User login
Benefits of Medicare Shared Savings Program ACOs lacking
or improving quality, according to new research.
“Our conclusion that the MSSP was not associated with improvements in spending, quality, or most measures of hospital use differ from that of previous evaluations of Medicare ACOs,” Adam Markovitz, of the University of Michigan, Ann Arbor, and colleagues wrote in a new research report published in Annals of Internal Medicine.
“Our instrumental variable model addresses selection effects not directly captured in previous evaluations,” the researchers continued.
To illustrate the point, the researchers found an association between MSSP and spending when using an adjusted longitudinal model (change, –$118; 95% confidence interval, –$151 to –$85 per beneficiary per quarter), with savings coming from reductions in inpatient services, outpatient services, and skilled nursing facility charges.
However, when employing an instrumental variable model, there was not an association with changes in total spending (change, $5; 95%CI, –$51 to $62 per beneficiary per quarter.
“The instrumental variable estimate for spending differed significantly from the adjusted estimate,” Mr. Markovitz and colleagues noted. “Estimated savings were smaller in instrumental variable models than in adjusted models across each ACO cohort.”
Similar patterns were observed in quality observations.
“The MSSP was associated with improvements in all four clinical quality indicators in the adjusted longitudinal model but not in the instrumental variable model,” the authors wrote. “The MSSP was associated with modest decreases in all-cause hospitalizations and preventable hospitalizations in the longitudinal model but not in the instrumental variable model.”
Overall, the authors noted that the results “challenge the view that MSSP ACOs have lowered spending and improved quality; they indicate that savings by MSSP ACOs may be driven by nonrandom exit of high-cost clinicians and their patient panels from this voluntary program.”
Indeed, the report states that removing “high-cost clinicians from ACO contracts could have large effects on spending estimates and may contribute to reported findings that MSSP savings grow over time.”
Primary sources of funding for the research included the Horowitz Foundation for Social Policy, Agency for Healthcare Research and Quality, and the National Institute on Aging. No relevant disclosures were made by the authors.
SOURCE: Markovitz A et al. Ann Intern Med. 2019 Jun 18. doi: 10.7326/M18-2539.
or improving quality, according to new research.
“Our conclusion that the MSSP was not associated with improvements in spending, quality, or most measures of hospital use differ from that of previous evaluations of Medicare ACOs,” Adam Markovitz, of the University of Michigan, Ann Arbor, and colleagues wrote in a new research report published in Annals of Internal Medicine.
“Our instrumental variable model addresses selection effects not directly captured in previous evaluations,” the researchers continued.
To illustrate the point, the researchers found an association between MSSP and spending when using an adjusted longitudinal model (change, –$118; 95% confidence interval, –$151 to –$85 per beneficiary per quarter), with savings coming from reductions in inpatient services, outpatient services, and skilled nursing facility charges.
However, when employing an instrumental variable model, there was not an association with changes in total spending (change, $5; 95%CI, –$51 to $62 per beneficiary per quarter.
“The instrumental variable estimate for spending differed significantly from the adjusted estimate,” Mr. Markovitz and colleagues noted. “Estimated savings were smaller in instrumental variable models than in adjusted models across each ACO cohort.”
Similar patterns were observed in quality observations.
“The MSSP was associated with improvements in all four clinical quality indicators in the adjusted longitudinal model but not in the instrumental variable model,” the authors wrote. “The MSSP was associated with modest decreases in all-cause hospitalizations and preventable hospitalizations in the longitudinal model but not in the instrumental variable model.”
Overall, the authors noted that the results “challenge the view that MSSP ACOs have lowered spending and improved quality; they indicate that savings by MSSP ACOs may be driven by nonrandom exit of high-cost clinicians and their patient panels from this voluntary program.”
Indeed, the report states that removing “high-cost clinicians from ACO contracts could have large effects on spending estimates and may contribute to reported findings that MSSP savings grow over time.”
Primary sources of funding for the research included the Horowitz Foundation for Social Policy, Agency for Healthcare Research and Quality, and the National Institute on Aging. No relevant disclosures were made by the authors.
SOURCE: Markovitz A et al. Ann Intern Med. 2019 Jun 18. doi: 10.7326/M18-2539.
or improving quality, according to new research.
“Our conclusion that the MSSP was not associated with improvements in spending, quality, or most measures of hospital use differ from that of previous evaluations of Medicare ACOs,” Adam Markovitz, of the University of Michigan, Ann Arbor, and colleagues wrote in a new research report published in Annals of Internal Medicine.
“Our instrumental variable model addresses selection effects not directly captured in previous evaluations,” the researchers continued.
To illustrate the point, the researchers found an association between MSSP and spending when using an adjusted longitudinal model (change, –$118; 95% confidence interval, –$151 to –$85 per beneficiary per quarter), with savings coming from reductions in inpatient services, outpatient services, and skilled nursing facility charges.
However, when employing an instrumental variable model, there was not an association with changes in total spending (change, $5; 95%CI, –$51 to $62 per beneficiary per quarter.
