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Proposed Medicare Changes to Limit Opioid Prescribing
by Chad KollasOn February 1, 2018, the Centers for Medicare& Medicaid Services (CMS)published its Advance Notice of Methodological Changes for Calendar Year 2019. Included in these proposed rules were several directives intended to reduce" Opioid Overutilization ” (see p. 202), including formal adoption of the “90 morphine milligram equivalent (MME) threshold cited in the CDC Guideline, which was developed by experts as the level that prescribers should generally avoid reaching with their patients (p. 203). ” CMS proposed “adding additional flags for high-risk beneficiaries who use ‘potentiator’ drugs (such...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 4, 2018 Category: Palliative Care Tags: CMS health policy kollas medicare opioids Source Type: blogs

The UPMC-Highmark Brawl Spills Into Philadelphia ’ s Backyard
By TORY WOLFF The UPMC/Highmark rivalry continues to open new fronts in Pennsylvania. Highmark’s response to UPMC is differentiated in two ways: first, Highmark is using a coalition-building strategy and, second, it is controlling its exposure to big in-patient assets; in contrast, UPMC is building an integrated, single-brand system and happily taking over hospitals (and building more) along the way. When UPMC and Highmark make major investments in a region, local systems will be caught in the capex arms and feel the pressure to affiliate. Credibly threatening to respond in kind may defuse the arms race. But unaffiliated...
Source: The Health Care Blog - January 22, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Highmark UPMC Source Type: blogs

Hospice Care is covered by Medicare and Most Other Insurance
Dear Carol: My dad has aggressive prostate cancer that has spread to his liver and bones. His oncologist isn’t very communicative and when I asked about hospice care he said that’s up to us. He told us that Dad won’t get better but that he can keep treating him if we want. The treatments make Dad miserable. If they won’t help, what’s the point? I feel strongly that Dad needs hospice care and have been trying to talk my mom into it but she’s dragging her feet. How do we go about getting the service? Which one do we choose? Will Mom have to go on Medicaid to get it paid for? This is her biggest fear. – ST...
Source: Minding Our Elders - January 14, 2018 Category: Geriatrics Authors: Carol Bradley Bursack Source Type: blogs

New Evidence in JAMA Shows Insurance Gaps Leave Some Cancer Patients Without
BY BAILEY FITZGERALD “How long do I have?” The man was just diagnosed with lung cancer. “That depends,” his doctor says. “What insurance do you have?” New research suggests that conversations like these may be actually taking place across the country. Todd Pezzi and colleagues analyzed a national database for treatment outcomes for patients with limited stage non-small cell lung cancer, a diagnosis with high rates of response to treatment. The results, reported in JAMA Oncology last week were astounding: patients with Medicare, Medicaid, or no health insurance received different, and often worse, care than thos...
Source: The Health Care Blog - January 12, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Bailey Fitzgerald Cancer JAMA Oncology Standard of Care Source Type: blogs

New Evidence in JAMA Shows Insurance Gaps Leave Some Cancer Patients Without Treatment
BY BAILEY FITZGERALD “How long do I have?” The man was just diagnosed with lung cancer. “That depends,” his doctor says. “What insurance do you have?” New research suggests that conversations like these may be actually taking place across the country. Todd Pezzi and colleagues analyzed a national database for treatment outcomes for patients with limited stage non-small cell lung cancer, a diagnosis with high rates of response to treatment. The results, reported in JAMA Oncology last week were astounding: patients with Medicare, Medicaid, or no health insurance received different, and often worse, care than thos...
Source: The Health Care Blog - January 12, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Bailey Fitzgerald Cancer JAMA Oncology Standard of Care Source Type: blogs

Key Articles in Health IT from 2017 (Part 2 of 2)
The first part of this article set a general context for health IT in 2017 and started through the year with a review of interesting articles and studies. We’ll finish the review here. A thoughtful article suggests a positive approach toward health care quality. The author stresses the value of organic change, although using data for accountability has value too. An article extolling digital payments actually said more about the out-of-control complexity of the US reimbursement system. It may or not be coincidental that her article appeared one day after the CommonWell Health Alliance announced an API whose main purp...
Source: EMR and HIPAA - January 4, 2018 Category: Information Technology Authors: Andy Oram Tags: 3D Printing ACO Apple Connected Health Digital Health Gadgets Genomics Google Healthcare AI Healthcare Analytics Healthcare API Healthcare Devices Healthcare IT Security Healthcare Reimbursement HIE Meaningful Use Medical D Source Type: blogs

