Research Roundup - December 2016

California

Hospitals Penalized for Patient Safety Violations

By Mark Hedin | The Mercury News | Dec. 30, 2016

Ninety-six California hospitals were cited for high rates of patient injuries and inflections, including the spread of antibiotic-resistant germs, according to The Mercury News. The penalties come as CMS begins to require that hospitals establish antibiotics protocols as a condition of receiving Medicare funding. The Hospital-Acquired Condition Reduction Program, run by HHS, tracks the rates of infections from common procedures, including hysterectomies, colon surgeries, urinary tract catheters and central line tubes and the frequency of bed sores, hip fractures, blood clots and other complications.

Hawaii

Hawaii’s 1332 Waiver Approved

By D.J. Wilson | State of Reform | Dec. 30, 2016

Hawaii’s 1332 waiver is the first in the nation to be approved, according to State of Reform.  Hawaii will waive the ACA’s requirement that it establish a Small Business Health Options Program (SHOP) exchange for small businesses, and several other related provisions. However, the Obama administration also denied parts of the state’s proposal. The waiver is in effect from Jan. 1, 2017, until Dec. 31, 2021.

Indiana

Experiment May Reveal Obamacare’s Future

By Alana Semuels | The Atlantic | Dec 21, 2016

Indiana’s Medicaid Healthy Indiana Plan (HIP) may become a model for other state Medicaid reform efforts, according to The Atlantic. The program includes two levels of coverage.HIP Basic is available to all Hoosiers with incomes below poverty, but excludes dental and vision coverage and includes steep copays, which can saddle low-income families with high costs.HIP Plus coverage -- available to people below 138 percent of poverty -- requires enrollees to make monthly premium payments amounting to 2 percent of the beneficiary’s income. Failure to pay the monthly premium results in the removal of HIP Plus coverage and prevents the beneficiary from re-applying for six months. Seema Verma -- HIP’s primary architect -- has been appointed head of the Centers for Medicare and Medicaid Services (CMS) by President-Elect Trump.

Kentucky

Study Finds Kentucky Smoking Awareness Program Increased Use of High-Value Test

By Melissa Patrick | Kentucky Health News | Dec. 21, 2016

A study conducted by the University of Kentucky found that a community awareness program increased use of low-dose CT scans and prompted individuals to consider tobacco cessation, according to Kentucky Health News.  A low-dose CT scan is able to detect early signs of lung cancer and is recommended for people aged 55 to 77 who are at high risk such as current smokers. Kentucky has the highest smoking rate in the country.

Minnesota

Report Takes Deep Dive into Minnesota Healthcare Costs

By Jeremy Olson | Star Tribune | Dec. 13, 2016

A Minnesota nonprofit issued a report identifying the highest-cost health clinics in the state in an effort to help consumers, according to the Star Tribune.  Minnesota Community Measurement used claims data from the state’s largest health plans to find clinics with the highest prices and highest utilization rates. The report found that overall the total cost of care increased 5.6 percent overall from 2014 to 2015, while the total cost of pharmacy spending increased 9.3 percent.

New Hampshire

Prescription Drug Costs Still Rising

By Jack Rodolico | New Hampshire Public Radio | Dec. 21, 2016

New data from the New Hampshire insurance department show that prescription drug costs are rising faster than most other categories of health spending in the state, according to New Hampshire Public Radio. Pharmacies collected one in five dollars spent on healthcare in New Hampshire last year. Still, the report noted that despite their increasing price tags, high-cost drugs comprise less than 1 percent of all prescriptions for people with employer-based insurance and other group plans.

New Jersey

Push for Out-of-Network Surprise Medical Expenses Bill Continues in 2017

By Nichole Leonard | Press of Atlantic City | Dec. 22, 2016

Healthcare advocates will continue to push a bill restricting the practice of so-called ‘surprise’ medical bills in 2017, according to the Press of Atlantic City.  The legislation will likely get a hearing in January as stakeholders attempt to finalize how the bill would restrict the practice. Current draft legislation ties out-of-network reimbursements to Medicare rates.

New Mexico

Federal Law Embraces NM Model for Rural Healthcare

Silver City Sun-News | Dec. 15, 2016

A federal law requiring the U.S. Health and Human Services Department (HHS) to consider integrating and expanding the use of video conferencing for rural populations to access medical care was originally developed in New Mexico, according to the Silver City Sun-News.

New York

New York Hospital Prices Depend on Leverage, Not Quality

By Dave Barkholz | Modern Healthcare | Dec. 19, 2016

Some hospitals are 1.5 to 2.7 times more expensive than the lowest-priced hospitals within the same region of New York State, according to Modern Healthcare. The study, funded by the NYS Health Foundation, also found that a hospital’s market leverage—its bargaining power when negotiating with insurers—is a key factor in the prices a hospital can command. Hospitals with high prices do not necessarily have higher quality scores and those with lower prices do not necessarily have lower quality score.