“The instrumental variable estimate for spending differed significantly from the adjusted estimate,” Mr. Markovitz and colleagues noted. “Estimated savings were smaller in instrumental variable models than in adjusted models across each ACO cohort.”
Similar patterns were observed in quality observations.
“The MSSP was associated with improvements in all four clinical quality indicators in the adjusted longitudinal model but not in the instrumental variable model,” the authors wrote. “The MSSP was associated with modest decreases in all-cause hospitalizations and preventable hospitalizations in the longitudinal model but not in the instrumental variable model.”
Overall, the authors noted that the results “challenge the view that MSSP ACOs have lowered spending and improved quality; they indicate that savings by MSSP ACOs may be driven by nonrandom exit of high-cost clinicians and their patient panels from this voluntary program.”
Indeed, the report states that removing “high-cost clinicians from ACO contracts could have large effects on spending estimates and may contribute to reported findings that MSSP savings grow over time.”
Primary sources of funding for the research included the Horowitz Foundation for Social Policy, Agency for Healthcare Research and Quality, and the National Institute on Aging. No relevant disclosures were made by the authors.
SOURCE: Markovitz A et al. Ann Intern Med. 2019 Jun 18. doi: 10.7326/M18-2539.
FROM ANNALS OF INTERNAL MEDICINE
CMS seeks answers on prior authorization, other hassles to eliminate
Got an idea on how to reduce administrative burden to help reduce the cost of delivering health care? The Centers for Medicare & Medicaid Services wants to hear from you.
In a request for information published June 6, the agency seeks parties across the health care spectrum “to recommend further changes to rules, policies, and procedures that would shift more of clinicians’ time and our health care system’s resources from needless paperwork to high-quality care that improves patient health,” CMS officials said in a statement.
The request for information, part of the agency’s Patients Over Paperwork initiative, seeks suggestions on how to reduce hassles associated with reporting and documentation, coding, prior authorization, rural issues, dual eligible patients, enrollment/eligibility determination and the agency’s own process for issuing regulations and policies.
“Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated, or duplicative requirements that drain clinicians’ time but contribute little to quality of care or patient health,” CMS Administrator Seema Verma said in a statement. “Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks.”
The request for information is scheduled to published in the Federal Register on June 11. Comments are due to the agency on Aug. 12. Comments can be made at www.regulations.gov and should refer to file code CMS-6082-NC.
AGA will submit comments to CMS on this issue given the huge burden that prior authorization plays in practices and the time that it takes away from providing care to patients. In the meantime, ask your legislator to support Improving Seniors Access to Timely Care Act of 2019, which was recently introduced in Congress to streamline the prior authorization process in the Medicare Advantage program to relieve the administrative burdens this poses for physicians and help patients receive quicker access to the medical care they need. Learn more at http://ow.ly/tJfX30oW5l7.
SOURCE: Federal Register, CMS-6082-NC, https://federalregister.gov/d/2019-12215.
Got an idea on how to reduce administrative burden to help reduce the cost of delivering health care? The Centers for Medicare & Medicaid Services wants to hear from you.
In a request for information published June 6, the agency seeks parties across the health care spectrum “to recommend further changes to rules, policies, and procedures that would shift more of clinicians’ time and our health care system’s resources from needless paperwork to high-quality care that improves patient health,” CMS officials said in a statement.
The request for information, part of the agency’s Patients Over Paperwork initiative, seeks suggestions on how to reduce hassles associated with reporting and documentation, coding, prior authorization, rural issues, dual eligible patients, enrollment/eligibility determination and the agency’s own process for issuing regulations and policies.
“Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated, or duplicative requirements that drain clinicians’ time but contribute little to quality of care or patient health,” CMS Administrator Seema Verma said in a statement. “Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks.”
The request for information is scheduled to published in the Federal Register on June 11. Comments are due to the agency on Aug. 12. Comments can be made at www.regulations.gov and should refer to file code CMS-6082-NC.
AGA will submit comments to CMS on this issue given the huge burden that prior authorization plays in practices and the time that it takes away from providing care to patients. In the meantime, ask your legislator to support Improving Seniors Access to Timely Care Act of 2019, which was recently introduced in Congress to streamline the prior authorization process in the Medicare Advantage program to relieve the administrative burdens this poses for physicians and help patients receive quicker access to the medical care they need. Learn more at http://ow.ly/tJfX30oW5l7.
SOURCE: Federal Register, CMS-6082-NC, https://federalregister.gov/d/2019-12215.
Got an idea on how to reduce administrative burden to help reduce the cost of delivering health care? The Centers for Medicare & Medicaid Services wants to hear from you.
In a request for information published June 6, the agency seeks parties across the health care spectrum “to recommend further changes to rules, policies, and procedures that would shift more of clinicians’ time and our health care system’s resources from needless paperwork to high-quality care that improves patient health,” CMS officials said in a statement.
