News Blog

Can Doctors Choose Between Saving Lives and Saving a Fortune?
Friday, April 06, 2018

To understand something about the spiraling cost of health care in the United States, we might begin with a typical conundrum: Imagine a 60-something man — a nonsmoker, overweight, with diabetes — who has just survived a heart attack. Perhaps he had an angioplasty, with the placement of a stent, to open his arteries. The doctor’s job is to keep the vessels open. She has two choices of medicines to reduce the risk for a second heart attack. There’s Plavix, a tried-and-tested blood thinner, that prevents clot formation; the generic version of the drug costs as little as 25 cents a pill. And there’s Brilinta, a newer medicine that is also effective in clot prevention; it costs about $6.50 a pill — 25 times as much.
Brilinta is admittedly more effective than Plavix — by all of 2 percentage points. In a yearlong trial of 18,600 patients, 10 percent died from vascular causes, heart attack or stroke on Brilinta, while about 12 percent did on Plavix. Should the doctor prescribe the best possible medicine, assuming that the man has private health insurance that will pay the bulk of the costs? Or should she try to conserve health care costs by prescribing the cheaper medicine that is nearly as good? And consider this: If the cost to you was the same — you have maxed out your co-pay and will end up with the same out-of-pocket expenditure — would you agree to take the slightly inferior drug to benefit the system as a whole? You’ve just had a heart attack, for God’s sake. You pay thousands of dollars for health insurance. Is it fair to ask you to bear the slightly increased risk to enable some broader social good?
“We thought about this nearly every day when discharging patients from the cardiology unit,” Dhruv Khullar, a newly minted hospital attending, told me. “Some of us believed that a doctor’s job is to deliver the best possible care, period. Others argued that doctors should aim to find some balance between medical benefit, financial cost and social responsibility. It’s the kind of question that we aren’t really trained to solve. Are costs something that an individual doctor should do something about? What is a doctor supposed to do?” 2018-04-05 Healthcare Dive [issue:14760]&utm_term=Healthcare Dive

ACA plans expanded coverage for chronic conditions
Friday, April 06, 2018

  • As the Affordable Care Act increased the number of Americans with health coverage, 45% of adult ACA exchange enrollees had chronic conditions in 2014 and 2015. That’s a higher percentage than those with employer-based insurance and in nongroup plans not in the exchanges, according to a new study in Health Affairs.
  • The report, which was written by Michael Karpman, Sharon K. Long and Lea Bart, all from the Urban Institute, found people in ACA plans used more healthcare services than those in other plans, which the study authors said is part of the reason for rising premiums in nongroup insurance.
  • The authors warned that repeal of the individual mandate penalty in 2019 will force states to figure out how to stabilize nongroup premiums and protect coverage for adults with chronic conditions. That may include creating a balanced insurance pool.

My Job Isn't to Move Patients Quickly
Friday, April 06, 2018

A hospitalist is tired of being a cog in a machine

"We are playing the same sport, but a different game," the wise, thoughtful emergency medicine attending physician once told me. "I am playing speed chess -- I need to make a move quickly, or I lose -- no matter what. My moves have to be right, but they don't always necessarily need to be the optimal one. I am not always thinking five moves ahead. You guys [in internal medicine] are playing master chess. You have more time, but that means you are trying to always think about the whole game and make the best move possible."
In recent years, the drive toward "efficiency" has intensified on the wards. I am seeing much more speed chess played by us hospitalists, and I don't think that is a good thing.
The pendulum has swung quickly from, "problem #7, chronic anemia: stable but I am not sure it has been worked up before, so I ordered a smear, retic count, and iron panel," to "problem #1, acute blood loss anemia: now stable after transfusion, seems safe for discharge and GI follow-up." (NOTE: "acute blood loss anemia" is a phrase I learned from our "clinical documentation integrity specialist" – I think it gets me "50 CDI points" or something).

Rural Hospital Scam; Overdose Undercount; Prison Flu-Shot Scandal
Friday, April 06, 2018

The past week in health-related investigations

Welcome to MedPage Today's Investigative Roundup, highlighting the best pieces published in the past week with in-depth examinations of healthcare issues. As usual, we'd love to hear your ideas for issues to explore next. More evidence is better, and if you don't feel comfortable using the normal channels, we're available through more secure methods, too.

The CBS Evening News looks at the case of the small Campbellton-Graceville hospital in Florida's panhandle, which was purchased by the Miami-based Empower Group just days before the hospital was set to close. The Empower Group ran it for $30,000 a month, but also routed laboratory tests through the hospital -- which insurance companies then paid at much higher rates than they would in a more urban setting. In just over a year, $120 million in tests were funneled through the small hospital's lab, the hospital's attorney said.
The hospital's board shuttered the program, which led to lawsuits. In the end, Campbellton-Graceville had to close anyway.
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Hospital Prices Spike in February
Friday, April 06, 2018

Prescription drug price increases seem to be the biggest driver of healthcare spending

Hospital prices grew 3.8% last month, when compared with February 2017, the highest growth rate in more than a decade, according to Altarum's Health Sector Economic Indicators.
"We are puzzling over this significant jump in hospital prices in recent months based upon the hospital produce price indexes from Bureau of Labor Statistics," said healthcare economist Charles Roehig, of Altarum in with Ann Arbor, Michigan.
"Hospital prices averaged 1.6% growth in 2017, increasing to 3.5% during the first 2 months of 2018. Further, growth has accelerated for each of the three main payers: Medicare, Medicaid, and private health plans," he said.
For all of 2017, national health spending grew by 4.6% from its 2016 level.
"Year-over-year spending growth has remained close to this moderate but still not sustainable rate in each month since July 2017," according to the analysis. "We see 22 consecutive months where the healthcare spending share of GDP [gross domestic product] has not fallen below 17.9% nor risen above 18.1% including the most recent 3 months of the share being 18.0%."


