Featured Post
December 2, 2019
A state prescription drug policy first adopted in 1939, and last ended in 2004, appears to have influenced where Purdue Pharma chose to market its opioid drug OxyContin upon launch in 1996. The consequences of that decision reverberate to this day, according to a new NBER paper by LDI Senior Fellow Abby Alpert and colleagues, who estimate that states with the prescription policy had 11.4 fewer overdose deaths per 100,000 people in 2017.
The Centers for Medicare and Medicaid Services (CMS) has released its most recent list of hospitals that will receive bonuses, or in some cases penalties, under the Value-Based Purchasing Program. Along with initiatives such as the Hospital Readmissions Reduction Program and the Hospital-Acquired Conditions programs, the Value-Based Purchasing Program is part of Medicare’s increasing focus on aligning payment with quality.
But where should a hospital focus to ensure that patients reliably get great care and avoid costly outcomes like readmissions and other adverse events? Talk with anyone working in a hospital and they will be able to name countless programs and interventions that have cropped up to improve outcomes that are linked to these financial incentives and penalties. Looking at readmissions, for example, there are multiple interventions aimed at stemming the tide of readmissions: intensive discharge planning, telephone follow-up programs, patient education modules, and medication reconciliation programs.
Recently, the economist Uwe Reinhardt heralded the arrival of price transparency as a "disruptive innovation" in health care. Through modern electronic technology, Reinhardt predicts, open price competition may unleash the powers of the raw market to contain costs and improve quality.
Well, maybe, but it depends on how price information is framed and what providers do with that information. We can learn something from the experience of making the caloric content of fast food "transparent" as a way to stem the rising tide of obesity in the U.S. The idea made sense initially but didn't live up to its promise in the field.
In a harshly worded letter released Monday, the Food and Drug Administration (FDA) ordered the company 23andMe to “immediately discontinue marketing” its saliva spit test (from which a consumer’s DNA is isolated) and personalized genome service until it provides the FDA with requested information on safety and effectiveness. I asked Reed Pyeritz, MD, PhD, a medical geneticist at Penn and former president of the American College of Medical Genetics, to comment on this development.
The Sustainable Growth Rate (SGR) formula – a source of unpredictability in Medicare payments to physicians – may finally be repealed. While this might seem unrelated to medical education, what happens next could have a significant impact on academic medicine and the training of students, residents and fellows.
The SGR formula, adopted in 1998, stipulates that if Medicare spending increases faster than GDP, Medicare physician reimbursement will be cut in the ensuing year, by up to 5%. The formula worked quietly in the background until 2002, when Medicare spending grew faster than GDP, and the first cuts were put into place. The SGR never actually “worked” as a tool to limit growth, and in 2003 (and many subsequent years), the AARP, AMA and other groups successfully lobbied to have the cuts postponed, in an annual dance that has come to be known as the “Doc Fix.”
There's been some pushback lately about including maternity care in the “essential health benefit” package mandated by the ACA. No one suggests that maternity care is not essential to maternal and infant health; rather, the issue is who should pay for it. What is missing from the debate is any reference to our present state of maternity care. In a recently published article, William McCool and colleagues from Penn's School of Nursing look at 15-year trends and the current state of maternity and newborn care in Philadelphia, the fifth largest city in the U.S. Their findings are disturbing.
In just over a decade, the number of maternity centers in Philadelphia dwindled from 19 in 1997 to just 6 in 2011 [see below]. All of maternity units in community hospitals closed, taking most midwifery services with them. The number of births continued to increase, leading to dramatic increases in births in the remaining facilities.
(cross-posted with the Scattergood Foundation)
In a recent New York Times Opinionator column, James Heckman, a Nobel Laureate and a leading economist at the University of Chicago, called for investments in early childhood development as a way to reduce inequality and promote shared prosperity. Quality early childhood programs for disadvantaged children, he notes, more than pay for themselves in better education, health and economic outcomes.