The request for information, part of the agency’s Patients Over Paperwork initiative, seeks suggestions on how to reduce hassles associated with reporting and documentation, coding, prior authorization, rural issues, dual eligible patients, enrollment/eligibility determination and the agency’s own process for issuing regulations and policies.
“Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated, or duplicative requirements that drain clinicians’ time but contribute little to quality of care or patient health,” CMS Administrator Seema Verma said in a statement. “Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks.”
The request for information is scheduled to published in the Federal Register on June 11. Comments are due to the agency on Aug. 12. Comments can be made at www.regulations.gov and should refer to file code CMS-6082-NC.
AGA will submit comments to CMS on this issue given the huge burden that prior authorization plays in practices and the time that it takes away from providing care to patients. In the meantime, ask your legislator to support Improving Seniors Access to Timely Care Act of 2019, which was recently introduced in Congress to streamline the prior authorization process in the Medicare Advantage program to relieve the administrative burdens this poses for physicians and help patients receive quicker access to the medical care they need. Learn more at http://ow.ly/tJfX30oW5l7.
SOURCE: Federal Register, CMS-6082-NC, https://federalregister.gov/d/2019-12215.
Key clinical point: CMS is looking to expand Patients Over Paperwork initiative.
Major finding: The agency issued a request for information to solicit ideas to reduce administrative burdens.
Study details: Ideas are sought in the following areas: reporting and documentation, coding, prior authorization, rural issues, dual eligible patients, enrollment/eligibility determination and the agency’s own process for issuing regulations and policies. The request for information is scheduled to published in the Federal Register on June 11. Comments are due to the agency on Aug. 12. Comments can be made at www.regulations.gov and should refer to file code CMS-6082-NC.Disclosures: None .
Source: Federal Register, CMS-6082-NC, https://federalregister.gov/d/2019-12215.
Universal health care hearing: GOP hears what it wants to
While most Republicans used their time at the House Ways & Means Committee hearing on Medicare-for-all to trash the concept, one rogue member criticized the hearing as simply misguided.
“We are living a time of disruption,” Rep. David Schweikert (R-Ariz) said. “There is incredible technology that is about to crash the price of health care if this committee particularly is willing to challenge and do something that’s incredibly uncomfortable for those of us in elective office, and that is look incumbent providers, business, insurers, systems in the face and say ‘it’s time for the revolution.’
“Are we willing to talk to our hospitals, talk to our providers, talk to technology, talk to the FDA [Food and Drug Administration], and have the honest discussion that this is about to become your primary care physician,” he said, raising a smartphone in his hand. “We will be healthier because it is individualized to us instead of what is going here in the discussion of a collectivization of a system that is already pretty crappy.”
He cited the recent Medicare Trustees Report showing that the hospital insurance trust fund (Medicare Part A) is 6.5 years from insolvency. “I don’t know why this hearing isn’t about Medicare itself and protecting Medicare itself instead of nationalization of health care. ... So defending the current system is absurd for all of us.”
The partisan nature of the June 12 hearing was clear.
Republican committee members focused their questioning on Grace-Marie Turner, president of the conservative Galen Institute and an outspoken opponent of Medicare-for-all. Less attention was paid to witnesses who offered alternatives to achieving greater health care coverage for the population.
Ranking member Kevin Brady (R-Texas) set the tone in his opening statement: “While our American health care system does have real problems, we should focus on improving what’s working and to fix what’s broken, rather than starting over with a massive new socialized medicine scheme that will leave many families worse off,” he said.
He noted that the federal government is on the cusp of yet another shutdown after three shutdowns in 2018. “The federal government can’t even keep its doors open. Can you really trust Washington with your life-and-death health care decisions? Make no mistake, Medicare-for-all guts quality health care in favor of delays and long waiting lines. It gives Washington politicians unlimited control over your health care. It cancels good quality health care plans for millions of workers, children, and the elderly and is so costly – tens of trillions of dollars – it will bankrupt America.”
Ms. Turner was regularly called upon to back up these talking points, using an analysis of a specific legislative proposal (H.R. 1384), in which she noted that under that specific Medicare-for-all bill, “Washington would be deciding what benefits people are eligible to receive. It will be deciding how much providers will be paid, so yes, it significantly limits choices of individuals and we see this, of course, in other countries as well.”
And while Republicans were using the testimony of Ms. Turner to back up their agenda, no one queried Donald Berwick, MD, former administrator of the Centers for Medicare & Medicaid Services and president emeritus and senior fellow at the Institute for Healthcare Improvement, who testified in support of a Medicare-for-all program – that the true impact of any universal coverage plan is dependent upon the program’s design.
One common GOP criticism throughout the hearing was that there would be a 40% reduction in pay to physicians and hospitals because the higher payments rates from private insurers that currently help offset lower payments from Medicare and Medicaid would be lost.
“The rhetoric we are hearing about 40% cuts is not necessary,” Dr. Berwick testified. “We can have sensible payment under an expanded Medicare system. That’s rhetoric, not fact. That’s in the design.”