Ohio

One in Five Adults in Ohio Report Forgoing Medical Care Due to Cost

By Bill Cieslewicz | Columbus Business First | Nov. 29, 2016

A recent poll found that twenty percent of adult Ohioans reported they or a family member put off medical care due to cost in the previous year, according to Columbus Business First.  Affordability varied by income and education level, with individuals without a college degree and earning just above the eligibility level for Medicaid struggling the most to pay for needed care.

Rhode Island

$130 Million Awarded to Continue Medicaid ‘Reinvention’

By Kristin Gourlay | Rhode Island Public Radio | Nov. 28, 2016

Rhode Island has received a five-year federal grant to further transform the state’s Medicaid program prioritizing quality over quantity, according to Rhode Island Public Radio. The money will go to promoting care coordination, expanding the use of electronic medical records, hiring additional staff and providing better training to the future workforce. The existing initiative is estimated to have already saved the state $100 million.

Vermont

Vermont Takes Top Spot for Healthcare Access and Affordability

Vermont Business Magazine | Dec. 22, 2016

A new report from the Commonwealth Fund ranked Vermont best in the nation for healthcare access and affordability, according to Vermont Business Magazine. The state has the smallest disparity in access among income levels and is the only state in which less than ten percent of low-income individuals have delayed care due to cost in the past year.

Wisconsin

Healthcare Bills in Wisconsin Increase Half the National Rate

By Richard Kirchen | Milwaukee Business Journal | Dec. 15, 2016

Bills for commercial insurers in southeast Wisconsin increased at half the rate as the national average, according to Milwaukee Business Journal. It has been suggested that lower increases can be attributed to the competitive market of six healthcare systems at the time of the study.

For more state news, please visit www.healthcarevaluehub.org/state-news/

Recent Reports

Health Spending Grows Faster in 2015 as Coverage Expands and Utilization Increases

Anne B. Martin, et al. | Health Affairs | Dec. 2, 2016

A new analysis from CMS’s Office of the Actuary found that healthcare spending increased by 5.8 percent in 2015, a rate that is higher than previous years and more than double the GDP growth rate of 2.7 percent. The healthcare share of gross domestic product (GDP) also hit a high of 17.8 percent, according to this article in Health Affairs. For commentary on this uptick in the spending trend, see here and here and here.

Prices of Brand Name Prescription Drugs Increased Faster than Inflation, 2006 to 2016

By Stephen W. Schondelmeyer and Leigh Purvis | AARP | December 2016

Retail prices for widely used brand name drugs increased faster than general inflation in every year from 2006 to 2015, according to a recent AARP report. Between 2014 and 2015, retail prices for 268 widely used brand name drugs increased by 15.5 percent (the 4th straight year of double-digit average annual price increases), while general inflation only rose 0.1 percent in 2015. The report discusses the implications of increasing retail prices for brand name drugs for older Americans, including poorer health outcomes and higher future healthcare costs.

HHS Report to Congress Shows Increase in Prescription Drug Spending

AHA News | Dec. 20, 2016

Growth in prescription drug spending has accelerated considerably in recent years, and it is projected to continue rising during the next decade, according to a report HHS recently submitted to Congress. Specifically, the report shows that growth in retail prescription drug spending increased 12.6 percent in 2014 – a much higher increase than overall healthcare spending in the U.S.

The Financial Burdens of High-Deductible Plans

By Salam Abdus, Thomas M. Selden and Patricia Keenan | Health Affairs | December 2016

Consumers with family incomes below 250 percent of the federal poverty level experience markedly higher frequencies of spending more than 20 percent of after-tax income on premiums and services in 2011-13—even in low- and no-deductible plans, according to this article in Health Affairs. Burden prevalence rose sharply with deductible levels for low-income consumers, compared to consumers with higher incomes. When high-burden threshold was defined as spending 10 percent or more of the family income on healthcare premiums and services, burden rates exceeded 50 percent even for low-income families with low-deductible plans.

America’s Health Rankings Annual Report

United Health Foundation | December 2016

In 2016, health-related national successes included decreased smoking rates among adults, decreased preventable hospitalizations and increased insurance coverage and rates of immunization, according to United Health Foundation’s 2016 Annual Report. Comparatively, in 2016 the U.S. failed to improve the prevalence of obesity, death rate from drugs, premature death rate and death rate from heart disease.  

Millions of People are Finding it Easier to Pay Medical Bills

By Alison Kodjak | NPR | Nov. 30, 2016

Results from the National Center for Health Statistics show that fewer families struggle to afford their medical bills. Repealing the ACA could reverse this trend, according to policy experts in an NPR blog.

