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Healthcare Triage Podcast: What is cancer, and how do we treat it?
https://soundcloud.com/healthcaretriage/hctpod_renbarger
This month on the HCT Podcast, we’re talking to Dr. Jamie Renbarger, a pediatric oncologist and researcher. Dr. Renbarger tells us about what cancer is, the huge variety of cancer types, and some of the astonishing advances in treatment.
This episode of the Healthcare Triage podcast is presented in association with the Indiana University School of Medicine, whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research, and patient care.
As always, you can find the podcast in all the usual places, like iTunes and Soundcloud.
Bundled Payment Program Does Not Drive Hospitals to Increase Volume
The Issue
In 2013, the Centers for Medicare and Medicaid Services (CMS) introduced a voluntary program for hospitals called Bundled Payments for Care Improvement (BPCI). Under this alternative payment model, CMS makes a single, preset payment for an episode, or “bundle,” of care, which may include a hospitalization, postacute care, and other services. Evaluations of the program for lower extremity joint replacement surgery (e.g., a hip or knee replacement) have found that it reduced spending. But experts wonder if bundled payments could encourage hospitals to perform more surgeries than they would otherwise or to cherry-pick lower-risk patients. Commonwealth Fund–supported researchers explore these issues of volume and case mix in the Journal of the American Medical Association.The authors used Medicare claims data from before and after the launch of BPCI, comparing markets that did and did not participate in the program.
What the Study Found
3.8%
increase in mean quarterly market volume in non-BPCI markets after the program was launched
4.4%
increase in mean quarterly market volume in BPCI markets after the program was launched
- Participation in the BPCI program was not significantly associated with an overall change in the volume of surgeries performed.
- The mean quarterly market volume in non-BPCI markets increased 3.8 percent after the program was launched. For BPCI markets, the increase was 4.4 percent.
- The analysis found only one change in case mix: patients who had previously used skilled nursing facilities were slightly less likely to undergo a lower extremity joint replacement surgery at a hospital participating in BPCI.
The Big Picture
Results from this study alleviate concerns that hospitals’ participation in voluntary bundles may increase the overall number of joint replacement surgeries paid for by Medicare. In particular, the savings per episode observed in prior BPCI evaluations are not diminished or eliminated by an increase in procedure volume. The findings do raise concerns: if patients with prior use of skilled nursing facilities are less likely to undergo procedures at BPCI-participating hospitals, perhaps it is because hospitals avoid them based on perceived risk. On the other hand, the authors note, these decisions could have been based on clinically appropriate factors, like risk of complications.
The Bottom Line
Hospital participation in a bundled care program did not change overall volume, thereby alleviating the risk of eliminating savings related to the program. In addition, participation was generally not associated with changes in case mix.
Public blames everyone for high health costs
Health care costs remain a leading issue ahead of this year’s midterms, and voters have plenty of blame to go around, according to the Kaiser Family Foundation’s latest tracking poll.
- Kaiser asked its respondents whether certain factors are a “major reason” health care costs are rising. (There could be multiple “major reasons.”)
- Blame for the potential political culprits — the ACA and the Trump administration — was split about evenly.
- But there’s a broader bipartisan agreement that industry is to blame: At least 70% faulted drug companies, hospitals and insurers. Doctors caught a break, at 49%.
Partisanship reigns, though, on the question of whether President Trump will help.
- A mere 13% of Democrats are at least somewhat confident that Americans will pay less for prescription drugs under the Trump administration, compared with a whopping 83% of Republicans. Independents generally share Democrats’ skepticism.
- Roughly a quarter of Democrats and two-thirds of Republicans, think Trump’s public criticism of drug companies will help bring down prices.
Surprise hospital bills haven’t attracted the same political uproar as prescription drug costs, but the Kaiser poll provides more reason to believe they could be the next big controversy.
- 67% said they’re “very worried” or “somewhat worried” about being unable to pay a surprise medical bill, while 53% fear they won’t be able to pay their deductible and 45% are afraid of the tab for their prescription drugs.
- 39% experienced a surprise bill in the past year.
The health of 44M seniors is jeopardized by cuts to Medicare lab services
The Protecting Access to Medicare Act (PAMA)
Congress passed the Protecting Access to Medicare Act (PAMA) in 2014 to help safeguard Medicare beneficiaries’ access to needed health services, including laboratory tests. Unfortunately, the U.S. Department of Health and Human Services (HHS) has taken a flawed and misguided approach to PAMA implementation. As a result of the Department’s actions, seniors will face an estimated $670 million in cuts to critical lab services this year alone, leaving the health of 57 million Medicare beneficiaries hanging in the balance.
PAMA cuts will be particularly burdensome to the most vulnerable seniors, such as those in skilled nursing facilities, those managing chronic conditions, and seniors living in medically underserved communities. The American Clinical Laboratory Association has raised significant concerns about the impact of Medicare lab cuts on seniors and their access to lifesaving diagnostics and lab services.
Learn more about the harm posed by these cuts on seniors here. Read the lawsuit ACLA has filed against HHS here.
WHAT’S AT STAKE
In 2016, seniors enrolled in Medicare received an average of
16 individual lab tests per year
80% of seniors
have at least one chronic disease and 77% have at least two—successful disease monitoring and management requires reliable access to routine testing
1 million
seniors are living in assisted living or skilled nursing homes
3.5 million
homebound seniors
rely on skilled home health care services
An estimated
10 million
seniors live in rural areas
LACK OF ACCESS TO LAB TESTS
can result in undiagnosed conditions, lack of treatment for sick patients, and the failure to monitor and treat chronic conditions before they become worse—
resulting in a decline in overall health and longevity.
The PAMA cuts will also have a broad impact on laboratories across the country. Those that will face the brunt of the cuts are the very labs and providers that are uniquely positioned to provide services—like house-calls, 24-hour emergency STAT testing, and in-facility services at skilled nursing facilities—that are particularly important to seniors who are more likely to be homebound, managing multiple chronic conditions, or living in rural areas that are medically underserved.
The ACA is back in court
Today is all about the courts, the threats they might pose to the Affordable Care Act, and Democrats’ goal of using those threats to drive turnout in the midterm elections.
Driving the news: A federal district judge in Texas will hear oral arguments this morning on red states’ latest legal challenge to the ACA. At the same time, Brett Kavanaugh will be answering senators’ questions about his nomination to the Supreme Court.
Cartoon – Care in the Community
Cartoon – A Panic Alarm
Cartoon – The Good, the Bad, and the Ugly
Cartoon – Leading by Example
HENRY KOTULA 