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Industry News
In a final rule issued Monday afternoon, CMS backed down from earlier efforts to ensure network adequacy. The proposed rule would have forced insurers to have minimum quantitative standards for networks of hospitals and doctors and offer standardized options for health plans. Insurers that sell plans on the federal HIX had urged CMS to scale back those plans, Modern Healthcare reports. However, as in the proposed rule, CMS will implement a rating system for a plan's network coverage that will be available to consumers in 2017. (Modern Healthcare; Becker's Hospital Review; final rule)
The U.S. Supreme Court ruled Tuesday that Vermont cannot compel health insurers to hand over data on the amount paid on medical claims. In a 6-2 decision, the court found that a 2005 Vermont data-collection law that was aimed at improving the quality of health care did not apply to self-funded insurance plans, Reuters reports; such a requirement violates ERISA. Liberty Mutual, the plaintiff, argued that such requirements were a particular problem for companies that operate nationally because they must meet multiple mandates. The ruling is likely to put limits on similar laws in 17 other states. (Reuters; the ruling)
A new Office of the Inspector General report finds that Health and Human Services and CMS made many missteps throughout development and implementation that led to the poor launch of HealthCare.gov. Most critical was the absence of clear leadership. Additional missteps included failing to properly manage its key website development contract. The Washington Post offers several examples, including this: During the two years pre-launch, federal officials charged with creating HealthCare.gov received 18 written warnings that the project was mismanaged and off course, but never considered postponing its launch. (Washington Post; OIG report)
Software giant Oracle insists it's not responsible for the Covered Oregon debacle, but the Portland Tribune says it has documents that suggest otherwise. According to the Tribune, a recently revealed document "contains internal communications that contradict what Oracle has been telling politicians and the public, and suggest the company's own employees felt Oracle did not give Oregon its money's worth. In fact, Oracle is fighting to keep its internal communications under wraps." According to The Lund Report, Oregon Attorney General Ellen Rosenblum is trying to make public more of the details surrounding Covered Oregon. (Portland Tribune; The Lund Report)
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Innovation & Transformation
Creative writing can help physicians cope with the life and death issues they face every day, according to a piece in STAT. In fact, so many health care professionals write verse that it has become its own genre. Dr. Danielle Ofri, the editor in chief of the Bellevue Literary Review, says writing lets doctors slow down and revisit situations that may have raced by. Finding ways to cope is critical; FiercePracticeManagement notes 90 percent of doctors are afflicted by burnout at some point. Health care workers need to be attentive to their own physical, mental and emotional health. (STAT; FiercePracticeManagement)
In the American Action Forum's Daily Dish, health economist Robert Book answers the titular question "Why Are Hospitals Buying Physician Practices and Forming Insurance Companies?" He explains why this vertical consolidation is a rational business response to the Affordable Care Act. For the non-Medicare sector, the ACA incentivizes health plans with narrow networks. In Medicare, it's ACOs. "It is highly ironic that a law proposed, in part, because of the allegation health insurance companies were increasing their profits by denying care to patients is now the means by which the federal government pays physicians to, in effect, deny care to patients," he concludes. (Daily Dish)
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Access to labor and delivery units continues to decline in rural areas, Kaiser Health News reports. It's hard to find comprehensive data, but an analysis published in Health Services Research looked at 306 rural hospitals in nine states with large rural populations. It found 7.2 percent closed their obstetrics units between 2010 and 2014. Various initiatives could help bolster labor and delivery services in rural areas, say experts. The most important? Encouraging medical professionals to move to them. (Kaiser Health News; Health Services Research)
Health and Human Services wants to add behavioral health providers to its Meaningful Use program. Currently, federal rules bar behavioral health providers treating mental and substance abuse disorders from receiving Meaningful Use incentives. However, its 2017 budget submission to Congress contains just such a proposal, HealthDataManagement reports. "The expansion is meant to facilitate the integration of behavioral health and medical care, and promote the sharing of clinical data needed to provide better patient-centered care," HHS says in its proposal. (HealthDataManagement)
As health insurance plans become increasingly complicated, more patients are facing unexpected fees when they step outside their plan's coverage network. Nearly a third of insured Americans who have financial problems tied to medical bills faced charges their insurance would not cover, according to a recent survey by the Kaiser Family Foundation. These out-of-network charges were a surprise to nearly 70 percent of patients. The Associated Press provides a Q&A to help consumers better understand out-of-network charges. (Associated Press)
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New & Noted
Stressed employees? Who knew? Workers are more stressed, depressed and anxious than ever. The number of employee anxiety cases from 2012 to 2014 increased 74 percent, depression cases climbed 58 percent and stress cases increased 28 percent, according to a new Workplace Options report. (Employee Benefit News)
Saves AHRQ, steps down: Dr. Richard Kronick will step down as director of the Agency for Healthcare Research and Quality effective March 18. During his tenure, House Republicans tried, but failed, to shutter AHRQ. Deputy Director Dr. Sharon Arnold will serve as acting director. (Modern Healthcare)
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Multi-media
The new video from the Agency for Healthcare Research and Quality Innovations Exchange offers insights from a former patient--who is now a patient advisor--illustrating the value of hospitals partnering with patients to advance patient- and family-centered care. (AHRQ)
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MarketVoices...quotes worth reading
"You can stretch time in the past. You can speed up time. You can reframe it. You couldn't change what happened, but there are so many ways in which one can write about it."
--Dr. Danielle Ofri, editor-in-chief of the Bellevue Literary Review, on the value of creative writing for health care professionals, quoted in STAT
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