VA Hospital Secrecy and Excuses

Albuquerque Journal | Dec. 20, 2016

The Department of Veterans Affairs (VA) is providing a huge disservice to veterans by refusing to publicly release quality data more detailed than the Star Ratings, according to an editorial in the Albuquerque Journal. Advocates demand to know how the hospitals are rated and why, especially after recent criticism of VA quality of care and wait times. VA officials have recommended against using the rating to help make decisions, arguing that poorly ranking hospitals are the victims of bell curves requiring a loser.

National Veteran Health Equity Report

VA Office of Health Equity | December 2016

A report detailing patterns of health conditions for vulnerable veteran groups will allow the Department of Veteran Affairs to monitor the care of veterans and set goals for improving care, according to a report from the VA’s Office of Health Equity. Less than half of veterans had a service-connected disability and one-third had one or more mental health diagnoses.

U.S. Inpatient Emergency Department Cases May Lead to Surprise Medical Bills

By Christopher Garmon and Benjamin Chartock | Health Affairs Blog | Dec. 14, 2016

The number of admissions and outpatient visits likely leading to a surprise medical bill decreased between 2007 and 2014, according to the Health Affairs Blog. However, the problem remains a frequent problem. For example, in 2014, 20 percent of U.S. hospital inpatient admissions originating in the emergency department (ED), 14 percent of outpatient visits to the ED, and 9 percent of elective inpatient admissions likely led to a surprise medical bills. Surprise medical bill rates for ED patients varied significantly across state, with Florida (37%), New York (35%) and Texas (34%) having the highest rates.

Cost Edges Access as Most Urgent U.S. Health Problem

By Jeffrey M. Jones | Gallup | Dec. 7, 2016

More Americans now mention healthcare costs (27%) than mention access (20%) when asked to name the most urgent health problem facing the U.S., according to Gallup. These two issues typically rank at the top of the list in Gallup's annual poll but have tied for first the past two years.

Improving Community Health Through Hospital Community Benefit Spending

Sara Rosenbaum, et al. | Milken Institute School of Public Health | December 2016

A new report from George Washington University outlines actions that the Internal Revenue Service could take to encourage tax-exempt hospitals to broaden the reach of their community benefits. The report describes ambiguities in existing law regarding the provision of community benefits that could be clarified in order to provide hospitals with incentives for aligning community benefits with policies focused on population and community health.

Five National Foundations Highlight Promising Approaches for Patients with Complex Needs

The Playbook | December 2016

Five national healthcare foundations--the Robert Wood Johnson Foundation, Commonwealth Fund, John A. Hartford Foundation, Peterson Center on Healthcare, and The SCAN Foundation--have launched a new online resource, The Playbook of Best Practices, to help health organizations adopt interventions to improve outcomes and lower the cost of care for patients with multiple chronic conditions, functional disabilities and behavioral health problems. A new Commonwealth Fund survey of patients with complex medical needs shows that these patients consistently have more unmet medical needs than other adults.

For more background on the healthcare spending problem, high-deductible health plans, coordinated care for complex patients, medical harm, prescription drug costs and more, please visit www.healthcarevaluehub.org.

Commentary/News

Trump Should Keep the CMS Innovation Center

By Catherine Rampell | The Washington Post | Dec 1, 2016

The CMS Innovation Center, a hub to research and develop financial incentives that encourage providers to treat more effectively, is estimated to reduce net federal health spending by $34 billion over the next decade, according to this op-ed in The Washington Post. The delivery system reform work done by the Center can appease both sides of the aisle, saving taxpayers money and improving the quality care for Americans.

Why Healthcare Eats More of Your Paycheck Every Year

By Tom Murphy | Associated Press | Nov. 3, 2016

Millions of Americans are finding out this month that the price of their health insurance is going up next year — as it did this year, last year, and most of the years before that, according to this article from the Associated Press. And it's not just that the price is going up, it's that it goes up faster than wages and inflation, eating away at our ability to pay for other things we want (beer, televisions, vacations) or need (rent, heat, food). Insurance premiums have climbed 213 percent since 1999 for family coverage purchased through an employer, according to the Kaiser Family Foundation. Wages, by comparison, have risen 60 percent, while inflation is up 44 percent.

Developments and an Unknown Future for Value-Based Care Reimbursement

By Vera Gruessner | Modern Healthcare | Dec. 13, 2016

HHS finalized new Medicare alternative payment models for cardiac and orthopedic care despite Rep. Tom Price’s history of being critical of value-based care reimbursement initiatives, according to Modern Healthcare. Price, who is President-Elect Trump’s nominee for HHS Secretary, has claimed overreach by the Center for Medicare and Medicaid Innovation and that stakeholders are not engaged when payment models are being created. At the same time, the private health insurance market has widely adopted value-based care reimbursement in an effort to reduce wasteful spending.

