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Do doctors really hate Obamacare?

Do doctors really hate Obamacare? | Healthcare and Technology news |

Anti-Obamacare critics often claim that “every” physician they know hates Obamacare. For instance, pediatric neurosurgeon and GOP Presidential candidate Dr. Ben Carsontold Fox News that “he’s spoken to hundreds of doctors throughout the country about the Affordable Care Act, and not one of them ‘liked’ President Barack Obama’s signature health care law.”

Doctors hate Obamacare, it’s alleged, because it authorizes government to “control” the practice of medicine and impose “rationing” of care, thereby harming patients.  The conservative Examiner website quotes a New Jersey family physician, Dr. John Tedeschi as saying, “Just as a guitar string has to be tuned, so does a person’s health to get the right tone. The government has taken away, or refocused the intelligence part of the tuning, and has just about destroyed the creative, or compassion component. Now, with Obamacare, we are left with an incompetent mechanism that does not have the best interest of the patient in mind.”  An ER physician quoted in the articles said that the “storm of patients [created by Obamacare] means when they can’t get in to see a primary care physician, even more people will end up with me in the emergency room.”

There is no question that some doctors (mainly conservatives) hate Obamacare, and if they were the only ones you talked to (like the ones who apparently talked to Dr. Carson), you might think that all doctors feel the same way. But the reality is that — surprise, surprise! — primary care physicians’ views are just like the rest of us, split by their partisan leanings.

A new survey by the respected Kaiser Family Foundation found that 87 percent of Democratic-leaning physicians view Obamacare favorably, while the exact same percentage of GOP-leaning physicians view it unfavorably. Independent doctors split 58 percent unfavorable to 42 percent favorable.  Because there were more GOP and independent physicians among the survey respondents, the overall breakdown of primary care physicians’ views on the ACA is  52 percent unfavorable to 48 percent favorable.  Yet only 26 percent of all primary care physicians viewed the law “very unfavorably. “  So it might be said that just one out of four primary care physicians “hate” Obamacare.

And a deeper dive into the survey results directly refutes the contention of anti-Obamacare doctors that the law is leading to poorer quality, physicians turning away patients, or longer waits for appointments:

  • Most primary care physicians say that quality has stayed the same: 59 percent said that their ability to provide high-quality care to their patients has stayed about the same, while 20 percent said it has improved, and 20 percent said it has gotten worse.
  • More primary care physicians report that Medicaid expansion has had a more positive impact on quality than a negative one: “When asked more specifically about the expansion of Medicaid under the ACA, nearly four of 10 providers (36 percent of physicians and 39 percent of nurse practitioners and physician assistants) said the expansion has had a positive impact on providers’ ability to provide quality care to their patients. About two of 10 said it has had a negative impact, and the remainder said it has not made a difference, or they are not sure.”
  • Ease of getting same-day appointments is about the same as before the ACA: “Overall, about four of 10 primary care providers said almost all their patients who request a same- or next-day appointment can get one; another quarter said most of their patients can get such appointments” which is largely unchanged from 2009 and 2012.
  • Most continue to accept new patients: “A large majority of primary care providers (83 percent of physicians, 93 percent of midlevel clinicians) said they are currently accepting new patients . . . A survey conducted in late 2011 through early 2012 found that 89 percent of primary care physicians were accepting new patients and 52 percent were accepting new Medicaid patients.  This indicates that while physicians’ rates of accepting new patients overall may have declined slightly since the ACA coverage expansions went into effect, acceptance rates for Medicaid have remained about the same.”

When asked specifically about their views on the impact of the Affordable Care Act on five dimensions, the ACA fared well, with one exception (costs to patients).

  • Access to health care and insurance in the country overall: 48 percent positive, 12 percent no impact,  24 percent negative, and 14 percent not sure.
  • Overall impact on practice: 31 percent reported no impact, 23 percent a positive  impact, 36 percent negative  and 9 percent not sure.
  • Quality of care their patients receive: 50 percent reported no impact, 18 percent positive, 25 percent negative, and 6 percent not sure.
  • Ability of the practice to meet patient demand: 44 percent no impact, 18 percent positive, 25 percent negative, and 10 percent not sure.
  • Cost of health care for their patients: 17 percent no impact, 21 percent positive, 44 percent negative, and 16 percent not sure.

However, “physicians’ responses to questions that mention the ACA by name are deeply divided along party lines. For example, by a three-to-one margin, physicians who identify as Democrats are more likely to say the ACA has had a positive (44 percent) rather than a negative (15 percent) impact on their medical practice overall. Republican physicians break in the opposite direction by about seven-to-one (57 percent negative, 8 percent positive).”

The survey also does not support the contention that the ACA is contributing to primary care physician dissatisfaction with practice and burn-out:

“Even though providers with different political affiliations do not share views about the Affordable Care Act, a large majority of primary care providers (83 percent of physicians and 93 percent of nurse practitioners and physician assistants) — both Republicans and Democrats — reported they are very or somewhat satisfied with their medical practice overall. The changing environment does not appear to be affecting overall provider satisfaction even among providers who see a larger share of Medicaid patients or work in Medicaid expansion states. Indeed, current satisfaction levels are slightly higher than what was reported by primary care physicians before the ACA. In 2012, 68 percent of primary care physicians reported they were very satisfied or satisfied with practicing medicine.”

Interestingly, Democratic physicians (56 percent) are more likely to recommend a career in primary care than Republicans (39 percent)  or Independents (40 percent).

I know that many conservative primary care doctors have a strong and principled objection to Obamacare, believing  passionately that it gives the government too much power and the physicians, and their patients will be hurt as a result.  I (and ACP) may not agree with them, but I respect their views, and their right to make their case to their colleagues and to the public.

But the Kaiser Family Foundation survey shows us that the anti-Obamacare doctors do not represent the views and experience of most primary care doctors on the front lines, never mind “all” of them.  Doctors (at least those in primary care, who knows about surgeons?) clearly don’t “hate” Obamacare.  Rather, more of them see Obamacare as doing some good things, like improving access; and doing not as well on other things, like lowering costs to patients.  Much of what they do and see in their practices remains unchanged by it, for good or bad.

And that strikes me about right, Obamacare is making many things better, but there is a lot more that needs to be done to improve quality and access, lower costs to patients, and sustain and support primary care.  Of course, such nuances do not make for as good a headline or political talking point as “Doctors Hate Obamacare.”

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Obamacare’s Big Gamble on Hospital Productivity

Obamacare’s Big Gamble on Hospital Productivity | Healthcare and Technology news |

Can hospitals provide better care for less money? The assumption that they can is baked into the Affordable Care Act.

Historically, hospital productivity has grown much more slowly than the overall economy, if at all. That’s true of health care in general. Productivity — in this case the provision of care per dollar and the improvements in health to which it leads — has never grown as quickly as would be required for hospitals to keep pace with scheduled cuts to reimbursements from Medicare.

But to finance coverage expansion, the Affordable Care Act made a big bet that hospitals could provide better care for less money from Medicare. Hospitals that cannot become more productive quickly enough will be forced to cut back. If the past is any guide, they may do so in ways that harm patients.

The Obamacare gamble that hospitals can become much more productive conflicts with a famous theory of why health care costs rise. William Baumol, a New York University economist, called it the “cost disease.” (He wrote a book about it by that title; I blogged on it as I read it if you’d like to quickly get the gist.)

