A project of the Galen Institute

Issue: "Business Impact"

The Medicare Data Release Conundrum

gail Wilensky
Annals of Internal Medicine
Wed, 2014-08-20
"In April 2014, the Centers for Medicare & Medicaid Services (CMS) published detailed information on the $77 billion that 880 000 health care practitioners billed for some 6000 Medicare Part B services in 2012. This commentary by a former CMS administrator discusses how these data can be helpful, what is missing that might lead to misinterpretation, and why such transparency is here to stay."

More Bad News for Obamacare

Megan McArdle
Bloomberg
Tue, 2014-08-19
"Last Monday, Jed Graham of Investor’s Business Daily reported that insurers say Affordable Care Act enrollment is shrinking, and it is expected to shrink further. Some of those who signed up for insurance on the exchanges never paid; others paid, then stopped paying. Insurers are undoubtedly picking up some new customers who lost jobs or had another “qualifying life event” since open enrollment closed. But on net, they expect enrollment to shrink from their March numbers by a substantial amount -- as much as 30 percent at Aetna Inc., for example. How much does this matter? As Charles Gaba notes, this was not unexpected: Back in January, industry expert Bob Laszewski predicted an attrition rate of 10 to 20 percent, which seems roughly in line with what IBD is reporting. However, Gaba seems to imply that this makes the IBD report old news, barely worth talking about, and I think that’s wrong, for multiple reasons."

AHA doled out $3.3 million in 2013 to advocate Medicaid expansion

Paul Demko, Modern Healthcare
Tue, 2014-08-19
"The American Hospital Association's expenditures increased by 7% in 2013, to $117 million, spurred in part by efforts to convince states to expand Medicaid, according to the organization's most recent tax return. The group spent $3.3 million on grants to state hospital associations last year to assist with efforts to convince states that they should expand Medicaid to households with incomes up to 138% of the federal poverty level. Under the Patient Protection and Affordable Care Act, the federal government will pick up 100% of the tab for the first three years of Medicaid expansion and 90% of the cost thereafter."

Why Would Chinese Hackers Steal Millions of Medical Records?

Michael Riley and Jordan Robertson
Bloomberg
Tue, 2014-08-19

CT’s individual insurance market grew 55 percent under Obamacare

Arielle Levin Becker, Connecticut Mirror
Tue, 2014-08-19
"The number of Connecticut residents covered by health insurance purchased through the state’s individual market rose by nearly 60,000 since last year, a 55 percent increase since the implementation of major provisions of Obamacare, according to figures released by the Connecticut Insurance Department. The data also show that more than half the people who bought their own health insurance last year have maintained their old policies or other plans purchased late in 2013. But more than 50,000 of them won’t be able to keep their health plans beyond this year, potentially setting up a repeat of last fall’s turmoil and frustration among people whose policies were discontinued."

FDA vs. right to try: Our view

Editorial board
USA Today
Tue, 2014-08-19
"The deadly Ebola outbreak spreading through Africa is so extreme, it is driving health officials to do something that they would instinctively resist in normal circumstances: Subject patients to unproven experimental drugs. The drugs are risky. Some have not even been tested on humans. Even so, a World Health Organization ethics committee just declared such use ethical, and its reasoning is hard to dispute, at least for patients who would otherwise die. Some chance is better than none, even with unknown side effects. Too bad American patients suffering from terminal illnesses have so much trouble getting the same chance. The process for getting experimental drugs is so daunting that fewer than 1,000 people sought and got federal approval to take such drugs last year. Food and Drug Administration rules require patients to clear a series of hurdles. First, they and their doctors must find a company to provide its drug.

Patient advocates say insurers avoiding the sick

Ricardo Alonso-Zaldivar
The Associated Press
Mon, 2014-08-18
"WASHINGTON -- Ending insurance discrimination against the sick was a central goal of the nation's health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers. The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there's reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors. With open enrollment for 2015 three months away, the Obama administration is being pressed to enforce the Affordable Care Act's anti-discrimination provisions. Some regulations have been issued; others are pending after more than four years. More than 300 patient advocacy groups recently wrote Health and Human Services Secretary Sylvia Mathews Burwell to complain about some insurer tactics that "are highly discriminatory against patients with chronic health conditions and may ...

Bringing Sunshine into the Light

John Castellani
PhRMA
Mon, 2014-08-18
"New information related to physician-industry interaction is scheduled to be released to the public for the first time on September 30. The public database from the Centers for Medicare & Medicaid Services (CMS), which is part of the Sunshine Act implementation, will focus on payments that biopharmaceutical and medical technology companies have made to physicians. Although the release date is less than six weeks away, concerns about what the data will look like and its effect on medical innovation are already being brought to light by stakeholders across the board. One of the primary concerns that PhRMA shares with more than two dozen other patient and industry organizations is that the data needs to include context to explain what the payments represent – collaborations that benefit patient health and innovation. It’s critical to note that the new database will include information on many different types of interactions.

The Obama Administration Has Little to Tout About Obamacare

Ed Haislmaier
The Daily Signal
Thu, 2014-08-14
"There has not exactly been an overabundance of good news on Obamacare. So it did come as some surprise two weeks ago when the Department of Health and Human Services issued a press release with the headline: “Consumers have saved a total of $9 billion on premiums,” and the subheading; “Health care law will return to families an average refund of $80 each this year.” There is nothing unusual or even untoward about the Obama administration doing what it can to put a positive spin on the law. But what makes this item interesting is it reveals how little the administration actually has to tout about Obamacare and how far it must reach to manufacture a success story. The purpose of the press release was to announce data on the effects of Obamacare’s “medical loss ratio” regulation, which “requires insurers to spend at least 80 percent of premium dollars on patient care and quality improvement activities.

Is the Sunshine Act website repeating HealthCare.gov's mistakes?

Darius Tahir
Modern Healthcare
Thu, 2014-08-14
"A mix-up of information about two physicians with the same name in different states has opened a window on wide-ranging technical problems the CMS is facing with its Open Payments website reporting industry payments to doctors and teaching hospitals. Registration for the system, which was scheduled..." NOTE: This article is behind a paywall.

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