has Accomplished in Ebola Preparedness in Only Two Months. With things under control here America has stopped paying attention, but Ebola is still ravaging Sierra Leone.

Drugs
For those who doubted the worth of the Open Payments database: ”An analysis of the new federal Open Payments database shows that five of the 20 physicians who received the most money from Insys recently faced legal or disciplinary action, including three who were said to have inappropriately prescribed painkillers.”  (Using Doctors With Troubled Pasts to Market a Painkiller)

Meanwhile, bad behavior by drug companies continues as Naloxone, a Drug to Stop Heroin Deaths, Is More Costly, the Police Say. Just as the laws are changing to allow first responds to carry this life saving drug, costs are rising dramatically.

And finally, since we haven’t discussed Sovaldi in a few weeks, here is a review of the topic – and what it says about our healthcare system – from our friends at Vox: This drug costs $84,000: And there’s nothing the US health-care system can do to stop it.

System Transformation
Medical errors kill thousands of people every year. While there is still a long way to go, it is exciting news that the number of errors is dropping. This is due in part due to changes brought about by the ACA, over a three year period 50,000 lives were saved: Obama's plan to reduce hospital errors is working — and it's saved 50,000 lives.

That said, if you are looking for something to worry about, this news out of India is frightening: ‘Superbugs’ Kill India’s Babies and Pose an Overseas Threat “Indeed, researchers have already found “superbugs” carrying a genetic code first identified in India — NDM1 (or New Delhi metallo-beta lactamase 1) — around the world, including in France, Japan, Oman and the United States.” In the world today, no health problem can be restricted by boarders – we’re all in this together.

Moving back to some good news, while a bit technical, this has the potential to make a huge difference in the utility of electronic health records: EHR vendors, tech-savvy providers unite around Internet-like interoperability  “The hook could enable both the EHR and the mobile app to not only read data from each other, such as lab values or care plans, but also write data back to each other, in formats that each system could display and compute.”

I wasn't sure if I should put this here or under the drug section, but a great story about Prescribing Vegetables, Not Pills. Another piece to the idea that you need to take an individual’s situation into account when figuring out how to treat them.

And finally, for my data-geek friends out there a new resource. “The Peterson–Kaiser Health System Tracker provides comprehensive data on how the system is performing on critical quality and cost measures, offering clear, up-to-date information on relevant trends, drivers and issues. The Tracker also will illustrate how the United States is performing relative to other countries, and how different parts of the system are performing relative to one another. Regular in-depth insight briefs will delve into major issues” Have fun: Peterson-Kaiser Health System Tracker


All comments and suggestions are welcome; please let me know what you think. And as always, thanks for reading!

Funded by support from the Maine Health Access Foundation

*The title is a tribute to the BBC show, the NBC show and the amazing Tom Lehrer album "That Was The Year That Was"