Latest Hospital Injury Penalties Include Crackdown on Antibiotic Resistant Germs

By Jordan Rau | Kaiser Health News | Dec. 21, 2016

769 hospitals will be penalized in the most recent Medicare penalty assessment, according to Kaiser Health News. The policy aims to incentivize hospitals to prevent potentially avoidable complications such as infections and bedsores. The lowest performers will lose 1 percent of Medicare funding beginning retroactively to October 2016.

The Demise of the Part B Demo: Doom for Value-Based Payment?

By Rachel Dolan | Health Affairs | Dec. 27, 2016

The demonstration project designed to test payment changes to drugs in Medicare Part B was not finalized, according to Health Affairs. Part B covers outpatient drugs, and payments for drugs are made directly to providers based on sales price, with no consideration of effectiveness or formulary management. The project would have changed the payment rate and tested the use of value-based purchasing tools.

HSA Balances Climb But Benefits Reward Wealthier Consumers Most

By Michelle Andrews | Kaiser Health News | Dec. 2, 2016

President-Elect Trump’s reliance on expanding health savings accounts (HSA) neglect America’s low-income consumers, according to Kaiser Health News. People with low incomes are less likely to have the extra cash to invest in an HSA and get less benefit compared to those in higher tax brackets.People who don’t meet the income tax filing threshold get no benefit at all.

Medicare Outpatients Risk Higher Bills Compared to Inpatient

By Ricardo Alonso-Zaldivar | Associated Press | Dec. 19, 2016

Medicare has taken steps to protect patients from costly outpatient services, according to the Associated Press. The HHS inspector general is recommending further changes to billing rules after finding that for some services, Medicare patients were spending more when they go to outpatient facilities compared to inpatient.

Price Transparency is Nice. Just Don’t Expect It to Cut Health Costs

By Austin Frakt | The New York Times | Dec. 19, 2016

The public’s lack of interest may undermine the success of transparency tools, according to this op-ed in The New York Times. Despite the establishment of statewide, insurer and employer websites to provide cost estimator tools for consumers, most consumers do not use them. Few people realize these tools exist or find the process too complicated, including consumers with high deductibles or chronic conditions.    

CMS Research Illustrates Four Healthcare Transparency Paradoxes

By Jackson Williams | Health Affairs Blog | Dec. 28, 2016

Since 2006, HHS has been dedicated to a Value-Drive Healthcare Initiative based on four cornerstones, including the reporting of price and quality information, according to this Health Affairs Blogpost.According to the research, aspects of HHS’s transparency efforts are limited by consumers preferences. For example, a doctor’s recommendation over relying on websites featuring provider metrics and a skeptical view about government involvement in quality ratings information.

After Harsh Light, A Cheaper Version Of EpiPen From Mylan

The Associated Press | Dec. 16, 2016

Mylan is releasing a generic version of EpiPen at half the price of the branded option after drawing intense scrutiny from Congress and consumers nationwide, according to this report by the Associated Press. Mylan is expected to generate millions of dollars in revenue while protecting their market share against competition. While some consumers will continue to get access to discounts, costs to employers and insurers will receive little reprieve which can affect the price of health insurance premiums.

Maryland Joins 19 Other States in Lawsuit Over Drug Prices

Associated Press | Dec. 19, 2016

Twenty state attorneys general filed a federal lawsuit claiming six generic drug makers inflated and manipulated prices to reduce competition for medication, according to this Associated Press article. After a two-year investigation, Connecticut Attorney General George Jepsen believes he has “developed compelling evidence of collusion and anticompetitive conduct” among many market generic drug manufacturers including Heritage Pharmaceuticals; Aurobindo Pharma USA Inc.; Citron Pharma LLC; Mayne Pharma Inc.; Mylan Pharmaceuticals Inc.; and Teva Pharmaceuticals USA. Plaintiff states include Connecticut, Delaware, Florida, Hawaii, Idaho, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Nevada, New York, North Dakota, Ohio, Pennsylvania, Virginia and Washington.

VA Expands Scope of Nurse Practice

By Virgil Dickson | Modern Healthcare | Dec. 13, 2016

The Veteran Affairs Department finalized a rule allowing advanced-practice registered nurses to practice to their full authority at VA facilities beginning Jan. 14, 2017, according to Modern Healthcare. The VA believes the new rule will make it easier for veterans to receive needed care. About half of states have full scope of practice laws for nurse practitioners.

