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Industry News
The move to value-based reimbursement models continues, and it's moving fast, according to a McKesson-commissioned survey. Payers report they are 58 percent along the continuum toward full value-based reimbursement; that's a 10 percent increase since 2014. Hospitals are a little behind, at 50 percent, up 4 percent in the past two years. The report shows providers and payers are making fundamental changes to their business models to support value-based health care. The vast majority of providers have either joined an accountable care organization or plan to in the near term, the survey found. (HealthLeaders Media; survey
In a ruling that could increase providers' False Claims Act liability, the U.S. Supreme Court ruled 8-0 that a federal contractor's Medicaid claims were illegal even though payment conditions were never explicitly stated. The case, Universal Health Services v. Escobar, hinged on the theory of implied false certification, which says government contractors may be liable for FCA violations if they fail to disclose noncompliance with relevant laws and regulations when filing a claim. (Healthcare Dive; opinion)
Long-acting opioids may increase mortality from cardiorespiratory and other problems, according to a study published in JAMA. Among more than 45,000 patients in the study, those using opioid painkillers had a 64 percent higher risk of dying within six months of starting treatment compared to patients taking other prescription pain medicine. Unintentional overdoses accounted for about 18 percent of the deaths among opioid users, versus 8 percent of the other patients. "As bad as people think the problem of opioid use is, it's probably worse," Dr. Wayne Ray of Vanderbilt, the lead author, tells the Associated Press. (AP; JAMA) 
Innovation & Transformation  
Thomas McGinn, MD, chairman of medicine for the Northwell Health system, has developed a predictive tool to help determine the likelihood a patient has certain conditions, the Wall Street Journal reports. Doctors ask a short series of questions and, based on the responses, a calculator predicts the probability of the suspected ailment. Such predictive tools can contribute to physicians' "click fatigue," some warn. And physicians want to rely on their instinct. For his part, McGinn says he values the doctor-patient bond; he simply seeks "the marriage of science and instinct." (Wall Street Journal)
Wednesday, June 29, at 1 p.m. EDT, join Steve Simenson, BPharm, FAPhA, DPNA, CEO and managing partner of Goodrich Pharmacy, Inc., and Terry McInnis, MD, MPH, CPE, FACOEM, president of Blue Thorn Inc., for a free webinar on comprehensive medication management in the ambulatory/community pharmacy setting. Simenson will discuss how Goodrich integrated CMM into an independent community pharmacy. McInnis, principal investigator of Get the medications right: a nationwide snapshot of expert practices, will discuss key findings from the report and their relevance to community pharmacy. (registration; details)  
Consumers & Providers
Five years ago, an Institute of Medicine report noted that clinical practice guidelines may be influenced by companies that sell health care goods or services, through their financial arrangements with the organizations that sponsor those guidelines and the individuals who produce them. But a Health Care Renewal blog post argues that physicians ought to be very, very skeptical of guidelines. Citing research published in PLoS Medicine, it argues "the likelihood that any given guideline was produced so as to reduce the influence of conflicts of interest on it is low." (Health Care Renewal; PLoS Medicine) 
While the uninsured rate is at an historically low 9 percent, individuals paying for their own coverage may find themselves struggling to pay premiums next year if they rise as predicted. "People receiving subsidies can protect themselves from premium increases, but others who buy their own coverage don't have that option," said Larry Levitt, who tracks the health law for the nonpartisan Kaiser Family Foundation. With some premium increases as high as 60 percent, rates could be as much as a mortgage while these same consumers can't even get appointments close to home. (The New York Times)
Starting Aug. 6, Medicare patients will receive a form written in "plain language" after 24 hours of observation care, but no later than 36 hours. Federal law will require hospitals to tell their Medicare patients if they have not been formally admitted and why. Critics point out the law doesn't require the hospital to provide enough information to observation patients. (Kaiser Health News)
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New & Noted   
Enforcing the ACA: The federal government is making available $22 million for state insurance regulators to ensure health insurers are complying with the Affordable Care Act's consumer protections. (announcement) 

Medicaid and uncompensated care: Hospital costs for uncompensated care have decreased in states that expanded Medicaid but have remained stagnant in the states that have not, according to a new Kaiser Family Foundation report. (KFF report)

Retail clinic partnership: Advocate Health Care has opened 56 clinics inside Walgreen stores located across the Chicago area. Employed by Advocate Medical Group, certified nurses and medical assistants staff the clinics. People do not have to be Advocate patients to receive care. (Chicago Tribune) 

Patients with poorly controlled risk factors for heart disease may lower their risk when pharmacists help manage their care, according research published in Journal of the American College of Cardiology. People receiving pharmacists' care lowered their estimated future risk of heart disease by more than 5 percent from the beginning of the study to its conclusion three months later. There was little change in risk for those receiving usual care. (MedLine Plus; Journal of the American College of Cardiology--audio commentary)
MarketVoices...quotes worth reading
"The huge and complex web of individual and institutional conflicts of interest that binds much of the health care system, the government, and industry may be good for the insiders, but is stifling improvement in our dysfunctional health care system."--a post on the Health Care Renewal blog
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Roxanna Guilford-Blake
Sandy Mau




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Wednesday, June 22, 2016