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 Yevgeniy Feyman (@yfeyman), Stephanie Caty (@), and Rajkumar Pammal (@rspammal).
Healthcare Finance News: 43 states flunk when it comes to healthcare price transparency, groups say
- A new report card from the Health Care Initiatives Improvement Institute and Catalyst for Payment Reform gives 43 states an “F” on health care price transparency.
- New Hampshire, Colorado, and Maine received “As”.
- Oregon received a “B.”
- Vermont and Virginia received a “C.”
- Arkansas received a “D.”
- The report identifies which states are failing, which are trying to improve, and offers recommendations to policymakers.
- A variety of components are used to evaluate states:
- The existence of data sources including all-payer claims databases (APCD), or other price reporting requirements.
- The quality of price information being provided – actual amounts paid are preferred to charges.
- The presence of an “accessible, mandated website.” While some transparency laws simply require information upon request, others mandate publicly accessible websites.
- The report card provides more information on the variation between states receiving the same letter grade.
- Though California received an “F,” the state maintains a voluntary APCD. Meanwhile, neither Alaska nor Alabama, which both received failing grades, have any price transparency laws.
Modern Healthcare: Insurers will consolidate even if mega-mergers fail
- While the Justice Department has said that they will challenge the two mega-mergers: Aetna-Humana and Anthem-Cigna, consolidation is likely even if the mergers fail.
- According to Jeff Loo, an analyst with Standard & Poors Global Market Intelligence, one of the “big five” insurers may still make a play for a smaller insurer.
- Some of this may be due to incentives under the Affordable Care Act (ACA).
- Potential targets may include Molina Healthcare, WellCare, or Centene. All three primarily focus on Medicaid managed care, and have benefited from the ACA’s expansion.
- Cigna’s $9 billion in cash on hand makes it particularly well-suited to pursue smaller mergers.
- Nevertheless, the Aetna-Humana merger may have a shot of going through.
- The companies, both have significant market shares in Medicare Advantage (MA), and would likely become the largest single insurer in the program.
- The companies will argue that MA actually competes with traditional Medicare. By expanding the relevant product market, the effect on competition of their merger would be muted.
Modern Healthcare: South Carolina hospital to pay $17 million over physician pay allegations
- After allegations that Lexington Medical Center made unreasonably high payments to physicians in exchange for expectations of referrals to Lexington, the South Carolina-based hospital has settled to pay the government $17 million, avoiding costly litigation in the future
- The government stated that Lexington’s actions were in direct violation of the Stark law, which forbids doctors from referring Medicare patients to health services (labs, hospitals, physicians) with which the doctors have financial relationships
- David Hammett, a former employee of Lexington, raised the original lawsuit, and will receive $4.5 million from the successful case
- Previous settlements stemming from similar allegations include North Broward (Florida) for $69.5 million in September 2015, Adventist Health System (Florida) for $118.7 million that same month, and Tuomey Healthcare System (South Carolina) for $72.4 million in October 2015
- Critics of the Stark law point to its complicated nature, including a Senate Committee that has stated the law has created “a minefield for the healthcare industry”
- On Thursday, a study on patient outcomes during hospital transitions to new electronic health records (EHRs) systems was published in The BMJ
- The article, authored by Michael Barnett of Harvard T.H. Chan School of Public Health, and Ateev Mehrotra and Anupam Jena of Harvard Medical School, analyzed the short-term association between mortality, readmissions, and adverse safety events with inpatient implementation of EHRs
- After identifying 17 U.S. hospitals that implemented new impatient EHR in 2011-2012 and fit the study criteria, statistical analysis was performed to determine associations with the selected outcome measures
- The study concluded that implementation of EHRs has no negative association with inpatient mortality, readmissions, and adverse safety events
- Therefore, despite previous concerns over the implementation of EHRs having an adverse impact on patient care, this study supports hospitals and physicians planning to transition to EHRs
- Due to four recent cases of Zika transmission that are suspected to have been spread via local mosquitos, the FDA has requested that blood centers in Miami-Dade and Broward counties of Florida cease blood collection until they can test donated blood for the Zika virus
- The FDA has also recommended that nearby counties implement similar precautions, and that any individuals who have traveled to Miami-Dade or Broward county refrain from donating blood at this time
- One of the major blood collection centers in Florida, OneBlood, has begun implementing precautions to protect against transmission via blood donations
- If there is confirmation of transmission via local mosquitoes, OneBlood will stop collecting blood in the affected counties and bring in blood from elsewhere
- OneBlood has received approval to test blood for Zika infection, and will provide Zika-screened blood from unaffected areas to hospitals with patients at high risk of Zika complications
- OneBlood will continue with precautions implemented earlier this year, including asking donors about potential risk for Zika infection
- The FDA is working with companies developing tests to screen for the Zika virus in donated blood to ensure that tests will be available to blood collection centers now and in the future, regardless of whether Zika transmission has been documented in the surrounding areas
Mhealth Intelligence: Medicare’s CCM telehealth program gets a bit of good news
- A recent survey of more than 100 Medicare patients conducted by Hello Health found that the Chronic Care Management telehealth program is well liked by Medicare beneficiaries:
- 90% of those surveyed reported that they were satisfied or very satisfied with the clinical engagement services
- 60% reported that they felt their health had improved due to the program
- The CCM telehealth program is designed to reimburse clinicians for 20 minutes per month of telehealth-conducted interactions with a patient with two or more recognized chronic conditions. The program reimburses doctors $41.92 per patient per month.
- Currently, only an estimated 275,000 beneficiaries utilize these services out of 35 million eligible Medicare beneficiaries
- While Hello Health’s survey demonstrates patient satisfaction with the service, some stakeholders feel that the program needs improvements
- Physician perspective: 20 minutes is not enough to cover all the topics patients want to discuss
- American Association of Family Practitioners perspective: not enough flexibility for providers to adapt program to suit patient needs