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Category Archives: Uncategorized
Multiple Recurring C. Diff. Infections on the Rise
The incidence of Clostridium difficile infections rose by 43% from 2001 to 2012, while the incidence of multiple recurring CDI rose by 189% over the same period.
Multiple recurring Clostridium difficile infections are becoming more common in the nation’s hospitals and researchers aren’t sure why. In an analysis of a large, nationwide health insurance database, researcher’s at the University of Pennsylvania’s Perelman School of Medicine found that the annual incidence of multiple recurring C. difficile (mrCDI) increased by almost 200% from 2001 to 2012.
During the same period the incidence of ordinary CDI increased by only about 40%. The study results were published this week in the Annals of Internal Medicine.
Related: C. Diff Infection Raises Hospital Costs by 40% per Case The reasons for the sharp rise in mrCDI incidence is unknown.
Researchers said the finding points to an increased burden on the healthcare system, including increased demand for new treatments for recurrent CDI. The most promising of these new treatments, fecal microbiota transplantation—the infusion of beneficial intestinal bacteria into patients to compete with C. difficile—has shown good results in small studies, but hasn’t yet been thoroughly evaluated. “The increasing incidence of C. difficile being treated with multiple courses of antibiotics signals rising demand for fecal microbiota transplantation in the United States,” said study senior author James D. Lewis, MD, professor of gastroenterology and senior scholar in the Center for Clinical Epidemiology and Biostatistics.
Related: Intractable C. Diff Infection Linked to Multiple Care Settings “While we know that fecal microbiota transplantation is generally safe and effective in the short term, we need to establish the long term safety of this procedure.” In their analysis of CDI trends, the researchers examined records on more than 40 million patients enrolled in private health insurance plans. Cases of CDI were considered to have multiple recurrences when doctors treated them with at least three closely spaced courses of CDI antibiotics.
Low-Cost Health Insurance Limits Access to Top Cancer Doctors
The nation’s top cancer doctors are more likely to be excluded from low-cost health insurance plans offered on the nation’s individual market, potentially crimping access to the highest-quality care for Americans when they need it most, a new study found.
The individual exchanges, opened in 2014 as part of the Affordable Care Act, often include lower-cost policies that limit the number of physicians available to members as a way to cut costs. Those “narrow networks” are becoming more prevalent in Obamacare, as insurers seek ways to offer cheaper coverage, according to McKinsey & Co. The study was published in the Journal of Clinical Oncology and examined data from 2014.
The study offers a sense of the tradeoffs Americans face when buying health-care coverage on their own: Plans with lower premiums often get costs down by limiting choices of doctors and hospitals, asking patients to pay more out of pocket, or some combination of the two. It’s an issue patients are increasingly facing in insurance provided by employers, too, and one they’d likely continue to deal with under Republican plans to replace Obamacare. The current GOP proposals offer less financial help for people to buy coverage and could shift more people into lower-cost plans.
For the study, researchers from the University of Pennsylvania analyzed data on 23,442 oncologists in the U.S., evaluating how often doctors affiliated with National Cancer Institute-designated centers were covered by lower-cost insurance plans. The University of Pennsylvania is an NCI-designated cancer center.
Oncologists working at the U.S.’s 69 NCI facilities in the U.S., which offer access to scientific research and are known for their handling of complex cases, were twice as likely to be excluded from plans with the narrowest networks, according to the study.
“Most common cancers can be treated well anywhere,” said Justin Bekelman, associate professor of radiation oncology, medical ethics and health policy at the University of Pennsylvania, and one of the researchers. “But there are many patients with rare or uncommon tumors who need access to the most advanced clinical trials, and that access is often only at these NCI cancer centers. On the individual market, when people are spending their own hard-earned dollars, they can chose to have access or not. But right now they are choosing in a blind way.”
Network Questions
The Obama administration had been working to make it easier for people to figure out whether individual doctors and drugs were covered by their Obamacare plans by looking up such information online. It’s harder for consumers to determine the comprehensiveness of an insurance plan’s network, however, and so far there’s only been a limited effort to require plans to disclose the overall size of their networks.
Regulating insurers’ networks is largely left up to the states. The Trump administration has said it will defer to states rather than conduct its own reviews, for the most part.
“Certainly there are real issues with consumers trying to understand what kind of network they’re getting,” said Justin Giovanelli, an associate research professor at Georgetown University’s Center on Health Insurance Reforms who wasn’t involved in the study. “What you want is to have more information so you can make good choices about it.”