While most Republicans used their time at the House Ways & Means Committee hearing on Medicare-for-all to trash the concept, one rogue member criticized the hearing as simply misguided.
“We are living a time of disruption,” Rep. David Schweikert (R-Ariz) said. “There is incredible technology that is about to crash the price of health care if this committee particularly is willing to challenge and do something that’s incredibly uncomfortable for those of us in elective office, and that is look incumbent providers, business, insurers, systems in the face and say ‘it’s time for the revolution.’
“Are we willing to talk to our hospitals, talk to our providers, talk to technology, talk to the FDA [Food and Drug Administration], and have the honest discussion that this is about to become your primary care physician,” he said, raising a smartphone in his hand. “We will be healthier because it is individualized to us instead of what is going here in the discussion of a collectivization of a system that is already pretty crappy.”
He cited the recent Medicare Trustees Report showing that the hospital insurance trust fund (Medicare Part A) is 6.5 years from insolvency. “I don’t know why this hearing isn’t about Medicare itself and protecting Medicare itself instead of nationalization of health care. ... So defending the current system is absurd for all of us.”
The partisan nature of the June 12 hearing was clear.
Republican committee members focused their questioning on Grace-Marie Turner, president of the conservative Galen Institute and an outspoken opponent of Medicare-for-all. Less attention was paid to witnesses who offered alternatives to achieving greater health care coverage for the population.
Ranking member Kevin Brady (R-Texas) set the tone in his opening statement: “While our American health care system does have real problems, we should focus on improving what’s working and to fix what’s broken, rather than starting over with a massive new socialized medicine scheme that will leave many families worse off,” he said.
He noted that the federal government is on the cusp of yet another shutdown after three shutdowns in 2018. “The federal government can’t even keep its doors open. Can you really trust Washington with your life-and-death health care decisions? Make no mistake, Medicare-for-all guts quality health care in favor of delays and long waiting lines. It gives Washington politicians unlimited control over your health care. It cancels good quality health care plans for millions of workers, children, and the elderly and is so costly – tens of trillions of dollars – it will bankrupt America.”
Ms. Turner was regularly called upon to back up these talking points, using an analysis of a specific legislative proposal (H.R. 1384), in which she noted that under that specific Medicare-for-all bill, “Washington would be deciding what benefits people are eligible to receive. It will be deciding how much providers will be paid, so yes, it significantly limits choices of individuals and we see this, of course, in other countries as well.”
And while Republicans were using the testimony of Ms. Turner to back up their agenda, no one queried Donald Berwick, MD, former administrator of the Centers for Medicare & Medicaid Services and president emeritus and senior fellow at the Institute for Healthcare Improvement, who testified in support of a Medicare-for-all program – that the true impact of any universal coverage plan is dependent upon the program’s design.
One common GOP criticism throughout the hearing was that there would be a 40% reduction in pay to physicians and hospitals because the higher payments rates from private insurers that currently help offset lower payments from Medicare and Medicaid would be lost.
“The rhetoric we are hearing about 40% cuts is not necessary,” Dr. Berwick testified. “We can have sensible payment under an expanded Medicare system. That’s rhetoric, not fact. That’s in the design.”
While most Republicans used their time at the House Ways & Means Committee hearing on Medicare-for-all to trash the concept, one rogue member criticized the hearing as simply misguided.
“We are living a time of disruption,” Rep. David Schweikert (R-Ariz) said. “There is incredible technology that is about to crash the price of health care if this committee particularly is willing to challenge and do something that’s incredibly uncomfortable for those of us in elective office, and that is look incumbent providers, business, insurers, systems in the face and say ‘it’s time for the revolution.’
“Are we willing to talk to our hospitals, talk to our providers, talk to technology, talk to the FDA [Food and Drug Administration], and have the honest discussion that this is about to become your primary care physician,” he said, raising a smartphone in his hand. “We will be healthier because it is individualized to us instead of what is going here in the discussion of a collectivization of a system that is already pretty crappy.”
He cited the recent Medicare Trustees Report showing that the hospital insurance trust fund (Medicare Part A) is 6.5 years from insolvency. “I don’t know why this hearing isn’t about Medicare itself and protecting Medicare itself instead of nationalization of health care. ... So defending the current system is absurd for all of us.”
The partisan nature of the June 12 hearing was clear.
Republican committee members focused their questioning on Grace-Marie Turner, president of the conservative Galen Institute and an outspoken opponent of Medicare-for-all. Less attention was paid to witnesses who offered alternatives to achieving greater health care coverage for the population.
Ranking member Kevin Brady (R-Texas) set the tone in his opening statement: “While our American health care system does have real problems, we should focus on improving what’s working and to fix what’s broken, rather than starting over with a massive new socialized medicine scheme that will leave many families worse off,” he said.
