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Pollyanna Rhetoric, Proximate Futures and Realist's Primer on Health IT Realities in 2015
In conclusion: Next time you encounter pollyanna/head-in-the-sand statements about health IT that ignore the risks, throw this primer the way of the authors and audience of such statements. -- SS
Source: Health Care Renewal - April 27, 2015 Category: Health Management Tags: Charlie Jarvis David Blumenthal Edward Ehlinger healthcare IT difficulties healthcare IT myths healthcare IT pollyanna Mark Leavitt proximate future subjunctivisation bias Trisha Greenhalgh Source Type: blogs

Owner Of Durable Medical Supply Company Sentenced to 6 ½ Years In Prison
Last week, the owner of a durable medical equipment (DME) supply company was sentenced to 6 ½ years in prison for her role in submitting more than $7 million in fraudulent claims to Medicare.  Adeline Ekwebelem’s Los Angeles-based DME company, Adelco Medical Distributors, Inc., billed Medicare for medically unnecessary power wheelchairs “for beneficiaries often recruited off the street,” notes the government press release. Ekwebelem’s scheme, according to the prosecutors, implicated a “handful of complicit doctors,” who would write fraudulent prescriptions for wheelchairs in exchange for kickbacks. One s...
Source: Policy and Medicine - May 4, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

DaVita Settles Another Lawsuit Amidst Accusations of "Managing Witnesses to Provide False Testimony," After Justice Department Lost Interest in Participating
The Latest Case Less than a year since its last big settlement (look here), DaVita HealthCare Partners, the big for-profit dialysis provider, has to settle again.  The basics, according to the Denver Post, were:DaVita HealthCare Partners said Monday it will pay up to $495 million to settle a whistle-blower lawsuit accusing the Denver company of defrauding the federal Medicare program of millions of dollars. The company, which said it does not admit any wrongdoing, has now settled its third whistle-blower lawsuit since 2012, with payouts totaling nearly $1 billion.The civil suit, filed in Atlanta in 2011, revolves...
Source: Health Care Renewal - May 8, 2015 Category: Health Management Tags: DaVita fraud impunity legal settlements Source Type: blogs

Senator Grassley Sets Sights On Medicare Advantage; Sends Letters To CMS and DOJ Asking For Their Strategies To Mitigate "Risk Score" Fraud
Senator Charles Grassley (R-IA), the co-author of the Physician Payments Sunshine Act, sent letters last week to the Centers for Medicare and Medicaid Services (CMS) and the Department of Justice (DOJ) concerning alleged Medicare Advantage fraud. Update: Senator Claire McCaskill, the top ranking Democrat on the Senate Special Commission on Aging, also sent a letter to CMS asking what steps the government is taking to combat alleged Medicare Advantage fraud and abuse.    Medicare Advantage plans are run through approved private insurance companies, and offer an alternative to traditional Medicare for seniors. CM...
Source: Policy and Medicine - June 1, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Health Affairs’ June Issue: Markets, Prices, And Incentives
The June issue of Health Affairs, a variety issue, includes a number of articles examining how health care markets function — and how the policies that set prices create incentives for behavior, both desirable and undesirable. Another featured article examines incentives for public health in an area close to many of us: reducing teen driving fatalities. The Top Fifty Highest-Markup Hospitals: Forty-Nine Are For Profit In the United States, individual hospitals establish billing rates for services, which are not subject to any limit in most states. These rates are often several times the Medicare-allowable costs. Pat...
Source: Health Affairs Blog - June 8, 2015 Category: Health Management Authors: Lucy Larner Tags: Costs and Spending Elsewhere@ Health Affairs Featured Global Health Health Professionals Hospitals Medicare Payment Policy EHRs PEPFAR Teen Driving Source Type: blogs

Brookings vs Yelp and E-Patients: They’re All Wrong, but Mostly Brookings
By ADAMS DUDLEY, MD Can I fool you with the picture above? Apparently, some people think so. I’m a Twitter newbie, but I’ve already discovered that sometimes you can tweet what you think is a helpful piece of data, then find yourself suddenly caught up in an explosive controversy.  When it’s the Brookings Institute and US News and World Report on one side and passionate e-patients on the other, a research tweep is liable to feel like a nerdy accountant who wandered into the OK Corral at high noon with neither Kevlar nor a gun. This happened to me when Niam Yaraghi of Brookings posted on the US News blog and the Bro...
Source: The Health Care Blog - June 20, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Uncategorized Adams Dudley Source Type: blogs

The Core Quality Measures Collaborative: A Rationale And Framework For Public-Private Quality Measure Alignment
Editor’s note: The full list of authors for the Core Quality Measures Collaborative Workgroup is included at the end of the blog post. In today’s health care system, physicians are faced with an unprecedented number of quality measures required by different entities. Payment is pivoting away from traditional reimbursement models toward value-based health care, where value is a function of both quality and cost. Patients are making an about-face from traditionally passive receivers of health care to informed consumers with expectations of transparency. Payers and employer groups are demanding accountability for how thei...
Source: Health Affairs Blog - June 23, 2015 Category: Health Management Authors: Patrick H. Conway and the Core Quality Measures Collaborative Workgroup Tags: Featured Hospitals Organization and Delivery Payment Policy Population Health Quality 3Rs AHIP AHRQ CMS health outcomes National Quality Forum Source Type: blogs