Health plans have procedures that let patients who need specialized care get to the appropriate doctors, according to a statement from the industry group America’s Health Insurance Plans. The group noted that the study dealt with coverage for individual physicians, not for the facilities themselves.
“Patient access to an oncologist affiliated with an NCI-designated or NCCN cancer center is separate from patient access to treatment at these centers,” Kristine Grow, an AHIP spokeswoman, said in the statement. “Community oncologists who are part of the plan’s network can recommend patients to these centers based on patient needs.”
Higher Costs
According to the researchers, doctors at NCI-designated cancer centers, such as Memorial Sloan-Kettering in New York, Dana-Farber in Boston, MD Anderson in Houston and the University of Pennsylvania, may be excluded from the narrow networks because of their cost. Because of the doctors’ status, the centers may be more able to negotiate higher reimbursement rates for their services. They may also attract more complicated, and thus costly, patients. Excluding them could help insurers control expenses at the price of limiting access to high-quality, specialized care, the researchers said.
“In an ideal world, narrow networks could be a great tool for insurers to steer patients toward these higher quality providers, to ensure that overall costs are actually lower,” said lead researcher Laura Yasaitis, from the department of health economics at the University of Pennsylvania. “It looks like in the data we looked at that prices may be the more prominent motivator for insurers.”
The Penn researchers analyzed 248 insurance networks across the U.S. operating in areas with NCI-designated centers. They found that one in every three significantly limited the number of oncologists in their insurance plans. Of all the cancer doctors who were part of those narrow networks, 17 percent worked at NCI centers. Of all the doctors who were excluded from those plans, 35 percent participated at NCI centers.
The discrepancy wasn’t seen in broader insurance networks. In those plans, 34 percent of included oncologists were affiliated with NCI centers, compared with 29 percent of those cancer doctors who were excluded, according to the study.
Voters want Bipartisanship on Health Care
https://morningconsult.com/2017/07/05/voters-critical-gops-partisan-approach-health-care-overhaul/
Fewer than one in three voters approve of the partisan approach taken by congressional Republicans in their effort to repeal and replace the Affordable Care Act, according to a new Morning Consult/POLITICO poll.
Thirty-two percent of registered voters said GOP lawmakers should work only with fellow Republicans on health care legislation, while 59 percent said Republicans should work with Democrats on a compromise measure. Nine percent said they didn’t know or had no opinion.
The national survey, conducted as lawmakers returned home for the July Fourth recess, also shows that a majority of the GOP’s base disapproves of the Republican approach to remaking the nation’s health care system. Thirty-nine percent of Republican voters said GOP lawmakers should work on a partisan basis, while 53 percent said there should be an effort to reach across the aisle.
GOP leaders have brushed off criticism about not working with their Democratic counterparts, who have vowed not to cooperate on health care legislation unless Republicans drop their push to repeal Obamacare.
Despite the partisanship in Congress on health care, 28 percent of voters said passing a health care overhaul bill should be the top priority on Capitol Hill. That was followed by 21 percent of voters who said the top priority should be investigating some of President Donald Trump’s campaign officials for alleged connections or contacts with the Russian government during the 2016 race for the White House. Of the GOP’s other legislative items, 13 percent said passing tax reform should be the top priority for lawmakers, with the same percentage pointing to the importance of overhauling entitlement programs such as Medicare and Social Security.
The electorate appeared split on whether Republicans should continue their push to repeal Obamacare. Forty-four percent of respondents said the GOP should give up its efforts to undo the Affordable Care Act, while 42 percent said Republicans should press on. But responses were divided along party lines, with 67 percent of Democrats saying Republicans should throw in the towel, and 68 percent of GOP voters saying Republicans should stick with it. Independents were split, with 41 percent favoring repeal and 40 percent saying Republicans should move on to other issues.
Amid pushback from both GOP moderates and conservatives, Senate Majority Leader Mitch McConnell (R-Ky.) last week postponed a vote on legislation that would replace Obamacare. Senate GOP leaders now aim to revamp the legislation and take up a revised version later this month.
Voters are skeptical of the GOP’s legislative efforts. Without specifying differences between the House and Senate measures, 41 percent said they approved of the legislation, while 45 percent disapproved. Fifty-two percent said they believe the legislation would increase the number of uninsured Americans.
