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Industry News

Report explores problems posed by market power

Market power--specifically, the ability to raise and keep prices higher than they would be in a competitive market--is a serious problem requiring closer scrutiny, according to a new National Academy of Social Insurance (NASI) report, Addressing Pricing Power in Health Care Markets: Principles and Policy Options to Strengthen and Shape Markets. NASI convened a panel of economists, anti-trust experts, researchers, hospital leaders and insurance executives to explore the issue; their findings are featured in the report. They also discussed their findings at a gathering sponsored by the Kaiser Family Foundation. (NASI--link to report and event video)



Weekend admissions linked to preventable complications

A new study finds patients admitted to hospitals on weekends had a more than 20 percent increased likelihood of developing a hospital-acquired condition compared with patients admitted on weekdays. Falls were the most common complication, although pressure sores and catheter-associated urinary tract infections were also common. Despite the massive amount of data compiled for the study, it remains unclear if factors intrinsic to hospitals are entirely to blame: Sarah Krein of the Ann Arbor VA Center for Clinical Management Research noted patients admitted on weekends are likely sicker and in need of more urgent treatment. (Reuters; BMJ)

Report: Decrease government role, increase competition to cut ACA costs 

In a recent report, the Committee for Economic Development calls for big changes to the Affordable Care Act in order to cut costs. The business-led policy group's plan would reduce the federal government's role in health care reform while increasing direct competition between private and public exchanges. The report also calls for greater variety of plan choices on individual exchanges, replacing subsidies with refundable tax credits and allowing insurers to cross state lines, FierceHealthPayer reports. (FierceHealthPayerreport)

Innovation & Transformation

Pioneer ACOs controlled costs 

Medicare beneficiaries in Pioneer ACOs had a smaller increase in spending than traditional fee-for-service beneficiaries, with little change in patient experience, according to data published in JAMA. Aggregate savings: $385 million. CMS subsequently released an independent evaluation and certified the Pioneer model for expansion. "We are excited that as opposed to it taking five years for the Pioneer ACO model to be certified for expansion based on the quality results and the reduced costs, we actually have so robust results that we are able to certify the model after only two years," says Patrick Conway, MD, CMS' chief medical officer. (Medscape Medical NewsJAMA)



UnitedHealthcare has announced a partnership with three telemedicine companies to cover video-based doctor visits. "The decision by so influential a player in the healthcare industry to telemedicine is the strongest sign yet that the technology is entering the mainstream," reports Wired. These video visits typically cost $40-$50 each, but United clients will pay only their usual co-pay. For now, video visits are available only to UnitedHealth's self-funded customers, but the program is expanding. Newer insurers and several traditional ones have embraced telemedicine. (Wired) 



Nam on the gentle disruption of retail clinics

Retail clinics transform care delivery by adding new options for underserved patients and allowing new technologies and models to be refined, according to a new post on the Clayton Christensen Institute's blog. Retail clinics are disruptive, "not because they will replace the incumbent model today, but because they are ready for the new emerging customers," writes senior research fellow Spencer Nam. They attract underserved patients with clinical issues hospitals aren't well equipped to address. "Unless hospitals are ready for this new world, they will become less important to customers." (blog post)


Consumers & Providers

ED visits increasing, ACEP survey finds

Emergency department visits are increasing, according to a poll released Monday by the American College of Emergency Physicians. Twenty-eight percent of the 2,099 doctors surveyed reported large increases in volume; 47 percent saw slight increases. Such hikes run counter to one of the ACA's goals: Reduce pressure on EDs by providing better primary care access, USA Today reports. One reason for the surge: a shortage of primary care physicians to handle all the newly insured patients, says ACEP President Dr. Mike Gerardi. (USA Today)

Study: Chronic loneliness is a public health issue 

A recent study reveals chronic loneliness in older adults can lead to increased use of health care services. The study, conducted by the University of Georgia College of Public Health, ranked participants on an index of loneliness and compared the results to the number of physician visits and hospitalizations. Researchers found those who reported chronic loneliness over the four-year study period had significantly higher numbers of doctor visits. There was, however, no association to a higher number of hospitalizations, suggesting many are turning to physicians for social contact. (UGA TodayAmerican Journal of Public Health)
St. Elizabeth's Hospital in Belleville, Ill., is part of a national trend; it plans to leave its current location and relocate to a more affluent area. The non-profit Catholic hospital was founded in 1875 with the mission to "embody Christ's healing love" to the sick, elderly and poor, but it is struggling to maintain its bottom line. Many locals, including downtown business owners and Belleville's mayor, fear the move may cause irreparable damage to the downtown economy, while hospital officials claim that maintaining their obsolete facility is more expensive than rebuilding. (Kaiser Health News)
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New & Noted   

Gawande on unnecessary care: In his latest New Yorker article, Dr. Atul Gawande discusses the "epidemic" of unnecessary care, noting that millions of Americans get costly drugs and undergo procedures that not only won't make them better, but may actually cause harm. (New Yorker)



MNsure CEO resigns: Scott Leitz, CEO of the troubled MNsure HIX, resigned Monday to take a position with a health care think tank. He took the helm in December 2013 after the original CEO resigned amid controversy, the Grand Forks Herald reports. (Grand Forks Herald)



Stiffer penalty needed?Current penalties may be too low to entice individuals to purchase insurance coverage, according to a new report from Avalere Health. "Individuals earning more than double the poverty level may continue to forgo coverage since paying the fine is still much more affordable than purchasing insurance," says Avalere's Caroline Pearson. (FierceHealthPayer; report)



Despite ACA, addiction treatment programs aren't reaching patients

Marketplace explores a new Health Affairs paper that finds the ACA's increased coverage for addiction treatment doesn't mean those battling addiction have access to such programs. Many facilities lack the capacity to take on new clients. Half don't meet basic insurance company requirements, and--at least as of 2012--63 percent lacked the health IT needed to communicate with clinicians and hospitals. As the Health Affairs researchers conclude, "In the absence of technical assistance, it is unlikely that addiction treatment programs will fully realize the ACA's promise to improve access to and quality of addiction treatment." (Marketplace; Health Affairs) 

MarketVoices...quotes worth reading


"They don't have anywhere to go but the emergency room. This is what we predicted. We know people come because they have to." -- ACEP President Dr. Mike Gerardi, an emergency physician in New Jersey, on why emergency departments are seeing a surge in patients despite the Affordable Care Act, quoted in USA Today



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Wednesday, May 6 2015































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