He noted that the federal government is on the cusp of yet another shutdown after three shutdowns in 2018. “The federal government can’t even keep its doors open. Can you really trust Washington with your life-and-death health care decisions? Make no mistake, Medicare-for-all guts quality health care in favor of delays and long waiting lines. It gives Washington politicians unlimited control over your health care. It cancels good quality health care plans for millions of workers, children, and the elderly and is so costly – tens of trillions of dollars – it will bankrupt America.”
Ms. Turner was regularly called upon to back up these talking points, using an analysis of a specific legislative proposal (H.R. 1384), in which she noted that under that specific Medicare-for-all bill, “Washington would be deciding what benefits people are eligible to receive. It will be deciding how much providers will be paid, so yes, it significantly limits choices of individuals and we see this, of course, in other countries as well.”
And while Republicans were using the testimony of Ms. Turner to back up their agenda, no one queried Donald Berwick, MD, former administrator of the Centers for Medicare & Medicaid Services and president emeritus and senior fellow at the Institute for Healthcare Improvement, who testified in support of a Medicare-for-all program – that the true impact of any universal coverage plan is dependent upon the program’s design.
One common GOP criticism throughout the hearing was that there would be a 40% reduction in pay to physicians and hospitals because the higher payments rates from private insurers that currently help offset lower payments from Medicare and Medicaid would be lost.
“The rhetoric we are hearing about 40% cuts is not necessary,” Dr. Berwick testified. “We can have sensible payment under an expanded Medicare system. That’s rhetoric, not fact. That’s in the design.”
REPORTING FROM A HOUSE WAYS & MEANS COMMITTEE HEARING
FACTS Consortium calls for research on preventing pediatric firearm injuries
The 26 research agenda items from FACTS, which span across the broad topic areas of epidemiology, surveillance, and risk and protective factors; primary, secondary, and cross-cutting protective factors; policy-related issues; and data-enhancement priorities, were published in JAMA Pediatrics.
“Firearms are the second leading cause of death among children and adolescents aged 1 to 18 years in the United States and responsible for more than 2,570 deaths and nearly 12,000 nonfatal injuries requiring emergency department treatment in 2017,” said Rebecca Cunningham, MD, of the University of Michigan, Ann Arbor, and colleagues who are members of the FACTS Consortium.
“Pediatric firearm injuries result from a range of causes, including the unintentional discharge of a firearm, self-inflicted wounds, or the escalation of interpersonal violence,” they continued. “Nearly 265 million firearms are in civilian hands in the United States, and a 44% increase in pediatric firearm mortality rate has been documented during the past 5 years.”
The FACTS Consortium defined an agenda “to serve as a guide for future research efforts to decrease pediatric death and injury.”
Some of the research agenda items include the following:
- Understanding epidemiologic trends and how demographic factors are associated with fatal and nonfatal outcomes.
- The long-term cost associated with pediatric firearm outcomes.
- The effectiveness of health care–focused primary prevention strategies for children, adolescents, and their families to reduce firearm outcomes.
- Examination of health care–based interventions for children and adolescents who have experienced or witnessed a firearm injury to prevent (or reduce) subsequent firearm outcomes including firearm injury recidivism and mental health, socioemotional, and educational outcomes.
“It is an excellent list, and I think it was very thoughtful to come out with a research agenda for firearm safety for kids,” Marlene Melzer-Lange, MD, chair of the American Academy of Pediatrics subcommittee on violence prevention, said in an interview. “The thing that’s been lacking nationally has been funding for firearm injury prevention, both for children and adults, and to have something focused specifically on children – because children have the biggest chance of living the longest – is really important.”
She described the research agenda as being “comprehensive” and didn’t see anything that stood out as missing from the list, although the big issue that remains is getting funding for the research now that an agenda has been outlined.
And getting that is not going to be easy.
“I think it’s going to take some political will of the people and particularly of our legislators ... to allow the [Centers for Disease Control and Prevention] to provide funding” said Dr. Melzer-Lange, an attending emergency department physician at Children’s Hospital of Wisconsin, Milwaukee, adding that AAP has long been asking for such funding. “It’s going [to come down to] the legislators [having] enough guts to actually put the funding in and not be afraid of external groups that might ask them not to do that.”
She remains optimistic and hopeful that the legislators are going to look at it and will eventually say that this is an crisis and will take more action beyond just talking about it.
Dr. Melzer-Lange also emphasized that this is about firearm safety and not firearm control, especially for children and teenagers.
All authors reported receiving grants from National Institutes of Health/National Institute of Child Health and Human Development.
SOURCE: Cunningham RM et al. JAMA Pediatrics. 2019. doi: 10.1001/jamapediatrics.2019.1494.
The 26 research agenda items from FACTS, which span across the broad topic areas of epidemiology, surveillance, and risk and protective factors; primary, secondary, and cross-cutting protective factors; policy-related issues; and data-enhancement priorities, were published in JAMA Pediatrics.
