Blog Home

Archive for September, 2012




This Week’s Health Wonk Review


September 28th, 2012

Wing of Zock has this week’s Nationals Play-Off Edition of the Health Wonk Review. Jennifer Salopek presents a nice line-up of posts, including the Health Affairs Blog post by Michael Saks looking at what the polls really tell us concerning public attitudes about the Affordable Care Act.

Read the rest of this entry »

Implementing Health Reform: The Multi-State Plan Program


September 27th, 2012

On September 21, 2012, the Office for Personnel Management (OPM) issued a request for comments on a Multi-State Plan Program (MSPP) application. The MSPP plays an important role under the Affordable Care Act (ACA). The ACA requires the OPM, which administers the Federal Employees Health Benefits Program, to contract with at least two Multi-State Plans (MSPs); each of these MSPs must by 2014 offer plans through the individual and small group exchanges in at least 60 percent of the states, and by 2017 in all states.

At least one of the MSPs must be non-profit and at least one must not offer the option of abortion coverage. The MSPP is intended to increase competition and ensure plan choice in state health insurance markets, which are now often highly concentrated.

The MSPP is a federal program run by a federal agency—the OPM—but will offer products through the state-level exchanges. The ACA itself imposes a number of requirements on MSPs, although most are requirements that apply to all qualified health plans under the statute. The ACA also requires MSPs to comply with applicable FEHBP requirements and minimum standards; it authorizes the OPM to negotiate terms and conditions of participation with MSPs as necessary to protect consumers, including medical loss ratios, profit margins, and premiums. MSPs must also be licensed by states in which they do business, and must meet all requirements of state law not inconsistent with the MSP requirements.

Read the rest of this entry »

Modest Payment Redistribution Means That Hospital Quality Program Is Working, Not Failing


September 27th, 2012

Rachel Werner and R. Adams Dudley’s article on Medicare’s hospital value-based purchasing (VBP) program in the September Health Affairs concludes that the program is likely to have only a small impact on hospital payments. While it is true that relatively little money is likely to be redistributed from bottom-performing hospitals to those at the top, this is no reason to conclude that the program is not working as intended. Quite the contrary, it’s performing exactly as intended so far.

This should come as no surprise. After all, the Centers for Medicare & Medicaid Services (CMS) has said all along it did not expect any hospital to attain or lose more than 1 percent of its net Medicare revenues when the program goes into effect this Oct. 1.

But the limited dollars at risk for any individual hospital for both payment incentives and penalties is no reason to conclude that the program won’t achieve its desired goal. VBP was designed by lawmakers not as a penalty program but as a means to drive faster performance improvement by tying performance to payment.

Read the rest of this entry »

Health Affairs Briefing: Current Challenges In Comparative Effectiveness Research


September 27th, 2012

On Thursday, October 11, Health Affairs will hold a briefing to unveil its October 2012 issue, “Current Challenges In Comparative Effectiveness Research.” The volume examines how findings from comparative effectiveness research will be communicated, particularly if they pertain to prescription drugs and if the findings could be useful for promotional purposes yet fall short of the standard of “substantial evidence” required by the Food and Drug Administration (FDA) under federal law.

The cluster of articles includes a hypothetical case study of comparative effectiveness research involving a fictional migraine drug and a symposium of analyses and responses follows from various stakeholders. The issue received funding support from the National Pharmaceutical Council.

Please join us for a briefing at the Washington Marriott at Metro Center on Thursday, October 11, 8:30 a.m. – 12:30 p.m., as we unveil the issue. Register by clicking here or by going to https://events.r20.constantcontact.com/register/eventReg?llr=tcmi8ydab&oeidk=a07e6fg62xrf0a8dd14

Read the rest of this entry »

Still Committed After All These Years: Research and Evaluation at the RWJF


September 26th, 2012

GrantWatch Blog invited the author, vice president of research and evaluation at the Robert Wood Johnson Foundation, to report on a webinar that the funder held this month.  The fortieth anniversary of the Robert Wood Johnson Foundation (RWJF), a national funder, is a time for reflection on how we at the foundation have done, what […]

Read the rest of this entry »

Reminder: Health Affairs Payment Reform Briefing Available Online


September 26th, 2012

If you missed the Health Affairs briefing earlier this month on the journal’s September payment reform issue, or you just want to relive the good times, the briefing is available on the Health Affairs website. You can view the entire briefing, or you can select the speakers or panels that particularly interest you.

