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Heart attacks and bypass surgery are likely to be the next procedures Medicare covers through bundled payments. Under a new CMS proposal, beginning in 2018 hospitals in 98 markets would be financially accountable for the cost and quality of all care associated with bypass surgery and heart attacks. Earlier this year, CMS enacted bundled payment requirements for hip and knee surgeries--and it's expanding that to include surgeries repairing hip and femur fractures. All of this is designed to meet the goal of using alternate payment models for half of all Medicare payments by 2018. (Modern Healthcare; CMS factsheet)

Many well-known hospitals failed to earn the coveted five stars in CMS hospital quality ratings, Kaiser Health News reports. Hospitals don't like the system; it remains controversial because some say it unfairly penalizes hospitals with the poorest and sickest patients. Steven Lipstein, president of BJC HealthCare, which runs Barnes-Jewish Hospital, says his 14 hospitals received between two and four stars. The main difference: the relative affluence of the patients each served, with poorer-scoring hospitals located in lower-income areas. Consumer advocates, however, say patients need such ratings to help them choose wisely. KHN offers a roundup of news on the topic. (KHNKHN news roundup
Responding to criticism about delays, the Department of Veterans Affairs has worked to expand coverage and speed up claims processing. Now critics say the reduced evidence requirements and briefer investigations can mean claims get padded, wasting funds and time better directed to veterans in greater need of care, according to The Wall Street Journal. It conducted interviews with more than 40 current and former VA staffers, doctors, veterans and government agents. Among the issues: implementation of a software system designed to reduce paperwork that relies primarily on self-reported ailments to determine disability levels. (The Wall Street Journal)
Legislation requiring pharmaceutical companies to reveal some of their costs related to drug development and advertising was proposed--and rejected--in several states during the last legislative session. These bills, supported by the insurance industry, were strongly opposed by the pharmaceutical industry. "Transparency is a first step toward making prescription drugs more affordable to patients," says Clare Krusing, spokeswoman for America's Health Insurance Plans. The pharmaceutical industry argues the bills don't fully consider the costs of drug development and post-market surveillance, nor do they consider the value and savings drugs bring to society. (Bloomberg BNA)
Innovation & Transformation  
Enabling clerks to use administrative tasks to establish personalized, long-term relationships with patients can strengthen the patient-centered medical home, according to research published in the Annals of Family Medicine. Such relationships are engendered through care coordination activities clerks perform and may be bolstered by organizational investment in clerks as skilled health care team members. "PCMH clerks have unique roles that can be leveraged to better deliver patient-centered primary care. Integration and support of clerks will make it possible for such team-based initiatives as medical homes to optimize their true potential of transforming how patient care is delivered." (Annals of Family Medicine)
Consumers & Providers
Medical students use EHRs to track their former patients, according to research published in JAMA Internal Medicine; for some, this raises ethical and privacy concerns. Researchers found 96.1 percent of students surveyed said they used EHRs to track former patients. Of those, 92.9 percent found it beneficial from an educational standpoint. Survey results "suggest that tracking patients is a potentially valuable and widely practiced educational activity. However, it is associated with ethical problems that students may not appreciate, and it is unclear how patients view this activity," the researchers conclude. (FierceHealthcare; JAMA Internal Medicine; editor's note)
Sometimes, families don't need palliative care counseling; in fact, it can increase symptoms of post-traumatic stress, according to research published in JAMA. "When informational support provided by the primary team is sufficient, additional focus on prognosis may not help and could further upset an emotional family," according to researchers. Scarce palliative care resources are better spent identifying the families that can benefit from such care--for instance, when the family disagrees about how to care for the patient. (Kaiser Health NewsJAMA)
The Affordable Care Act allows health insurance companies to charge smokers an up-to-50 percent surcharge on their premiums, but it appears this penalty does nothing to reduce smoking. It does, however, appear to lead to reduced coverage, according to research published in Health Affairs. "This suggests that tobacco surcharges increased neither smoking cessation nor financial protection from high health care costs--the primary goal of the Affordable Care Act." In addition, other evidence suggests smokers may lie about the habit to avoid paying the extra money. (Health Affairs; Fortune)
In what's come as a pricey shock to many seniors, health insurers can enroll plan members into Medicare Advantage when an individual becomes eligible for Medicare. It's called a "seamless conversion," and all the insurer has to do is send a letter explaining the new coverage and giving the member 60 days to opt out. They need Medicare approval, but CMS officials aren't talking, Modern Healthcare reports. Among the insurers planning to do this: Aetna, UnitedHealthcare and Humana. Critics are unhappy, noting an insurer's letter can easily be overlooked. (Kaiser Health News)
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New & Noted   
Cigna expands ACA offerings: Cigna is bucking the trend and expanding into a few Affordable Care Act marketplaces. Last week, it filed to offer insurance on marketplaces in Chicago, the Raleigh/Durham area of North Carolina, and Northern Virginia and Richmond. (The Hill)

No RN shortage: Adequate numbers of registered nurses are entering the workforce to offset the number of those retiring, according to the 2015 National Nursing Workforce Survey. In addition, the average age has dropped, from 50 in 2013 to 48.8 in 2015. (American Journal of Nursing)

Community health IT: Community health centers may soon have better health IT tools. The Health Resources and Services Administration's Bureau of Primary Health Care will start disbursing $90 million in grant funds to about 1,380 health centers transitioning to value-based models of care who will need new IT tools. (HealthDataManagement)

When a person shares data with a health care provider, that's private; it's covered by HIPAA. But share that data with Apple or Fitbit, it's not. That's the gist of a recent piece from the NPR show Invisibilia. The implications are disturbing: "Legal scholars are wondering--is this a backdoor way to discriminate against insured populations based on their medical history?" (NPR)
MarketVoices...quotes worth reading
"The stars tell you more about the socio-demographics of the population being served than the quality of the hospital."--Steven Lipstein, the president of BJC HealthCare, which runs Barnes-Jewish Hospital and 13 other hospitals, in an interview with Kaiser Health News about Medicare's star rating system.

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Wednesday, August 3, 2016