1. Kaiser Health News reports on Republican efforts to allow states to tighten Medicaid eligibility rules.
2. Health Affairs writes about the important role that advanced practice registered nurses will play in the imminent ACO landscape.
3. iHealthBeat has a story on how researchers are preparing IBM’s Watson computer for medical applications.
4. Maggie Mahar discusses how, and why, the growth of Medicare is (somewhat surprisingly) below that of inflation.
5. The New England Journal of Medicine has a piece on the policy reasons why we must revisit the E&M coding system that forms the foundation of medical billing.
1. Becker’s Hospital Review describes how the Mayo Clinic, the Cleveland Clinic, Geisinger Health System, and Intermountain Health, are hesitant to join ACOs, at least as ACOs are implemented under the new regulations.
2. The Health Care Blog has a story on how Google Health appears to be in a deep freeze in terms of development.
3. The New England Journal of Medicine has a piece on the ACA’s controversial Independent Payment Advisory Board (IPAB), a 15 member board whose recommendations to Congress for restraining Medicare spending become effective absent legislative action.
4. iHealthBeat reports on how the federal government’s Health IT Policy Committee is weighing adjustments to the second stage of the meaningful use program that incentivizes providers to adopt HIT.
5. Health Data Management discusses a new study showing that medical devices may act as vectors for malicious attacks on the devices and networks to which they attach.
1. The NYT reports on how Florida is retooling their Medicaid system by, among other things, channeling some Medicaid patients into for-profit HMOs.
3. Health Data Management reports on J&J’s acquisition of device maker Synthes for $21.3 billion.
4. Health Affairs has a piece on how comparative effectiveness research can change the practice of medicine.
5. Becker’s Hospital Review has a piece on the 6 technology building blocks of ACOs.
1. Medicaid Moves: Kaiser Health News reports on Medicaid policy developments, including controversial GOP efforts to reform Medicaid.
2. HIT: The New England Journal of Medicine outlines the unrealized potential of HIT.
3. ACOs: The Wall Street Journal discusses Atrius Health, a large ACO-like entity that offers insight into the ways in which such organizations have been successful.
4. Doc Fix Fix?: The Commonwealth Fund reports on MedPAC’s alleged plan to revise the Sustainable Growth Rate, and with it, the perennial ‘Doc Fix’ problem.
5. Waste: A Health Care Blog piece outlines the myriad ways that the U.S. health care system is ‘wastefully complex‘.
1. Insurers are Expanding Their Reach: Kaiser Health News reports that health insurance companies — in fear of losing revenue from health care reform — are looking to expand to other unregulated areas of business.
2. Single-Payer at the State Level: The New England Journal of Medicine has a piece detailing Vermont’s attempt to enact single-payer, state-based health care.
3. Innovation: The Health Affairs Blog has a piece detailing innovations to the health care system that are incorporated in the ACA.
4. Hospital Help: Becker’s Hospital Review discusses the 10 struggling New Jersey hospitals that are receiving upwards of $30 million dollars from the New Jersey Health Care Stabilization Fund.
5. Happy Birthday ACA!: Ezra Klein discusses the first birthday of modern health care reform, and the basics of the reform provisions that the statute includes.
1. Fast Track — Kaiser Health News reports that the 11th Circuit Court of Appeals has agreed to fast track the federal government’s appeal of a Florida district court ruling that invalidated the health care reform law.
2. Sebelius v. GOP — Politico reports that HHS Secretary Kathleen Sebelius is clashing with Republicans, arguing that the House’s continuing resolution bill would force HHS to stop making Medicare payments.
3. Medicaid Policy — At the Health Care Blog, health policy expert Harold Pollack discusses an ongoing debate that he has been having with Avik Roy of the National Review about the benefits and burdens of the Medicaid system. It gets personal.
4. Medicaid Pay-For-Performance — The Health Care Economist has a nice overview of existing Medicaid pay-for-performance models; a timely issue considering the ACA’s inclusion of p4p ideas.
5. Medicare Advantage — Marsha Gold at the Health Affairs Blog discusses the facts, fallacies, and the future of Medicare Advantage.
6. Transparency — The New England Journal of Medicine has a detailed piece discussing the challenges and potential effects of greater price transparency in health care.
1. NPR has a story about the Obama Administration’s move to accept a bipartisan proposal that will allow states to opt-out of some of the ACA regulations if they can provide a suitable alternative.
