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CMS Will Soon Unleash a New Appropriate Use Mandate
Cardiac imaging is in need of some wrangling. Professional medical associations and universities across the U.S. have developed appropriate use criteria (AUC) for physicians when determining if a patient should go through cardiac testing. However, a group of physicians believe that the AUC “is no longer an idealistic exercise” and a Centers for Medicare& Medicaid Services (CMS)-approved technique will soon be required when evaluating a patient ’s need for imaging procedures.AUC encourages physicians to utilize evidence or expert opinion when deciding if a patient should receive testing while using a three-fold ru...
Source: radRounds - March 15, 2017 Category: Radiology Authors: Julie Morse Source Type: blogs
How Trump Can Kill the Cancer In Obamacare Without Congress
By BRIAN JOONDEPH, MD
Cancer is a devious and devastating disease. All it takes are a few bad cells to grow uncontrollably, first destroying organs, then an entire person. It can also lie dormant for years after supposedly being cured, then at some moment awaken from its remission slumber to resume its search-and-destroy mission. Even if cancer is controlled, it can still leave its victim in a weakened or debilitated condition, a shadow of its former robust self.
What if the Affordable Care Act, affectionately known as Obamacare, was unintentionally infected with cancer back in 2010 when it was voted into law? What if the ...
Source: The Health Care Blog - March 13, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
The American Health Care Act And Medicaid: Changing A Half-Century Federal-State Partnership
Based on page length alone, it is evident that Medicaid is a focal point of the American Health Care Act, released on March 6. Although its fate is uncertain, the bill provides a clear sense of where the Affordable Care Act repeal and replace strategy is heading. Where Medicaid is concerned, what has been discussed for years has now become real: using ACA repeal/replace as the vehicle for a wholesale restructuring of the very financial foundation of the Medicaid program as it has existed over an unparalleled, half-century federal/state partnership.
As expected, the House bill essentially eliminates the enhanced funding lev...
Source: Health Affairs Blog - March 10, 2017 Category: Health Management Authors: Sara Rosenbaum Tags: Featured Medicaid and CHIP ACA repeal and replace Planned Parenthood Source Type: blogs
Bringing on-demand rideshare to medical transport. Interview with Veyo ’ s CEO
Uber and Lyft have transformed (and largely destroyed) the taxi industry. Now startup companies like Veyo are applying similar approaches to the medical transportation field. I interviewed Veyo’s CEO, Josh Komenda to get his take.
1.How is non-emergency medical transportation (NEMT) defined? What’s included? How big is it?
Non-Emergency Medical Transportation (NEMT) is a transportation benefit for Medicaid or Medicare members who need to get to and from medical services, but have no means of transportation. NEMT provides eligible patients with trips that are non-emergency in nature, meaning there is no i...
Source: Health Business Blog - March 9, 2017 Category: Health Management Authors: dewe67 Tags: Entrepreneurs Patients Podcast Technology medical transportation NEMT rideshare Source Type: blogs
Foundation Blogs Round-Up: Social Determinants Of Health, Kansas Medicaid, And More
Data Analytics In Health Care (And Baseball)
“Bringing Moneyball to Medicine,” by Andy Bindman of the University of California, San Francisco (UCSF) on the California Health Care Foundation’s blog, February 15. Bindman, who is now a professor of medicine, health policy, epidemiology, and biostatistics at UCSF, directed the Agency for Healthcare Research and Quality (AHRQ) from May 2016 until the conclusion of the Obama administration. In this post (and when he was at AHRQ), Bindman uses the example of the movie Moneyball (which is about baseball) to make his point about how data analytics help. He says, “It was my ...
Source: Health Affairs Blog - March 7, 2017 Category: Health Management Authors: Lee-Lee Prina Tags: GrantWatch Medicaid and CHIP Environmental Health Health Philanthropy Health Reform Nonmedical Determinants Social Determinants of Health Source Type: blogs
R & D Costs For Pharmaceutical Companies Do Not Explain Elevated US Drug Prices
That pharmaceutical companies charge much more for their drugs in the United States than they do in other Western countries has contributed to public and political distrust of their pricing practices. When these higher US prices (which are sometimes cited as being two to five times the prices in Europe) are challenged, the pharmaceutical industry often explains that the higher prices they charge in the US provide them with the funds they need to conduct their high-risk research.
This claim—that premiums earned from charging US patients and taxpayers more for medications than other Western countries funds companies’...
Source: Health Affairs Blog - March 7, 2017 Category: Health Management Authors: Nancy Yu, Zachary Helms and Peter Bach Tags: Costs and Spending Drugs and Medical Innovation Payment Policy Big Pharma drug pricing Source Type: blogs
Myths About The Medicaid Expansion And The ‘Able-Bodied’
A conservative critique of the Affordable Care Act’s (ACA’s) expansion of Medicaid eligibility is that it helps adults who are “able-bodied” and may discourage them from working. For example, a policy summary released by House Republicans proposes that “Obamacare’s Medicaid expansion for able-bodied adults [should] be repealed in its current form” (emphasis added). Arkansas Governor Asa Hutchinson has declared that if people are not willing to work and are “able-bodied, they ought to be kicked off the system.” In fact, the great majority of adults covered by the Medicaid expansion are in ill health or are...