Ascension Partners With Lyft to Ease Patient Transportation

By Dave Barkholz |

California

Hospitals Penalized for Patient Safety Violations

By Mark Hedin | The Mercury News | Dec. 30, 2016

Ninety-six California hospitals were cited for high rates of patient injuries and inflections, including the spread of antibiotic-resistant germs, according to The Mercury News. The penalties come as CMS begins to require that hospitals establish antibiotics protocols as a condition of receiving Medicare funding. The Hospital-Acquired Condition Reduction Program, run by HHS, tracks the rates of infections from common procedures, including hysterectomies, colon surgeries, urinary tract catheters and central line tubes and the frequency of bed sores, hip fractures, blood clots and other complications.

Hawaii

Hawaii’s 1332 Waiver Approved

By D.J. Wilson | State of Reform | Dec. 30, 2016

Hawaii’s 1332 waiver is the first in the nation to be approved, according to State of Reform.  Hawaii will waive the ACA’s requirement that it establish a Small Business Health Options Program (SHOP) exchange for small businesses, and several other related provisions. However, the Obama administration also denied parts of the state’s proposal. The waiver is in effect from Jan. 1, 2017, until Dec. 31, 2021.

Indiana

Experiment May Reveal Obamacare’s Future

By Alana Semuels | The Atlantic | Dec 21, 2016

Indiana’s Medicaid Healthy Indiana Plan (HIP) may become a model for other state Medicaid reform efforts, according to The Atlantic. The program includes two levels of coverage.HIP Basic is available to all Hoosiers with incomes below poverty, but excludes dental and vision coverage and includes steep copays, which can saddle low-income families with high costs.HIP Plus coverage -- available to people below 138 percent of poverty -- requires enrollees to make monthly premium payments amounting to 2 percent of the beneficiary’s income. Failure to pay the monthly premium results in the removal of HIP Plus coverage and prevents the beneficiary from re-applying for six months. Seema Verma -- HIP’s primary architect -- has been appointed head of the Centers for Medicare and Medicaid Services (CMS) by President-Elect Trump.

Kentucky

Study Finds Kentucky Smoking Awareness Program Increased Use of High-Value Test

By Melissa Patrick | Kentucky Health News | Dec. 21, 2016

A study conducted by the University of Kentucky found that a community awareness program increased use of low-dose CT scans and prompted individuals to consider tobacco cessation, according to Kentucky Health News.  A low-dose CT scan is able to detect early signs of lung cancer and is recommended for people aged 55 to 77 who are at high risk such as current smokers. Kentucky has the highest smoking rate in the country.

Minnesota

Report Takes Deep Dive into Minnesota Healthcare Costs

By Jeremy Olson | Star Tribune | Dec. 13, 2016

A Minnesota nonprofit issued a report identifying the highest-cost health clinics in the state in an effort to help consumers, according to the Star Tribune.  Minnesota Community Measurement used claims data from the state’s largest health plans to find clinics with the highest prices and highest utilization rates. The report found that overall the total cost of care increased 5.6 percent overall from 2014 to 2015, while the total cost of pharmacy spending increased 9.3 percent.

New Hampshire

Prescription Drug Costs Still Rising

By Jack Rodolico | New Hampshire Public Radio | Dec. 21, 2016

New data from the New Hampshire insurance department show that prescription drug costs are rising faster than most other categories of health spending in the state, according to New Hampshire Public Radio. Pharmacies collected one in five dollars spent on healthcare in New Hampshire last year. Still, the report noted that despite their increasing price tags, high-cost drugs comprise less than 1 percent of all prescriptions for people with employer-based insurance and other group plans.

New Jersey

Push for Out-of-Network Surprise Medical Expenses Bill Continues in 2017

By Nichole Leonard | Press of Atlantic City | Dec. 22, 2016

Healthcare advocates will continue to push a bill restricting the practice of so-called ‘surprise’ medical bills in 2017, according to the Press of Atlantic City.  The legislation will likely get a hearing in January as stakeholders attempt to finalize how the bill would restrict the practice. Current draft legislation ties out-of-network reimbursements to Medicare rates.

New Mexico

Federal Law Embraces NM Model for Rural Healthcare

Silver City Sun-News | Dec. 15, 2016

A federal law requiring the U.S. Health and Human Services Department (HHS) to consider integrating and expanding the use of video conferencing for rural populations to access medical care was originally developed in New Mexico, according to the Silver City Sun-News.

New York

New York Hospital Prices Depend on Leverage, Not Quality

By Dave Barkholz | Modern Healthcare | Dec. 19, 2016

Some hospitals are 1.5 to 2.7 times more expensive than the lowest-priced hospitals within the same region of New York State, according to Modern Healthcare. The study, funded by the NYS Health Foundation, also found that a hospital’s market leverage—its bargaining power when negotiating with insurers—is a key factor in the prices a hospital can command. Hospitals with high prices do not necessarily have higher quality scores and those with lower prices do not necessarily have lower quality score.

