Health Policy News and Views
Compiled by Benita M. Dodd
Time and seats are running out for the Heartland Institute’s Emerging Issues Forum Atlanta’s Capital City Club on Thursday, August 15. Among the topics: Health Care, Education, Energy and Tax Reform. (I’ll be on the panel on energy issues.) Find out more at http://eif.heartland.org/. Just 25 seats remain!
Win a seat to the Forum: The Georgia Public Policy Foundation is giving away four tickets, valued at $100 each, to the daylong session. For a chance to win a ticket, tell your Facebook friends what you like about the Foundation, and why. Be sure to “like” the Foundation Facebook page and tag us in your post! We’ll announce four winners in the Friday Facts this week, so make your case by noon on Thursday,. Remember, if you don’t tag us, we can’t see you!
Another case of the machine that goes ping? Ever notice how you can start out for an oil change at some service centers and come home with new brakes and transmission fluid you never knew you needed in the first place? A new Government Accountability Office report makes you wonder if that’s the mentality at some urology specialty groups. The GAO found that providers “substantially increased the percentage of their prostate cancer patients they referred for [radiation therapy] after they began to self-refer.” Between 2006 and 2010, such services performed by self-referring groups increased from about 80,000 to 366,000. Providers that began self-referring in 2008 or 2009 – referred to as switchers – referred 54 percent of their patients who were diagnosed with prostate cancer in 2009 for radiation therapy, compared to 37 percent of their patients diagnosed in 2007. In contrast, providers who did not begin to self-refer – that is, non-self-referrers and providers who already self-referred the entire period – experienced much smaller changes over the same period. Among all providers who referred a Medicare beneficiary diagnosed with prostate cancer in 2009, those that self-referred were 53 percent more likely to refer their patients for radiation therapy and less likely to refer them for other treatments, especially a radical prostatectomy or brachytherapy – less costly and often considered equally appropriate treatments with different risks and side effects. “These analyses suggest that financial incentives for self-referring providers – specifically those in limited specialty groups were likely a major factor driving the increase.” Which means, according to the GAO, that “beneficiaries may not be aware that their provider has a financial interest in recommending [radiation therapy] over alternative treatments that may be equally effective, have different risks and side effects, and are less expensive for Medicare and beneficiaries.”
444 drugs bringing hope: There are 444 drugs under development for treating neurological disorders, according to a report by the Pharmaceutical Research and Manufacturers of America (PhRMA). The drugs in clinical development or awaiting Food and Drug Administration approval include 82 for Alzheimer’s disease; 82 for pain; 62 for brain tumors; 38 for multiple sclerosis; 25 for headaches and migraines; 28 for epilepsy and seizures; 27 for Parkinson’s disease; seven for Huntington’s disease and eight for amyotrophic lateral sclerosis, a devastating degenerative and ultimately fatal condition also known as ALS or Lou Gehrig’s disease. Source: Drug Store News
Affordable Care Act
And then there were five: Aetna and the company it recently acquired, Coventry, dropped out of the Georgia health insurance exchange last week, leaving just five insurers: Blue Cross and Blue Shield of Georgia, Kaiser Foundation Health Plan, Humana, Alliant and Peach State. Enrollment is supposed to start on October 1. State Insurance Commissioner Ralph Hudgens noted in a statement, “ObamaCare has created great uncertainty in the health insurance market, and I am not surprised that Aetna and Coventry have decided not to participate in the federally facilitated Georgia Exchange.’’ Source: Georgia Health News
Gone: Aetna and Coventry also pulled out of Maryland’s exchange after the state pressed it to lower its proposed rates by up to 29 percent. In an August 1 letter sent to the Maryland Department of Insurance, Aetna said the state’s requirement for rate reductions off its proposed prices would lead it to operate at a loss. See Maryland’s rates here.
Gone up: Florida health insurance premiums could increase by up to 40 percent for individuals and up to 20 percent for small businesses when the new exchanges go into effect, according to the Florida Office of Insurance Regulation. The state expects individuals to see premium increases of 30 to 40 percent, while small businesses could experience premium hikes of anywhere from 5 to 20 percent. Eleven insurers filed to sell policies on the state’s individual exchange and five filed to sell coverage on the small business exchange.
Here we go again: Technically, the issues with congressional staff subsidies within the health insurance exchange market is a special consideration under the law’s requirements, so it’s not exactly a waiver – but either way, the Obama Administration has engaged in another exemption from the law for a powerful and connected group, the Heartland Institute reports. That means that lawmakers and staff, unlike the rest of us, can be secure that their health care tab is not going to soar next year. The Office of Personnel Management, under heavy pressure from Capitol Hill, is expected to issue a ruling this week that says the government can continue to make a contribution to the health care premiums of members of Congress and their aides, according to several Hill sources.
What’s the difference? Becker’s Hospital Review lists these on its medical tech terms cheat sheet:
mHealth: The practice of medicine or public health when supported by mobile devices such as smartphones or tablets.
Telemedicine: Using telecommunications devices to deliver health care remotely.
Electronic health record: A digitized patient record, it is designed to be able to share patient information between providers, and able to be accessed by all parties involved with the patient’s care.
Electronic medical record: A digitized patient record, it contains the medical and treatment history of a patient at one practice.
Who’s on top? Capterra, an online service that facilitates the purchase of business software, has released a report detailing the top 20 most popular electronic health record systems, based on a combination of total number of customers, users and social presence. With a market size estimated to hit $6 billion by 2015, growing at a rate of over 16 percent per year, EHRs typically include medical history, laboratory results, medication, allergies and even billing information to help create a more streamlined process for patient care, according to Capterra.
Cost-effective telehealth: Over two years, a telehealth program in rural Iowa cut the total cost of enrolled diabetes patients’ care by 32 percent. The Iowa Care Consortium’s “Keep it in Check” Iowa Medicaid Diabetes Program employed remote patient monitoring through a device-free platform of 650 participants. The program improved patient engagement and self-management and reduced hospitalizations and health care costs among participants. The total cost of care was reduced by 18 percent during the first year of the program and 32 percent the second year, and the claims paid over two years were $1.5 million less than those of a control group. According to the American Diabetes Association, 23.8 million people in the United States, or 8.3 percent of the population, have diabetes. Source: PRWeb
Read “What Farmers Can Teach Physicians,” a commentary on telemedicine, by Dr. Jeffrey Grossman, an Atlanta physician.
Healthy work culture cuts health care costs: If a company is measuring the effect of its wellness programs by the bottom line, these programs could be making the company sick, according to Tom Emerick and Al Lewis, authors of “Cracking Health Costs.” They contend that 90 percent of wellness programs being sold to companies are “counterproductive at worse and worthless at best.” Evidence is pointing to the fact that a better solution to decreasing health care costs is to provide an environment that not only supports employees’ health, such as low stress, but also serves to attract healthy employees, Lewis notes. Source: IndustryWeek
Quotes of note
“For fast acting relief, try slowing down.” – Lily Tomlin
“If you ask what is the single most important key to longevity, I would have to say it is avoiding worry, stress and tension. And if you didn’t ask me, I’d still have to say it.” – George F. Burns