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Does aggressive screening lead to more penalties? Yes, academic medical centers argue: They are being "perversely penalized" because they aggressively screen patients. Northwestern Memorial Hospital, for instance, has identified so many infections and serious blood clots that the federal government is cutting Medicare payments for a year, by about $1.6 million, Kaiser Health News reports. At Northwestern, ordering lab tests is so common physicians often refer to a "culture of culturing" that they credit for helping keep their death rate lower than most hospitals'. "If you don't look for infections, you're never going to find them," said Dr. Gary Noskin, Northwestern's chief medical officer. (Kaiser Health News)
Health care was the top target for cyberattacks last year, according to an IBM report. Five of the eight largest health care security breaches took place in the first half of 2015. In each, more than 1 million records were compromised; more than 100 million records were compromised during all of 2015. Unauthorized access remained a leading cause across all industries; in 60 percent of cases, attacks were carried out by insiders--employees, business partners or other third parties. Approximately a third of attacks were due to people falling prey to phishing scams or opening a malware-infected attachment. (FierceHealthIT; report)

Measuring quality is in need of major reform, according to a report from the Healthcare Association of New York State. The group identified more than 2,100 metrics providers must keep track of to meet the requirements of private insurers, ACOs, the federal government and others. "While the value of measurement is clear, measurement is also clearly out of control and in need of reform," according to the report. The goal is to move from "measurement madness" to "measurements that matter." (Modern Healthcare; report)
Innovation & Transformation  
A recent study shows Medicaid expansion seems to be paying off. In states that expanded their Medicaid program, 10 percent more people saw or talked to a doctor, 4.7 percent more people were diagnosed with diabetes and 6.7 percent fewer people reported lack of a usual source of care due to costs. States that did not expand saw marginal improvements in these areas. "The results provide compelling evidence that states that expanded Medicaid did a very, very good thing for their citizens," said Vernon Smith, Medicaid expert and principal with consulting firm Health Management Associates. (Kaiser Health News)
Using a bundled payment approach, some large companies are paying for certain major surgeries at prestigious hospitals at no cost to the employee, Kaiser Health News reports. The Pacific Business Group on Health negotiates for Lowe's, Walmart and other large employers, and can get rates 20 to 30 percent below what the companies used to pay for the procedures. "The mere fact that people now think about what they're doing helps us control costs across the board," says Bob Ihrie, senior VP for compensation and benefits at Lowe's, who came up with the idea. (Kaiser Health News)
Consumers & Providers
Most Americans do not perceive the price and quality of health care to be associated. However, a substantial minority believe there is an association or don't know if there is one. "Both findings underscore the need to report quality information alongside price information, so that consumers have some basis on which to differentiate between services and providers," researchers conclude. Framing matters, too: People were more likely to state price and quality are not associated if they were asked about high price and high quality (vs. questions about low price and low quality). (Health Affairs)
Roughly a third of radiology recommendations that call for additional clinical action are not heeded, and nearly half of those directives are not even acknowledged, according to research presented at the recent American Roentgen Ray Society meeting. And it may not be that physicians are ignoring the recommendations: "We cannot assume that information about patients' health sent by radiologists will always be received by referring providers," said study investigator Nadja Kadom, MD, from Emory University. (Medscape)
When identifying patients for care management, "big data" isn't always enough, Drs. James Colbert and Ishani Ganguli write in a Health Affairs Blog post. "Clinicians often know details about their patients that are not captured in commonly used risk algorithms: their living situation, social support networks, and ability to follow through with personal health goals. Leveraging provider insights can allow an organization to select patients for complex care management who will truly benefit from additional services or home-based interventions, and may in turn save providers time by helping to manage some of their most complex patients." (Health Affairs Blog)
Using anonymous IRS data from 1.4 billion tax records over 15 years, economists from Stanford University, the Massachusetts Institute of Technology, Harvard University, consulting firm McKinsey & Co. and the U.S. Treasury's office of tax analysis found that being wealthy leads to a longer life. Their data showed a 40-year-old male in the top 1 percent income bracket could expect to live approximately 14 years longer than his counterpart in the bottom 1 percent. "Income is correlated with other attributes that directly affect health." (Bloomberg; JAMA)
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New & Noted   
ACO update: Roughly 28.3 million people are now covered by an accountable care arrangement, according to data from Leavitt Partners. There are 838 active ACOs; this represents a 12.6 percent increase over last year. Drs. David Muhlestein and Mark McClellan provide a detailed update in a Health Affairs Blog post. (Health Affairs Blog)

Suicide rates up: Suicide rates in the United States increased 24 percent between 1999 and 2014, according to a new report from the CDC. (CDC report) 
Maine mandates e-prescribing: Maine has become the second state to mandate e-prescribing of controlled substances. New York was the first. Minnesota law calls for e-prescribing controlled substances, but there's no enforcement mechanism. (MedCity News)

National Institutes of Health Clinical Center in Bethesda needs reform to ensure that patient safety is never subservient to the demands of science, according to a task force of independent experts convened by the NIH. (NPR; task force report)
MarketVoices...quotes worth reading
"Looking beyond the clinical conditions that appear in patient charts, we find people with bills to pay, children to raise, and jobs to keep. They may live in houses with stairs that they can no longer climb confidently or have trouble making medical appointments because they are struggling with addiction. In short, patients' lives--and their relationships with the health care system--are messy."  -- Drs. James Colbert and Ishani Ganguli, in a Health Affairs Blog post discussing why more than "big data" is required to identify candidates for care management. 
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Roxanna Guilford-Blake
Sandy Mau




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Wednesday, April 27, 2016