This theory asserts that productivity growth in health care is inherently low for the same reason it is in education: Productivity-enhancing technologies cannot easily replace human doctors or teachers. In contrast with, say, manufacturing — a sector in which machines have rapidly taken over functions that workers used to do, and have done them better and more cheaply — there are, at least for the time being, far fewer machines that can step in and outperform doctors, nurses or other health sector jobs.

But a new study casts doubt on that theory and suggests Obamacare’s bet may indeed pay off. The study, published in Health Affairs by John Romley, Dana Goldman and Neeraj Sood, found that hospitals’ productivity has grown more rapidly in recent years than in prior ones. Hospitals are providing better care at a faster rate than growth in the payments they receive from Medicare, according to the study.

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President Obama Signs SGR Repeal Legislation, Shifting Medicare Physician Payment Incentives

President Obama Signs SGR Repeal Legislation, Shifting Medicare Physician Payment Incentives | Healthcare and Technology news |

On Thursday afternoon, April 16, President Barack Obama signed the Medicare Access and CHIP Reauthorization Act of 2015, or “MACRA,” a bill passed by the House of Representatives on March 26 and by the Senate on April 14 that now permanently repeals the long-maligned Sustainable Growth Rate (SGR) formula for Medicare physician payment.

As the Washington Post reported, in signing the bill into law, the President praised the bipartisan nature of the legislation, cobbled together in the House by Speaker John Boehner (R-Oh.) and Democratic Leader Nancy Pelosi (D-Calif.) for negotiating the terms of the legislation. He further said that “It also improves it [physician reimbursement] because it starts encouraging payments based on quality, not the number of tests that are provided or the number of procedures that are applied but whether or not people actually start feeling better. It encourages us to continue to make the system better without denying service,” he added.

Congress’s passing of this legislation and the President’s signature on it, end a series of 17 so-called “doc fixes” since 1997 when the SGR formula was passed into law but never fully implemented because of physician uproar, the MACRA legislation averts what would have been a 21-percent cut to Medicare physician payment, replacing it with 0.5-percent “updates,” or physician payment increases, in 2015, 2016, 2017, and 2018.

More broadly, MACRA ends physician payment incentives  under the meaningful use program within the HITECH (Health Information Technology for Economic and Clinical Health) Act, and those under the Physician Quality Reporting System (PQRS), replacing the incentives in those programs with a new program called the Merit-based Incentive Payment Program, or MIPS. Physicians will also be able to opt for an alternative program involving slightly higher payments in return for participation in certain Alternative Payment Models, or APMs.

As Healthcare Informatics’ analysis of the legislation noted last month, it targets four key areas: quality, resource use, clinical practice improvement (including care coordination and improvement activities), and the meaningful use of electronic health record technology.

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Obama presents climate change as hazard to your health

Obama presents climate change as hazard to your health | Healthcare and Technology news |

President Barack Obama will ask Americans to think of climate change as a threat not just to the environment, but also to their health.

Warning of the perils to the planet has gotten the president only so far; polls consistently show the public is skeptical that the steps Obama has taken to curb pollution are worth the cost to the economy. So Obama is aiming to put a spotlight on ways that climate change will have real impacts on the body, like more asthma attacks, allergic reactions and injuries from extreme weather.

"It's not just the air we breathe — climate change is leading to more heat-related deaths," Obama senior adviser Brian Deese told reporters in a conference call previewing the announcement.

"The challenges we face are real and they are clear and present in people's daily lives."

Microsoft's research arm will develop a prototype for drones that can collect large quantities of mosquitoes, then digitally analyze their genes and pathogens. The goal is to create a system that could provide early warnings about infectious diseases that could break out if climate change worsens.

Google has promised to donate 10 million hours of advanced computing time on new tools, including risk maps and early warnings for things like wildfires and oil flares using the Google Earth Engine platform, the White House said. Google's camera cars that gather photos for its "Street View" function will start measuring methane emissions and natural gas leaks in some cities this year.

The Obama administration was also to announce a series of modest steps it will take to boost preparedness, such as expanding access to data to predict and minimize the health effects from climate change.

Obama's effort to link climate change to health comes as he works to build support for steps he's taken to curb U.S. emissions that are opposed by business and industry, including strict limits on vehicles and power plants. The president is relying on those emissions cuts to make up the U.S. contribution to a global climate treaty that he and other world leaders expect to finalize in December.

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Supreme Court Rules that Providers Cannot Sue States Over Medicaid Payment

Supreme Court Rules that Providers Cannot Sue States Over Medicaid Payment | Healthcare and Technology news |

On Tuesday morning, March 31, the U.S. Supreme Court ruled in Armstrong et al v. Exceptional Child Center, Inc., et al, that private healthcare providers cannot sue states over low Medicaid reimbursement rates, in a 5-4 ruling, reversing a lower court’s ruling. Providers had argued that suing over low rates is sometimes the only way to enforce federal payment requirements.  But their opponents asserted that a ruling in favor of providers could lead to unending litigation that would slow the system.

The Supreme Court took up the case after Idaho residential providers for disabled patients sued state officials over that state’s failure to implement higher reimbursement rates, after the Idaho Legislature failed to sufficiently fund such reimbursement. A federal district court ruled that Idaho’s rates did not align with requirements in federal law requiring adequate reimbursement, and the distrct court was upheld by the 9th U.S. Circuit Court of Appeals.

A report in the online news service NewsMax reported that  “State officials recommended increases in reimbursement rates in the late 2000s but they were never implemented because the Idaho legislature declined to appropriate funds, according to court papers.Writing on behalf of the majority,” the NewsMax report said, “Justice Antonin Scalia said that the providers have no right to sue the state under the so-called Supremacy Clause of the U.S. Constitution, which holds that federal law generally trumps state law. The clause ‘instructs courts what to do when state and federal law clash, but is silent regarding who may enforce federal laws in court,’ Scalia wrote.”

The report further said that “Scalia noted that the providers have another option: they can ask the federal government to intervene on their behalf. In a dissenting opinion, Justice Sonia Sotomayor said there was nothing in the Medicaid law to suggest that Congress intended to prevent private lawsuits.”

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House Republican Budget Overhauls Medicare and Repeals the Health Law

House Republican Budget Overhauls Medicare and Repeals the Health Law | Healthcare and Technology news |

House Republicans on Tuesday will unveil a proposed budget for 2016 that partly privatizes Medicare, turns Medicaid into block grants to the states, repeals the Affordable Care Act and reaches balance in 10 years, challenging Republicans in Congress to make good on their promises to deeply cut federal spending.

The House proposal leans heavily on the policy prescriptions that Representative Paul D. Ryan of Wisconsin outlined when he was budget chairman, according to senior House Republican aides and members of Congress who were not authorized to speak in advance of the official release.

With the Senate now also in Republican hands, this year’s proposal is more politically salient than in years past, especially for Republican senators facing re-election in Democratic or swing states like Pennsylvania, Wisconsin, Illinois and New Hampshire, and for potential Republican presidential candidates.

Mr. Ryan’s successor, Representative Tom Price, Republican of Georgia, promised on Monday “a plan to get Washington’s fiscal house in order, promote a healthy economy, protect our nation and save and strengthen vital programs like Medicare.”

Democrats — and those Republicans who support robust military spending — will not see Mr. Price’s “Balanced Budget for a Stronger America” in those terms. Opponents plan to hammer Republican priorities this week, as the House and Senate budget committees officially begin drafting their plans on Wednesday, and then try to pass them through their chambers this month.

On Monday, President Obama tried to get ahead of the debate by criticizing Republican plans to abide by strict domestic and military spending caps.

