Federal Health IT Standards Pushed Back Yet Again


Sometimes deadlines just slip. The federal government’s deadline for providers certifying “Meaningful Use Stage 2″ in order to get federal funding for their electronic health records (EHRs) has just been bumped yet again:

The Centers for Medicare & Medicaid Services has reconsidered its original position not to extend the deadline for applying for Meaningful Use hardship exemptions and reopened the application submission period through Nov. 30, according to an announcement.

Eligible hospitals (EHs) and eligible professionals (EPs) who have not attained Meaningful Use and have not been granted a hardship exception are subject to “payment adjustments” of their Medicare reimbursement beginning Oct. 1 for EHs and Jan. 1, 2015 for EPs. The previous deadlines for submitting hardship exception applications had been April 1 for EHs and July 1 for EPs.

Where are the “Open Payments” from Government?


doctor-xray-2Well, now we know how much pharmaceutical companies and medical-device makers pay doctors for consulting and similar services. Paul Keckley aptly summarizes last week’s data dump from the Centers for Medicare & Medicare Services (CMS):

  • In the last five months of 2013, drug manufacturers made 4.4 million payments totaling $3.5B to 546,000 physicians and 1,360 teaching hospitals to encourage acceptance and use of their drugs/devices: $1.49B for research, $1.02B for ownership interests, $380M for speaking/consulting fees, $302M for royalties/licensing, $93M for meals, $74M for travel, and $128M for “other.”

Half of Doctors Give Obamacare D or F


Confident DoctorsThe Physicians Foundation and Merritt Hawkins (a physician recruiting firm) have just published their biennial physicians’ survey. The survey interviews over twenty thousand physicians in all fifty states and multiple specialties:

  • Only 19 percent say they have time to see more patients.
  • 44 percent plan to take steps to reduce services or find non-clinical employment.
  • Only 35 percent describe themselves as “independent practice owners,” down from 62 percent in 2008.
  • 53 percent describe themselves as hospital or medical-group employees, up from 38 percent in 2008.

Medicare Advantage: Telemonitoring Cuts Hospital Readmissions 44 Percent, ROI $3.30 per Dollar


Geisinger Health Plan has conducted a study of elderly patients enrolled in Medicare Advantage who were treated for congestive health failure. It is reported by Mobihealthnews‘ Jonah Comstock:

A new study from Pennsylvania hospital system Geisinger Health Plan shows that remote monitoring of congestive heart failure patients can reduce readmissions by 38 to 44 percent and produce a return on investment of $3.30 on the dollar.

Hiring in Health Care Finally Slows Down


Fast-paced hiring in health care, which I previously discussed with respect to the jobs report for August, seems to have tempered in September. The case I’ve been making over the last few months is that healthcare providers have been adding workers faster than the rest of the economy. In September, that turned.

As shown in Table 1, nonfarm payrolls increased by 1.07 percent from August, seasonally adjusted. However, when health care is separated from the rest of the workforce, the headcount increased by only 0.15 percent, versus 1.18 percent for the non-healthcare workforce.


Reporting Changes in Uninsured Due to Obamacare: Government Agencies Can Be Clearer


One of the themes of this blog is that the number of uninsured Americans is not decreasing as quickly or surely as Obamacare’s supporters would have us believe. Part of the problem estimating this is a confusing series of releases from federal agencies, which has led to inconsistent interpretation by scholars.

Last month, the Centers for Disease Control and Prevention (CDC) released the results of the National Health Insurance Survey (NHIS), which I discussed under the headline “Number of Uninsured Americans Aged 18-64 Down 2 Percentage Points.” What this was referring to was that the percentage of residents in that age group who were uninsured at the time of the interview had dropped from 20.4 percent in 2013 to 18.4 percent in the first quarter of 2014. That’s about 3.8 million people.

However, the proportion who were uninsured for at least part of the last year barely budged from 24.4 percent to 24.3 percent, and the proportion who were uninsured for more than a year dropped by 1.7 percentage points, from 15.7 percent to 14 percent. That’s about 3.2 million people. Obviously, the last group is a subset of the second group. The first group is also a subset of the second group, but it is not clear how to connect the first group and the third group.

