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Health and Human Services has taken the first step to changing the rule governing the privacy of medical records of those with substance abuse disorders. Historically, substance abuse disorder providers "have struggled with obtaining the correct permission from patients to allow other clinicians to view data from their records in a fast and efficient way," according to Behavioral Healthcare. The current rule--unlike HIPAA--requires patient consent before records can be shared with another provider. The change is designed to let these patients participate in "new integrated healthcare models without adverse consequences that could result from inappropriate disclosure of patient records." (Behavioral Healthcare; HHS announcement) 

Twenty major companies--including American Express, Coca-Cola, HCA, IBM and Verizon--have formed an alliance to share employee health data. According to the Wall Street Journal, they plan to use their collective data and market power to hold down the cost of health care benefits. Ultimately, the goal is to change how they contract for care. Some members say they hope more companies could join and the group could potentially form a purchasing cooperative to negotiate for lower prices, WSJ reports. Bill Allen, Macy's chief human resources officer, said it was possible the companies also would take a hard look at the health industry's middlemen, such as pharmacy benefit managers and third-party administrators. (Wall Street Journal)

Employee wellness programs may have started off being voluntary, but some employers are pushing their employees hard to participate. A few have gone so far as to deny health benefits for those who do not, Bloomberg Business reports. The Equal Employment Opportunity Commission argues that denying employer-sponsored coverage crosses the line from voluntary to coercive. However, several federal courts have ruled in favor of the employers. Observers expect more legal activity. (Bloomberg Business; FierceHealthPayer)
Innovation & Transformation 
Pay-for-performance incentives have a positive impact on physician behavior in pediatric ACOs, improving basic health measures, according to research published in JAMA Pediatrics. They may not be the best way to effect change, however. "Pay for performance resulted in modest changes in physician performance in a pediatric ACO, but other interventions at the disposal of the ACO may have been even more effective," researchers conclude. For example, effective quality-improvement support for the practice made an even bigger difference in quality measures, lead author Sean P. Gleeson, MD, told Managed Health Executive. (Managed Health Executive; JAMA Pediatrics) 
Northeastern University and the Harvard School of Dental Medicine have launched the Nurse Practitioner-Dentist Model for Primary Care. The schools are pursuing the idea of integrating the disciplines with $1.2 million in funding from the Health Resources and Services Administration. Northeastern NP students and Harvard dental students will provide holistic medical care to underserved elderly populations, in one of Harvard's dental clinics. The goal is to help them get needed care while teaching medical students how to balance the disciplines. Patients will be able to have a physical examination and a dental visit during the same appointment. (Boston Magazine)
Emergency department visits for 19 to 25 year olds decreased slightly overall following the implementation of the Affordable Care Act, but visits for mental illnesses in this age group increased significantly, according to a study in Annals of Emergency Medicine. "Increased health insurance coverage reduced ER visits by young people for conditions that can be treated in office-based settings, but the lack of mental health resources continues to bring these patients to the ER in ever larger numbers," said study author Renee Hsia, MD, of the University of California San Francisco. (Annals of Emergency Medicineannouncement)
Americans living in the U.S.'s most rural areas continue to have least geographic access to a primary care clinician (primary care doctors, nurse practitioners and physician assistants), according to research published in Medical Care. The problem is even greater for those living in a state that didn't expand its Medicaid program. Nurse practitioners were relatively more likely to practice in rural areas than in urban areas. "Removing restrictive scope-of-practice laws may expand the overall capacity of the primary care workforce, but only modestly in the short run," researchers conclude. (announcement; Medical Care)
Last month, the Pharmacy Benefit Management Institute released what it says is the industry's first report examining pharmacy trends in ACOs. Among the findings: Only 57 percent of respondents currently employ or contract with clinical pharmacists. Overall, respondents identified improving adherence and persistency, reducing inappropriate utilization, and drug selection that improves clinical outcomes as the top three goals for managing medications. Most say ACOs will decrease cost (56 percent) and increase the quality (69 percent) of prescription drug therapy. (Drug Store News; announcement) 

Communication errors kill patients and cost millions, according to a new CRICO Strategies CBS Report, Malpractice Risks in Communication Failures. Researchers looked at 23,658 medical malpractice claims and suits (2009-2013) in which patients suffered harm; 30 percent included at least one specific communications breakdown. The result: 1,744 patient deaths--and $1.7 billion in malpractice costs, STAT reports. Among the report's many stories is one about a woman whose cancer diagnosis was delayed a year because her lab result was entered into the EHR but was not flagged to her primary care provider. (STAT; report) 
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New & Noted   
HIX tally:  A total of 12.7 million people enrolled in health care plans for 2016 through the ACA insurance exchanges, according to the Department of Health and Human Services. Of that number, more than 4 million were new customers. (HHS)

EHR use up: Nearly 75 percent of office-based providers in 2014 had a certified electronic health record system, up from 68 percent in 2013, according to new CDC data. The percentage of office-based providers with a certified EHR ranged from 88.6 percent in Minnesota to 58.8 percent in Alaska. (CDC dataiHealthBeat)
Hamilton vs. Jefferson: We're still living out the conflict between Alexander Hamilton and Thomas Jefferson, writes David Blumenthal, MD, Commonwealth Fund president. "Here is the origin of so many of our conflicting ideological and cultural instincts: suspicion of central authority and a strong belief in American exceptionalism versus trust in Washington's ability to solve problems and a willingness to look abroad for inspiration and solutions." That's true for the politics of health care and politics in general, he argues. (Commonwealth Fund Blog)

The pinkification of breast cancer annoys many women with the disease. For men, it may mean they don't get the support and treatment they need. Oncologist Dr. Sharon Giordano tells NPR about a male patient who, after a biopsy, was given a pink floral ice pack that came with instructions to "place it inside your bra." The general lack of awareness of breast cancer in men means less investment in research into how breast cancer in men differs from women, she says. Treatments for men are based on evidence from research trials with women--and men have lower survival rates than women. (NPR)
MarketVoices...quotes worth reading
"The troubling finding is that young adults were more likely to visit the emergency department for mental illnesses following expanded insurance coverage under the ACA. Significant barriers to care for mental health issues persist, leaving these patients little choice but to seek care in the only place they know they can get it: the ER." -- Renee Hsia, MD, of the University of California San Francisco, in anannouncement of a study she authored for Annals of Emergency Medicine 
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Wednesday, February 10, 2016