“I can tell you that if the budget maintains sequester-level funding, then we would actually be spending less on pre-K to 12th grade in America’s schools in terms of federal support than we were back in 2000,” the president said in a speech to the Council of the Great City Schools. “The notion that we would be going backward instead of forwards in how we’re devoting resources to educating our kids makes absolutely no sense.”

But Republican aides said they have weathered those attacks ever since Mr. Ryan released his first budget plan in 2011. They said the easiest way to prevail in the House, at least, is to put forward the budget plan most House members have voted on multiple times.

“We’ve had House people vote on these four years in a row. We’ve held on to our majority and even expanded it,” said Representative Tom Cole, Republican of Oklahoma and a Budget Committee member. “The idea you’re going to lose an election on this is more political theater than political reality.”

Congressional budgets do not have the force of law and are largely advisory documents, but they represent the broadest statement of governing philosophy each year and set overall spending levels for the coming fiscal year. And in coming months, this one may contain language easing passage of taxation and entitlement legislation.
Continue reading the main story

Under congressional rules, a budget cannot be filibustered in the Senate, so Republicans would bear most of the responsibility if they failed to pass one.

House Budget Committee members previewed their plans in an unusual, campaign-style video on Monday. The plan envisions a remaking of the federal government. Future recipients of Medicare would be offered voucherlike “premium support” to pay for private insurance rather than government-provided health care.

Spending on Medicaid would be cut substantially over 10 years, with the money turned into block grants to state governments, which in turn would have much more flexibility in deciding how it is allocated.

The budget “repeals all of Obamacare,” Representative Diane Black, Republican of Tennessee, said the same day the Obama administration announced that the law had provided coverage to 16.4 million previously uninsured people.

To placate advocates of the military who say strict budget caps are hurting national defense, the House budget adds “emergency” war spending through the “overseas contingency operations” account, which does not count against the spending limits.

The budget will also include language that orders members of the tax-writing Ways and Means Committee to draft a “fairer, simpler tax code,” said Representative Todd Rokita, Republican of Indiana.

And it will include parliamentary language — called “reconciliation” — aimed at allowing legislation to repeal the Affordable Care Act to pass the Senate with a simple majority. If that bill is passed, it will still be subject to a presidential veto.

Conservative groups insist Republicans must keep their promise and repeal the Affordable Care Act.

“Republicans owe their majorities to their unwavering opposition to Obamacare, a reality that must be reflected in the budget,” declared Heritage Action, the political arm of the conservative Heritage Foundation. “A throwaway line that the budget ‘repeals Obamacare in its entirety’ is not enough.”

House Republicans conceded on Monday that the Senate was not likely to propose such extensive cuts. Even before the Senate plan is unveiled, deep rifts are appearing. Senator John McCain of Arizona, chairman of the Senate Armed Services Committee, reiterated his demand on Monday that any budget raise military spending well above the statutory caps. And he said he would not accept an approach that raised spending through the war-fighting emergency account or by shifting money from already squeezed domestic programs.

Last year, Mr. Ryan called “emergency spending” increases “a backdoor loophole that undermines the integrity of the budget process.”

Republican leaders worry that the Republican senators making moves to run for president — Ted Cruz of Texas, Rand Paul of Kentucky, Marco Rubio of Florida and Lindsey Graham of South Carolina — will never find a budget to their liking. At the same time, Republican senators from Democratic states, such as Mark S. Kirk of Illinois, will be hard-pressed to agree to the House’s conservative vision.

In 2013, when the Senate was presented an amendment to prohibit replacing Medicare’s guaranteed benefits “with the House passed budget plan to turn Medicare into a voucher program,” 96 senators agreed. Only three, Mr. Cruz, Mr. Paul and Senator Mike Lee, Republican of Utah, supported the House’s vision.

“Historically, the Senate has been less willing to take on the tough issues, and the early sounds are they’re not going to do a Ryan-type Medicare-Medicaid plan,” Mr. Cole said. “They face a very difficult election atmosphere next year.”

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Obamacare opponents should be careful what they wish for

Obamacare opponents should be careful what they wish for | Healthcare and Technology news |

“Obamacare is a train wreck, and that’s actually not fair to train wrecks.”

So said Sen. Ted Cruz (R-Texas) at last week’s Conservative Political Action Conference in Maryland. It was a line that drew both applause and laughs, as you would expect from a gathering of folks who view the Affordable Care Act as an abomination.

Chances are that Cruz and his CPAC fans are hoping the Supreme Court will do what Congress has so far been unable to do, when the justices rule in a few months on King v. Burwell. That’s the lawsuit to be argued at the high court this week —the one arguing that the subsidies millions of people are getting in 34 states to help cover the cost of their health insurance are illegal. Cruz and others who despise Obamacare are hoping that if the Supreme Court rules in favor of the plaintiffs, what they consider a scourge on the nation will soon be eradicated.

But if there ever was a reason to cite the maxim, “be careful what you wish for,” it’s about this lawsuit. A Supreme Court decision that goes against Obamacare would lead to a train wreck with almost unimaginable consequences. And Republicans likely would get much of the blame.

Anyone who thinks such an outcome would usher in an era of a better functioning health insurance marketplace should read the amicus brief submitted by America’s Health Insurance Plans, the industry’s largest trade group.

AHIP’s brief supports the government, not the plaintiffs. It paints a picture not of a new heaven on earth if the Supreme Court decides against the government, but of a health insurance apocalypse. Not everywhere, though, ironically. The marketplace meltdown would occur only in those 34 states, led primarily by Republican governors, like in Texas, that defaulted to the federal government to operate their health insurance exchanges.

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U.S. agency says work to fix problem hampering Obamacare applications

U.S. agency says work to fix problem hampering Obamacare applications | Healthcare and Technology news |

A day before the open enrollment deadline for private health coverage under Obamacare, some consumers are unable to submit applications because of "intermittent issues" with income verification, the U.S. Health and Human Services Department said on Saturday.

The department said in a statement that it was working hard to resolve the problem with "external verification sources" ahead of the Feb. 15 deadline.

Those visiting the government's website can set up their account, look at the available plans and start working on their application, the statement said. It did not say how many people were affected.

"Any consumer who is trying to get covered ahead of the deadline for March 1 coverage will be able to do so," it said.

A senior U.S. health official said last week that nearly 7.5 million people had signed up for 2015 Obamacare health plans through the federal exchange, and that demand was increasing as the Feb. 15 deadline approached.

Enrollment for individual plans, created as part of the Affordable Care Act, commonly known as Obamacare, opened for the second year of coverage on Nov. 15. The plans are sold on for 37 states. The other 13 states plus Washington, D.C., run their own websites.

The Obama administration said on Monday that 2015 Obamacare subsidies are averaging $268 a month for people in the 37 states who have qualified for federal assistance.

An administration statement said subsidies had reduced average monthly premiums to $105 as of Jan. 30 for 6.5 million people who qualified through the federal website.

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How Big Data Will Transform Our Economy And Our Lives In 2015

How Big Data Will Transform Our Economy And Our Lives In 2015 | Healthcare and Technology news |

The great Danish physicist Niels Bohr once observed that “prediction is very difficult, especially if it’s about the future.” Particularly in the ever-changing world of technology, today’s bold prediction is liable to prove tomorrow’s historical artifact. But thinking ahead about wide-ranging technology and market trends is a useful exercise for those of us engaged in the business of partnering with entrepreneurs and executives that are building the next great company.

Moreover, let’s face it: gazing into the crystal ball is a time-honored, end-of-year parlor game. And it’s fun.

