#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 Zoe Lyon (@zoemarklyon), Kim Reimold (@kimreimold), and Anthony Moccia (@anthony_moccia). 

New IFHP Price Report Highlights America’s Out-of-control Healthcare Prices

  • Every two years, the International Federation of Health Plans releases a report that compares prices for common healthcare services and drugs in different countries
    • This week, the 2015 report was released and showed that, as consistent with all preceding IFHP reports, the price for nearly every procedure or prescription drug is much higher in the US than in the other countries featured in the report
  • Health policy experts often seek to make the point that it’s not that we do more in the US and that’s the driver of astronomical healthcare spending, but rather than it is our higher-than-necessary prices that compound spending to an extreme degree
  • A few highlights from the report:
    • Humira, an arthritis medication taken by millions of Americans, costs three times as much in the US as it does in Switzerland for a 28-day supply ($2,669 vs. $822)
    • An MRI costs on average $1,119 in the US, where as it costs on average $503 in Switzerland and $215 in Australia
    • The average hospital cost per day comes in at $5,220 in the US versus $424 in Spain
  • There are some exceptions to the rule: in the US, colonoscopies and CT scans are cheaper in the US than in some countries
  • The upshot: Americans spend so much on healthcare largely because of the prices and we should be considering different ways to negotiate and set prices

ProPublica: Problem Care Harms Almost One-Third of Rehab Hospital Patients

  • A new government report published on Thursday showed that 29% of patients in rehab facilities suffer from some sort of medical error, be it a bedsore, infection, medication error, or other type of injury/harm
    • Doctors who reviewed cases from a sampling of rehab facilities report that almost 50% of the incidents they spotted were clearly or likely preventable
  • The study comes from the office of the inspector general of HHS and focuses on rehab facilities that are not affiliated with hospitals; patients at these facilities are often presumed to be healthier than patients in more typical inpatient setting such as a hospital or nursing home
  • To conduct the study, doctors and nurses identified cases of harm by reviewing records from 417 randomly selected Medicare patients who stayed in US rehab facilities in March 2012
    • 158 adverse events were idenfitied
    • Adverse events ranged in severity from temporary injury to permanent disability or death
    • Almost a quarter of the harmed patients had to be admitted to an acute care hospital, at a cost of about $7.7 million for the month analyzed
  • The inspector general is recommending that Medicare and AHRQ create a list of adverse events that occur in rehab hospitals in order to reduce harm

NY Times: U.S. Sues to Block Anthem-Cigna and Aetna-Humana Mergers

  • After a briefing earlier in the week hinted that the Justice Department were going to sue, they officially made moves on Thursday and filed lawsuits to block two health insurance mergers:
    • The $37 billion deal between Aetna and Humana
    • The $48 billion deal between Anthem and Cigna
  • In the lawsuits, the Justice Department reasoned that allowing four large insurance companies to merge would hinder competition.
    • A compliant said that “if allowed to proceed, this merger would enhance Aetna’s power to profit at the expense of seniors who rely on Medicare Advantage and individuals and families who rely on the public exchanges for affordable health insurance.”
  • While Cigna is still evaluating its options, Aetna and Humana plan to move forward and will go to court if a deal cannot be made.
  • If both deals are withdrawn, there will be a new record of the most merger and acquisition deals abandoned in one year. Additionally, Anthem will need to pay $1.85 billion to Cigna and Aetna will owe $1 billion to Humana.

Kaiser Health News: Medicare Prepares to Go Forward With New Hospital Quality Ratings

  • Coming to the Internet near you are star ratings for the quality of care for 3,662 hospitals.
    • Star ratings will be based on 64 public measures of hospitals including mortality rates, number of readmissions, patient opinions, infection rates, and frequency of medical scans.
  • Preliminary Results
    • Different size hospitals were rated similarly.
    • On average, critical access hospitals – typically small and rural – ranked slightly better.
    • Ratings did not account for relative wealth of patients: 29% of safety-net hospitals were rated as 1 or 2 stars compared to 22% of other hospitals.
    • Teaching hospitals received fewer stars on average.
  • While the government thinks the ratings will allow consumers to better access the overall quality of care offered by hospitals, the hospital industry is concerned that the ratings could be misleading or oversimplified.
    • According to Dr. Janis Orlowski, an executive at the Association of American Medical Colleges, Medicare’s methods for assigning stars might be flawed since many prestigious hospitals were give a low rating.
  • The Centers for Medicare & Medicaid Services noted that “hospitals of all types are capable of performing well on star ratings and also have opportunities for improvement.”

STAT: AstraZeneca loses court battle to prevent generic versions of Crestor

  • AstraZeneca, the creator of cholesterol drug Crestor, was dealt a blow this week when a federal judge refused to issue an order that would have blocked several companies from selling generic versions of the drug
  • Last month AstraZeneca filed a lawsuit against the US Food and Drug Administration to block generic competition to Crestor, hoping to maintain a monopoly on Crestor through 2023
    • The drug maker accused the FDA of illegally broadening the indication for Crestor
  • Several pharmaceutical companies are now poised to sell generics
  • Last May the company was granted approval by the FDA to sell Crestor to treat children with a specific genetic disorder and, thanks to the Orphan Act, was allotted 7 years of marketing exclusivity for treating the disease
  • The drug creator argued that any generic label “could potentially” not contain the same information as Crestor and pose a safety risk for patients
  • The US Department of Justice issued a statement saying the case is about “AstraZeneca’s profit-driven desire to substantially extend its virtual monopoly on one of the world’s most popular medicines.”
  • By delaying the creation of generic Crestor, AstraZeneca may have already placed patients at a disadvantage
    • Recent study in JAMA Internal Medicine found that a six-month delay in the availability of generic versions of the Lipitor lead to consumers paying more out-of-pocket

KHN: Tracking Cancer in Real Time

  • A pilot project in California is using electronic forms to report cancer diagnoses in close to real-time to the California Cancer Registry
    • Current registry relies on data that is up to 2 years old
  • Pathologists and medical providers claim that the delay and tardiness of registries in California and around the country inhibits their ability to help patients
  • The goal is to report 100% of cancer diagnoses
    • Currently only 5% is being reported in real time
    • The hope is to get to 65% by 2022
  • According to the California Public Health Official the goals of the project are to:
    • Generate real-time surveillance statistics
    • Identify cases for ongoing research
    • Implement statewide program to improve the quality of cancer treatment

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