“Firearms are the second leading cause of death among children and adolescents aged 1 to 18 years in the United States and responsible for more than 2,570 deaths and nearly 12,000 nonfatal injuries requiring emergency department treatment in 2017,” said Rebecca Cunningham, MD, of the University of Michigan, Ann Arbor, and colleagues who are members of the FACTS Consortium.
“Pediatric firearm injuries result from a range of causes, including the unintentional discharge of a firearm, self-inflicted wounds, or the escalation of interpersonal violence,” they continued. “Nearly 265 million firearms are in civilian hands in the United States, and a 44% increase in pediatric firearm mortality rate has been documented during the past 5 years.”
The FACTS Consortium defined an agenda “to serve as a guide for future research efforts to decrease pediatric death and injury.”
Some of the research agenda items include the following:
- Understanding epidemiologic trends and how demographic factors are associated with fatal and nonfatal outcomes.
- The long-term cost associated with pediatric firearm outcomes.
- The effectiveness of health care–focused primary prevention strategies for children, adolescents, and their families to reduce firearm outcomes.
- Examination of health care–based interventions for children and adolescents who have experienced or witnessed a firearm injury to prevent (or reduce) subsequent firearm outcomes including firearm injury recidivism and mental health, socioemotional, and educational outcomes.
“It is an excellent list, and I think it was very thoughtful to come out with a research agenda for firearm safety for kids,” Marlene Melzer-Lange, MD, chair of the American Academy of Pediatrics subcommittee on violence prevention, said in an interview. “The thing that’s been lacking nationally has been funding for firearm injury prevention, both for children and adults, and to have something focused specifically on children – because children have the biggest chance of living the longest – is really important.”
She described the research agenda as being “comprehensive” and didn’t see anything that stood out as missing from the list, although the big issue that remains is getting funding for the research now that an agenda has been outlined.
And getting that is not going to be easy.
“I think it’s going to take some political will of the people and particularly of our legislators ... to allow the [Centers for Disease Control and Prevention] to provide funding” said Dr. Melzer-Lange, an attending emergency department physician at Children’s Hospital of Wisconsin, Milwaukee, adding that AAP has long been asking for such funding. “It’s going [to come down to] the legislators [having] enough guts to actually put the funding in and not be afraid of external groups that might ask them not to do that.”
She remains optimistic and hopeful that the legislators are going to look at it and will eventually say that this is an crisis and will take more action beyond just talking about it.
Dr. Melzer-Lange also emphasized that this is about firearm safety and not firearm control, especially for children and teenagers.
All authors reported receiving grants from National Institutes of Health/National Institute of Child Health and Human Development.
SOURCE: Cunningham RM et al. JAMA Pediatrics. 2019. doi: 10.1001/jamapediatrics.2019.1494.
The 26 research agenda items from FACTS, which span across the broad topic areas of epidemiology, surveillance, and risk and protective factors; primary, secondary, and cross-cutting protective factors; policy-related issues; and data-enhancement priorities, were published in JAMA Pediatrics.
“Firearms are the second leading cause of death among children and adolescents aged 1 to 18 years in the United States and responsible for more than 2,570 deaths and nearly 12,000 nonfatal injuries requiring emergency department treatment in 2017,” said Rebecca Cunningham, MD, of the University of Michigan, Ann Arbor, and colleagues who are members of the FACTS Consortium.
“Pediatric firearm injuries result from a range of causes, including the unintentional discharge of a firearm, self-inflicted wounds, or the escalation of interpersonal violence,” they continued. “Nearly 265 million firearms are in civilian hands in the United States, and a 44% increase in pediatric firearm mortality rate has been documented during the past 5 years.”
The FACTS Consortium defined an agenda “to serve as a guide for future research efforts to decrease pediatric death and injury.”
Some of the research agenda items include the following:
- Understanding epidemiologic trends and how demographic factors are associated with fatal and nonfatal outcomes.
- The long-term cost associated with pediatric firearm outcomes.
- The effectiveness of health care–focused primary prevention strategies for children, adolescents, and their families to reduce firearm outcomes.
- Examination of health care–based interventions for children and adolescents who have experienced or witnessed a firearm injury to prevent (or reduce) subsequent firearm outcomes including firearm injury recidivism and mental health, socioemotional, and educational outcomes.
“It is an excellent list, and I think it was very thoughtful to come out with a research agenda for firearm safety for kids,” Marlene Melzer-Lange, MD, chair of the American Academy of Pediatrics subcommittee on violence prevention, said in an interview. “The thing that’s been lacking nationally has been funding for firearm injury prevention, both for children and adults, and to have something focused specifically on children – because children have the biggest chance of living the longest – is really important.”
She described the research agenda as being “comprehensive” and didn’t see anything that stood out as missing from the list, although the big issue that remains is getting funding for the research now that an agenda has been outlined.
And getting that is not going to be easy.
“I think it’s going to take some political will of the people and particularly of our legislators ... to allow the [Centers for Disease Control and Prevention] to provide funding” said Dr. Melzer-Lange, an attending emergency department physician at Children’s Hospital of Wisconsin, Milwaukee, adding that AAP has long been asking for such funding. “It’s going [to come down to] the legislators [having] enough guts to actually put the funding in and not be afraid of external groups that might ask them not to do that.”