The nonpartisan Congressional Budget Office estimates that 22 million more people would lose health insurance over the next decade under the Senate bill, and 23 million under the House-passed measure, compared with current law.
While GOP lawmakers say their legislation would reduce health care costs, 45 percent of voters said it would increase the amount their family would spend on health services. Twenty-one percent said it would lower costs, and 19 percent said they dodn’t know or have no opinion.
Both the House and Senate bills would roll back Obamacare’s expansion of Medicaid, a popular component of the 2010 law, and would impose budget constraints on state Medicaid programs.
The online survey was conducted June 29 and June 30 among a national sample of 1,989 registered voters and has a margin of error of plus or minus 2 percentage points.
GOP promises lower health premiums but ignores all that’s driving them
http://www.politico.com/story/2017/07/06/health-care-premiums-republicans-obamacare-240242
Republicans promise to bring down the cost of health insurance for millions of Americans by repealing Obamacare.
But in the race to make insurance premiums cheaper, they ignore a more ominous number — the $3.2 trillion-plus the U.S. spends annually on health care overall.
Republicans are betting it’s smart politics to zoom in on the pocketbook issues affecting individual consumers and families. But by ignoring the mounting expenses of prescription drugs, doctor visits and hospital stays, they allow the health care system to continue on its dangerous upward trajectory.
That means that even if they fulfill their seven-year vow to repeal Obamacare and rein in premiums for some people,the nation’s mounting costs are almost sure to pop out in other places — includingfresh efforts by insurers and employers to push more expenses onto consumers through bigger out-of-pocket costs and narrower benefits.
As a presidential candidate, Donald Trump didn’t talk much about health care in 2016 — not compared to the border wall, jobs, or Hillary Clinton’s emails. But the final days of the campaign coincided with the start of the Obamacare sign-up season — and Trump leapt to attack what he called “60, 70, 80, 90 percent” premium increases. Big spikes did occur in some places, but they weren’t the rule, and most Obamacare customers got subsidies to defray the cost.
But the skyrocketing premium made a good closing message for Trump — and Republicans have stuck with it.
“The Republicans decoded: What is the single, 10-second thing that says why you are running against the Affordable Care Act?” said Bob Blendon, an expert on health politics at the Harvard T.H. Chan School of Public Health. “Premiums became the face of what’s wrong.”
The GOP approach differs from the tack Democrats took when they pushed for the Affordable Care Act back in 2009-10. That debate was about covering more Americans — and about “bending the curve” of national health care spending, which eats up an unhealthy portion of the economy.
Conservatives like Sen. Ted Cruz of Texas argue that Obamacare failed to achieve its promise to bring down costs.
“The biggest reason that millions of people are unhappy with Obamacare is it’s made premiums skyrocket,” said Cruz, who is leading a small band of conservatives trying to pull the Senate repeal bill to the right as leaders seek to cobble together 50 votes. “We’ve got to fix that problem that was created by the failing policies of Obamacare.”
The answer, he says, is getting government out of the way. Conservatives want to free insurers from many of the coverage requirements and consumer protections in Obamacare. That means they could sell plans that wouldn’t cover as comprehensive a set of benefits — but they’d be cheaper.
Even some prominent critics of the Affordable Care Act think that’s not getting at the heart of the U.S. health care problem, even if it sounds good to voters.
“Too many in the GOP confuse adjustments in how insurance premiums are regulated with bringing competitive pressures to bear on the costs of medical services,” the American Enterprise Institute’s James Capretta wrote in a recent commentary for Real Clear Health. “They say they want lower premiums for consumers, but their supposed solution would simply shift premium payments from one set of consumers to another.”
The Congressional Budget Office has not yet evaluated how the House repeal bill, which narrowly passed, or the Senate companion legislation, which is still being negotiated, would affect overall health spending in coming years. It is already a sixth of the U.S. economy — more than 17 cents out of every dollar — and spending is still growing, partly because of an aging population.
The nonpartisan budget office projected the federal government would spend about $800 billion less on Medicaid over a decade, as the GOP legislation upends how Washington traditionally paid its share. But CBO hasn’t yet reported on how that would affect the health sector overall.
Many Republicans predict that limiting federal payments to states would force Medicaid to be more efficient. Democrats says the GOP bill would basically thrust those costs onto the states and onto Medicaid beneficiaries themselves, who are too poor, by definition, to get their care — often including nursing homes — without government assistance.