Source: Health Affairs Blog - March 6, 2017 Category: Health Management Authors: Leighton Ku and Erin Brantley Tags: Following the ACA Insurance and Coverage Medicaid and CHIP Quality ACA repeal and replace Arizona Medicaid expansion medicaid expansion states Source Type: blogs
Drug Price Debate Could Stall, Unless Consumers Get Engaged
By STEVEN FINDLAY
It’s still unclear whether Congress or the Trump administration will try to tackle the prescription drug price/cost issue this year. Amid ACA repeal and replace, and possible Medicaid and Medicare reform fights, it seems a stretch.
In recent weeks, Trump has also changed his tune on the subject. Soaring prescription prices were a populist rallying cry at his campaign stops pre-election and then pre-inauguration. (“They’re getting away with murder,” he bellowed, referring to drug companies.)
But, fitting a post-inauguration pattern, Trump softened his message after a get-together with p...
Source: The Health Care Blog - February 28, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
How The Trump Administration Could Advance Federal Prevention Policy
Chronic disease prevention was an explicit priority of the Secretaries of Health and Human Services in both of the President George W. Bush and President Barack Obama administrations. While the policies and programs may have differed across administrations, there has been a recognition by both parties that promoting wellness is an important policy objective.
Prioritizing prevention can and should remain an essential part of the Trump Administration’s health priorities. Addressing the high and growing costs of chronic disease is critical to ensuring a sustainable health care system, and tackling well-known risk factors th...
Source: Health Affairs Blog - February 28, 2017 Category: Health Management Authors: Anand Parekh, Lisel Loy and G. William Hoagland Tags: Costs and Spending Featured Insurance and Coverage Population Health Public Health ACA repeal chronic disease prevention Community Preventive Services Task Force Healthy People Prevention and Public Health Fund. Trump administration Source Type: blogs
Non-Alternative Facts About the Healthcare System
By JOE FLOWER
The economic fundamentals of healthcare in the United States are unique, amazingly complex, multi-layered and opaque. It takes a lot of work and time to understand them, work and time that few of the experts opining about healthcare on television have done. Once you do understand them, it takes serious independence, a big ornery streak, and maybe a bit of a career death wish to speak publicly about how the industry that pays your speaking and consulting fees should, can, and must strive to make half as much money. Well, I turn 67 this year and I’m cranky as hell, so let’s go.
The Wrong Question
We are ba...
Source: The Health Care Blog - February 26, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
As US Attorney, Labor Secretary Nominee Enabled Drug and Biotechnology Executives ' Impunity
The new Trump administration nominee for US Secretary of Labor is a former US Attorney for the southern district of Florida. In that role, he seemed to uphold the ideas that certain big corporations, particularly big pharmaceutical and biotechnology corporations, are too big to jail, and that top executives of big corporations should not be held accountable for their corporations ' actions.He had central involvement in three bigsettlements of charges of corporate misbehavior which held no individuals accountable for enabling, authorizing, directing or implementing the bad behavior. The settlements imposed only ...
Source: Health Care Renewal - February 21, 2017 Category: Health Management Tags: bribery Bristol-Myers-Squibb deception Donald Trump Genzyme GlaxoSmithKline impunity kickbacks legal settlements manipulating clinical research Sanofi-Aventis Source Type: blogs
Can Employers Take A Bigger Role In Controlling Drug Costs?
An estimated 150 million Americans receive insurance through their employer — and employees and employers alike continue to suffer from “sticker shock” for prices for new drugs, despite several years of debate and threatened congressional action to control the high prices of pharmaceutical products. While considerable attention has been paid to potential actions by Medicare or the Food and Drug Administration (FDA), there has been less focus on the role of private payers to solve the issue. Employers sponsoring health benefits are not bound by the same statutory constraints that apply to Medicare and can ...
Source: Health Affairs Blog - February 17, 2017 Category: Health Management Authors: Robert Galvin and Troyen Brennan Tags: Costs and Spending Drugs and Medical Innovation Drugs and Medical Technology Insurance and Coverage employer coverage launch prices pharmacy benefit managers prescription drug prices QALY Source Type: blogs
Gaming the System
This post was originally published by The Health Care Blog on February 11.
As physicians ready themselves for the future of medicine under onerous MACRA regulations, it seems appropriate to glance into the future and visualize the medical utopia anticipated by so many. Value-based care, determined by statistical analysis, is going to replace fee for service.
Six months ago, I received my first set of statistics from a state Medicaid plan and was told my ER utilization numbers were on the higher end compared to most practices in the region. This was perplexing as my patients tend to avoid ER visits at all cost...
Source: Disruptive Women in Health Care - February 15, 2017 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Medicaid Source Type: blogs
How Can We Increase The Use Of Palliative Care In Medicare?
In August, 2016, a 93-year-old woman—the grandmother of one of this Blog post’s authors—died of congestive heart failure, five weeks after she underwent surgery to receive a pacemaker. There were alternative care options, but they were not offered to her and her family in a timely manner, at least in part because of Medicare’s long-standing payment rules that value procedures over discussion of goals and alleviation of symptoms. Medicare paid for the surgery and pacemaker with no questions asked, even though the procedure was, in retrospect, unproductive, wasteful, and even harmful from the family’s persp...
Source: Health Affairs Blog - February 13, 2017 Category: Health Management Authors: Donald Taylor, Matthew Harker, Andrew Olson and Janet Bull Tags: End of Life & Serious Illness Medicare Alternative Payment Models Dying in America Medicare Part B Palliative Care Source Type: blogs
