#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 is from @rspammal, @anothony_moccia, and @kimreimold.

The Hill: White House urges states to resist ObamaCare hikes

  • Due to proposed healthcare premium hikes of 10 percent or more, the White house is urging states to be more aggressive against health insurance companies.
  • To combat premium increases, the federal health department announced Wednesday that it will allot $22 million to boost state-level rate reviews.
    • Federal health officials hope that states can use this funding to hire insurance experts that can prove that the proposed hikes are unjustified.
  • However, America’s Health Insurance Plans (AHIP) is against further expansion of the rate review process, which currently requires insurers to justify any increase about 10 percent.
    • According to Dan Mendelson, founder and CEO of Avalere Health, state health insurance departments might need to approved double-digit increases this year to keep insurance companies afloat.
    • Larry Levitt, senior vice president for the Kaiser Family Foundation, warns that if states are too aggressive, struggling insurance companies might be forced out of the market, thus decreasing competition.

Kaiser Health News: Advisory Panel Targets Rising Medicare Drug Costs In Its Latest Report To Congress

  • The Medicare Payment Advisory Commission (MedPAC) has recently reported to Congress that rising drug costs, among other factors, have led to a major increase in Medicare spending in recent years
  • As such, the MedPAC has made multiple proposals, which combine for an estimated reduction in spending of $10 billion over the course of five years. Some parts of these proposals include
    • Requiring HHS to adjust copayments for low-income seniors to best encourage the use of low-cost drugs.
    • Creating an annual spending cap that eliminates enrollees’ 5% out-of-pocket share in the catastrophic phase of coverage
    • Requiring insurers to cover 80% of drug costs above the out-of-pocket threshold, an increase from current 15%
  • Patient groups are concerned that the proposals will result in longer coverage gaps, in which Medicare enrollees whose out-of-pocket drug spending passes a certain point ($3,310) would pay a higher percentage of drug costs until they reach the catastrophic coverage threshold ($4,850)
  • MedPAC recommends a change in catastrophic benefit cost sharing such that insurers pay a larger share of costs while the government pays a smaller share. Insurers are thereby incentivized to direct enrollees toward lower-cost medications so that they do not reach the catastrophic threshold

Wall Street Journal: CMS Proposes Requiring Medicare Hospitals to Adopt New Antibiotic Controls

  • The Centers for Medicare and Medicaid Services released a proposal on Monday to require U.S. Medicare hospitals to restrict the overuse of antibiotics, or face ejection from Medicare.
  • This proposal stems from concerns over drug-resistant bacteria, which are immune to antibiotics and pose a serious public health rise.
  • In proposing multiple measures to increase infection oversight, CMS cited that infection-control rules for Medicare hospitals haven’t been updated in 30 years.
  • Currently, the American Hospital Association is reviewing the proposed rules, including the requirement for hospitals to have personnel in charge of antibiotic oversight.
  • According to Boston University Health Law Professor (and TIE contributor) Kevin Outterson, “The proposed rule will create an incentive for hospitals that have yet to develop programs to oversee antibiotic use”.

NY Times: Orlando Injuries Were Severe, but Trauma Care Was Nearby

  • The mass shooting in Orlando, the largest in American history, occurred only blocks away from the region’s only major trauma care hospital.
  • Initial takeaways about the medical response:
    • Compared to other mass causalities where emergency medical technicians assess the victims and evacuate patients based on severity of need, technicians skipped assessments, driving and delivering multiple patients to the hospital faster than it would have taken to assess them.
    • With upward of 90 patients in the emergency room, doctors had to act more aggressively than they normally would.
    • The hospital, although well stocked, had to rely on the children’s hospital across the street as their supplies dwindled.
  • Implications for health policy:
    • With the escalating severity and frequency of mass shootings, how medical institutions respond to mass shootings should be re-evaluated.

Modern Healthcare: FTC loses and decides to appeal Chicago-area merger loss

  • Case summary:
    • The Federal Trade Commission (FTC) issued an action to block the proposed merger of Advocate Health Care Network and NorthShore University HealthSystem (two of the leading general acute care inpatient hospitals in Chicago).
    • The merger would create the 11th largest nonprofit hospital network in the nation, accounting for about 60% of the general acute care inpatient hospital services. The FTC argued that this would result increased healthcare costs and diminished incentives to upgrade services and improve quality.
    • NorthShore and Advocate claim that a merger would lead to better outcomes and lower overall costs of care, that the FTC wrongly defined the market and that it is closer to 30%, snd that the merger would save $1.1 billion a year with a new insurance plan.
  • After years of winning merger and acquisition cases amongst hospitals, this comes as the second loss in a row for the FTC.
  • The decision to allow the merger to happen could spark other mergers throughout the country.
  • The FTC is appealing the decision as well as the decision in the Pennsylvania health system merger.

The Guardian: 66% of patients keep leftover opioid painkiller pills after treatment

  • According to the CDC in 2014 there were 29,000 opioid overdoses in the US.
  • Last March CDC issued guidelines against prescribing opioids for chronic pain, with exceptions for cancer and palliative care.
  • Published in JAMA IM this week, is a research letter titled “Medication Sharing, Storage, and Disposal Practices for Opioid Medications Among US Adults” that evaluated the response of 1,000 survey participants prescribed painkillers.
  • The study was conducted before the CDC guidelines went into effect, and it found that 66% of the survey participants had not disposed of the left over medication after they finished using it.
    • Of these participants, 20% reported sharing their leftover pills, and 73% of these said they shared the medication to help the person they shared them with manage pain.
    • 14% said they were likely to share with a family member, and 8% said they would share with a friend.
    • Fewer than 10% of those surveyed kept their medications locked, and 50% said they received no information on how to store or dispose of the medication.

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