Tag Archives: Health Policy

Medicare shouldn’t pay more for drugs when others pay less

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https://www.statnews.com/2016/10/18/medicare-drug-prices/?_hsenc=p2ANqtz–zfLIsv2nEEzVlLISqrp28lPm5ANNScP2_qYXJZI-DenazQvHTSROulTck5xdVsR5KMAzBoOaUWrYMEPSR1ZxAyLybMQ&_hsmi=36101369

Hillary Clinton and Donald Trump don’t see eye-to-eye on much. But they do agree that drug costs are spiraling out of control at the public’s expense. Both the Democratic and the Republican candidates for president have said that Medicare should be able to negotiate drug prices, something that currently isn’t allowed by law. Letting Medicare do that — which the Department of Veterans Affairs and other countries have been doing for years — has the potential to transform health care.

Most developed nations, including Canada and the United Kingdom, negotiate with pharmaceutical companies to determine how much they will pay for medications. In the US, health care is covered by many different payers, with Medicare being the largest by far. The federal government never gave Medicare the power to negotiate drug prices. Instead, that’s done by the many private insurers that manage Medicare drug plans.

Giving Medicare the power to negotiate drug prices would immediately save billions of dollars. The implications would also reach far beyond the 37 million Americans covered by the Medicare drug benefit (Part D), because commercial insurers often follow Medicare’s lead.

 

 

FTC puts an end to Penn State-PinnacleHealth deal

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http://www.fiercehealthcare.com/finance/ftc-prevails-squelching-penn-pinnaclehealth-deal

FTC logo

Thanks to the Federal Trade Commission, the Penn State Health and PinnacleHealth merger will not go forward.

Plans to merge were called off late last week, according to PennLive.com. The Penn State Board of Trustees voted unanimously to call off the deal, which would have created a four-hospital system in the Harrisburg region, including Penn State’s Hershey Medical Center and the three PinnacleHealth facilities.

The FTC and the Pennsylvania Attorney General intervened in the deal late last year, with both claiming that residents in Central Pennsylvania would have few alternatives for other healthcare providers, leaving the likelihood open that the merged entity would raise prices. Thetransaction was initially approved by a U.S. District Court in May, but the parties were dealt a blow when the ruling was reversed by the U.S. Third Circuit Court of Appeals last month.

The aborted deal cost Penn State an estimated $17.6 million in legal fees and other costs, according to PennLive.

The case is part of what has been heightened scrutiny of recent hospitals deals by both federal and state regulators. In November, the FTC intervened in a deal between two rural hospitals in West Virginia, Cabell Huntington Hospital and St. Mary’s Medical Center. The agency recently prevailed in a 2010 case where it intervened in ProMedica’s acquisition of St. Luke’s Medical Center in Toledo, Ohio. The agency is also fighting a proposed merger between Advocate Health Care and NorthShore University HealthSystem in Chicago, although as in the Penn State matter, it has lost at the lower court level.

FTC Chairwoman Edith Ramirez expressed concern earlier this year that ongoing hospital mergers will soon impact healthcare pricing around the U.S., but deal-making appears to go on unabated. That’s despite the fact that a recent analysis suggested that mergers even across markets can lead to double-digit cost increases.

Editor’s Corner: Lack of preventive care in the US may hurt hospitals

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http://www.fiercehealthcare.com/finance/lack-preventative-care-u-s-could-wind-up-deeply-damaging-hospitals?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTlRSaU16TTJNREEwTUdZeSIsInQiOiJDTzgyZXFNZW1rc0hNb28wOE41R0hkcUVLSE9nb3pHemVGTFY0ZEJ0OFNkXC9UODNLaDNUYXRxR281Z2NMbWJET01wZGRlQ3FvNlFsSWJ1RHpVMjZKbmxoVHNMa1Y0b3ArNFRmbktOSUtvWm89In0%3D

Editor's corner

Bold statements are fairly rare from the heads of large hospital systems, but Robert Ostrowsky, the head of RWJBarnabas Health, made a pretty strong assertion in a recent interview with the Asbury Park Press: Hospitals should keep their communities healthy. But they don’t.

“It’s not easy because no one is willing to pay for that right now, meaning I don’t get reimbursed by insurance companies to keep somebody healthy and the government doesn’t seem to want to pay us to keep someone healthy,” Ostrowsky told the publication. “They all prefer to pay us when someone gets sick and they want us to spend less when that person is sick. That’s where the concentration has been. But an ounce of prevention. If they would take X number of dollars and say, ‘Here, use it to keep people healthy,’ actuarially, that will show you eventually spend less on sickness care.”

That needs to change for a variety of reasons that have begun to cascade into something profound. Princeton economist Alan Krueger has recently published a study (.pdf) showing a strong correlation between poor health and lack of workforce participation.

Measuring What Really Matters

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http://altarum.org/health-policy-blog/measuring-what-really-matters

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Not everything that is important for a person’s health can be measured and not everything that can be measured in health care is important to the average person.