Ohio

One in Five Adults in Ohio Report Forgoing Medical Care Due to Cost

By Bill Cieslewicz | Columbus Business First | Nov. 29, 2016

A recent poll found that twenty percent of adult Ohioans reported they or a family member put off medical care due to cost in the previous year, according to Columbus Business First.  Affordability varied by income and education level, with individuals without a college degree and earning just above the eligibility level for Medicaid struggling the most to pay for needed care.

Rhode Island

$130 Million Awarded to Continue Medicaid ‘Reinvention’

By Kristin Gourlay | Rhode Island Public Radio | Nov. 28, 2016

Rhode Island has received a five-year federal grant to further transform the state’s Medicaid program prioritizing quality over quantity, according to Rhode Island Public Radio. The money will go to promoting care coordination, expanding the use of electronic medical records, hiring additional staff and providing better training to the future workforce. The existing initiative is estimated to have already saved the state $100 million.

Vermont

Vermont Takes Top Spot for Healthcare Access and Affordability

Vermont Business Magazine | Dec. 22, 2016

A new report from the Commonwealth Fund ranked Vermont best in the nation for healthcare access and affordability, according to Vermont Business Magazine. The state has the smallest disparity in access among income levels and is the only state in which less than ten percent of low-income individuals have delayed care due to cost in the past year.

Wisconsin

Healthcare Bills in Wisconsin Increase Half the National Rate

By Richard Kirchen | Milwaukee Business Journal | Dec. 15, 2016

Bills for commercial insurers in southeast Wisconsin increased at half the rate as the national average, according to Milwaukee Business Journal. It has been suggested that lower increases can be attributed to the competitive market of six healthcare systems at the time of the study.

For more state news, please visit www.healthcarevaluehub.org/state-news/

Recent Reports

Health Spending Grows Faster in 2015 as Coverage Expands and Utilization Increases

Anne B. Martin, et al. | Health Affairs | Dec. 2, 2016

A new analysis from CMS’s Office of the Actuary found that healthcare spending increased by 5.8 percent in 2015, a rate that is higher than previous years and more than double the GDP growth rate of 2.7 percent. The healthcare share of gross domestic product (GDP) also hit a high of 17.8 percent, according to this article in Health Affairs. For commentary on this uptick in the spending trend, see here and here and here.

Prices of Brand Name Prescription Drugs Increased Faster than Inflation, 2006 to 2016

By Stephen W. Schondelmeyer and Leigh Purvis | AARP | December 2016

Retail prices for widely used brand name drugs increased faster than general inflation in every year from 2006 to 2015, according to a recent AARP report. Between 2014 and 2015, retail prices for 268 widely used brand name drugs increased by 15.5 percent (the 4th straight year of double-digit average annual price increases), while general inflation only rose 0.1 percent in 2015. The report discusses the implications of increasing retail prices for brand name drugs for older Americans, including poorer health outcomes and higher future healthcare costs.

HHS Report to Congress Shows Increase in Prescription Drug Spending

AHA News | Dec. 20, 2016

Growth in prescription drug spending has accelerated considerably in recent years, and it is projected to continue rising during the next decade, according to a report HHS recently submitted to Congress. Specifically, the report shows that growth in retail prescription drug spending increased 12.6 percent in 2014 – a much higher increase than overall healthcare spending in the U.S.

The Financial Burdens of High-Deductible Plans

By Salam Abdus, Thomas M. Selden and Patricia Keenan | Health Affairs | December 2016

Consumers with family incomes below 250 percent of the federal poverty level experience markedly higher frequencies of spending more than 20 percent of after-tax income on premiums and services in 2011-13—even in low- and no-deductible plans, according to this article in Health Affairs. Burden prevalence rose sharply with deductible levels for low-income consumers, compared to consumers with higher incomes. When high-burden threshold was defined as spending 10 percent or more of the family income on healthcare premiums and services, burden rates exceeded 50 percent even for low-income families with low-deductible plans.

America’s Health Rankings Annual Report

United Health Foundation | December 2016

In 2016, health-related national successes included decreased smoking rates among adults, decreased preventable hospitalizations and increased insurance coverage and rates of immunization, according to United Health Foundation’s 2016 Annual Report. Comparatively, in 2016 the U.S. failed to improve the prevalence of obesity, death rate from drugs, premature death rate and death rate from heart disease.  

Millions of People are Finding it Easier to Pay Medical Bills

By Alison Kodjak | NPR | Nov. 30, 2016

Results from the National Center for Health Statistics show that fewer families struggle to afford their medical bills. Repealing the ACA could reverse this trend, according to policy experts in an NPR blog.