The evidence base for this assertion is strong, and growing. Heckman was, in fact, one of the first economists to formally model the importance of early childhood (defined as in utero through age five). We now know quite a bit about the effects of early childhood development on social outcomes such as educational attainment, marriage, and labor market success. We have learned a great deal about the importance of early childhood for physical health outcomes and longevity. But we have learned less about how early childhood affects behavioral health outcomes, such as mental health and substance use and abuse.
A seemingly arcane but important provision in the Affordable Care Act (ACA) created a system of risk corridor payments during 2014-2016 for insurers offering individual coverage through the exchanges. Similar to an existing risk corridor system for insurers offering Medicare prescription drug coverage, the ACA’s risk corridor system will partially shield insurers from unexpectedly high costs in relation to premiums for coverage sold on the exchanges.
The provision hadn’t attracted much attention until last week, when the President announced that insurers have the option of continuing health policies in 2014 that fail to meet the ACA’s new coverage and rating requirements. The accompanying letter to State Insurance Commissioners said that HHS intended to “explore ways to modify the risk corridor program final rules to provide additional assistance” to insurers that might face unanticipated costs as a result of the decision.
New York State Health Commissioner Nirav Shah, MD, MPH gave the Samuel Martin III Memorial Lecture yesterday at the Leonard Davis Institute, and described New York’s ongoing plans to improve health outcomes while containing the growth of Medicaid costs. The investments might surprise you, as they lie beyond the usual borders of the health care system. Shah calls it the Health-In-All-Policies Approach.
A question arose on Twitter yesterday about the ACA’s provisions for surcharging tobacco users (h/t @onceuponA and @Prof_Richardson). That led me to a deeper dive into the regulations for implementing this part of the ACA. Here are some answers to questions you may have on who is subject to the surcharge, how the surcharge is structured, and who is policing all of it.
Cross-posted on The Field Clinic blog at philly.com
October 1st – the day the Insurance Marketplaces opened – came and went in Pennsylvania without an answer to whether many uninsured low-income residents will be able to get coverage through Medicaid. Unlike states that are participating in the Medicaid expansion under Obamacare, roughly 350,000 Pennsylvanians living in the income gap between the current Medicaid program and newly subsidized private insurance will be left out.
Last month, Governor Corbett proposed to the federal government a “private option” plan similar to one recently adopted by Arkansas. Under the so-called “private option,” instead of enrolling low-income individuals in Medicaid, newly eligible Pennsylvanians would be sent to insurance “marketplaces” where they would be offered a heavily subsidized private plan. Since those plans would require a lot of cost sharing for patients and states are prohibited from requiring new out-of-pocket costs within the Medicaid program, the government would have to supplement the coverage of the private plans. The key question is, will it cost more money?
A working group at the Leonard Davis Institute has been studying aspects of health insurance exchanges for more than a year. When Tom Baker, JD, Penn law professor and Co-Director of the working group, and I started brushing up for his Radio Times appearance this week, we thought we’d be able to assemble a state-by-state snapshot that would give us a clear-cut idea of which health insurance exchanges are the most successful. Instead, we had a bit of a reporting reality check.
Most of the country’s insurance shoppers are shaking their fists at their computer screens in an (often unsuccessful) attempt to sign up on HealthCare.gov, so it’s easy for journalists to capitalize on the nation’s frustration. But in doing so, they’ve made some lofty claims. A cursory glance at any front page shows sweeping generalizations about the Affordable Care Act’s (ACA) failures (where, unsurprisingly, HealthCare.gov is synechdoche for Obamacare as a whole), but these assertions are premature. Below, I’ll try to clear up some of the misinformation that’s clogging the newswires.
Insurance is a complex product, and choosing among different plans is a complex decision. As states and the federal government roll out health insurance exchanges, “choice architecture”—how options are presented—will affect what consumers choose. According to LDI Senior Fellow Amanda Starc, standardizing plans and information about plans can help consumers make better decisions.
In a new NBER working paper, Starc of Wharton and co-author Keith Marzilli Ericson of Boston University take advantage of a 2010 regulatory change in Massachusetts to assess whether standardizing information on the exchange changed consumer behavior. When the Massachusetts exchange launched in 2007, plans had latitude in designing their features, and were simply listed in ascending premium order. Six insurers offered a choice of 25 plans.