So in the spirit of the season, I have identified five big data themes to watch in 2015. As a marketing term or industry description, big data is so omnipresent these days that it doesn’t mean much. But it is pretty clear that we are at a tipping point. The global scale of the Internet, the ubiquity of mobile devices, the ever-declining costs of cloud computing and storage, and an increasingly networked physical word create an explosion of data unlike anything we’ve seen before.

The creation of all of this data isn’t as interesting as the possible uses of it. I think 2015 may well be the year we start to see the true potential (and real risks) of how big data can transform our economy and our lives.

Big Data Terrorism

The recent Sony hacking case is notable because it appears to potentially be the first state-sponsored act of cyber-terrorism where a company has been successfully threatened under the glare of the national media. I’ll leave it to the pundits to argue whether Sony’s decision to postpone releasing an inane farce was prudent or cowardly. What’s interesting is that the cyber terrorists caused real fear to Sony by publicly releasing internal enterprise data — including salaries, email conversations and information about actual movies.

Every Fortune 2000 management team is now thinking: Is my data safe? What could happen if my company’s data is made public and how could my data be used against me? And of course, security software companies are investing in big data analytics to help companies better protect against future attacks.

Big Data Becomes a Civil Liberties Issue

Data-driven decision tools are not only the domain of businesses but are now helping Americans make better decisions about the school, doctor or employer that is best for them. Similarly, companies are using data-driven software to find and hire the best employees or choose which customers to focus on.

But what happens when algorithms encroach on people’s privacy, their lifestyle choices and their health, and get used to make decisions based on their race, gender or age — even inadvertently? Our schools, companies and public institutions all have rules about privacy, fairness and anti-discrimination, with government enforcement as the backstop. Will privacy and consumer protection keep up with the fast-moving world of big data’s reach, especially as people become more aware of the potential encroachment on their privacy and civil liberties?

Open Government Data

Expect the government to continue to make government data more “liquid” and useful – and for companies to put the data to creative use. The public sector is an important source of data that private companies use in their products and services.

Take Climate Corporation, for instance. Open access to weather data powers the company’s insurance products and Internet software, which helps farmers manage risk and optimize their fields. Or take Zillow as another example. The successful real estate media site uses federal and local government data, including satellite photography, tax assessment data and economic statistics to  provide potential buyers a more dynamic and informed view of the housing market.

Personalized Medicine

Even as we engage in a vibrant discussion about the need for personal privacy, “big data” pushes the boundaries of what is possible in health care. Whether we label it “precision medicine” or “personalized medicine,” these two aligned trends — the digitization of the health care system and the introduction of wearable devices — are quietly revolutionizing health and wellness.

In the not-too-distant future, doctors will be able to create customized drugs and treatments tailored for your genome, your activity level, and your actual health. After all, how the average patient reacts to a particular treatment regime generically isn’t that relevant; I want the single best course of treatment (and outcome) for me.

Health IT is already a booming space for investment, but clinical decisions are still mostly based on guidelines, not on hard data. Big data analytics has the potential to disrupt the way we practice health care and change the way we think about our wellness.

Digital Learning, Everywhere

With over $1.2 trillion spent annually on public K-12 and higher education, and with student performance failing to meet the expectations of policy makers, educators and employers are still debating how to fix American education. Some reformers hope to apply market-based models, with an emphasis on testing, accountability and performance; others hope to elevate the teaching profession and trigger a renewed investment in schools and resources.

Both sides recognize that digital learning, inside and outside the classroom, is an unavoidable trend. From Massive Open Online Courses (MOOCs) to adaptive learning technologies that personalize the delivery of instructional material to the individual student, educational technology thrives on data. From names that you grew up with (McGraw Hill, Houghton Mifflin, Pearson) to some you didn’t (Cengage, Amplify), companies are making bold investments in digital products that do more than just push content online; they’re touting products that fundamentally change how and when students learn and how instructors evaluate individual student progress and aid their development. Expect more from this sector in 2015.

Now that we’ve moved past mere adoption to implementation and utilization, 2015 will undoubtedly be big data’s break-out year.

Irina Donciu's curator insight, January 15, 2015 4:33 AM

The great Danish physicist Niels Bohr once observed that “prediction is very difficult, especially if it's about the future.”

Maryruth Hicks's curator insight, September 8, 2015 11:27 AM

Digital learning and big data in education might lead to educational reform!!

Draft Medicare ACO rules would allow more time with less risk - Modern Healthcare

Draft Medicare ACO rules would allow more time with less risk - Modern Healthcare | Healthcare and Technology news |

The CMS is planning major changes to the financial incentives for Medicare accountable care organizations in a revamp aimed at preventing hospitals and medical groups from dropping out of the initiative.

A proposed rule issued late Monday (PDF)would alter the structure of the Medicare Shared Savings Program, an attempt launched in 2012 under the Patient Protection and Affordable Care Act to reduce U.S. health spending with new incentives that seek to improve the quality and efficiency of healthcare.

Those incentives have been a battleground between policymakers and the healthcare industry since the program's start. Policymakers have sought more substantial incentives—penalties as well as rewards—as a means to hasten changes to the way healthcare is delivered. Hospital officials and physicians have called for less financial risk so they can build the infrastructure and expertise they need to succeed.

The rules adopted in 2011 require accountable care organizations to face penalties after the first three years unless they volunteer to assume downside financial risk earlier in exchange for bigger bonuses if they do well.

The industry appears to have scored a victory in the proposed rules, which acknowledge widespread concern among the participants and experts that some organizations may need more time before penalties take effect. The switch after three years “may be too steep” for organizations that lack experience and infrastructure to achieve quality and cost-saving targets and organizations may exit as a result. Even those that perform well but “not yet ready” to accept the risk of penalties may depart without another option, the agency said.

Medicare, under the revised structure, would no longer require organizations to face penalties after the third year, but they could forgo penalties only if they meet certain criteria. ACOs that fail to slow spending in their first two years would be excluded. All ACOs must assume the risk of penalties after six years if they want to remain in the program.

In order to make it more appealing for ACOs to jump into the riskier track, the CMS would reduce the potential bonuses after the third year in the safer track to 40% from 50%.

In another bid to make riskier contracts more attractive, the agency wants to add a new option, or a third track, that would include potential penalties and bonuses and would use new methods to identify which patients are included in the ACO. Organizations in this new track could keep up to 75% of what they save. They also would be responsible for up to 75% of their losses, but the amount could be reduced based on quality performance. The agency capped the bonuses at 20% of ACOs' benchmarks and losses at 15%.

Participants in the third track would also have a list of patients at the start of the year whose care and costs they must manage. Under the current rules, Medicare identifies beneficiaries as included in the ACO at the end of the year based on how much care they received from the providers in the network. ACOs have called on the CMS to identify the patients at the beginning of the year to allow more focused improvement efforts.

The CMS has rapidly expanded the Medicare Shared Savings Program over the past three years, and it is perhaps one of the most visible efforts under the law to tame the nation's healthcare bill. But many experts feared the widespread enthusiasm for the program would wane significantly if the CMS declined to modify the program to keep less experienced providers on board.

All but five of more than 300 ACOs in the program chose to forgo the penalty. That may have been wise, because their financial performance has been uneven. Only a quarter of ACOs launched in 2012 and 2013 have saved enough to earn bonuses.

Clif Gaus, chief executive officer of the National Association of ACOs, said he was “pleased and disappointed” by the proposed rule. He praised the proposal to give ACOs more time before they face penalties for financial performance, but he also said the decision to couple that with a smaller potential bonus was “counterproductive.”

