What’s New in Health Care Reform: Nov. 15

The Week in Review provides an overview of the past week’s top health care content, including industry news and trends, Mayo Clinic and Mayo Medical Laboratories news, and upcoming events.

Trump Picks Alex Azar to Lead Health and Human Services

President Trump is nominating a former pharmaceutical executive to lead the Department of Health and Human Services, the agency that, among other things, regulates prescription drugs. The nomination comes at a time when rising drug prices have become a hot political issue. Via NPR.

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Some States Roll Back "Retroactive Medicaid," A Buffer for the Poor—and for Hospitals

If you’re poor, uninsured, and fall seriously ill, in most states if you qualify for Medicaid—but weren’t enrolled at the time—the program will pay your medical bills going back three months. It protects hospitals, too, from having to absorb the costs of caring for these patients. But a growing number of states are rescinding this benefit known as “retroactive eligibility.” On November 1, Iowa joined three states that have eliminated retroactive coverage for some groups of Medicaid patients since the Affordable Care Act passed. Each state had to secure approval by the federal government. Via Kaiser Health News.

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Add to the List of People Hit by the Opioid Epidemic in Minnesota: Medical Examiners

When we hear about the strain caused by a mounting death toll, the narrative is often focused on the human tragedy—a descent into dependence on the highly addictive drugs, lives destroyed or lost—often at a young age, and grieving families. We don’t hear as often about the strain the increase in overdose deaths can place on the people whose job it is to investigate the circumstances of them: those who work in medical examiners’ offices. Via MinnPost.

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Medicare Plan to Cut Hospital Readmission Is Tied to More Deaths

A U.S. government program meant to improve medical care and cut costs by penalizing hospitals that repeatedly readmit people with heart failure may have instead increased the risk that the patients would die, a new study suggests. The policy, called the Hospital Readmissions Reduction Program, was created in 2010 under Obamacare as one of several ways to use Medicare’s immense buying power to improve care. Under the program, hospitals were reimbursed less when heart failure patients were readmitted within a month. It did reduce the number of costly readmissions, according to the study, which was published by JAMA Cardiology. Yet the number of patients who died rose as well. The findings could indicate an additional 5,000 to 10,000 deaths annually across the U.S., said Gregg Fonarow, the senior author of the paper and professor of cardiovascular medicine at the University of California, Los Angeles. Via Bloomberg.

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Trump Health Agency Challenges Consensus on Reducing Costs

For several decades, a consensus has grown that reining in the United States’ $3.2 trillion annual medical bill begins with changing the way doctors are paid: Instead of compensating them for every appointment, service and procedure, they should be paid based on the quality of their care. The Obama administration used the authority of the Affordable Care Act to aggressively advance this idea, but many doctors chafed at the scope and speed of its experiments to change the way Medicare pays for everything from primary care to cancer treatment. Now, the Trump administration is siding with doctors—making a series of regulatory changes that slow or shrink some of these initiatives and let many doctors delay adopting the new system. Via NY Times.

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Trump Administration Guiding Health Shoppers to Agents Paid by Insurers

After cutting funds for nonprofit groups that help people obtain health insurance under the Affordable Care Act, the Trump administration is encouraging the use of insurance agents and brokers who are often paid by insurers when they help people sign up. The administration said in a recent bulletin that it was “increasing partnerships” with insurance agents and viewed them as “important stakeholders” in the federal marketplace, where consumers are now shopping for insurance. But some health policy experts warned that a shift from nonprofit groups, which are supposed to provide impartial information, to brokers and agents, who may receive commissions for the plans they recommend, carries risks for consumers. Via NY Times.

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Doctors Call for Help to Overcome Barriers to Joining Alternate Pay Models

Physician groups say they need more government support in order to boost alternative payment model participation across medical specialties and organizations to comply with the Medicare Access and CHIP Reauthorization Act. The American College of Physicians, American College of Rheumatology, and other organizations told members of the House Energy & Commerce Committee's Health Subcommittee that their members have concerns that have kept them from moving toward participation in an alternative pay model. The CMS expects more than 359,000 clinicians to enter into one of four of models offered by the agency in 2017. Via Modern Healthcare.

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Pace of Sign-Ups under Affordable Care Act Blows Past Prior Years

More than 600,000 people signed up last week for health insurance under the Affordable Care Act, significantly beating the pace of prior years as consumers defied President Trump’s assertion that the marketplace was collapsing. In a report on the first four days of open enrollment, the Trump administration said on Thursday, 601,462 people had selected health plans in the federal marketplace, HealthCare.gov. Of that number, 137,322 consumers, or 23 percent, were new to the marketplace and did not have coverage this year through the federal insurance exchange. Via NY Times.

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Growth in Health Care Prices Slows to Near-Historic Low

Health care prices rose just 1.1% year-over-year through September, representing the lowest price growth rate in roughly two years, according to a new report from Altarum. That growth rate was just slightly higher than the all-time low growth rate of 0.9% in December 2015. The figure has fluctuated between 1.2% and 2.3% over the past year. Via Modern Healthcare.

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Is It an Emergency? Insurer Makes Patients Question ER Visit

In an effort to curb unnecessary and costly ER visits, the Blue Cross–Blue Shield insurer has told customers in a few U.S. states to go to the hospital only in a real emergency such as a heart attack, stroke, and major bleeding—or they could wind up footing the bill. Anthem, the nation’s second-largest insurer, wants patients to consider alternatives like drugstore clinics, nurse advice hotlines, or telemedicine. Insurers for years have been raising ER co-payments to try to deter unnecessary—and expensive—visits, and Anthem’s policy marks another round in this long-standing fight. Via STAT.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Clinic Laboratories.

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