2. Respectful Insolence has a detailed story about Bruesewitz v. Wyeth — a SCOTUS decision that recently upheld the federal law that preempts design defect suits against vaccine manufacturers, instead channeling the complaints into a Vaccine Court that awards damages from an industry-sponsored fund.
3. The Healthcare Economist has a review of a Robert Wood Johnson article on the ACA’s various Value-Based Purchasing provisions.
4. Bradley Herring at the NEJM has a an economic perspective on the individual mandate’s severability from the ACA.
5. The Wall Street Journal has a piece about governors’ struggle with Medicaid budgets, and the strategies they are implementing to deal with ballooning costs.
1. Medicaid in Arizona: Kevin Sack of the New York Times discusses Arizona’s planned removal of a quarter of a million Medicaid patients from their rolls; Secretary Sebelius has signed off.
2. Essential Benefits: Ian Spatz at the Health Affairs Blog continues the discussion of the controversial determination of essential benefits under the health reform statute.
3. Integration and Prices: Maggie Mahar at Health Beat has a piece on the concern about price increases due to integration by accountable care organizations and other similar entities.
4. Clinical Practice Guidelines: David Williams at KevinMD.com details a recent survey which appeared to find more public support for arguments against treatment guidelines as opposed to arguments in favor of the guidelines.
5. Individual Mandate: Bob Laszewski at Health Care Policy and Marketplace Review posits alternatives to the individual mandate.
1. 10 Most Wanted: Taking a page out of the FBI’s playbook, HHS’s Office of Inspector General is now publishing a top ten list — with pictures – of the most wanted health care fraud and abuse fugitives.
1. Straight to the Source: Jonathan Cohn discusses what Richard Foster — the chief federal actuary for Medicare — thinks about the chances that health care reform will hold down costs.
2. Individual Mandate Mandatory? NPR has a story investigating whether health reform could be implemented without the individual mandate.
3. Dartmouth Research Questioned: Maggie Mahar discusses a recent Institute of Medicine report which posits that in some circumstances, an increase in health care spending may lead to better outcomes.
4. Value-Based Purchasing: The Health Care Economist has an interesting post detailing Oregon’s experience with value-based purchasing.
1. Maggie Mahar at Health Beat discusses a new report published in the NEJM that supports the importance of the individual mandate in combating adverse selection.
2. At the Health Care Blog, Paul Levy writes sardonically about the accountability of accountable care organizations.
2a. On a less sardonic note, Chris Fleming gives an overview of Health Affairs’ special issue covering ACOs.
2b. Thomas Greaney writes in the NEJM about how the federal government’s can help ACOs navigate an already concentrated health care landscape.
3. The Hill reports on the essential items and services that health insurers will have to provide when offering their products in the new exchanges.
4. David Kibbe and Brian Klepper document the federal government’s initiatives in giving the HIT market a much needed shot-in-the-arm.
5. The Commonwealth Fund’s Melinda Abram’s discusses one of the most important facets of health care reform: how the ACA will bolster primary care.
1. The Health Care Blog has an important piece on the role of HIT in Accountable Care Organizations (ACOs) and whether they will be open networks or walled gardens.
Will ACO (accountable care organization) IT models be walled gardens or open platforms? i.e., will ACO IT platforms focus on exchanging information within the provider network of the ACO, or will they also be able to exchange information with providers outside the ACO network?
2. Kaiser Health News discusses rules proposed by the Obama administration that would require health insurers to justify double-digit increases in premium rates.
Under the proposal, the flagged premium increases would be subject to review by the states – or the federal government in some cases – to determine if they are unreasonable.
In following years, the Department of Health and Human Services will adjust the specific percentage threshold for each individual state. Thresholds would vary partly because medical costs vary by state.
3. The New York Times has run a piece on a new antitrust lawsuit filed against Blue Cross Blue Shield of Michigan.
Federal prosecutors contend that Blue Cross in Michigan thwarts competitors by pressuring hospitals to charge rival insurers more to provide care, a practice prosecutors say has made health care extremely expensive in a state that can’t afford it.
4. Tim Jost provides an overview at Health Affairs of the current state of the argument over the constitutionality of the individual mandate — including the recent decision by a federal judge in Virginia ruling the mandate unconstitutional.