Who Benefits? - Rising Generic Drug Prices and the Case of Mylan's Conflicted Property Purchases
Rising Generic Drug PricesHealth care costs in the US continue their seemingly inexorable rise.  Even the parts of health care that used to seem reasonably priced now are affected.  As Ed Silverman discussed on PharmaLotprices for many generic drugs have been climbing, prompting concerns that a low-cost staple of the U.S. health care system might soon strain budgets.Generic drugs, like practically every other part of US health care, have become big business.  As a Forbes article pointed out, the industry is becoming more consolidated, and more likely to suffer from manufacturing and regulatory issues.  ...
Source: Health Care Renewal - July 9, 2015 Category: Health Management Tags: boards of directors conflicts of interest executive compensation mission-hostile management Mylan perverse incentives Source Type: blogs

"Quality" Measures Update
According to CMS, more than 460,000 of the 1.25 million eligible Medicare providers did not meet deadlines to submit data for the Physician Quality Reporting System in 2013. The agency noted that about 70% of those who did not meet the deadlines see fewer than 100 Medicare patients annually. Nearly 40 percent of healthcare providers treating Medicare patients will have their payments docked 1.5% this year because they did not submit data on patients’ health to the government. However, nearly 642,000 providers did comply in 2013 and will earn a 0.5% boost in payments this year. For many small practices, the administrative...
Source: Policy and Medicine - July 9, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Health Affairs’ August Issue: Hospital Quality And Care
The August issue of Health Affairs contains a cluster of articles focusing on hospital quality and care. Other subjects covered in this variety issue: ways state vaccine exemption laws affect disease outbreaks; how states with strong health insurance rate review managed lower premiums; and characteristics of health care “super-utilizers.” State Vaccination Exemption Laws, Exemption Rates, And Disease Outbreaks In the United States, it is left to individual states to require that their kindergarteners show proof of vaccinations or have a vaccination exemption before being admitted to school. W. David Bradford and Anne M...
Source: Health Affairs Blog - August 3, 2015 Category: Health Management Authors: Chris Fleming Tags: Costs and Spending Elsewhere@ Health Affairs Equity and Disparities Organization and Delivery Population Health Public Health Quality Health Affairs August Issue Mental Health pay-per-performance super-utilizers vaccination laws Source Type: blogs

CMS Releases 2016 Open Payments Teaching Hospital List
As they did on October 1st last year, yesterday, the Centers for Medicare and Medicaid Services (CMS) released an updated Teaching Hospital list and increased (slightly) reporting thresholds for the next year’s reporting cycle. In looking at the new hospital file, CMS has added to its list—the agency included 1,203 last year, it is up to 1,222 this year. In terms of a “de minimis” threshold, if a payment or other transfer of value is less than $10.22 ($10.21 for 2015; $10.18 for 2014), unless the aggregate amount transferred to, requested by, or designated on behalf of a covered recipient exceeds $102.19 in a cale...
Source: Policy and Medicine - October 2, 2015 Category: American Health Authors: Policy and Medicine Writing Staff Source Type: blogs

Provider Payment Sunshine Act: Senators Grassley and Blumenthal Introduce Bill to Expand Open Payments Reporting Requirements to Nurse Practitioners and Physician Assistants
On October 7, Sen. Charles Grassley (R-Iowa) and Sen. Richard Blumenthal (D-Conn) introduced a bill that would expand the Open Payments reporting requirements to include nurse practitioners and physician assistants. Currently, to comply with the Sunshine Act, pharmaceutical and medical device manufacturers are required to report payments and other transfers of value to physicians and teachings hospitals. While the definition of physician is broad—and includes doctors of medicine, osteopathy, dentists, podiatrists, optometrists and chiropractors who legally authorized to practice by a state—the law currently does not co...
Source: Policy and Medicine - October 9, 2015 Category: American Health Authors: Policy and Medicine Writing Staff Source Type: blogs

Wave of Health Insurance CO-OPs to Shut Down in Latest ACA Failure
Hundreds of thousands people will lose their insurance plans as a raft of health insurance cooperatives (CO-OPs) created by the Affordable Care Act will cease operations. Just last week, CO-OPs in Oregon, Colorado, Tennessee and Kentucky announced that they would be winding down operations due to lower than expected enrollment and solvency concerns (although the one in Colorado is suing the state over the shutdown order).  They join four other CO-OPs that have announced that they would be closing their doors. In total, only 15 out of the 23 CO-OPs created by the law remain. These closures reveal how ill-advised this aspec...
Source: Cato-at-liberty - October 22, 2015 Category: American Health Authors: Charles Hughes Source Type: blogs

Expanded Coverage Appears To Explain Much Of The Recent Increase In Health Job Growth
The rate of health sector hiring started to increase in the middle of 2014, and has continued to accelerate through the first three quarters of 2015. The timing of this acceleration corresponds to the recent expansion of health insurance coverage, but thus far there is little direct evidence of a relationship between expanded coverage and health jobs. We use state-level data on health jobs and insurance coverage to show that much of the acceleration in health jobs can be explained by expanded coverage. This suggests that as insurance coverage stabilizes, health job growth should revert back to more typical historical level...
Source: Health Affairs Blog - November 20, 2015 Category: Health Management Authors: Charles Roehrig, Ani Turner and Katherine Hempstead Tags: Costs and Spending Featured Health Professionals Insurance and Coverage American Community Survey Bureau of Labor Statistics Current Employment Statistics health sector jobs Source Type: blogs

Senate Finance Committee Releases Results of Investigation Into Gilead’s Pricing Strategy for Hepatitis-C Drugs
Discussion The Gilead example does not represent the life science community well, and highlights the need to put extra thought into the way drugs are priced. Gilead clearly was allowing marketing to drive the pricing ship and displayed what could be considered an almost reckless disregard for availability and affordability. Pharmaceutical companies can, and should, attempt to maximize their profit, but should consider doing so in a way that ensures availability and affordability for patients and payers alike. While there is no clear answer to the drug pricing dilemma we currently face, perhaps more thought and research s...
Source: Policy and Medicine - December 2, 2015 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs