Checking Up On Health: April 14, 2015

Health Policy News and Views
Compiled by Benita M. Dodd



It’s not just the Internal Revenue Service’s extension of subsidies to enrollees of federal exchanges that go against the language in the Affordable Care Act. While that is awaiting a Supreme Court ruling in King v. Burwell, according to Jonathan Adler, the Tax man’s poetic license with tax credit eligibility appears to be the rule rather than the exception.

Writing in the Volokh Conspiracy in the Washington Post, Adler cites research out of Yale that found, “Combined with other instances of the IRS and HHS disregarding the PPACA’s plain text, it appears the federal government has little regard for what the PPACA actually says.”

Specifically, “IRS regulations disregard the statutory text so as to extend tax credit eligibility to some low-income aliens not lawfully residing in the U.S.” Further, “the IRS also issued regulations effectively disregarding the income requirements for tax credit eligibility.  Under the PPACA, individuals are only eligibile for tax credits if they earn between 100 and 400 percent of the poverty line.  Under the IRS regulations, however, the 100 percent threshold is disregarded in some instances.”

This creates the potential of more liabilities for employers, Adler points out, “Congress has already made over one dozen changes to the PPACA that have been signed into law, and there is no reason it could not make others.  If more changes are necessary (and I suspect most think they are), it is a job for Congress, not the IRS.”

Read Adler’s full commentary here.

Health IT: We’ve been saying it for a while, now someone else is! Georgia is IT among the nation’s top health IT hotspots. Writing for Becker’s Hospital Review, Akanksha Jayanthi points out the state is home to a number of prominent health IT players, including Carrollton-based Greenway Health, Alpharetta-based McKesson Technology Solutions, Alpharetta-based MedAssets and Alpharetta-based REACH Health. According to the Metro Atlanta Chamber, there are more than 200 health IT companies throughout the state. Not only are the health IT companies numerous, but they represent a variety of perspectives within the industry. Her listing of companies represents software providers, telehealth providers, EHR vendors and business performance solution providers. “Because of the depth within so many different facets of health IT, we have really risen to the top as the nation’s health IT capital,” says Amanda Shailendra, director of health sciences and advanced technology in the Georgia Department of Economic Development. Read more here.

Telemedicine: Not everything’s better in Texas, judging by the vote of the Texas Medical Board last week to sharply restrict telemedicine in the state. While other states – including Georgia – are loosening the reins on the practice in acknowledgement of the increasing demand since the Affordable Care Act, the board tightened its rules. They now state that “questions and answers exchanged through email, electronic text, or chat or telephonic evaluation of or consultation with a patient” are inadequate to establish a doctor-patient relationship. The move significantly tightens rules that already preclude video consultations except under a narrow set of circumstances, according to The New York Times. The vote was the latest salvo in a four-year battle between the state board, which licenses and regulates doctors, and Teladoc, a Dallas-based company that provides telephone or video consultations with doctors on its staff, typically for routine problems like urinary tract infections, sore throats and rashes.

Patients on telehealth: Patients are evenly split in their willingness to receive telehealth services. A telephone survey of 263 patients by Rochester, Minn.-based Mayo Clinic found 38 percent of patients said they would be “very likely” to see their provider via video and 33.8 percent said they would be “not at all likely” to do so. Approximately 75 percent said they were not at all likely to accept a video appointment if it were not covered by insurance The telehealth model would have the patient supply the hardware and Internet connection. The primary factors affecting willingness to participate in a video appointment include comfort in setting up a video call, age and distance participants would have traveled for an in-clinic appointment, researchers found.

Millennials and technology: A joint survey from Salesforce and Harris Poll found that 71 percent of millennial patients would like to have their providers use mobile apps to book appointments, share health data and manage preventive care. According to the survey, 60 percent of millennials support the use of telehealth options to eliminate in-person visits.

Kudos to six Georgia-based health care facilities that made the Becker’s Hospital Review list of 150 Great Places to Work in Health Care 2015:, a staffing company in Alpharetta and part of Jackson Healthcare
Tanner Health System of Carrollton
WellStar Health System, based in Marietta
Children’s Healthcare of Atlanta
Emory Health Care of Atlanta T
ouchpoint Support Services of Atlanta

Be careful what you ask for: Linda Gorman writes for the Heartland Institute on the crisis in nationalized health care in Britain where, newspapers report, in December 2014 and January 2015 more than 7,000 surgeries were canceled because of a lack of beds. The National Health Service has waiting times for cancer treatment at the highest in six years and 12.5 percent of patients – more than 39,400 people – waited more than 18 weeks for hospital treatment in November 2014. The blame was laid first on hospital bed shortages supposedly caused by a surge in unexpected admissions through overloaded emergency departments. But U.S. hospitals have handled a similar surge without a widespread crisis, according to the Heartland report. “A significant problem is many officials do not understand centrally run systems inevitably create these problems,” writes Gorman. “The U.S. private health care sector, which handled a huge increase in emergency room usage without hospital shortages, is more decentralized and has developed a variety of alternatives to hospital-based care. Decentralized decision-making and pricing stimulate people to find new ways to treat patients and encourage hospitals to be more productive and responsive to changing patient needs.”

Scary note: Prescription drug abuse can kill you – in more ways than one. While an outbreak of HIV is rarely reported these days, state officials in Indiana say one related to intravenous prescription-drug abuse in southeastern Indiana has reached 106 cases. The outbreak, centered in Scott County, is the biggest HIV outbreak the state has ever seen. A short-term state-authorized needle exchange program, authorized by Gov. Mike Pence, began April 11 in Scott County to combat the outbreak and expires April 25, but it may be extended the need arises. The cases in Scott County, about 30 miles north of Louisville, Ky., are been linked to the use of contaminated syringes and the painkiller Opana in the area. Almost all of the confirmed HIV cases have been from Austin, a rural city of about 4,200 people, according to news reports.

Biosimilar first: The U.S. Food and Drug Administration (FDA) has approved, for the first time, a “biosimilar” for sale in the United States. Zarxio, a drug used by cancer patients to help fight infections, will be manufactured by Sandoz. Biosimilars are generic versions of biopharmaceuticals whose patents have expired, and the move may lower prices of these expensive prescription drugs. Because they are produced from living tissue instead of chemical compounds, they are not exact duplicates of the original in the same way other generic drugs are, and the FDA did not have a process for approving biosimilars until the Affordable Care Act directed it to develop one. Source: Heartland Institute

Curious about Hillary Clinton? Becker’s Hospital Review has listed her health care positions here. I’m sharing because many presume she’s the Democratic Party’s presidential candidate. Republicans, on the other hand … For space reasons, I may have to wait until the field narrows!

Quotes of Note

“Consumers can access physicians with Teledoc, get a second opinion from Grand Rounds, and share their experiences on PatientsLikeMe. Access and collaboration matter a great deal to patients.” – Joshua Newman, “Can You Heal Me Now?”