Many ACOs need the additional time to prepare for the risk of potential penalties, he said. “Three years is not enough.”

Efforts to revamp the delivery of care will require more time as ACOs build new relationships, new infrastructure and learn and adapt early redesign efforts, he said. “It's probably a decade-long process to redesign all of the care processes that lead to both better care and more appropriate care,” based on experience of organizations such as Geisinger Health System or Intermountain Healthcare, he said. “There's a big learning curve for many ACOs,” he said. “They are almost new businesses starting from scratch.”

The association surveyed Medicare Shared Savings Program ACOs in October and found two-thirds were somewhat or highly unlikely to continue if they were required to accept penalties. About 20% of the MSSP ACOs responded. “There's too much risk for the amount of reward” under contracts with penalties and bonuses, he said.

Coastal Carolina Quality Care in New Bern, N.C., entered Medicare's accountable care program in 2012 and saw its expenditures increase a marginal 0.6% against projections during the first year.

“It's very unlikely that we would continue” without the continued option to forgo penalties, said Stephen Nuckolls, Coastal Carolina's CEO.

Dr. Farzad Mostashari, founder and chief executive of accountable care contractor Aledade, said the option to continue without penalties may benefit some smaller organizations in the program. “There are a lot of home grown ACOs,” said Mostashari, a former national coordinator for health information technology at HHS. “It takes them a long time to get going.”

Policymakers, however, likely also want to discourage organizations from abusing Medicare's shared savings program as a way to consolidate market clout with little interest in achieving the program's savings goals, he said. The proposed rule, however, may do little to discourage them from remaining in the program. The proposed criteria for ACOs to continue without penalties, Mostashari said, is “a pretty low bar."

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21st Century Cures Act Passes U.S. House of Representatives, Moves to Senate

21st Century Cures Act Passes U.S. House of Representatives, Moves to Senate | Healthcare and Technology news |

On Friday afternoon, July 10, the U.S. House of Representatives passed the 21st Century Cures Act, H.R. 6, by a vote of 344-77, sending it to the U.S. Senate. The main focus of the legislation is an attempt to remove regulatory roadblocks in the review process for new pharmaceuticals and medical devices on the part of the Food and Drug Administration (FDA). In addition, according to, the federal government’s official legislation tracking service, “Requirements are established [in the bill] for interoperability and certification of health information technology. Practices that discourage the exchange of electronic health information are prohibited.”

After the House’s passage of the bill, the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) released a statement attributed to Leslie Krigstein, interim vice president of public policy, praising the bill’s focus on interoperability.  “The 21st Century Cures Act is a landmark piece of legislation that will move our nation closer to a 21st Century healthcare system,” Krigstein said in the statement. “As recognized in this bill, health information technology will serve as the foundation to foster many of the ideologies in delivering lifesaving cures to patients more rapidly.”

Krigstein’s statement went on to say that “The Committee's choice to tackle the complex issue of interoperability is to be commended. Without nationwide interoperability, we will be unable to derive the value promised by the nation's $30 billion investment in electronic health records (EHRs). Expediting cures to patients will not be possible without a health information highway that allows providers and patients the data they need, when and where they need it.”

Krigstein added that “CHIME appreciates the Committee's recognition that harmonizing standards adoption will exponentially move interoperability forward. We agree that clear, enforceable standards are necessary to foster nationwide interoperability. The inclusion of increased testing requirements for certified products, including 'real world' testing, is a priority for CHIME members as a means to bring value to the certification program. We appreciate the Committee's inclusion of the need to ensure the information in one's EHR belongs to the patient. We hope that this language will begin a sincere dialogue on the need to address the ongoing patient safety and care coordination challenges arbitrarily imposed by the lack of a national approach to patient identification. Without a patient identity matching strategy, patient data matching errors and mismatches will become exponentially more problematic and dangerous.”

The CHIME statement concluded by stating that “We view this legislation as a starting point in the conversation on health IT reform. We hope to build on the language in 21st Century Cures Act to ensure the Meaningful Use Program, among other ongoing federal policy initiatives, enable the implementation and use of EHR systems to meaningfully improve patient care.”

Additional praise for the House of Representatives’ passage of the bill came from the Charlotte-based Premier healthcare alliance. Attributed to Blair Childs, Premier’s senior vice president of public affairs, it said, “Members of the Premier healthcare alliance commend House leadership for the passage of new health information technology (HIT) interoperability requirements within the 21st Century Cures legislation that passed overwhelmingly today. Requiring free and secure exchange of health information among disparate IT assets will improve patient care, reduce costs, and unlock “big data” in healthcare.  This is also an essential ingredient in enabling providers to improve the health of a defined population health across the care continuum.” That statement concluded by stating that “We are encouraged by the Senate’s equal focus on achieving interoperability among EHR systems.”

How did the legislation pass the House, and what are its chances in the Senate? Alex Lash, writing Friday in, wrote this: Passage in the House was due in no small part to the bill’s original sponsors, Reps. Diana DeGette (D-CO) (pictured) and Fred Upton (R-MI), whose work—appearances, town halls, info-gathering sessions—for more than a year leading up to the vote at times resembled a permanent campaign. But the Cures Act still must get through the Senate, where single opponents can often hold popular legislation hostage,” Lash noted. “And, despite the strong support in the House, critics are asking if the rush to approve new drugs might tilt away from traditional safeguardstoo much. Fiscal hawks will no doubt pick through the costs associated with the bill, as reported last month by the Congressional Budget Office.”

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Is Synchrony on the Horizon When It Comes to Harmonizing MD Quality Reporting Efforts?

Is Synchrony on the Horizon When It Comes to Harmonizing MD Quality Reporting Efforts? | Healthcare and Technology news |

As if federal healthcare officials hadn’t laid out enough clarity around where things are going in terms of incentives to providers in U.S. healthcare during HIMSS15, on Thursday, Apr. 23, the federal Centers for Medicare and Medicaid Services (CMS) clarified things even further. As HCI reported  last week, the agency announced, via a blog post by Patrick Conway, M.D., principal deputy administrator and chief medical officer at CMS, the release of its strategic vision for physician quality reporting programs, describing a long-term vision for the agency’s M.D. quality reporting program, and a vision for physician quality reporting going forward.

As the blog noted, the agency believes that five principles will ensure that physician quality measurement and public reporting play a critical role in improving care, those five being:

  • Input from patients, caregivers, and healthcare professionals, which will guide those programs.
  • Feedback and data drives rapid-cycle quality improvement
  • Public reporting providers meaningful, transparent, and actionable information.
  • Quality reporting programs rely on an aligned measure portfolio.
  • Quality reporting and value-based purchasing programs are aligned.

In the CMS blog, Dr. Conway noted that “CMS relies heavily on quality measurement and public reporting to facilitate the delivery of high quality care. This strategic vision articulates how we will build up on our successful physician quality reporting programs to reach a future-state where quality measurement and public reporting are optimized to help achieve the CMS quality strategy’s goals and objectives.”

Conway further noted that “These quality measurements and public reporting goas and initiatives encourage stakeholder engagement; reduce participation burden for healthcare professionals; and support meaningful public reporting.”

Interestingly, also at the same time last week, the Oliver Wyman consulting firm reported that the number of accountable care organizations (ACOs) nationwide continued to rise in 2014, to the extent that nearly 70 percent of the U.S. population now lives in localities served by ACOs, and 44 percent lives in areas served by two or more ACOs. What’s more, the Oliver Wyman reported noted, ACOs of all kinds now collectively serve between 49 and 59 million U.S. residents, or between 15 and 17 of the nation’s people.

The synchrony in those two developments is worth noting. As HCI reported earlier this month, the U.S. Congress passed, and President Obama signed, legislation eliminating the much-criticized sustainable growth rate (SGR) formula for Medicare physician payment, and within that legislation was contained an overhaul of physician quality reporting programs under Medicare. Interestingly enough, as more and more accountable care programs emerge in U.S. healthcare, with many private-payer programs mimicking some of the core elements of the Medicare program’s ACO programs, over time, the vast majority of U.S. physicians are coming under contract with public and/or private payers that are measuring their outcomes. Now, one of the longstanding complaints about all the various measurement programs out in the industry has been how many there are and how complicated their differing requirements are making life and practice for practicing physicians.

What inevitably seems to be happening here is that some kind of harmonization of outcomes measurement is evolving forward organically. It is still quite nascent; yet it is also clear. As I reported during HIMSS15, the Blue Cross Blue Shield Association’s Blue Distinction Total Care Program is pulling many tens of thousands of practicing physicians into its nationwide umbrella population health program, creating a quality outcomes reporting program within its population health program that could become one of a few dominant such programs in the U.S. private insurer sector.

So the reality is that the long-anticipated harmonization of physician quality reporting emerging both on the public (Medicare) and private health insurer sides of the industry could be starting to come into focus now as we speak. The opportunities coming out of the gradual harmonization of outcomes reporting and measurement efforts across the industry will certainly be a welcomed development for practicing physicians nationwide—and a signal that healthcare quality measurement is reaching a new, more impactful stage.

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How bill awaiting congressional OK achieves Medicare savings

How bill awaiting congressional OK achieves Medicare savings | Healthcare and Technology news |

Details of how the bipartisan bill rewriting Medicare reimbursement of doctors, awaiting congressional approval this month, would squeeze savings from the health care program for the elderly:


Current law: Most people pay $105 monthly for medical coverage, which is 25 percent of the program's cost. The prescription drug premium varies widely, according to plan and region.

People earning at least $85,000 annually pay higher premiums, which grow as income increases. Top-earning individuals making more than $214,000 pay 80 percent of the program's costs, or $336 monthly for medical coverage. The income thresholds double for couples.

Medicare legislation: Starting in 2018, some top earners would pay higher premiums, starting with people making over $133,500. The highest 80 percent bracket would start for people earning over $160,000.


Current law: Income levels that trigger higher premiums have been frozen since 2011. In 2020, they are scheduled to increase by an amount equaling all the inflation that will have occurred between 2011 and 2020.

Medicare legislation: Unchanged except in 2020, the income levels will grow by the inflation that occurs only in 2019. This means the thresholds would be lower than otherwise and more people will breach them and owe larger premiums.


Current law: People can purchase policies that insure virtually all costs not covered by Medicare.

Medicare legislation: Starting with people buying new policies in 2020, coverage would be limited to costs above Medicare's deductible for medical costs, which is currently $147 monthly but could be higher by then.

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Medicare bill helps doctors and kids, but deficit foes cool

Medicare bill helps doctors and kids, but deficit foes cool | Healthcare and Technology news |

Republicans say bipartisan legislation reworking how Medicare pays doctors is a milestone toward curbing the huge, growing benefit program.

It's "the first real entitlement reform in decades," says House Speaker John Boehner, R-Ohio, using Washington jargon for programs that automatically pay people who qualify.

Many deficit foes are less impressed.

A look at the debate over how significantly the legislation, which is nearing congressional approval, would bolster Medicare's finances:



Nothing a few trillion bucks wouldn't fix. The program, which helps pay medical bills for more than 50 million elderly people, is expected to spend more than $600 billion this year. That's one-sixth of the entire federal budget. The nonpartisan Congressional Budget Office expects that price tag to nearly double by 2025 as more baby boomers retire.



The budget office says the Medicare legislation would cost $214 billion over the coming decade. The House approved it overwhelmingly March 26, and Senate passage seems likely this month.

Besides helping physicians, the bill finances health care for children and low-income people. Most of its cost is for replacing a law that has threatened repeated, steep reductions in physician reimbursements for treating Medicare patients. Doctors say such cuts, which Congress usually prevents, could make them stop seeing Medicare recipients.

Most costs over the next decade - $141 billion - would be financed by making federal deficits even larger. To pay for around half the rest, federal payments would be reduced to hospitals, home health care companies and other providers.

The bill would also squeeze $35 billion from beneficiaries.

Most - $34 billion - would come from raising monthly premiums for medical care and prescription drugs for top-earning Medicare recipients beginning in 2018, and making additional higher-income recipients pay larger premiums starting in 2020.

An additional $1 billion would come from requiring people buying Medigap insurance, which covers costs Medicare doesn't pay, to incur out-of-pocket expenses before Medigap coverage begins. This would start for people buying new policies in 2020. Currently, some Medigap policies protect purchasers from virtually any out-of-pocket costs.

It's these beneficiary changes Republicans are crowing about.



To a degree, yes.

They modestly curbed Medicare without raising taxes, which Democrats normally demand in exchange for squeezing benefit programs.

There's true savings because the more Medicare recipients pay in premiums, the less the program needs government money. And making Medigap policy holders pay more for their own care should encourage them to watch their medical spending, easing some Medicare expenses.

Republicans say the initial $35 billion in savings would escalate the second decade from now as the number of Medicare recipients and medical costs grow.

They cite an estimate by Douglas Holtz-Eakin, a Republican-appointed former Congressional Budget Office director, that those changes would reduce Medicare spending by $230 billion from 2026 through 2035. This helped win votes for the bill from House conservatives unhappy over its projected deficit increases between now and 2025.



Critics say saving $35 billion over a decade pales compared to the nearly $9 trillion Medicare is expected to spend over that period. That's a saving of about one-third of 1 percent.

They say President Barack Obama, House Republicans and the 2010 bipartisan commission headed by former Democratic White House chief of staff Erskine Bowles and former Sen. Alan Simpson, R-Wyo., have all proposed more robust plans for bolstering Medicare than what's in the bill.

"These are wimpy forms of important policies," said Maya MacGuineas, president of the bipartisan Committee for a Responsible Federal Budget.

The critics say Holtz-Eakins' estimate covered only potential savings during the decade he examined, not the Medicare bill's net expenditures. They note that the budget office, Holtz-Eakin's old employer, warned of "considerable uncertainty" over such long-range predictions and said the bill might save or cost money two decades from now, with small savings in the middle of their estimate range.



That's debatable.

Under President George W. Bush, Congress increased Medicare medical premiums for higher-earning recipients for the first time, as part of the 2003 law creating the program's prescription drug coverage. The higher premiums started in 2007, and around 5 percent of recipients pay them today.

Obama's 2010 health care law required upper-income people to pay higher prescription drug premiums, too.

That law also froze the income levels above which people pay higher premiums through 2019, instead of increasing those thresholds annually with inflation. This meant more people owed the bigger premiums each year as their incomes grew.

Republicans don't consider those savings true reform because they came packaged with new, expensive benefit programs - Medicare's prescription drug coverage and Obama's health care overhaul.

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Crossing the Threshold Into a New Healthcare Policy Era

Jeff Smith, vice president of public policy at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), is helping the healthcare IT executive leaders’ national association to make major waves on Capitol Hill and at federal agencies these days. The Washington, D.C.-based Smith sees the present moment as a time of great opportunity for CHIME and other healthcare professional associations to have a real impact on federal policymakers in Congress, the administration, and federal agencies, as healthcare IT becomes ever more critical to healthcare system reform efforts.

