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Years after end-of-life planning consultations were characterized as "death panels," Medicare will now pay doctors for such discussions. The Obama administration issued the final rule on Friday. The draft rule, issued in July, received "overwhelmingly positive comments about the importance of these conversations between physicians and patients," according to Dr. Patrick Conway, CMS chief medical officer. And next week, the Commission for Case Manager Certification will offer a free webinar on the topic, Effective communication: Navigating delicate conversations: "It's always too soon, until it's too late." Scheduled for Nov. 10, 1-2 p.m. EST, it will feature Harriet Warshaw, executive director of The Conversation Project. (New York Times; CCMC webinar)
 

Employers will be able to collect even more health information about employees under a rule the EEOC proposed last Thursday. It allows voluntary employer workplace wellness programs to ask for health information, including some limited genetic details, from participants and their spouses. The EEOC specifically seeks comments on several questions, including whether the rule should address what employers must do to safeguard personal information stored electronically. It also asks if wellness programs should be prohibited from accessing genetic information from sources such as patient claims data and medical records. (Kaiser Health News; proposed rule)
 

Specialty drugs contribute to double-digit increases in pharmacy drug costs, according to a recent Aon survey. They were expected to jump by almost 23 percent in 2015, up from about an 18 percent increase in 2014. And although most employers rely on plan design changes (e.g., copays) to manage prescription drug costs, some are looking for more innovative approaches, Workforce reports. One example: narrow pharmacy networks that provide consumers with lower prices when they use selected pharmacies. (Workforce)
Innovation & Transformation 
The health care industry is now focusing on value-based care, and community retail pharmacies should play a critical role in that effort, according to Dr. William H. Shrank, chief scientific and medical officer of Health Systems Alliances for CVS Health. Writing in the Harvard Business Review, he cites the company's experience in more than 60 health system partnerships. They work, he says, because they build on five realities in population health management. Among them: Medication adherence is a team sport and, in population health, data is king. (Harvard Business Review) 
 
Study: Conversational hypnosis beats drug for pre-surgical relaxation
In a study involving 100 patients undergoing hand surgery, quietly talking in a positive and reassuring way--"conversational hypnosis"--was compared to the use of hydroxyzine, often given to patients to relax them before surgery. Half received conversational hypnosis while being given regional anesthesia; half were given hydroxyzine 30 minutes to an hour before receiving anesthesia. The patients who received conversational hypnosis were calmer and had lower anxiety levels, according to the study presented last month at the annual meeting of the American Society of Anesthesiologists. (HealthDay News)
 
 
NYU med school program requires students to understand big data
The new "Healthcare by the Numbers" program at NYU medical school requires students to demonstrate "big data" competencies such as defining patient panels and using population health management data to coordinate care. According to Health IT Analytics, the approach "represents an important turning point for the healthcare industry's outlook on the impact and potential of big data analytics, and the necessity of training future generations of students to cope with aging populations, complex chronic disease management, and increasing patient engagement--all while navigating a payment revolution and a potentially disastrous shortage of colleagues." (Health IT Analytics)
 
Consumers & Providers
Dartmouth-Hitchcock Medical Center is the latest to pull out of the CMS Innovation Center's Pioneer ACO initiative. Departures have reduced the number of Pioneers to 19 from the original 32. Dartmouth-Hitchcock is at an unfair disadvantage under formulas that cost the ACO $3.6 million in the third year, CEO Dr. James Weinstein tells Modern Healthcare, comparing the organization to a fast runner who is asked to constantly best his own time. "You're asking organizations that are already running really well to run a 2-minute mile...It's not possible." He says Dartmouth-Hitchcock may enter Medicare's Next Generation ACO program next year. (Modern Healthcare)
 
Study: Errors occur in half of surgeries
A mistake or adverse event occurred during one out of every two surgeries and in five percent of drug administrations, according to a study of more than 275 operations at Massachusetts General Hospital. The findings appear in Anesthesiology and were presented at the ANESTHESIOLOGY 2015 meeting. According to the authors, this was the first study to measure the incidence of medication errors and adverse drug events during the perioperative period. (UPI; Anesthesiology)
 
 
According to both CMS and the Medical Group Management Association, the first month of the ICD-10 transition has gone relatively smoothly. Total claims submitted remain consistent with the historical baseline at 4.6 million per day. The total number of claims denied was only slightly higher (10.1 percent of total claims processed vs. 10 percent). Robert Tennant of MGMA attributes this, in part, to "the enormous amount of 'prep work' the industry completed in the time leading up to the compliance date." (iHealth Beat; Health Data Management)
 
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New & Noted   
No more auto-enrollment: The last-minute, bipartisan budget legislation passed last week makes at least one important change to the Affordable Care Act: It does away with the requirement that employers with at least 200 employees automatically enroll employees in a health care plan. (Business Insurance)
 
   
The literal smoke-filled room: On Sunday's Meet the Press, new House Speaker Paul Ryan--a gym-loving nonsmoker--discussed one of the unexpected hurdles of his new position: removing the smell of smoke from the office once inhabited by former Speaker and current smoker John Boehner. Making matters worse: Ryan sleeps in his office during the week. (NBC)
 
 
HIX open enrollment began Sunday:
In this third open-enrollment period, the challenges are different, Kaiser Health News reports. This time, it's not technology: It's fewer plan choices and--in some cases--higher premiums. (KHN news roundup) 
Multi-media 
A short (37-minute) documentary, Secret Sauce, explores the factors in Grand Junction's success in making health care both patient-centered and cost-effective. It includes interviews with clinicians, patients and others. (video)
 
MarketVoices...quotes worth reading
     
"At this moment of great change in health care systems, it is crucial to measure and manage the impact of consolidation on prices so we don't inadvertently end up spending more on health care at a time when we're trying to go in the other direction." -- Hannah Neprash, a doctoral candidate in the Harvard Program in Health Policy and lead author of a JAMA Internal Medicine study that found when hospitals acquire practices, prices go up; quoted in Science Daily


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Wednesday, November 4, 2015