#6things That Happened in Health Policy This Week

6 Things That Happened in Health Policy This Week is produced by a mix of research assistants from the Healthcare Quality & Outcomes (HQO) Initiative at the Harvard T.H. Chan School of Public Health. In each edition we feature a variety of news articles, reports, and studies focused on U.S. health policy and health services research. This week’s edition includes contributions from Stephanie Caty (@stephaniecaty), Yevgeniy Feyman (@YFeyman) and Kim Reimold (@KimReimold).

Modern Healthcare: FTC wins appeal to halt Penn State Hershey/PinnacleHealth merger

  • The U.S. Court of Appeals for the 3rd Circuit reversed a lower court’s ruling against the FTC’s challenge of a hospital merger in Pennsylvania.
    • The FTC claimed that the new entity would control over 64 percent of one market, and 76 percent of another.
    • In May, the FTC lost its case challenging the Penn State Hershey-PinnacleHealth merger.
    • The decision in that case hinged on a geographic market definition that the court decided was too narrow.
    • The appeals court’s opinion, however, notes that the district court mistakenly accepted a long unused approach to defining geographic markets.
    • Additionally, the appeals court rejected the idea that private contracts that the hospitals had with insurers were relevant for the analysis.
    • The next step in this case will be an FTC administrative law hearing, which has the possibility of resulting in a settlement between the hospitals and the FTC.
  • This win is good news for the FTC, which has seen two courts reject its geographic market definitions.
    • The FTC is currently waiting on the Court of Appeals for the 7th Circuit to rule on the other failed challenge in the Chicago-area Advocate-NorthShore merger.

Mercatus Center: Certificate-of-Need Laws and Hospital Quality

  • A recent study using Medicare data on hospital-level outcomes has found that so-called “Certificate of Need” (CON) laws don’t appear to have identifiable benefits.
    • CON laws have existed for decades, and as of 2015, 36 states and DC have such laws.
    • These laws require approval from state healthcare planning agencies before hospitals and other providers can make capital expenditures. The goal of these laws was to restrain healthcare spending, and potentially improve quality of care.
    • Prior research has found no difference in quality of care across a variety of procedures and outcome measures in states that have and those that don’t have CON laws.
    • In this study, the authors address methodological issues in prior studies to make causal rather than correlational estimates of the effect of CON laws on healthcare quality.
  • The study finds that mortality for pneumonia, heart failure, and heart attacks are higher in hospitals in CON states. Deaths from complications are also higher.
  • These findings suggest that the theoretical benefits of CON laws don’t appear to be borne out in reality.

The Wall Street Journal: Medical Record Mix-Ups a Common Problem, Study Finds

  • The ECRI Institute, a nonprofit research group that studies patient safety, found that patient-identification mix-ups are common and often have deadly consequences.
  • The study looked at over 7,000 cases of medical record mix-ups that 181 healthcare organizations voluntarily submitted (and were protected under federal law) over a 2 ½ year period. Of mix-ups:
    • 91% were caught before the patient was harmed
    • 13% occurred at registration by the creation of a duplicate record or by the combining of two different patients’ records
    • 33% originated from diagnostic tests such as x-rays and lab work
    • 22% involved treatments and procedures
  • According to Hardeep Singh, a patient-safety researcher, the opportunities for error are increasing as “we’re doing many more labs tests, more imaging tests, more procedures and more transitions through the system.”
  • Steps to improve healthcare outcomes include:
    • Standardize protocol to verify patient identities – this could include having to match bar codes on patient wrist bands to an array of tests, medications, and procedures.
    • Discuss mix-ups and other errors more openly

Kaiser Health News: Congress Finally Approves Funding To Fight Zika — But What Does This Mean?

  • Congress agreed on Wednesday to dedicate $1.1 billion toward the Zika epidemic, with about $400 million repurposed from other areas.
  • Of this sum, $935 million will be allocated toward efforts curbing Zika in the U.S, while the remaining will go toward efforts abroad. Domestically,
    • $152 million will go toward vaccine development
    • $394 million will go toward areas affected by Zika
    • $387 million will go to an emergency fund for Zika testing and treatment
  • This funding package falls short of President Obama’s hopes for $1.9 billion, and Anthony Fauci, director of NIAID, said that vaccine development would ideally get $40 million more. However, public health experts think this is still “a meaningful start.”

Patient Engagement HIT: CMS Posts Patient-Centered Rules for Long-Term Care Facilities

  • CMS has updated its rules for long-term care facilities for the first time in 25 years
  • The updates include provisions to improve patient safety and make care more patient-centered, including a key provision which bans arbitration clauses
  • Arbitration clauses in the past required patients to settle any complaints outside of the court system, which made it more difficult for regulators to be notified of potential issues
  • Patients will now be able to settle disputes in court, but still maintain the option to arbitrate should they choose, however facilities must clearly explain the arbitration process and inform patients that they can discuss any complaints with regulators
  • Other important updates to long-term care facility rules include:
    • Ensuring that staff are trained to care for patients with dementia
    • Allowing clinicians to practice at the top of their license
    • Better utilizing care planning strategies, such as discharge planning

US News & World Report: White House Set to Engage Millennials in Obamacare

  • This week, the White House hosted the Millennial Outreach and Engagement Summit to discuss strategies to improve enrollment numbers of young adults
  • The 26-34 age bracket has seen low insurance rates for many years, pre-dating the ACA; however, the lack of young, healthy people in the exchanges is proving problematic as insurers are facing higher than anticipated costs and must now raise premiums to cover those costs
  • Strategies to target millennials discussed at the summit include:
    • Advertising open enrollment on Twitch, an online gaming platform
    • A social media campaign using the hashtag #HealthyAdulting
    • A Healthy Campus Challenge, where students will have the opportunity to enroll on campus
    • And an improved healthcare.gov mobile site for easier access and use
  • While those who do not have insurance in some form must pay a $695 penalty, this may not be enough to incentivize millennials to purchase insurance, especially given the potential for large expenditures with high deductibles
  • Given that it is an election year, changing the penalty amount prior to open enrollment is unlikely, so the Department of Health and Human Services has been focused instead on targeting millennials; however some, including Aetna CEO Mark Bertolini, argue that this still may not be enough, and that plans for millennials may need to be fundamentally redesigned to include things young adults will want, such as fitness benefits

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