Overriding EHR Alerts May Up Adverse Drug Events
Friday, April 06, 2018

Two things are likely familiar to any physician working in an electronic health record (EHR): Seeing clinical decision support (CDS) alerts and overriding those alerts.
Such alerts remind clinicians about everything from a patient's drug allergies, to possible drug interactions, to dosing guidelines, to lab testing guidance. Clinicians can either follow the alerts' recommendations, override them, or ignore them.

"They're frequently overridden, and often these are done appropriately," said Adrian Wong, PharmD, MPH, an outcomes research and pharmacy informatics fellow in the division of general internal medicine and primary care at Brigham and Women's Hospital in Boston.
Overriding alerts that are clinically relevant can potentially lead to harm, according to a study in BMJ Quality & Safety, by Wong and colleagues.
The prospective observational study examined medication-related CDS overrides among adults admitted to any of six Brigham and Women's ICUs from July 2016 to April 2017.
The study included 2,448 overridden alerts from 712 unique patient encounters. Although 81.6% of the overrides were appropriate, the "inappropriate over-rides were six times as likely to be associated with potential and definite ADEs [adverse drug events], compared with appropriate over-rides," according to Wong's group.

Joint Commission Introduces New Accreditation Standards for Telehealth Services
Thursday, March 29, 2018

Editor’s note: Following publication of our blog post, The Joint Commission contacted Health Care Law Today on September 14, 2017 and informed us it will not move forward at this time with its proposed ambulatory telemedicine standards. The Joint Commission said it continues to evaluate options, and additional comments may be sent to Mary Brockway, director, Department of Standards and Survey Methods, The Joint Commission, at
The Joint Commission has proposed changes to its accreditation standards to account for direct-to-patient telehealth services. The new standards will apply to Joint Commission-accredited hospitals and ambulatory health care organizations offering direct-to-patient telehealth services. Accredited hospitals and organizations, as well as entrepreneurial telemedicine companies that contract with such hospitals, should be mindful of these proposed rule changes and how they will affect their telehealth services and operations. The changes are not yet final, so interested providers may want to consider contacting the Joint Commission with comments or feedback.

What Are the Proposed Telehealth Accreditation Standards?

The Joint Commission’s proposed telehealth changes involve revisions to two existing Standards and creation of one new Standard.

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Three Years Later, Foley Survey Reveals Positive Prognosis for Telemedicine
Thursday, March 29, 2018

When we launched Foley’s inaugural Telemedicine and Digital Health Survey in 2014, it was apparent that health care executives weren’t ready to make telemedicine a significant focus of their business and patient strategies. The interest was there but, despite tremendous technological breakthroughs and imaginative applications, most telemedicine programs were in the early stages and there was little acceptance by the broader health care community.
Fast forward to present time and the industry outlook has changed dramatically, due in large part to proven patient outcomes and surging demand among providers looking to improve the quality of care in a more convenient, cost-effective manner.
According to our 2017 survey, where we queried a range of executives at hospitals, specialty clinics, ancillary services and related organizations, three-quarters of respondents currently offer, or are planning to provide, telemedicine services. Now, compare that to three years ago when nearly 87 percent didn’t expect their patients to be using telemedicine services by this time – that’s quite a turnaround.

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New OIG Project Expands Telemedicine Audits to State Medicaid Programs
Thursday, March 29, 2018

Following on the heels of its plans to review Medicare payments for telehealth services, the federal Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) just announced a new project to review state Medicaid payments for telemedicine and other remote services. Accordingly, providers who bill state Medicaid programs for telemedicine, telehealth, or remote patient monitoring services may expect to have those claims reviewed to confirm payment was correctly made in accordance with the conditions for coverage. The project will be added to the OIG’s 2017 Work Plan.

How Does OIG Define Projects Contained on their Work Plan

Historically, at the beginning of each new fiscal year, the OIG issued its Work Plan, setting forth the compliance and enforcement projects and priorities OIG intends to pursue in the coming year. Beginning this past June, OIG began updating the annual Work Plan on a monthly basis. The Work Plan contains dozens of projects affecting Medicare and Medicaid providers, suppliers and payors, as well as public health reviews and Department-specific reviews.

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Medicare’s New Remote Patient Monitoring Reimbursement: What Providers Need to Know
Thursday, March 29, 2018

The new year continues to offer big opportunities for telemedicine and digital health companies, and one of the most notable developments is CMS’ decision to reimburse providers for remote patient monitoring (RPM). Effective January 1, 2018, the Medicare program will pay providers for RPM services billed under CPT code 99091. The service is currently defined as the “collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.”
It is great to see CMS agree with health innovation advocates that RPM services can be a significant part of ongoing medical care and that the Medicare program should recognize these services for separate payment as soon as practicable. Providers and telehealth companies should act now to embrace this landmark shift by Medicare to directly pay for RPM services on a monthly recurring basis.

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