In Depth Review of CMS MACRA QPP Regulations
As we continue our coverage of the MACRA Quality Payment Program (QPP) rule, the following article provides a more in-depth look at the regulations promulgated by CMS. We drafted an initial summary when the rule was released in early November. Biggest surprise: cost category of MIPS In its proposed rule in July 2017, CMS proposed completely removing the cost domain from MIPS for 2018, despite the underlying statute requiring that cost account for 30% of the overall MIPS score by 2019. However, in the final rule, CMS shocked many when it reversed its position and finalized a cost domain weight of 10 percent for the 2018 p...
Source: Policy and Medicine - December 28, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Can technology and the art of medicine coexist?
While on the way to a national meeting on health and public policy, I ponder on what the practice of medicine has become and whether this meeting will provide any hope for improvement. It hasn’t been clear to me that those most responsible for public health policy are listening to doctors. Politicians have been leading this charge, sometimes solo, sometimes in a group but rarely in a collaborative fashion — and mostly without the requisite experience or knowledge that appropriate collaboration can provide. I think back to one of the seemingly endless coding and quality meetings in modern medicine as I talk with my pati...
Source: Kevin, M.D. - Medical Weblog - December 22, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/lianne-marks" rel="tag" > Lianne Marks, MD < /a > Tags: Policy Primary Care Public Health & Source Type: blogs

5 challenges of working in a county hospital
As a trainee at a large private health system (residency) followed by a NCI-designed comprehensive cancer (fellowship) in two large metropolitan areas in the United States, I was not prepared to face the challenges of working at a university setting affiliated with a county (public) hospital in more rural west-Texas.  After one and a half years of experience as a practicing urologic oncologist, these are the five challenges I have encountered: 1. Access to the latest technology. County (public) hospitals are typically more cash-conscious without access to large amounts of research money, wealthy donors, high-profile fundr...
Source: Kevin, M.D. - Medical Weblog - December 6, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/pranav-sharma" rel="tag" > Pranav Sharma, MD < /a > Tags: Policy Hospital-Based Medicine Surgery Source Type: blogs

National Hospice and Palliative Care Month: Divide and Conquer
by Christian Sinclair (@ctsinclair)Now thatNational Hospice and Palliative Care Month (NHPCM) is in the books for 2017, December is a good time to reflect on what these awareness months can (and cannot) accomplish and how we can make a better strategy for the future. Awareness campaigns have blazed brightly through the bracelet and ribbon eras, and are firmly in the social media era with no signs of stopping (other than possibly fatigue from so much awareness about awareness campaigns.)No single group is technically is in charge of National Hospice and Palliative Care Month. Very few calendar-based advocacy campaigns (CBAC...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 4, 2017 Category: Palliative Care Tags: hospice palliative sinclair The profession Source Type: blogs

Urine Testing: The Next Shoe to Drop?
Opioids have been a topic of discussion for months now, and every week it seems as though a new company or individual is in hot water over opioid prescribing practices, or over alleged opioid prescribing practices. One facet of the opioid epidemic that has not been touched upon is the requirement many pain management physicians and others have that when a patient is under their care and receiving opioids and/or habit-forming prescriptions, the patient must affirm that they are not seeing other physicians for prescriptions and/or that all prescriptions are being filled at the same pharmacy. To that end, the patient typical...
Source: Policy and Medicine - November 22, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Remembering Uwe
By JEFF GOLDSMITH The healthcare world learned with great sadness this week of the passing of our friend, Uwe Reinhardt. I met Uwe in 1982 at the Federation of American Hospitals meeting in Las Vegas. Uwe opened the meeting by apologizing, in his disarming German accent, for not being his usual sharp self. He had, he said, skipped breakfast because his wife May had instructed him not to pay for anything in Las Vegas that he could get for free at home. This was vintage Reinhardt, innocent and knowing at the same time. That meeting was the beginning of a long and warm friendship. Uwe would have been acutely uncomfortable wi...
Source: The Health Care Blog - November 15, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs

Changes to 340B Program Reduces Hospital Reimbursement for Pharmaceutical Products by 28.5%
Recently, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period (CMS-1678-FC), which includes updates to the 2018 rates and quality provisions, and other policy changes. CMS adopted many policies that will support care delivery; reduce burdens for health care providers, especially in rural areas; lower beneficiary out of pocket drug costs for certain drugs; enhance the patient-doctor relationship; and promote flexibility in healthcare. This final rule p...
Source: Policy and Medicine - November 14, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

NYTimes: The Growing Toll of Our Ever-Expanding Waistlines
The Growing Toll of Our Ever-Expanding WaistlinesBy  JANE E. BRODY NOV. 13, 2017Paul Rogers I hope you ’re not chomping on a bagel or, worse, a doughnut while you read about what is probably the most serious public health irony of the last half century in this country: As one major killer — smoking — declined, another rose precipitously to take its place: obesity.Many cancer deaths were averted after millions quit lighting up, but they are now rising because even greater numbers are unable to keep their waistlines in check.Today, obesity and smoking remain the two leading causes of preventable dea...
Source: Dr Portnay - November 13, 2017 Category: Cardiology Authors: Dr Portnay Source Type: blogs