Last week, Smith sat down with HCI Editor-in-Chief Mark Hagland at the CHIME Washington, D.C. offices, to converse about some of the policy and political currents that CHIME and the other healthcare professional associations are working through these days. Below are excerpts from their interview.

When you look at the legislative and regulatory landscape in Washington, D.C. right now, how would you characterize that landscape overall?

To use a maturity analogy, over the past five years, we’ve gained enough experience with health IT policy to know that there are areas for improvement [with regard to policy development]. And I think when you look at the legislative and regulatory landscape, you see a lot of people in Congress and in the federal agencies who want to help. And when multiple parties want to help, multiple parties have different solutions. So for those of us who work in health IT policy, the real challenge is understanding which policies will jibe together, and which will be detrimental. So whether you’re talking about the Ellmers bill that would shorten the meaningful use reporting period to 90 days [the Flexibility in Health IT Reporting Act of 2015, or “Flex-IT Act,” introduced in mid-January by Rep. Renee Ellmers (R-N.C.)], or the SOFTWARE [Sensible Oversight for Technology which Advances Regulatory Efficiency] Act, which would essentially prohibit the FDA [Food and Drug Administration] from regulating health IT in the same way that agency regulates medical devices; what you see is people trying to be helpful.

The challenge for us is trying to figure out which bills are going to be helpful, which bills are going to be a complement to what the federal agencies are doing, and which bills are going to be the opposite. Health IT is now very much on the policy radar in the last year and a half. And for the most part, that’s a very positive development, because it means that people are paying attention; but it also means they could mess things up. So it’s a very busy space, a very active time for health IT policymaking.

Do you think there’s a level of understanding now on the Hill regarding what’s actually going on in the healthcare industry?

Yes, I would say that the degree of understanding on the Hill is actually higher than it was five years ago. But there’s a constant turnover of members and staffers; so there’s always going to be a need to educate, and to help to flatten the learning curve.

What are the biggest issues for you right now as an association, with regard to policy initiatives on the Hill?

In comparison to other years, the SOFTWARE Act, trans-industry cybersecurity legislation that might affect healthcare as one of other industries, as well as other pieces of legislation, are all out there and in play on the Hill. Meanwhile, meaningful use is still a very big deal for us. We are trying to make that program sustainable, trying to figure out if there is a gap between what the federal agencies want to do with meaningful use, and what’s going to make it most pragmatic for those who have to implement it.

So right now, that’s where there’s a lot of focus for us. And having the Stage 3 rule proposed now will help, as we’ll be able to see where the federal agencies are at mentally; so we can go back and see where they’re on track and where they need help. I would be surprised if there were additional pieces of legislation coming out this year relative to meaningful use, depending on how the industry internalize the proposed rules, and depending on how HHS [the Department of Health and Human Services] articulates final rules, you could see legislation being devised. But a lot of it goes back to macro-dynamics. And by that, I mean is, are more than 50 percent of physicians being successful with meaningful use? I think if that number gets closer to 75 percent, policymakers will be put more at ease. If hospital participation remains at the level it is now, they’ll be OK. But if Stage 3 is seen as a problem, then we’ll have to figure out what to do.

Tell me more about CHIME’s initiative around the national patient identifier issue?

With regard to our efforts around the concept of a national patient identifier, essentially, CHIME, through a host of partner organizations, decided that we needed to take steps in the private sector to really raise the profile of the safety and cost implications of misidentification. And we were lucky enough to have a well-timed meeting with Peter Diamandis, CEO of the XPrize Foundation. And essentially, we were able to convince him that accurate patient identification is a national imperative. We do not currently have the cultural, political, social, cultural, or technical climate to achieve 100-percent accuracy on patient identification through legislation or regulation; but we believe that it is time that the private sector take bold steps in this area.

We’re still very much in the scoping phase, and are looking at a relatively length process; this is not going to happen in the next few months. But we’re hoping that after we scope out the criteria and open up the challenge to anybody and everybody who think they have the solution, we can develop something that sits in the public trust, is not a for-profit or proprietary solution, but which will lead to positive identification, and is scalable across the industry. And we’ve already got some buy-in from some vendors and other organizations. We’ve got some important players on board. You’ll be hearing a lot more about it in the coming weeks.

What’s different about this is it’s not going to e a governmental solution. We think there’s plenty of opportunity for a non-governmental actor to be the honest broker. We think there’s a lot of room for a non-profit organization to come in to be the organization that could be that honest broker and broker solutions. And honestly, Russ [CHIME president and CEO Russell P. Branzell] is much closer to this than I am, but he and others have had conversations with some of the folks who have pushed back on this in the past, and they’re not pushing back on this idea; they want to make sure it’s private and that it’s secure. There will always be a contingent of tinfoil-hat people. But we’re hoping that if we can get the commonsensical people and even some people who haven’t been that commonsensical, to partner with us, those on the fringe will remain on the fringe, and those 25 people who are crazy and loud will stay on the fringe, and we’ll say, OK, we acknowledge you’re out of 300 million people.

What should CIOs be thinking now, with regard to the current waves of healthcare policy trends, and what could happen in the next few years?

In their minds, they should be dispelling any rumor that things are ever going to be the way they used to be. We’ve crossed the threshold into a new era where the government is involved in health IT, and healthcare IT leaders need to know that we have to start acting like partners to healthcare policy leaders in Washington.


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Hospital Profits Soar As Obamacare Prescribes More Paying Patients

Hospital Profits Soar As Obamacare Prescribes More Paying Patients | Healthcare and Technology news |

Hospital operators continue to see profits and revenue not seen in a decade thanks to the Affordable Care Act and related efforts to sign up uninsured patients to coverage so facilities can reduce unpaid medical bills.

Large hospital operators HCA Holdings (HCA), Tenet Healthcare (THC) and Community Health Systems (CYH) in the last month issued robust 2014 earnings, revenues and large declines in uncompensated care costs, a key measure of expenses.

“We reported Tenet’s strongest quarterly EBITDA in more than 10 years,” Tenet chief executive officer Trevor Fetter boasted last week of a key earnings acronym in the hospital chain’s 2014 fourth quarter.

Hospitals have been working to enroll uninsured patients. Tenet said its “Path to Health program” launched in 2013 continued to enroll more patients in this year’s second open enrollment period through the use of financial counselors, direct mail marketing and community events.

“We held nearly 800 outreach and enrollment events, reaching tens of thousands of people in our priority markets,” Fetter said. “Our daily enrollments have increased by more than 60% during this enrollment period and we estimate that we will exceed the number of exchange enrollments that we achieved last year.”

Hospital operators are reporting more paying patients and fewer uninsured, which means far fewer unpaid medical bills. “For the last four quarters, the decline in self-pay admits and adjusted admits and the increase in Medicaid in expansion states have grown quarter over quarter,” Community Health CFO Larry Cash said.

HCA reported a decline of nearly 9 percent in “same facility self-pay and charity admissions,’ executives said on its fourth quarter earnings call.  “These represent 7.2% of our total admissions compared to 8.3% last year and has continued to turn favorable for the company,” HCA chief financial officer William Rutherford told analysts.

But it wasn’t just the health law that helped hospitals with the improving economy and more Americans with jobs and commercial insurance boosting health facility finances.