She remains optimistic and hopeful that the legislators are going to look at it and will eventually say that this is an crisis and will take more action beyond just talking about it.
Dr. Melzer-Lange also emphasized that this is about firearm safety and not firearm control, especially for children and teenagers.
All authors reported receiving grants from National Institutes of Health/National Institute of Child Health and Human Development.
SOURCE: Cunningham RM et al. JAMA Pediatrics. 2019. doi: 10.1001/jamapediatrics.2019.1494.
FROM JAMA PEDIATRICS
CMS seeks answers on prior authorization, other hassles to eliminate
Got an idea on how to reduce administrative burden to help reduce the cost of delivering health care? The Centers for Medicare & Medicaid Services wants to hear from you.
In a request for information published June 6, the agency seeks parties across the health care spectrum “to recommend further changes to rules, policies, and procedures that would shift more of clinicians’ time and our health care system’s resources from needless paperwork to high-quality care that improves patient health,” CMS officials said in a statement.
The request for information, part of the agency’s Patients Over Paperwork initiative, seeks suggestions on how to reduce hassles associated with reporting and documentation, coding, prior authorization, rural issues, dual eligible patients, enrollment/eligibility determination and the agency’s own process for issuing regulations and policies.
“Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated, or duplicative requirements that drain clinicians’ time but contribute little to quality of care or patient health,” CMS Administrator Seema Verma said in a statement. “Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks.”
The request for information is scheduled to published in the Federal Register on June 11. Comments are due to the agency on Aug. 12. Comments can be made at www.regulations.gov and should refer to file code CMS-6082-NC.
SOURCE: Federal Register, CMS-6082-NC, https://federalregister.gov/d/2019-12215.
Got an idea on how to reduce administrative burden to help reduce the cost of delivering health care? The Centers for Medicare & Medicaid Services wants to hear from you.
In a request for information published June 6, the agency seeks parties across the health care spectrum “to recommend further changes to rules, policies, and procedures that would shift more of clinicians’ time and our health care system’s resources from needless paperwork to high-quality care that improves patient health,” CMS officials said in a statement.
The request for information, part of the agency’s Patients Over Paperwork initiative, seeks suggestions on how to reduce hassles associated with reporting and documentation, coding, prior authorization, rural issues, dual eligible patients, enrollment/eligibility determination and the agency’s own process for issuing regulations and policies.
“Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated, or duplicative requirements that drain clinicians’ time but contribute little to quality of care or patient health,” CMS Administrator Seema Verma said in a statement. “Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks.”
The request for information is scheduled to published in the Federal Register on June 11. Comments are due to the agency on Aug. 12. Comments can be made at www.regulations.gov and should refer to file code CMS-6082-NC.
SOURCE: Federal Register, CMS-6082-NC, https://federalregister.gov/d/2019-12215.
Got an idea on how to reduce administrative burden to help reduce the cost of delivering health care? The Centers for Medicare & Medicaid Services wants to hear from you.
In a request for information published June 6, the agency seeks parties across the health care spectrum “to recommend further changes to rules, policies, and procedures that would shift more of clinicians’ time and our health care system’s resources from needless paperwork to high-quality care that improves patient health,” CMS officials said in a statement.
The request for information, part of the agency’s Patients Over Paperwork initiative, seeks suggestions on how to reduce hassles associated with reporting and documentation, coding, prior authorization, rural issues, dual eligible patients, enrollment/eligibility determination and the agency’s own process for issuing regulations and policies.
“Patients over Paperwork has made great inroads in clearing away needlessly complex, outdated, or duplicative requirements that drain clinicians’ time but contribute little to quality of care or patient health,” CMS Administrator Seema Verma said in a statement. “Our goal is to ensure that doctors are spending more time with their patients and less time in administrative tasks.”
The request for information is scheduled to published in the Federal Register on June 11. Comments are due to the agency on Aug. 12. Comments can be made at www.regulations.gov and should refer to file code CMS-6082-NC.
SOURCE: Federal Register, CMS-6082-NC, https://federalregister.gov/d/2019-12215.
Opioid prescriptions declined 33% over 5 years
Fewer opioid retail prescriptions are being filled, according to a new report issued by the American Medical Association Opioid Task Force.
Opioid prescribing declined by 33% over a 5-year period based on the total number of opioid retail prescriptions filled. Total prescriptions declined from 251.8 million in 2013 to 168.8 million in 2018, according to the report.
The numbers come as the most recent data from the Centers for Disease Control and Prevention show a leveling of deaths involving prescription opioids. The CDC data were most recently updated in January 2019 and cover the period 1999-2017.
A closer look shows that deaths involving prescription opioids, but not other synthetic narcotics, peaked in 2011 and have generally declined since then. Deaths involving other synthetic narcotics, however, have been rising, offsetting the reduction and keeping the total number of deaths involving opioids relatively stable between 2016 and 2017.
