Telehealth Parity Laws

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=162

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Ongoing reforms are expanding the landscape of telehealth in the US health care system, but challenges remain.

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Preserving The Bipartisan Commitment To Health Care Delivery System Reform

http://healthaffairs.org/blog/2017/05/18/preserving-the-bipartisan-commitment-to-health-care-delivery-system-reform/

Bipartisan agreement between the republican and democrat organiization as a symbol for a two party system with a flag of the United States connecting two mountain cliffs shaped as an elephant and donkey.

Improving and reforming our health care delivery system is not a partisan issue. The need to improve health care delivery models, as a means for ensuring better patient outcomes and a more efficient health care system, enjoys broader consensus than elements surrounding health insurance coverage and financing. It is important for Congress, the Trump administration, and the health care industry to continue bipartisan efforts to shift our health care delivery system and provider payment models toward value-based care.

The Long History Of Bipartisanship In Medicare

For more than 30 years, Democrats and Republicans have worked together on incremental approaches to fostering smarter payment models in federal health programs, which seek to reward providers and health plans for delivering cost-efficient, high-quality care. In 1983, Democratic and Republican leaders of the Senate Finance Committee and House Ways and Means Committee agreed to modernize Medicare’s payment system for inpatient hospital stays, moving from cost-based reimbursement to a pre-set prospective payment for a duration of care for a specific condition.

In 2000 and again in 2003, Congress enacted bipartisan legislation to authorize Medicare payment demonstrations that laid the groundwork for the accountable care organization and bundled payment programs that are in operation today. Most recently, Democrats and Republicans worked together to pass the Medicare Access and CHIP Reauthorization Act of 2015, which reshaped Medicare’s payment system for physician and practitioner services to better link payment to quality performance and encourage clinician participation in alternative payment models. The passage of the 21st Century Cures Act last December was also bipartisan legislation. It created policies to address site-of-service payment differences in our health care delivery system, while improving interoperability of health information technology systems.

It is critical that we continue to build upon these delivery reform efforts, as shifting payment incentives for both providers and managed care plans represents our best chance to improve quality and control health care cost growth without limiting access to services or reducing the scope of covered benefits.

While many programs are still working through growing pains, we have some early evidence of success. Medicare’s voluntary bundled payment program for orthopedic surgery cases produced savings of $864 per 90-day episode of care, on average during 2014. Meanwhile, the Independence at Home Demonstration resulted in average annual savings of $3,070 per participating beneficiary in the demonstration’s first year of operation. Under this demonstration, primary care practices share in Medicare savings that result from care coordination and in-home visits tailored to chronically ill patients’ needs. Finally, a recent Medicare demonstration to address avoidable hospitalizations among nursing home residents showed significant reductions in avoidable hospital admissions, achieved through enhanced medication management and nurse-led care coordination across primary and specialty care.

In continuing implementation of delivery system reform, policy makers must work to develop payment models that avoid unneeded complexity. The new payment arrangements must be understandable to participating providers and patients, to achieve necessary engagement of both patients and providers in the care model.

The Broader Landscape For Delivery System Innovation

The delivery system innovation movement allows for the prospect of federal health programs building off of successful private-sector models, such as the Pacific Business Group on Health’s value-based payment programs for large employer-sponsored health plans. Such complementary efforts will help encourage the public and private sectors to coalesce around a unified long-term vision for delivery reform.

Delivery system reform efforts have most often focused on breaking down payment silos in fee-for-service medicine and providing incentives for care coordination. Although these steps are critical to improving quality and promoting efficiencies, delivery system reform also presents an opportunity to foster person-centered care, including through the provision of non-medical social supports, for high-need, high-cost chronically ill individuals. Heightened focus on the high-need, chronically ill population will be increasingly important for delivery system reform, as these individuals incur medical expenses that are more than four times the national average.

While Democrats and Republicans will continue to disagree on key aspects of health care policy, we firmly believe that the bipartisan work to enhance and improve the health care delivery system must continue unabated. In forthcoming publications through this series, our Bipartisan Policy Center colleagues and policy leaders from both sides of the aisle will present potential paths forward in the ongoing march toward a smarter, value-based health care delivery system.

House GOP may have to vote again on healthcare bill

http://www.fiercehealthcare.com/aca/house-gop-may-have-to-vote-again-healthcare-bill?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWlRsbE5tRmhNVGsxWVRnMSIsInQiOiIrSG9qdHJ5aEdETGxnaVl4QWYybXJqdnhZN0JqREZCVWF4NWFPRXZ0TnhqdFRZOVZtbFBrbjVhS0doQXhvNCtLOEVkditHSUpCOHkyQXVlVDVyQUV6Wmlpa3NleHhETzNQMm9QbnU1NkxKZjhlWFl4cGxsWiszQkI2SHpobnpGcSJ9

capitol building above trees

House Republicans, who voted on the American Health Care Act before the Congressional Budget Office scored the bill, might have to take another vote on the measure if the CBO finds it doesn’t reduce spending by at least $2 billion.

The bill has yet to be sent to the Senate as the House awaits the CBO’s report to see if it meets budget reconciliation rules. If it doesn’t, it will need 60 Senate votes to pass instead of 51—a threshold that would be be impossible without support from at least some Democrats.