Read the rest of this entry »

Better Use Of Dedicated Hospital Observation Units Could Save $3.1 Billion A Year


September 26th, 2012

The rising demand for acute care has caused more crowding in emergency departments (EDs) in US hospitals. Because hospital care accounted for more than 30 percent of total 2009 health care expenditures, alternative solutions are badly needed to bring costs under control. A hospital observation unit—a dedicated space usually near or within an emergency department, which about one-third of hospitals have—can be a viable alternative to an inpatient admission for many patients who cannot be safely discharged to their homes following an emergency department visit.

In what is believed to be the first attempt to quantify the potential financial impact of observation unit expansion, a new Web First study from Health Affairs estimates that, on average, adding an observation unit could save a hospital with sufficient ED volume $4.6 million per year. If all hospitals with adequate ED volume that do not have such units added them and ran them at benchmark levels of efficiency, the nation could save $3.1 billion in health costs annually.

Read the rest of this entry »

An Evidence-Based Approach To Communicating Health Care Evidence To Patients


September 25th, 2012

It has been 22 years since David M. Eddy—the heart surgeon turned mathematician and health care economist—put the term “evidence-based” into play with a series of articles on practice guidelines for the Journal of the American Medical Association.

But as we have learned in the years since, one person’s evidence-based guideline is another person’s cookbook. For some, a sound body of evidence is fundamental to sound medical decisions. After all, as Jack Wennberg and Dartmouth researchers have pointed out for decades, if the practice of medicine varies so widely from place to place in this country, everyone can’t be right. Yet for others, evidence connotes not just “cookie-cutter medicine,” it is only one step shy of a trip to the death panel. This heavy baggage influences the way evidence-based medicine is discussed from the doctor’s office to the clinic to Capitol Hill.

With this in mind, we and others working under the aegis of the Institute of Medicine set out to find an evidence-based approach to communicate with the public about evidence. The full fruits of our work can be seen in this new IOM discussion paper, “Communicating with Patients on Health Care Evidence.” What we found based on both focus groups and a national poll is that, in the context of shared decision-making, the public does not view evidence-based medicine as an indicator of cookbook medicine. Far from it. Patients actually put significant emphasis on the latest medical evidence.

Read the rest of this entry »

Behind The Uninsured Numbers, A Diminishing Sense Of Urgency


September 24th, 2012

After a summer of disappointing economic news, the recent Census report on the uninsured was a rare bit of sunshine. The number of uninsured Americans declined by about 3 percent, or 1.34 million, to 48.6 million in 2011. This was the largest one-year numerical decline in twelve years. There were “only” about 1.7 million more uninsured in 2011 than there were in 2006, before the devastating recession.

The search for policy fingerprints on these findings points directly to Medicaid. For all the controversy over this program, the safety net did its job. Medicaid enrollment rose another 4.4 percent in 2011, or 2.2 million people, likely masking continued shrinkage in private insurance coverage. If Medicaid rolls had not expanded by 10 million folks from 2006 to 2011, the number of uninsured would have soared due to the recession.

Read the rest of this entry »

What Do Polls Really Tell Us About The Public’s View Of The Affordable Care Act?


September 21st, 2012

Since its passage, the public has been told repeatedly how it feels about the Affordable Care Act (ACA), namely, that most of us disapprove of the ACA and detest its “mandate” that we be insured. A closer look at the national opinion data reveals that on those and related issues, public opinion actually favors the ACA.

Let’s begin with the basic finding that has been repeated so often: public disapproval of the ACA outweighs approval by a gap averaging around 5 to 10 points. But very few polls ask why people disapprove. The answers to that question change the picture dramatically.

One study that did ask “why” found that quite a bit of the disapproval comes from people who want health care reform expanded. When asked what they want done with the ACA, only 38 percent of survey respondents want it replaced with a Republican alternative or simply repealed; 25 percent want it kept as is, and 28 percent want more than the ACA provides. These latter 28 percent doubtless are the remnants of the 46-65 percent of the public who wanted health care reform to include a “public option,” or the 35 percent who want a single-payer system. Put simply, most Americans (53 percent versus 38 percent) want either the ACA or something with a greater role for government.