Virginia adopted a statute purporting to nullify the minimum essential coverage requirement even before Congress enacted the Affordable Care Act, and the lawsuit was brought to enforce this statute. Judge Hudson had earlier this year denied a Justice Department motion to dismiss the Virginia case, holding that the Commonwealth had standing to defend its legislation. In his earlier decision, Judge Hudson had also held that the Commonwealth had an arguable claim that the minimum coverage requirement was unconstitutional. Subsequent briefs filed by the Justice Department and by amici (interested parties who file as “friends of the court,” or amici curiae) supporting the reform law apparently failed to change Judge Hudson’s mind.
5. The Wall Street Journal has a story outlining the tremendous pecuniary benefits that certain spine doctors are receiving for conducting spine surgeries that some question as unnecessary.
The five surgeons are also among the largest recipients nationwide of payments from medical-device giant Medtronic Inc. In the first nine months of this year alone, the surgeons—Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno—received more than $7 million from the Fridley, Minn., company.
1. Bob Laszewski at the Health Care Policy and Marketplace Review discusses the interesting bi-partisan bill recently announced by Scott Brown and Ron Wyden.
2. Brian Klepper and David Kibbe detail what would happen if employers walked away from health coverage.
3. The Health Care Blog: The Direct Project — formerly NHIN Direct — recently announced the release of its open-source software aimed at enabling secure messaging between health care providers.
4. The Health Care Economist reports on a Commonwealth Fund study which examines concentration in the Medicare Advantage market.
5. The New England Journal of Medicine has a piece on the complexity between the ACA and Medicaid expansion.
1. Medicaid Madness: Kaiser Health News details the debate over whether Medicaid recipients could purchase subsidized insurance on the ACA-mandated exchanges
2. On Republican Repeal: Ezra Klein discusses a piece by Peter Suderman of Reason Magazine that outlines the the dilemma that Republicans may face in their efforts to repeal the ACA.
3. Unemployment and Health Care: The Health Care Blog has a nice piece detailing the effect that rising unemployment could have on the the financial viability of hospitals.
4. Berwick Bashing: Donald Berwick will be testifying on Capital Hill this week. Politico spoke with members on the Hill about how they expect to grill Berwick.
5. Loko: Time Magazine has a piece on the FDA’s expected decision on whether to ban the highly alcoholic and caffeinated Four Loko drink that has been implicated in serious illness and death.
Update: Four Loko has decided to voluntarily remove caffeine from their alcoholic beverages.
1. HRW’s Frank Pasquale’s post on reciprocal transparency — the idea that companies and other entities should be more transparent with respect to their data collection practices as patients become more transparent — is featured on The Health Care Blog.
2. On KevinMD.com, Maggie Mahar discusses what she thinks would happen if health reform is killed.
3. At the New England Journal of Medicine, Timothy Jost discusses recent rules governing the controversial restrictions on medical loss ratios.
4. Kaiser Health News has a short video up of their interview with the AMA’s president, Cecil B. Wilson, where they discuss the AMA’s new strategy regarding the “doc fix” that is set to cut physician reimbursement by up to 30 percent by Dec. 1st.
5. Chris Fleming at the Health Affairs Blog describes a new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation that covers the new process of “grandfathering” insurance plans under the health reform statute.
1. ACO Yo!: The Healthcare Economist discusses recent research into how the accountable care organization (ACO) model may be leveraged by providers to increase prices. For those looking to learn more about ACOs, the New England Journal of Medicine has recently released a video which can be found here.
2. Playing Politics?: Merril Goozner picks up on questionable appointments to the Patient-Centered Outcome Research Institute — the entity that PPACA tasked with increasing our utilization of comparative effectiveness research.
3. Mandate Mania: Tim Jost provides an update (and overview) of the constitutional mandate case in Michigan.
6. Fragmentation Symposium: Concurring Opinions held an online book review symposium of Barak Richman, Daniel Grossman, and Frank Sloan’s chapter, Fragmentation in Mental Health Benefits and Services, in Our Fragmented Health Care System: Causes and Solutions (Einer Elhauge, ed. 2010).
Waldo’s Optimal Fragmentation by Elizabeth Weeks
Why “House” is the True American Health Care Hero, And What To Do About It by Vickie Williams
Getting Mental Health Coverage Wrong by John Jacobi