HHS delays 340B drug program regulations: 4 things to know

http://www.beckershospitalreview.com/finance/hhs-delays-340b-drug-program-regulations-4-things-to-know.html

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HHS on Thursday delayed a regulation preventing drug companies from overcharging hospitals under the 340B drug discount program.

Here are four things to know.

1. The 340B drug pricing program, enacted in 1992, ensures hospitals treating a large proportion of low-income patients can buy drugs from manufacturers at a discount of 20 to 50 percent, according to the report. About one-third of U.S. hospitals — or 2,000 — participate in the program, purchasing about $12 billion in discounted drugs in 2015, reports The Washington Post.

2. In 2010, Congress instructed HHS to implement program regulations to set price ceilings fordrugs and establish civil monetary penalties on manufacturers that “knowingly and intentionally overcharge 340B covered entities,” according to a statement from HHS. The agency in January issued a final rule for the regulations to take effect March 6.

3. After President Donald Trump initiated a hiring freeze on all federal agencies in early March, HHS pushed back the rule until May 22. The agency also requested comments over a proposal to further delay implementation of the regulations until October. After reviewing the comments, HHS decided to officially push back the regulations to take effect Oct. 1.

4. 340B Health, a lobby group representing hospitals and health systems in the 340B program, shared an emailed statement with Becker’s, saying it was “disappointed with HHS’ decision to further delay … a long-overdue regulation to police the pharmaceutical industry.”

The health system CEO’s affiliation playbook — 5 thoughts from a CEO who has executed 50+ agreements

http://www.beckershospitalreview.com/hospital-management-administration/michael-dowling-the-health-system-ceo-s-affiliation-playbook-5-thoughts-from-a-ceo-who-has-executed-50-agreements.html

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As hospitals and health systems seek ways to fortify their organizational strategies amid the transition to value-based care, the drive to forge new partnerships will continue. Although analysts forecast the consolidation trend will carry on, strategic organizations are increasingly realizing the value of establishing other relationships, such as affiliations and joint ventures.

The local forces at play in a given region are a significant determinant of an organization’s need to merge with, acquire or be acquired by another hospital or health system. And while transactional deals will always be necessary, ongoing financial pressures stemming from the transition to value-based reimbursement and the overall emphasis on population health management have prompted health care leaders to partner with their likeminded peers to deliver better, more cost-effective care.

The key is figuring out where your organization can do a better job working with a partner than alone, and more importantly, who to collaborate with.

In some cases, this has led to the union of unlikely bedfellows — organizations that were formerly competitors are, in some cases, coming together to pursue a joint goal. In other cases, hospitals and health systems may benefit from establishing partnerships with pharmaceutical companies, medical device makers, retail clinics or even non-healthcare entities. For example, Northwell Health has worked with The Ritz-Carlton and Tiffany & Co. as part of our efforts to improve the patient experience and our operational processes.

As with all relationships, the most positive and high functioning are symbiotic; both partners must satisfy and complement the other. They must also — at the most basic level — get along. Here are five more ideas on successful partnerships, affiliations and joint ventures.

1. Know what you need and what you can offer. Partnerships create opportunities to expand into new markets and broaden your reach. But when it comes to selecting a partner, it’s important to clarify what it is they have that you want — and visa versa.

For example, we have a strategic affiliation with Cold Spring Harbor (N.Y.) Laboratory, a premier cancer research facility on Long Island. They have an international reputation, with  several Nobel laureates in their ranks. We needed to strengthen our cancer research, and they needed a clinical partner that would allow them to connect with patients. We entered into a long-term partnership in 2015. Even though we’re very different organizations, we both benefit from the relationship. 

2. Don’t overemphasize the short-term benefits. Focus as much on the short-term benefits of a partnership or affiliation as you do on your goals for five or 10 years down the line. Most relationships hit a rough patch in the beginning, but if you give up on the partnership because your troubles are making you doubt the viability of your short-term goals, you’re being too impetuous. In other words, success takes time. Take steps to solve short-term complications, but hang in there and try to make it work.

3. Be open to new partners. Keep an open mind when it comes to discussing new relationships with different partners — even those that don’t seem to make much sense in the beginning. The rapid pace of change in healthcare and our collective pursuit of innovation oblige us to at least listen to others’ ideas and consider new possibilities. 

4. Don’t get stuck in an abusive relationship. New partners might hit a rough patch or need to adjust their communication style to meet one another’s needs, but it is also important to know when it’s better to cut your losses and call it quits. If a relationship becomes abusive or dysfunctional and there is no longer any benefit for being involved, then it’s time to re-evaluate the situation.

5. Determine whether you’re truly compatible with a potential partner. If your organization is looking for a long-term partner — not just a fling — the two entities must mesh culturally. When considering a potential partner, ask yourself if there is mutual respect on both sides. Do those who are in charge of communication and collaboration work well together? Is the relationship riddled with conflicts or is it smooth sailing? Keep in mind, however, that conflicts are not necessarily a symptom of an impending breakup. Sometimes the issue can be resolved by changing the people or metrics at hand.

Most importantly, there must be ongoing and open communication. Two partners can disagree, but in most cases they can work it out.