“ACA enrollments bore a lot of fruit for hospitals last year as previously uninsured patients sought healthcare, but year 2 is a different ball game,” Fitch Ratings’ Senior Director of Healthcare Megan Neuburger said.“We can’t discount other factors like greater disposable income as the economy improves or seasonal issues like the flu."

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What Do Women Know About Obamacare That Men Don’t?

What Do Women Know About Obamacare That Men Don’t? | Healthcare and Technology news |

For the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male – a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men – and in fact, some evidence indicates that they were less likely to be uninsured than males .

What is clear that many women were highly motivated to obtain coverage under the health reform law – most likely because they want it, and need it.

It’s widely accepted that women tend to be highly concerned about health and health care; they use more of it than men, in part due to reproductive services, and make 80 percent of health care decisions for their families . The early evidence also suggests that women who obtained coverage during open enrollment season last year actively used it.  According to Inovalon, a company that tracks and analyzes data for health plans and providers, people who used the coverage they bought through the marketplaces last year tended to be older, sicker, and more female than the general commercially insured population. As of June 2014, 41 percent of females who purchased coverage through exchanges had face-to-face visits with health care professionals, versus 32 percent of males.

Those numbers are consistent with the notion that many women who signed up for coverage under the ACA had preexisting conditions or other health issues that led them to seek treatment.  In some cases, their pre-ACA insurance may have excluded those conditions, or the preexisting conditions may have prevented them from obtaining coverage at all.

What’s more, as HHS points out in a recent report, there are plenty of benefits in the ACA’s qualified health plans that are especially attractive to women. These include coverage at no out of pocket cost for many preventive measures, such as mammograms or screening for gestational diabetes.  An estimated 48.5 million are benefitting from that provision of the law alone.

Other data support the notion that many U.S. women are in disproportionately higher medical need, relative to men – even adjusting for the fact that they typically live longer.  According to an analysis of Medical Expenditure Panel Survey data from the Agency for Healthcare Research and Quality, women constitute nearly 60 percent of people in the top tenth of medical expenditures in 2011 and 2012.  Most of those in the top tenth of spending are either ages 45 to 64, or 65 and older.

One obvious conclusion is that many, and perhaps most, of those who’ve benefited from coverage under the Affordable Care Act are female – and especially women in middle age and beyond. Another is that, if the Supreme Court rules in King v. Burwell that subsidized coverage can’t be obtained through the federal marketplace, women will be disproportionately harmed.

A case in point: Rosemary Forrest, 63, who lives in Augusta, Georgia.  Laid off from her job at a university science lab at age 55, she spent five years unemployed and without health insurance.   She now works as a contractor to a small nonprofit agency; battling painful osteoporosis, she sometimes earns less than $400 a month.  Last year, when the federal health insurance marketplace went live, she signed up for coverage.  This year, she re-enrolled, and after federal tax credits, pays $86 per month in premiums.

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Is Healthcare Spending About To Accelerate?

Is Healthcare Spending About To Accelerate? | Healthcare and Technology news |

Bend a resilient object and it will spring back with a vengeance once released from your grip. Is that what is about to happen to healthcare spending?

For years now, experts have been debating ways to “bend the cost curve ” – take the sharp rise in healthcare costs, picture a rapidly ascending line on a XY axis, and slow it down, bend it so it moves horizontally to the X axis.

In the last few years, we seem to have bent the curve as we’ve hoped to. Healthcare spending is growing more slowly than it has in decades. The federal government recently reported that: “The Congressional Budget Office now estimates that Federal spending on Medicare and Medicaid in 2020 will be $188 billion below what it projected as recently as August 2010.”

But this good economic news may soon come to an end, and the pent-up energy of the healthcare economy could snap back and break our budgets if we are not vigilant.

Experts are still debating why healthcare costs have slowed down of late. Some people think the Affordable Care Act, aka Obamacare, has helped to bend the cost curve. Some posit that the rise of high deductible health insurance plans accounts for a good deal of the savings.  But almost everyone agrees that the great recession of 2008 has played a leading role in reducing the growth of healthcare expenditures. When people don’t have money to spend on healthcare, they (surprise, surprise) spend less money on healthcare.

In a New England Journal of Medicine article, Charles Roehrig from the Altarum Institute mapped out what healthcare spending would have looked like if the great recession hadn’t happened, and what it would have looked like if healthcare spending had dropped in accordance with the size and depth of the recession. The picture shows that actual spending lies right between these two extremes:

The recession reduced healthcare spending. But not as much as you would think, because other factors are driving costs up, such as raising healthcare prices and the aging of our population.

Moreover, Roehrig warns that when we experience a stronger economic recovery, healthcare spending could rebound. Thanks to the ACA, more people have health insurance, and health insurance is well-known to increase the demand for healthcare services.

Pharmaceutical companies continue to bring out expensive “specialty drugs,” which Roehrig believes on their own could contribute a half percentage point per year to healthcare expenditures.

Helen Logan's curator insight, December 8, 2019 11:28 PM
This article discusses money spent on healthcare and how recession has affected this spending. It is interesting how it names the 2008 recession as one of the main reasons for decreased spending on healthcare. The Great Recession is a topic we have studied in class so I thought it was an interesting take on healthcare spending that relates to what we are currently learning. I think it is unfair the healthcare is so expensive in the United States so I am trying to understand why this is.!

Health Plan Enrollment Numbers Show Importance of Coming Supreme Court Case

Health Plan Enrollment Numbers Show Importance of Coming Supreme Court Case | Healthcare and Technology news |

A new report from the Obama administration highlights the very high stakes for a challenge to the Affordable Care Act before the Supreme Court. The subsidies that the court may eradicate are helping a large majority of customers pay for their health insurance.

The report is the first time that the Department of Health and Human Services has delivered some numbers on exactly who is signing up for health insurance for 2015, since the open enrollment period began in mid-November.

The data that was used isn’t perfect or complete — and many commentators rightly grumbled about its shortcomings — but the report is still a helpful snapshot of whom the new insurance markets are serving. It’s particularly detailed in looking at the people using the marketplaces in the 37 states that are letting the federal government manage their enrollment.

Over all, it found, customers who were using to pick insurance plans — some new customers, and some renewing customers — were overwhelmingly likely to qualify for federal subsidies to help them pay their premiums. On average, the report found that 87 percent of these customers were eligible for subsidies, with higher percentages in some states — up to a high of 95 percent in Mississippi.

Those numbers don’t include everyone in the marketplace; people who were enrolled in plans this year and simply automatically renewed them weren’t counted. But it’s reasonable to think that the proportion is representative. Last year’s number at the end of open enrollment was an average of 85 percent. A different report, also published Tuesday, said that a total of 6.5 million people in those states had selected plans or been automatically renewed into plans as of last week.

The plaintiffs in the Supreme Court case, called King v. Burwell, argue that the law does not allow the subsidies to help insurance customers in the states letting the federal government run individual insurance marketplaces. And if the court agrees, all those people would lose their subsidies, and many would be priced out of the market.

We’ve written before about the disruptions such a ruling would cause. But as more people sign up for health insurance — and more of them are relying on federal subsidies — the potential impact of the decision grows.

So far, outside of official briefs, administration officials have been quiet about any concerns about the case. Asked several times last week in a news conference about possible contingency planning, the H.H.S. secretary, Sylvia Mathews Burwell, insisted that her department was confident that the government would win in court and that it was focusing its efforts on signing up new insurance customers. But a department news release Tuesday highlighted the high rate of subsidy, suggesting that federal officials were aware of the case’s possible reach.

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