• #6Things That Happened in Health Policy This Week

    6 Things That Happened in Health Policy This Week was created by Zoe Lyon and Garret Johnson. Find them on twitter @zoemarklyon and @garretjohnson22.

    This newsletter is produced each week 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.

    ProPublica/NPR: Nonprofit Hospital Stops Suing So Many Poor Patients: Will Others Follow?

    • A ProPublica/NPR investigation of Heartland Regional Medical Center (St. Joseph, MO) found that the hospital was suing thousands of poor patients for unpaid bills, which led to an investigation by U.S. Sen. Charles Grassley (R-IA) and major changes to Heartland’s financial assistance policy
      • Grassley, on the floor of the U.S. Senate: “… nonprofit hospitals should not be in the business of aggressively suing their patients… because of the favorable tax treatment these hospitals receive, they have a duty to help our nation’s most vulnerable.”
    • Yet ProPublica reports this week that it has found “numerous” other nonprofit hospitals across the country “which pay no income tax, filing suits by the thousands.”
    • One key issue is that hospitals often are not proactive in informing patients about financial aid eligibility, which has caused many to go into massive debt
      • A 2015 study by Sayeh S. Nikpay and colleagues found that only 42% of hospitals notified patients about potential eligibility for charity care before attempting to collect unpaid bills
      • Even with new federal regulations that govern how nonprofits must treat a potential lawsuit against a patient, it is unclear who will enforce the rules to protect vulnerable patients

    Boston Business Journal: Baker signs health care law to avert ballot question

    • Charlie Baker (R-MA) signed a compromise hospital pricing bill into law on Tuesday that will avert a 2016 ballot question on the matter
    • Because MA expanded coverage before the Affordable Care Act and is now battling with some of the highest prices in the country, the state’s current efforts to cut costs could become a national model
    • Gov. Baker has formed a study commission that will take steps toward examining why MA hospital prices are so high, but the bill itself does not specifically encourage lower prices and stops way short of more stringent price regulations that had been supported by the powerful 1199SEIU (Service Employees International Union) as a ballot question. Specifically:
      • The bill creates a $45 million fund (by cutting from the state’s Center for Health Information and Analysis) over five years, which will distribute money to hospitals with prices below 120% of the statewide median price
      • The bill allows the state’s Medicaid program to return up to $15 M in additional relief to hospitals through higher payment rates
    • Legislative action comes less than 9 months after the release of State Attorney General Maura Healey’s (D) report on Massachusetts health care costs which found that “price variation unexplained by quality persists, contributing to providers having different levels of resources to carry out their mission… Across the state and within specific regions, higher priced providers continue to draw greater patient volume.”

    NEJM: A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care

    • The Comprehensive Unit-based Safety Program (CUSP) was tested in 926 units in 603 hospitals, located in 32 states (representing more than 10% of U.S. acute care hospitals), and aims to reduce the rates of CAUTI in acute care settings.
    • The intervention includes:
      • Daily assessment of the presence and necessity of in-dwelling catheter
      • Avoiding the use of the in-dwelling catheter using alternative urine collection methods
      • Emphasizing the importance of sterile technique when inserting catheters
      • In-person, telephone, and webinar-based education for hospital staff
    • Main outcome measure was the CDC’s “CAUTIs per 1,000 catheter days.”
    • Note: this study did not include a control group.
    • Findings:
      • CAUTI rates decreased in participating units by 14%, from 2.40 infections per 1000 catheter days at baseline to 2.05; incidence rate ratio=0.86, 95% CI 0.76 to 0.96
      • Most of the reduction occurred in non-ICUs (P for interaction with ICU status=0.001).

    KHN: UnitedHealth to exit California’s ACA exchange market

    • After announcing in April that it would be pulling out of most of the 34 health insurance marketplaces it participated it, UnitedHealth annoucned this week that it is dropping out of the California exchange
    • The pullout will also affect individual policies sold outside the Covered California exchange, which remain active through the end of 2016
    • The immediate impact of the California pullout is minimal, as UnitedHealth only joined the Caliornia exchange this year, and has about 1,200 enrollees
    • ACA critics pounced on the company’s exit, state by state, as further evidence the ACA exchanges aren’t sustainable financially and the premiums are unteneble for customers
    • However, UnitedHealth has faced criticism for making a series of blunders on rates and networks that led to big losses on individual policies across the country
      • Peter Lee, Covered California’s executive director said “Instead of saying ‘We screwed up, they said, ‘Obamacare is the problem and we may not play anymore’”

    HuffPo: Senators urge feds to expand access to opioid addiction medication Suboxone

    • Due to federal regulations, doctors can currently treat only 30 patients at a time in the first year their certified to prescribe buprenorphine (Suboxone), a medication that can decrease opioid cravings and keep withdrawal symptoms at bay
      • This leads to extreme issues of access, and addicts often find themselves on long waiting lists or driving hundres of miles to find a doctor who can prescribe them potentially life-saving medication
    • In late March, HHS announced a proposed rule that would allow doctors to treat as many as 200 patients at a time for opioid addiction medication
    • This week, a group of 22 senators (include Sen. Bernie Sanders) told HHS Secretary Sylvia Mathews Burwell that they believe the HHS proposal does not go far enough
    • The senators encouraged HHS to raise the number of patients a doctor can treat with Subuxone to 500, and the letter was signed by a bipartisan group of legislators, including several from states hit hardest by the opioid crisis. Among those who signed were:
      • Kelly Ayotte (R-N.H.)
      • Sherrod Brown (D-Ohio)
      • Kirsten Gillibrand (D-N.Y.)
      • Rand Paul (R-K.Y.)
      • Elizabeth Warren (D-Mass.)
    • The senators noted that there are no laws limiting doctors who can prescribe painkillers and argue that the cap only perpetuates the stigma of addiction

    Modern Healthcare: CMS says states can fight Zika with Medicaid funds

    • According to a letter sent on Wednesday from CMS to state officials, states will be able to use Medicaid funding to fight the spread of Zika virus
      • Funds will be available for mosquito repellent, contraception, and family planning services
    • CMS sent a bulletin to state Medicaid directors and managed-care programs outlining a list of services available to prevent spread of the disease, which includes preventive services and all diagnostics services recommended by a physician to detect for Zika or microcephaly
    • Baltimore city health commissioner Leana Wen praised the move by CMS, saying “Zika…is a disease of poverty”
      • Wen also said local and state public health departments need more funding than has been approved
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