For too long, value has been defined only for the benefit of regulators and purchasers. Our health care system is purpose-built to cater to their performance needs, oversight, and expectations, and as such has fostered the proliferation of all sorts of clinical quality measures by multiple organizations. The current state of quality measurement serves these audiences reasonably well.

However, the problem with evaluating quality using these tools is twofold. First as a physician, I still see too much variation in the technical quality of American health care. Second, clinical measures alone ignore how value is perceived through the eyes of those who actually use the delivery system. When we look at the highest users of health care – those with serious medical problems and functional limitations – we now have an abundance of technical measures for each condition on their problem list, and yet really no understanding of whether we are contributing to a person’s quality of life. Frankly, I care little about the fact that my 100-year-old grandmother has never had a screening colonoscopy, but I care mightily that no one seems responsible for her successful discharge and transition home after a bout of urosepsis.

We cannot improve what we do not measure…and it is time to start measuring health care from the vantage point of those needing care, not just for those who provide and pay for it. And if we are to achieve the dramatic improvements anticipated through new payment and service delivery models, the mushrooming of purely clinical measures must be thinned out to make room for a new generation of metrics that consider outcomes from the person’s perspective.

 

California Reforms Target Workers’ Compensation Fraud

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California Reforms Target Workers’ Compensation Fraud

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California is cracking down on graft in the state’s system of medical care for injured workers with two bills recently signed into law by Gov. Jerry Brown.

The reforms will prohibit medical providers who are felons from billing for workers’ compensation care and rein in a court-governed payment system that gave rise to hundreds of millions of dollars in unsanctioned treatment.

Lawmakers who introduced the bills cited an investigation by Reveal from The Center for Investigative Reporting that examined more than $1 billion in alleged fraud in the medical system for injured workers.

Reviewing more than a dozen prosecutions and analyzing state data, the investigation found that alleged scams affected more than 100,000 injured workers. Many were monolingual Latinos who were targeted in aggressive marketing efforts in Southern California. They encountered everything from kickback-fueled spinal surgeries to fraudulent providers to $1,600 tubes of pain cream.

Alleged scammers included felons and doctors banned from billing Medicare for malfeasance. Many fraud defendants exploited a feature of California’s workers’ compensations system that let them file a “lien,” or a demand for payment, for services after insurers refused to pay. They included therapies like shock wave pain treatments or unwanted drugs, such as the pricey pain creams.

The new laws would ban certain medical providers with troubled pasts from treating injured workers and also aim to limit the avalanche of liens that clog the docket in two dozen workers’ compensation courts throughout the state.

Christine Baker, director of the Department of Industrial Relations, which administers workers’ compensation, said she hopes the laws improve care for people who seek help for an on-the-job injury.

“I think both abuses and fraudulent activities prey on the most vulnerable populations and we’re hopeful that appropriate treatment will be provided to workers when needed,” Baker said. The laws “should reduce costs, because a lot of costs are tied to fraudulent activity, and that frees up dollars for the injured workers.”

Big Soda sponsored 96 health groups — a big conflict of interest, study says

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https://www.washingtonpost.com/news/to-your-health/wp/2016/10/10/big-soda-sponsored-96-health-groups-a-big-conflict-of-interest-study-says/

Nearly 100 national health and medical groups — including the American Heart Association, the American Diabetes Association and the Centers for Disease Control and Prevention — enjoy sponsorships by Coca-Cola Co. or PepsiCo, according to a new study by two Boston University researchers.

The report lands as the sugar industry’s supersized role in shaping — and spinning — health policy has come under increasing scrutiny. It also comes as the negative health effects of sugar and sugary drinks, including a link to rising obesity rates, are better understood.

“Now, most organizations refuse tobacco money,” write the study authors, Daniel Aaron and Michael Siegel. “Perhaps soda companies should be treated similarly.”

The authors identified 96 sponsorships, from 2011 to 2015, by Coca-Cola or PepsiCo to 96 “health organizations,” which they defined as any group or program “involved in the public’s health.” During that period, the researchers identified 29 proposed public health bills or regulations that one or both of the two companies lobbied against. All aimed to reduce soda consumption.

The American Beverage Association, which represents both Coca-Cola and PepsiCo, responded to the study with a statement saying: “America’s beverage companies are engaged in public health issues because we, too, want a strong, healthy America. We have a long tradition of supporting community organizations across the country. As this report points out, some of these organizations focus on strengthening public health, which we are proud to support.”

Coca-Cola and PepsiCo did not respond to a request for comment about the study.

A closer look at single-payer health care and how it works

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http://hub.jhu.edu/2016/10/11/single-payer-health-care-101/

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Johns Hopkins experts explain health insurance alternative mentioned during presidential debate

During Sunday’s heated presidential debate, an audience member raised the issue of health care, asking Hillary Clinton and Donald Trump about their plans to bring down costs and to make coverage better.

Both of the candidates’ responses included references to a “single-payer plan.” What does that mean, and could it work in the U.S.? For insight, we turned to experts from Johns Hopkins University’s Bloomberg School of Public Health.