VA Hospital Secrecy and Excuses

Albuquerque Journal | Dec. 20, 2016

The Department of Veterans Affairs (VA) is providing a huge disservice to veterans by refusing to publicly release quality data more detailed than the Star Ratings, according to an editorial in the Albuquerque Journal. Advocates demand to know how the hospitals are rated and why, especially after recent criticism of VA quality of care and wait times. VA officials have recommended against using the rating to help make decisions, arguing that poorly ranking hospitals are the victims of bell curves requiring a loser.

National Veteran Health Equity Report

VA Office of Health Equity | December 2016

A report detailing patterns of health conditions for vulnerable veteran groups will allow the Department of Veteran Affairs to monitor the care of veterans and set goals for improving care, according to a report from the VA’s Office of Health Equity. Less than half of veterans had a service-connected disability and one-third had one or more mental health diagnoses.

U.S. Inpatient Emergency Department Cases May Lead to Surprise Medical Bills

By Christopher Garmon and Benjamin Chartock | Health Affairs Blog | Dec. 14, 2016

The number of admissions and outpatient visits likely leading to a surprise medical bill decreased between 2007 and 2014, according to the Health Affairs Blog. However, the problem remains a frequent problem. For example, in 2014, 20 percent of U.S. hospital inpatient admissions originating in the emergency department (ED), 14 percent of outpatient visits to the ED, and 9 percent of elective inpatient admissions likely led to a surprise medical bills. Surprise medical bill rates for ED patients varied significantly across state, with Florida (37%), New York (35%) and Texas (34%) having the highest rates.

Cost Edges Access as Most Urgent U.S. Health Problem

By Jeffrey M. Jones | Gallup | Dec. 7, 2016

More Americans now mention healthcare costs (27%) than mention access (20%) when asked to name the most urgent health problem facing the U.S., according to Gallup. These two issues typically rank at the top of the list in Gallup's annual poll but have tied for first the past two years.

Improving Community Health Through Hospital Community Benefit Spending

Sara Rosenbaum, et al. | Milken Institute School of Public Health | December 2016

A new report from George Washington University outlines actions that the Internal Revenue Service could take to encourage tax-exempt hospitals to broaden the reach of their community benefits. The report describes ambiguities in existing law regarding the provision of community benefits that could be clarified in order to provide hospitals with incentives for aligning community benefits with policies focused on population and community health.

Five National Foundations Highlight Promising Approaches for Patients with Complex Needs

The Playbook | December 2016

Five national healthcare foundations--the Robert Wood Johnson Foundation, Commonwealth Fund, John A. Hartford Foundation, Peterson Center on Healthcare, and The SCAN Foundation--have launched a new online resource, The Playbook of Best Practices, to help health organizations adopt interventions to improve outcomes and lower the cost of care for patients with multiple chronic conditions, functional disabilities and behavioral health problems. A new Commonwealth Fund survey of patients with complex medical needs shows that these patients consistently have more unmet medical needs than other adults.

For more background on the healthcare spending problem, high-deductible health plans, coordinated care for complex patients, medical harm, prescription drug costs and more, please visit www.healthcarevaluehub.org.

Commentary/News

Trump Should Keep the CMS Innovation Center

By Catherine Rampell | The Washington Post | Dec 1, 2016

The CMS Innovation Center, a hub to research and develop financial incentives that encourage providers to treat more effectively, is estimated to reduce net federal health spending by $34 billion over the next decade, according to this op-ed in The Washington Post. The delivery system reform work done by the Center can appease both sides of the aisle, saving taxpayers money and improving the quality care for Americans.

Why Healthcare Eats More of Your Paycheck Every Year

By Tom Murphy | Associated Press | Nov. 3, 2016

Millions of Americans are finding out this month that the price of their health insurance is going up next year — as it did this year, last year, and most of the years before that, according to this article from the Associated Press. And it's not just that the price is going up, it's that it goes up faster than wages and inflation, eating away at our ability to pay for other things we want (beer, televisions, vacations) or need (rent, heat, food). Insurance premiums have climbed 213 percent since 1999 for family coverage purchased through an employer, according to the Kaiser Family Foundation. Wages, by comparison, have risen 60 percent, while inflation is up 44 percent.

Developments and an Unknown Future for Value-Based Care Reimbursement

By Vera Gruessner | Modern Healthcare | Dec. 13, 2016

HHS finalized new Medicare alternative payment models for cardiac and orthopedic care despite Rep. Tom Price’s history of being critical of value-based care reimbursement initiatives, according to Modern Healthcare. Price, who is President-Elect Trump’s nominee for HHS Secretary, has claimed overreach by the Center for Medicare and Medicaid Innovation and that stakeholders are not engaged when payment models are being created. At the same time, the private health insurance market has widely adopted value-based care reimbursement in an effort to reduce wasteful spending.