Read the rest of this entry »

Health Policy Brief: Improving Care Transitions


September 21st, 2012

The latest Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation looks at efforts to improve care transitions. These are the movements that patients make among health care providers and settings as their needs change during the course of illness—for example, from a hospital to a nursing home, and sometimes back again. If these transitions aren’t carefully coordinated, they can result in harm to patients and waste money. Researchers estimated that in 2011, poor transitions caused between $25 and $45 billion in wasteful medical spending through avoidable complications and unnecessary hospital readmissions.

Read the rest of this entry »

Health Reform: How Philanthropy Can Be of Use: An Example from California


September 20th, 2012

The author, director of state health policy at the California HealthCare Foundation, discusses how that funder has been working with California officials to support implementation of various pieces of the Affordable Care Act of 2010 at the state level. Federal health reform establishes the framework for sweeping changes to the nation’s health care delivery system […]

Read the rest of this entry »

For Payment Reform, Lessons from the Massachusetts Experience


September 20th, 2012

As the implementation of the Affordable Care Act continues, the Massachusetts example remains instructive. A new Health Affairs Web First article published yesterday looks at the health care cost control bill passed by the Bay State’s legislature at the end of its 2012 session and signed into law by Gov. Deval Patrick last month. This […]

Read the rest of this entry »

Dismantling The Affordable Care Act: What Could A President Romney And Hill Republicans Do?


September 20th, 2012

On November 6, 2012, Americans will go to the polls to elect a president.  One of the many issues that will be on their minds is the future of the Affordable Care Act.  Governor Mitt Romney’s website states: On his first day in office, Mitt Romney will issue an executive order that paves the way […]

Read the rest of this entry »

Caring, Freeloading, And The Fate Of The Affordable Care Act


September 19th, 2012

At the heart of the case for medical coverage for all isn’t the public’s health; it’s private tragedy.  Serious illness plunges people into a realm of Dickensian choice.  Some forgo life-prolonging treatment to preserve life savings for loved ones.  Others lose their homes or go bankrupt.  Insurance shields families against these scenarios.  From a population-wide […]

Read the rest of this entry »

State Perspectives On Building Information Technology For Health Reform


September 18th, 2012

Note: This blog summarizes key findings from a report by the National Academy of Social Insurance (NASI) Study Panel on Health Insurance Exchanges and the Center for Health Policy and Research at the University of Massachusetts Medical School. The report draws some key lessons from the experiences of the states most advanced in their implementation […]

Read the rest of this entry »

Foundation Leaders Honored on Lists of Modern Healthcare and Forbes magazines


September 17th, 2012

I thought I would start off the week with some people news. I am a bit behind on my reading, but I wanted to let you know about four foundation leaders who were recently named to these lists. Modern Healthcare 2012 100 Most Influential People in Healthcare list Risa Lavizzo-Mourey, president and CEO of the […]

Read the rest of this entry »

Primary Care Reform Led Health Affairs Blog’s Top Ten For August


September 17th, 2012

Rushika Fernandopulle’s proposal for rethinking the nation’s primary care system was the most-read Health Affairs Blog post for August. It was followed on the month’s top-ten list by Michael Cannon and Jonathan Adler’s argument that the Affordable Care Act does not allow premium tax credits on federally facilitated exchanges, and Jacob Bor’s reflections on the […]

Read the rest of this entry »

Rising Executive Compensation At Children’s Hospitals Threatens The Public Trust


September 14th, 2012

Editor’s note: The themes discussed in this post are among those discussed in the new book “Unaccountable,” by Dr. Marty Makary.  A video trailer about the book is available here.  In addition to Dr. Makary (photo and linked bio above), this blog post is coauthored by Andrew Ibrahim, MD, Case Western Reserve School of Medicine, […]

Read the rest of this entry »

What about Health Disparities Affecting Lesbian, Gay, Bisexual, and Transgender People?


September 14th, 2012

The author, director of health policy at the Missouri Foundation for Health, blogs about a recent report released by the St. Louis–based foundation. An often overlooked part of the Affordable Care Act of 2010, Section 4302 requires that the US secretary of health and human services “ensure that any federally conducted or supported health care […]

Read the rest of this entry »

Click here to email us a new post.




This blog is protected by dr Dave\\\'s Spam Karma 2: 1316233 Spams eaten and counting...