In a segment of WYPR’s On the Record on Monday morning, Bradley Herring, an associate professor in the Department of Health Policy and Management at the Bloomberg School, explained what a single-payer system is and how it works.

Bradley Herring and Gerard Anderson

Image caption:Bradley Herring (left) and Gerard Anderson

“The simplest way to think about a single-payer system is one in which the government is the single payer for all health care services for all citizens,” Herring said.

Countries around the world have successfully adopted single-payer health systems. An obvious example—and the one Trump pointed to in the debate—is Canada.

DOJ says Aetna, Humana are trying to derail antitrust case

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http://www.bizjournals.com/louisville/news/2016/10/11/doj-says-aetna-humana-are-trying-to-derail.html

Lawyers for the U.S. Department of Justice say Aetna Inc. and Humana Inc are trying to derail the government's antitrust challenge of Aetna's proposed $37 billion acquisition of Humana.

Lawyers for the U.S. Department of Justice say Aetna Inc. and Humana Inc are trying to derail the government’s antitrust challenge of Aetna’s proposed $37 billion acquisition of Louisville-based Humana.

This comes after lawyers for the companies accused the DOJ with “serious delay and misconduct” last week. The companies requested sanctions, claiming that the government withheld about 1 million documents and that this had “gravely undermined” the companies’ ability to mount a defense against claims that the acquisition would hurt competition.

The National Law Journal reports that the government’s response came Saturday in a court filing, in which it said the DOJ has tried to accommodate the “broad and extremely burdensome discovery demand” from Aetna (NYSE: AET) and Humana (NYSE: HUM) on the U.S. Department of Health and Human Services.

The government called the request for sanctions “a transparent attempt to derail the United States’ merger challenge before the district court ever hears from a single witness or reviews any evidence,” the law journal reported.

At issue is how much market share the combined company would control in Medicare Advantage, a type of Medicare plan offered by a private insurer. A court date is set for Dec. 5, 2016, and the judge says a decision isn’t likely until mid-January 2017 — past the companies’ end-of-year deadline to close the deal.

Lack Of Medicaid Expansion Hurts Rural Hospitals More Than Urban Facilities

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http://khn.org/news/lack-of-medicaid-expansion-hurts-rural-hospitals-more-than-urban-facilities/

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It isn’t news that in rural parts of the country, people have a harder time accessing good health care. But new evidence suggests opposition to a key part of the 2010 health overhaul could be adding to the gap.

The finding comes from a study published Wednesday in the journal Health Affairs, which analyzes how the states’ decisions on implementing the federal health law’s expansion of Medicaid, a federal-state insurance program for low-income people, may be influencing rural hospitals’ financial stability. Nineteen states opted not to join the expansion.

Rural hospitals have long argued they were hurt by the lack of Medicaid expansion, which leaves many of their patients without insurance coverage and strains the hospitals’ ability to better serve the public. The study suggests they have a point.

Specifically, the researchers, from the University of North Carolina Chapel Hill, found that rural hospitals saw an improved chance of turning a profit if they were in a state that expanded Medicaid — while in city-based hospitals, there was no improvement to overall profitability. Across the board, hospitals earned more if they were in a state where more people had coverage and saw declines in the level of uncompensated care they gave.

To put it another way: All hospitals generally fared better under the larger Medicaid program, but there’s more at stake for rural hospitals when the state expands coverage.

 

Trump’s Debate Claim On Health Care Costs: It Depends What You Mean By ‘Cost’

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http://khn.org/news/trumps-debate-claim-on-health-care-costs-it-depends-what-you-mean-by-cost/

ST LOUIS, MO - OCTOBER 09: Republican presidential nominee Donald Trump (L) speaks as Democratic presidential nominee former Secretary of State Hillary Clinton listens during the town hall debate at Washington University on October 9, 2016 in St Louis, Missouri. This is the second of three presidential debates scheduled prior to the November 8th election. (Photo by Win McNamee/Getty Images)

Health care finally came up as an issue in the second presidential debate in St. Louis Sunday night. But the discussion may have confused more than clarified the issue for many voters.

During the brief exchange about the potential fate of the Affordable Care Act, Republican Donald Trump said this: “Obamacare is a disaster. You know it. We all know it. It’s going up at numbers that nobody’s ever seen worldwide. Nobody’s ever seen numbers like this for health care.”

Let’s parse that discussion of costs piece by piece. Because when it comes to health care, there are many different types of costs: those for governments, employers and individuals. And those costs don’t always go up and down at the same time.

First, the federal government’s spending on the Affordable Care Act’s insurance is coming in under budget projections. According to the official scorekeeper, the Congressional Budget Office (CBO), in March, the net cost of the insurance coverage provisions of the law — including tax credits to subsidize some lower-income customers’ premiums and costs for adding people to Medicaid — “is lower by $157 billion, or 25 percent” than the estimate when the law was enacted in 2010.

Much of that is because CBO originally estimated that large numbers of employers would stop providing insurance to workers and send them to the law’s online marketplaces, where many of them would get federal subsidies. That didn’t happen. Medicaid spending increased more than CBO projected, but that was more than offset by the lower spending on tax credits.