#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 Kim Reimold (@kimreimold), Anthony Moccia (@anthony_moccia) and Raj Pammal (@rspammal). 

Modern Healthcare: NCQA will ask health plans to report infections acquired at network hospitals

  • On Tuesday, the National Committee for Quality Assurance (NCQA) added four new quality measures to the Healthcare Effectiveness Data and Information Set (HEDIS), which currently consists of more than 80 measures.
  • The four new measures are rates of :
    • Standardized healthcare-associated infection ratio,
    • Follow-up after emergency department visit for mental illness,
    • Follow-up after emergency department visit for alcohol and other drug dependence,
    • Depression remission or response for adolescents and adults.
  • The first measure — standardized infection ratios — will measure ratios for central line-associated bloodstream infections, catheter-associated urinary tract infections, MRSA infections, and Clostridium difficile intestinal infections. According to Gail Wilensky, a senior fellow at Project HOPE, “These infection rates ‘shouldn’t occur with appropriate, high-quality care.'”

The Commonwealth Fund: American’s Experiences with ACA Marketplace Coverage: Affordability and Provider Network Satisfaction

  • The Commonwealth Fund distributed a survey from February to April 2016 looking at the costs of marketplace plans and at how consumers view the affordability of their health insurance.
  • They compared premiums and deductibles of marketplace enrollees with those with employer plans
  • Findings:
    • 57% of adults in marketplace plans and 60% in employer plans spent less than $125/month on insurance.
    • 49% of adults with marketplace coverage reported that their premium was “somewhat” or “very easy” to afford.
    • 64% of people in marketplace plans with incomes of 250 percent of the poverty, compared to 45% of adults with lower incomes, reported their premiums had increased over the time they had their plan.
    • 54% of first time marketplace plan enrollees selected a less expensive, more narrow network plan.
    • 78% of recent marketplace enrollees were satisfied with the doctors covered by their insurance.
    • 46% of adults with marketplace coverage have switched plans over the time they had coverage.
  • Overall, people in marketplace plans are less likely to view their plan as affordable. Efforts to slow the rate of medical expenditures and premiums will be critical to ensuring healthcare is affordable.

Gingrich, Kennedy Take On Opioid Addiction — The KHN Conversation

  • Patrick Kennedy and Newt Gingrich along with criminal justice advocate Van Jones are joining forces to advocate for policy change.
  • Kennedy and Gingrich are seeking shifts in:
    • how the health system treats addiction,
    • how treatment is financed — allowing more doctors to prescribe opioid reduction therapy, and making insurance plans pay more generously for these types of treatments.
  • Kennedy citing the research of effective opioid replacement therapy states that we “can’t meet the large scale need” for two reasons:
    • First, there are not enough doctors who can prescribe these opioid replacement drugs.
    • Second, there are artificial limits from insurers on who doctors can prescribe to.
  • Kennedy believes the answer to the epidemic isn’t medication alone, but rather a combination of medication, cognitive behavioral therapy and peer support.
    • Kennedy claims that this solution must be reimbursed by health insurers and that this approach shows large reductions in overall healthcare spending.
    • Gingrich and Kennedy both believe that laws “compartmentalizing medical information” have a negative impact on patients and hinder proper diagnoses

A bug in fMRI software could invalidate 15 years of brain research

  • As many as 40,000 papers have used fMRI software to make conclusions about how the brain looks and behaves during exercise, gaming, love, and drug addiction.
  • A new study by Anders Eklund from Linkoping University in Sweden concludes that “statistical methods used have rarely been validated using real data”
  • Eklund concludes in the paper that software packages for fMRI analysis, believed to have only 5% false positives, can actually result in false-positives rates up to 70%.
  • A bug was found by Eklund and his team which has been in the system for the past 15 years, was only corrected in May 2015.
  • The improvement of computers and fMRI results being made freely available online, ensures that validation technology is up to the task of validation and replication.

Associated Press: Feds drop challenge to West Virginia hospital takeover

  • On Wednesday, the Federal Trade Commission (FTC) announced its decision to dismiss its challenge of a West Virginia hospital’s planned takeover of a nearby hospital.
  • Cabell Huntington Hospital Inc. agreed to assume control of St. Mary’s Medical Center (Huntington) in November of 2014, which would make the proposed combination the second largest hospital chain in the state.
  • The FTC dismissal cites state legislation exempting mergers from state and federal antitrust laws if they are approved by the West Virginia Health Care Authority, which approved the Cabell Huntington- St. Mary’s merger earlier this year.
  • The FTC referred to this case as “another example of healthcare providers attempting to use state legislation to shield anti-competitive combinations from antitrust enforcement”.
  • The Health Care Authority previously said that the acquisition would enable greater recruitment of professionals, reduce duplication, and increase efficiency/ quality of care.

Modern Healthcare: Medicaid plans can now pay mental health institutions. Most won’t until 2017.

  • On Tuesday a fifty-year ban on state Medicaid payment for mental health institutions was lifted.
  • The Center for Medicare and Medicaid Services (CMS) estimates that 7.1% of adults between the ages of 21 and 64 meet the criteria for serious mental health illness requiring inpatient treatment.
  • Since Medicaid’s creation in 1965, it has excluded payment for institutions of mental disease (IMDs) for Medicaid beneficiaries ages 21+.
  • This exclusion has meant negative care experiences for Medicaid beneficiaries suffering from mental illness, as they often have long stays in emergency departments and may be referred to stand-alone psychiatric facilities that have little incentive to provide quality care.
  • Still, Director of Legislative Affairs for National Alliance on Mental Illness (NAMI), Andrew Sperling, stated that no major changes would occur immediately, as plans needed time to contract with facilities and for these contracts to commence.

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