March 28, 2019 | ACA: Will it stay or will it go?

Industry News

ACA: Will it stay or will it go?

The fate of the Affordable Care Act is, once again, up in the air in Washington. Within hours of the Administration's Monday announcement that it will support a Texas federal judge's late 2018 ruling that the entire act is unconstitutional, Democrats proposed new legislation to expand it, including proposals to expand subsidies to people with higher incomes. The case appears destined for the Supreme Court; attorneys general from Democrat-led states have appealed the Texas decision. (Kaiser Health News)

Stark reform on the horizon. Will it satisfy?

The Stark Law has, as Modern Healthcare describes it, “metastasized in complexity” since its 1989 enactment 30 years ago. Even its author, former Rep. Pete Stark, has called for repeal. Full repeal is unlikely, but the Trump administration, backed by provider groups, plans dramatic reforms. “Providers would really like to see a new exception for value-based arrangements,” Kim Roeder, a health care compliance attorney at King & Spalding, tells Modern Healthcare. “Or, if we can’t agree on that, at least give relief by clarifying terms like the volume or value of referrals, to accommodate value-based payments.”(Modern Healthcare)

FDA, among others, scrutinizing EHRs

Outgoing FDA Commissioner Scott Gottlieb is calling for tighter scrutiny of electronic health record systems. One impetus is Botched Operation,” an investigative piece fromKaiser Health News and Fortune that called the system “an unholy mess.” The federal government spent more than $36 billion over the past decade to move providers from paper to digital with “little to show” for the investment. Nothing, that is, except thousands of reports of deaths, injuries and near misses linked to EHRs. Meanwhile, lawmakers are starting to act, driven in part by allegations against Community Health Systems related to its EHR implementation. (Fortune)

Innovation & Transformation

Employers seeking new ways to control benefit costs

The projected 2019 4.4 percent increase in benefit cost growth would be higher than the consumer price index and employees’ earnings growth, a new Mercer report warns. Perhaps unsurprisingly, when asked their top near-term strategies for managing health plans, “monitoring and managing high cost claims” was the top answer, just as it was last year. To deal with this, many employers are contracting directly with providers to care for employees. In fact, Amazon-Berkshire Hathaway-J.P. Morgan Chase’s Haven venture was created with an explicit goal of improving health care and reducing costs for their 1.2 million employees. Healthcare Dive notes that Haven is likely to form its own provider network eventually. (Healthcare Dive; Mercer survey)

Consumers & Providers

The tell-tale toilet talks

Scientists at Rochester Institute of Technology are developing a toilet seat equipped with an electrocardiogram, ballistocardiogram and a photoplethysmogram (try saying that word five times in a row). The smart toilet can measure and analyze heart rate, blood pressure, blood oxygenation level, body weight and heart stroke volume. Special algorithms analyze the data to determine if the patient's condition is deteriorating. Eventually, the toilet will be able to transmit data to health care providers, who could use the data to order medication changes or checkups. The current focus is heart failure, but the inventors say that’s just a start. (New Atlas

Not the good kind of data sharing…

Medical apps collect your data, but do you really know what they're doing with it? Research published in the BMJ sure does. Researchers tested 24 top health-related apps used on an Android smartphone. Seventy-nine percent of those apps share data. Among the more popular apps were medical reference site Medscape, symptom-checker Ada and the drug guide Some of the data were used to improve the apps, but some were used for targeted advertising by third parties, which sometimes sell bundled data to fourth parties. (GizmodoBMJ

Patient? Consumer? The discussion continues

“Patients as Consumers” is the theme of the March Health Affairs, and health economist Jane Sarasohn-Kahn delves into four of the papers to gain insights into the question, “what is the right noun to use for U.S. patients in 2019—patients, consumers, people, health citizens?” Among her observations: Patients in the U.S. have been “compelled” to take on aspects of consumer behavior relative to personal health care and health coverage choices. However, many are unable or unwilling to “exercise these consumer muscles,” and even the best-informed “consumers” make bad decisions. For Sarasohn-Kahn, the language of “health citizenship” seems to be the most appropriate.(HealthPopuli)

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New & Noted

eConsults increase efficiencyElectronic consultations (eConsults or eReferrals) appear to streamline health care delivery, according to health economist Austin Frakt. Research suggests these consults between primary care providers and specialists can save money, help patients avoid additional visits to specialists and free up capacity. They also enhance access—especially for those in rural areas, the uninsured and those on Medicaid. (The New York Times)

States take on PBMs: Last week, Kentucky’s attorney general announced an investigation into allegations that pharmacy benefit managers had overcharged state health insurance programs for drugs and discriminated against independent pharmacies. That same week, Ohio’s attorney general sued UnitedHealth Group's PBM, OptumRx, to recover nearly $16 million in alleged prescription drug overcharges. (Reuters)

Struggling with surprise: Last week’s Kaiser Health News podcast explored why it’s so hard to protect patients from surprise bills. Across the political spectrum, state and federal lawmakers, as well as industry groups, say they want to find a solution, but they can’t agree on just what to do. (Kaiser Health News)


Administration: Show us the real numbers

A little-noticed—until now—Trump administration proposal would require hospitals publicly reveal the actual prices they charge insurance companies for medical procedures and services. These negotiated prices are currently kept confidential. (NPR)

MarketVoices...quotes worth reading

“Redefining payment-for-referral policies would be a big step to spur innovation…[b]ut it’s not a silver bullet. If more-efficient care models aren’t developed by providers, changes in Stark alone won’t achieve better outcomes.” —Dennis Butts, managing director at Navigant, quoted in Modern Healthcare

Jorden Gunessever