The CBO gave a mixed assessment of what would happen to premiums under the GOP proposals. They’d rise before they’d fall — and they wouldn’t fall for everyone. Older and sicker people could well end up paying more, and government subsidies would be smaller, meaning that even if the sticker price of insurance comes down, many people at the lower end of the income scale wouldn’t be able to afford it.
“Despite being eligible for premium tax credits, few low-income people would purchase any plan,” the CBO said.
Shrinking insurance benefits may work out fine for someone who never gets injured or sick. But there are no guarantees of perpetual good health; that’s why insurance exists. If someone needs medical treatment not covered in their slimmed-down health plan, the costs could be astronomical and the treatment unobtainable.
Couple that with skimpier benefits, bigger deductibles, smaller subsidies and weaker patient protections, and “Trumpcare” — or whatever an Obamacare successor ends up being called — could spell voter backlash in the not-too-distant future, particularly as poll after poll shows the legislation is already deeply unpopular.
“Premiums are one of the important ways in which consumers experience cost. But it’s not the only way,” said David Blumenthal, president of the Commonwealth Fund, a liberal-leaning think tank, and a former Obama administration official. But deductibles running into the thousands of dollars and steep out-of-pocket costs, he added, “are a source of discontent for Trump and non-Trump voters alike.”
Even the 2009 health debate early in the Obama presidency, which looked at staggering national health spending and what it meant for the U.S. economy, didn’t translate into a bottom line for many American families, said Drew Altman, president and CEO of the Kaiser Family Foundation, which has extensively polled public attitudes on health care.
And the bottom line — the cost of care — is what ordinary people focus on, Kaiser has found. Not just on premiums, but on what it costs to see a doctor, to fill a prescription, or to get treated for a serious disease.
“That’s what all of our polling shows,” Altman said. “The big concern is health care costs.”
Democrats have a long list of things they detest about the Republican repeal-and-replace legislation — and the lack of attention to overall health spending for the country and for individuals and families is right up there.
Sen. Ron Wyden (D-Ore.), the top Democrat on the Finance Committee, would like a bill that tackles cost — starting with rising drug prices. But this bill, he said, does nothing about health care costs.
“This really isn’t a health bill. This is a tax-cut bill,” he said. The repeal bills would kill hundreds of billions of dollars of taxes — many on the health care industry or wealthy people — that were included in Obamacare to finance coverage expansion, though the Senate is now considering keeping some of them to provide more generous subsidies.
Conservative policy experts acknowledge that premiums aren’t the whole story.
The overall cost and spending trajectory “is something we have to get to,” said Stanford University’s Lanhee Chen, who has advised Mitt Romney and other top Republicans. But for now, he said, premiums are a good first step.
GOP tensions rise over Cruz proposal
56 hospital, health system outlook and credit rating actions in June
The following hospital and health system rating and outlook changes and affirmations took place in June, beginning with the most recent.
CHS divests 9 hospitals
Franklin, Tenn.-based Community Health Systems has completed its sale of nine hospitals.
CHS divested four hospitals to Harrisburg, Pa.-based PinnacleHealth System. The following hospitals are included in the transaction:
100-bed Memorial Hospital of York (Pa.)
214-bed Lancaster (Pa.) Regional Medical Center
148-bed Heart of Lancaster Regional Medical Center in Lititz, Pa.
165-bed Carlisle (Pa.) Regional Medical Center
CHS also divested hospitals in Louisiana, Texas and Washington. The company sold Spokane, Wash.-based Rockwood Health System, which includes two hospitals and a multi-specialty clinic, to Tacoma, Wash.-based MultiCare Health System. CHS divested 88-bed Lake Area Medical Center in Lake Charles, La., to Irving, Texas-based Christus Health and sold two Texas hospitals — 350-bed Tomball (Texas) Regional Medical Center and 67-bed South Texas Regional Medical Center in Jourdanton — to Nashville, Tenn.-based HCA Healthcare.
With the transactions completed, CHS operates 11 hospitals in Pennsylvania, two in Washington, two in Louisiana and 13 in Texas.
CHS divested the hospitals as part of a turnaround plan it put into place last year, which involves the company selling 30 hospitals to trim its debt load.
Cartoon – Pain Management
Cartoon – To Ease the Pain of Restructuring
HENRY KOTULA 