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Blog: AHRQ defunding shortsighted and risky

The House Appropriations Committee decision to defund the Agency for Healthcare Research and Quality (AHRQ) is the wrong way to address budgetary challenges, Academy Health Chair Paul Wallace, MD, writes in a Health Affairs Blog post. "In a resource limited environment, we have to make tough choices, but eliminating funding for AHRQ is shortsighted and places patients and their families at inappropriate risk." AHRQ's fate remains uncertain; the legislation must be approved by the full House and Senate. Meanwhile, HealthLeaders Media looks at AHRQ's role and mission and what its loss could mean. (Health Affairs Blog; HealthLeaders Media)



From enrollment to affordability, ACA faces multiple challenges

The Affordable Care Act isn't necessarily here to stay; important challenges remain. In its first five years, it has survived technical meltdowns, a presidential election, two Supreme Court challenges and countless repeal efforts in Congress. But its long-term future still isn't ensured. Kaiser Health News identifies five of the biggest hurdles remaining: Medicaid expansion, anemic enrollment, market stability, affordability and political resistance. In addition, the Associated Press reports on other pending court cases that threaten the ACA. (Kaiser Health News; AP) 
Many kidney failure patients continue to receive dialysis treatments via catheters, a method known to increase the risk of infections, clots and even death. The best method (an arteriovenous fistula) is not always the first resort, Modern Healthcare reports. It's a problem some associate with poor access to care, misaligned reimbursement incentives and geographic disparities. "We know fistula use is associated with the best outcomes--but we're still not doing a good job. It makes me think there's something wrong with the system," says Dr. Mahmoud Malas of Johns Hopkins School of Medicine. (Modern Healthcare)

Innovation & Transformation 

Pilot gives providers access to total cost of care 

An Oregon pilot project that lets providers look at the total cost of care is yielding positive results. Practices can look at referral patterns--both to ED and specialists--because of a cost and utilization report made available to providers by the Oregon Health Care Quality Corporation, part of a pilot project headed by the Network for Regional Healthcare Improvement (NRHI). Physician groups can't make meaningful improvement toward costs in a vacuum, says Elizabeth Mitchell, president and CEO of NRHI. Physicians "want and need this information to be effective, especially as they take on risk, but it's not being made available by payers." The next phase will be integrating Medicare data into claims databases. (HeathLeaders Media)



Independent at Home pilot reports positive results 

Medicare announced last week it saved more than $25 million in the first year of its Independent at Home demonstration project, now in its third year of testing how well a house call approach works and how to pay for it. About 8,400 frail seniors with multiple chronic conditions--Medicare's most expensive type of patient--are receiving customized home-based primary care from 17 programs around the country. Medicare will divide $11.7 million in incentive payments among the nine practices that met enough quality targets to qualify. (Associated Press) 
CVS Health is collaborating with Sutter Health in California, Millennium Physician Group in Florida, Bryan Health Connect in Nebraska and Mount Kisco Medical Group in New York. It provides them patient prescription and visit data through its Epic EHR platform. These providers will receive data on interventions conducted by CVS pharmacists, with the aim of improving their patients' medication adherence. The effort encourages collaboration between the health systems and MinuteClinic providers to improve coordination of care for MinuteClinic patients, Healthcare IT News reports. (Healthcare IT News)
Consumers & Providers

Patient-centered bullying costs anesthesiologist $500K 

A Virginia man who used his phone to record post-colonoscopy instructions actually recorded the entire procedure and discovered the surgical team mocked him while he was sedated. Worse, they placed a false diagnosis on his chart. The man sued the anesthesiologist and the gastroenterologist and their practices for defamation and medical malpractice. He won--$100,000 for defamation, $200,000 for medical malpractice and $200,000 in punitive damages. The court ordered the anesthesiologist--Dr. Tiffany Ingham--and her practice to pay him the $500,000. Dr. Soloman Shah, the gastroenterologist, reportedly made disparaging comments as well but was dropped from the suit. (Washington Post; audio clips; NPR interview with ethicist)



Study: Residents don't understand costs 

Only about a quarter of internal medicine residents say they know where to find cost estimates for tests and treatments, and that they can share those estimates with patients, according to an American College of Physicians survey published in  Academic Medicine: The Journal of the Association of American Medical Colleges. Forty-six percent say they incorporate those costs into clinical decisions. "I was surprised that so few of the residents knew where to find costs of tests and treatments and that so few of them incorporated costs into any clinical decision-making," says study co-author Cynthia Smith, MD. She calls the findings "a real cry for cost transparency." (Academic Medicine; HealthLeaders Media


Covered California, the state-run HIX, is embarking on an effort to collect insurance company data on prescriptions, doctor visits and hospital stays on each of its 1.4 million enrollees. Unsurprisingly, the effort has raised questions about patient privacy and data security. Covered California says the data-mining project is essential to measure the quality of care that patients receive and to hold health insurers and medical providers accountable, the Los Angeles Times  reports. (Los Angeles Times)

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New & Noted   

Assessing drug value: The American Society of Clinical Oncology has published a formula designed to help doctors and patients weigh the value of cancer treatments. It aims to help doctors and patients assess factors such as benefits, side effects and cost when deciding among treatment options. (Kaiser Health News roundup


Post-game analysis: In a Health Affairs Blog post, Timothy Jost, MD, offers an overview of the Supreme Court ruling that upheld HIX subsidies and looks at what may lie ahead. (Health Affairs Blog)



JGIM explores data collection: In a special issue of the Journal of General Internal Medicine, researchers address the value of access to accurate, timely information on physicians and their practices. In six articles and a companion editorial, the authors lay the conceptual groundwork for a national data-collection effort that includes all physicians in all specialties across the country. (Journal of General Internal Medicine; Mathematica announcement) 



It's time for physicians to take a more active role in guiding patients to good information

--and challenging them on bad information, says medical ethicist Art Caplan, PhD. "Many others, such as the Food Babe, who has been touting all kinds of healthy diet stuff, and even the much maligned Dr. Oz, who has been selling quick-fix solutions to obesity, are telling people that there are magic beans and super-duper extracts that can solve all manner of health problems." (Medscape Business of Medicine video) 

MarketVoices...quotes worth reading


"Societal investment in AHRQ specifically, and health services research in general, is key to designing, building, and sustaining critical infrastructure and capabilities so that the health system can work better, serving the needs of patients and those who care for them. This is not sexy work--it will not trend on Twitter, nor is it likely to make the front page of USA Today, at least not that you'd notice." --Paul Wallace, MD, chair of the board of directors for Academy Health, in a Health Affairs Blog post

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Wednesday, July 1, 2015































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