The person responding that he is uninsured at the time of the interview might have lost coverage yesterday, or many years ago. This is an important question for public policy, because the short-term uninsured are likely short-term unemployed: Fix the job market and you fix their health insurance. Those who have not had health insurance for a long time likely have a different challenge. Indeed, they may be eligible for Medicaid but not be enrolled. However, Obamacare is changing this. Its expensive outreach efforts are leading to more Medicaid enrollment than enrollment in subsidized, private Obamacare plans.

Obamacare Veteran Sues Obamacare to Disclose Premiums


Here’s one from the “you can’t make this up” files:

The Department of Health and Human Services is in the spotlight for claims it is violating the Affordable Care Act.

The lawsuit was filed by Mehri & Skalet attorney Jay Angoff, who used to oversee ACA implementation for HHS. Filed on behalf of a Missouri consumer advocacy group, the suit claims the federal agency is not following through on its obligation to make rate filings for 2015 publicly available in time for the public to comment on them.

Get it? Mr Angoff “used to oversee ACA implementation for HHS.” He used to run Obamacare. Now, he’s running against it. Here’s why:

There is a tension in the Obamacare coalition. Open enrollment begins on November 15, a week and a half after the election. The current story on premiums for benchmark Obamacare plans in 2015 is that they will go down by just under one percent. This comes from a Kaiser Family Foundation survey of cities in only fifteen states.

Notwithstanding serious criticism of this claim, the media have swallowed and recycled it. For obvious political reasons, it is necessary for the Administration that no further announcements of premiums for the rest of the states disturb this comfortable narrative.

On the other hand, lawyers like Mr. Angoff are eager to see rate hikes in the double digits. Obamacare has funded states to empower their insurance commissioners to roll back premiums on political grounds. Lawyers like Mr. Angoff look forward to a tidy business representing exploited consumers in such states.

I agree that all Obamacare premiums for 2015 should be announced before the November 4 election, so that voters have the freshest information about Obamacare’s consequences. Whether Mr. Angoff’s lawsuit will have an effect in so short a time, we will have wait and see.

Veterans Wait 3 Months for Primary-Care Appointment vs. 3 Days for Private Patients


I have noted with dismay that the U.S. government is trying to fix the Veterans Health Administration scandal over wait times by throwing more money at a fundamentally broken system.

Jonathan Bush, CEO of athenaHealth, a leading provider of cloud-base electronic health records (EHR’s) has researched his firm’s database to arrive at a shocking conclusion: Patients wait three days, on average, for a primary-care appointment. And that was for well patients: Sick patients got in in one day.

Bush concludes that veterans trapped in the Veterans Health Administration should be able to shop for care outside the VHA.

States’ “Right to Try” Laws Have a “Strange Allure”


Writing in JAMA: Journal of the American Medical Association, Patricia J. Zettler, JD, and Henry T. Greely, JD, both of Stanford University, criticize the “strange allure” of states’ laws that recognize patients’ “right to try” new medicines before the Food and Drug Administration (FDA) approves them.

These laws should help patients get access to medicines that the FDA forbids. However, these lawyers point out that the FDA’s power may overwhelm these laws:

Despite the attention they have received, right-to-try laws are unlikely to give patients more access to unapproved drugs or devices. Under the “Supremacy Clause” in the US Constitution, federal law trumps conflicting state laws. For example, states can repeal their laws against medical (or nonmedical) use of marijuana, but the federal government may still arrest and convict people in those states for violating medical marijuana prohibitions. Although the federal government has chosen to limit its enforcement of federal marijuana laws in certain circumstances, the FDA is unlikely to ignore unauthorized use of unapproved products, especially because the agency already provides physicians with a regulatory pathway for compassionate use.

U.S. Infant Mortality Still Lags Other Developed Countries


There’s more bad news for the U.S. on the infant mortality front: The U.S. ranks last of 26 countries in infant mortality: 6.1 per 1,000 live births, versus 2.5 in Sweden, according to a new study by the Centers for Disease Control and Prevention (CDC).

Infant mortality refers to the death of a baby before his first birthday. The proportion of pre-term births explains 39 percent of the difference between U.S. and Swedish outcomes, because the U.S. has a large proportion of pre-term births. This has led some to question the validity of the international comparison, because some countries measure very pre-term births (before 24 weeks differently). It has been argued that the U.S. will consider a baby born alive, who might be considered stillborn in another country, thereby making our infant mortality statistics look artificially worse.