Latest Hospital Injury Penalties Include Crackdown on Antibiotic Resistant Germs

By Jordan Rau | Kaiser Health News | Dec. 21, 2016

769 hospitals will be penalized in the most recent Medicare penalty assessment, according to Kaiser Health News. The policy aims to incentivize hospitals to prevent potentially avoidable complications such as infections and bedsores. The lowest performers will lose 1 percent of Medicare funding beginning retroactively to October 2016.

The Demise of the Part B Demo: Doom for Value-Based Payment?

By Rachel Dolan | Health Affairs | Dec. 27, 2016

The demonstration project designed to test payment changes to drugs in Medicare Part B was not finalized, according to Health Affairs. Part B covers outpatient drugs, and payments for drugs are made directly to providers based on sales price, with no consideration of effectiveness or formulary management. The project would have changed the payment rate and tested the use of value-based purchasing tools.

HSA Balances Climb But Benefits Reward Wealthier Consumers Most

By Michelle Andrews | Kaiser Health News | Dec. 2, 2016

President-Elect Trump’s reliance on expanding health savings accounts (HSA) neglect America’s low-income consumers, according to Kaiser Health News. People with low incomes are less likely to have the extra cash to invest in an HSA and get less benefit compared to those in higher tax brackets.People who don’t meet the income tax filing threshold get no benefit at all.

Medicare Outpatients Risk Higher Bills Compared to Inpatient

By Ricardo Alonso-Zaldivar | Associated Press | Dec. 19, 2016

Medicare has taken steps to protect patients from costly outpatient services, according to the Associated Press. The HHS inspector general is recommending further changes to billing rules after finding that for some services, Medicare patients were spending more when they go to outpatient facilities compared to inpatient.

Price Transparency is Nice. Just Don’t Expect It to Cut Health Costs

By Austin Frakt | The New York Times | Dec. 19, 2016

The public’s lack of interest may undermine the success of transparency tools, according to this op-ed in The New York Times. Despite the establishment of statewide, insurer and employer websites to provide cost estimator tools for consumers, most consumers do not use them. Few people realize these tools exist or find the process too complicated, including consumers with high deductibles or chronic conditions.    

CMS Research Illustrates Four Healthcare Transparency Paradoxes

By Jackson Williams | Health Affairs Blog | Dec. 28, 2016
Since 2006, HHS has been dedicated to a Value-Drive Healthcare Initiative based on four cornerstones, including the reporting of price and quality information, according to this Health Affairs Blogpost.According to the research, aspects of HHS’s transparency efforts are limited by consumers preferences. For example, a doctor’s recommendation over relying on websites featuring provider metrics and a skeptical view about government involvement in quality ratings information.

After Harsh Light, A Cheaper Version Of EpiPen From Mylan

The Associated Press | Dec. 16, 2016

Mylan is releasing a generic version of EpiPen at half the price of the branded option after drawing intense scrutiny from Congress and consumers nationwide, according to this report by the Associated Press. Mylan is expected to generate millions of dollars in revenue while protecting their market share against competition. While some consumers will continue to get access to discounts, costs to employers and insurers will receive little reprieve which can affect the price of health insurance premiums.

Maryland Joins 19 Other States in Lawsuit Over Drug Prices

Associated Press | Dec. 19, 2016

Twenty state attorneys general filed a federal lawsuit claiming six generic drug makers inflated and manipulated prices to reduce competition for medication, according to this Associated Press article. After a two-year investigation, Connecticut Attorney General George Jepsen believes he has “developed compelling evidence of collusion and anticompetitive conduct” among many market generic drug manufacturers including Heritage Pharmaceuticals; Aurobindo Pharma USA Inc.; Citron Pharma LLC; Mayne Pharma Inc.; Mylan Pharmaceuticals Inc.; and Teva Pharmaceuticals USA. Plaintiff states include Connecticut, Delaware, Florida, Hawaii, Idaho, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Nevada, New York, North Dakota, Ohio, Pennsylvania, Virginia and Washington.

VA Expands Scope of Nurse Practice

By Virgil Dickson | Modern Healthcare | Dec. 13, 2016

The Veteran Affairs Department finalized a rule allowing advanced-practice registered nurses to practice to their full authority at VA facilities beginning Jan. 14, 2017, according to Modern Healthcare. The VA believes the new rule will make it easier for veterans to receive needed care. About half of states have full scope of practice laws for nurse practitioners.

Ascension Partners With Lyft to Ease Patient Transportation

By Dave Barkholz | Modern Healthcare | Dec. 20, 2016

Ascension -- the nation’s largest not-for-profit hospital system operating in 24 states -- has partnered with Lyft to offer free and discounted rides to vulnerable patients requiring non-emergent care, according to Modern Healthcare. Ascension also decided to waive deductibles or unpaid bills for patients earning less than 250 percent of federal poverty.