Other data released by the AMA Opioid Task Force show that physicians are increasing their use of state-level prescription drug monitoring programs (PDMPs).
In 2017, there were 1.5 million physicians registered to use state PDMPs. That number rose to 1.97 million in 2019. And the physicians are using PDMPs. In 2018, physicians made 460 million PDMP queries, up 56% from 2017 and up 651% from 2014.
More education about opioid prescribing is being sought, with 700,000 physicians completing CME training and accessing other training related to opioid prescribing, pain management, screening for substance use disorders, and other related topics.
While the report does show positive trends, the task force is calling for more action, including more access to naloxone and better access to mental health treatment.
The report notes that more than 66,000 physicians and other health professionals have a federal waiver to prescribe buprenorphine, up more than 28,000 since 2016.
A number of policy recommendations are made in the report, including removing inappropriate administrative burdens or barriers that delay access to medications used in medication-assisted treatment (MAT); removing barriers to comprehensive pain care and rehabilitation programs, and reforming the civil and criminal justice system to help ensure access to high-quality, evidence-based care for opioid use disorder.
“We are at a crossroads in our nation’s efforts to end the opioid epidemic,” AMA Opioid Task Force Chair Patrice A. Harris, MD, stated in the report. “It is time to end delays and barriers to medication-assisted treatment – evidence based care proven to save lives; time for payers, [pharmacy benefit managers] and pharmacy chains to reevaluate and revise policies that restrict opioid therapy to patients based on arbitrary thresholds; and time to commit to helping all patients access evidence-based care for pain and substance use disorders.”
Dr. Harris continued: “Physicians must continue to demonstrate leadership, but unless these actions occur, the progress we are making will not stop patients from dying.”
Fewer opioid retail prescriptions are being filled, according to a new report issued by the American Medical Association Opioid Task Force.
Opioid prescribing declined by 33% over a 5-year period based on the total number of opioid retail prescriptions filled. Total prescriptions declined from 251.8 million in 2013 to 168.8 million in 2018, according to the report.
The numbers come as the most recent data from the Centers for Disease Control and Prevention show a leveling of deaths involving prescription opioids. The CDC data were most recently updated in January 2019 and cover the period 1999-2017.
A closer look shows that deaths involving prescription opioids, but not other synthetic narcotics, peaked in 2011 and have generally declined since then. Deaths involving other synthetic narcotics, however, have been rising, offsetting the reduction and keeping the total number of deaths involving opioids relatively stable between 2016 and 2017.
Other data released by the AMA Opioid Task Force show that physicians are increasing their use of state-level prescription drug monitoring programs (PDMPs).
In 2017, there were 1.5 million physicians registered to use state PDMPs. That number rose to 1.97 million in 2019. And the physicians are using PDMPs. In 2018, physicians made 460 million PDMP queries, up 56% from 2017 and up 651% from 2014.
More education about opioid prescribing is being sought, with 700,000 physicians completing CME training and accessing other training related to opioid prescribing, pain management, screening for substance use disorders, and other related topics.
While the report does show positive trends, the task force is calling for more action, including more access to naloxone and better access to mental health treatment.
The report notes that more than 66,000 physicians and other health professionals have a federal waiver to prescribe buprenorphine, up more than 28,000 since 2016.
A number of policy recommendations are made in the report, including removing inappropriate administrative burdens or barriers that delay access to medications used in medication-assisted treatment (MAT); removing barriers to comprehensive pain care and rehabilitation programs, and reforming the civil and criminal justice system to help ensure access to high-quality, evidence-based care for opioid use disorder.
“We are at a crossroads in our nation’s efforts to end the opioid epidemic,” AMA Opioid Task Force Chair Patrice A. Harris, MD, stated in the report. “It is time to end delays and barriers to medication-assisted treatment – evidence based care proven to save lives; time for payers, [pharmacy benefit managers] and pharmacy chains to reevaluate and revise policies that restrict opioid therapy to patients based on arbitrary thresholds; and time to commit to helping all patients access evidence-based care for pain and substance use disorders.”
Dr. Harris continued: “Physicians must continue to demonstrate leadership, but unless these actions occur, the progress we are making will not stop patients from dying.”
Fewer opioid retail prescriptions are being filled, according to a new report issued by the American Medical Association Opioid Task Force.
Opioid prescribing declined by 33% over a 5-year period based on the total number of opioid retail prescriptions filled. Total prescriptions declined from 251.8 million in 2013 to 168.8 million in 2018, according to the report.
The numbers come as the most recent data from the Centers for Disease Control and Prevention show a leveling of deaths involving prescription opioids. The CDC data were most recently updated in January 2019 and cover the period 1999-2017.
A closer look shows that deaths involving prescription opioids, but not other synthetic narcotics, peaked in 2011 and have generally declined since then. Deaths involving other synthetic narcotics, however, have been rising, offsetting the reduction and keeping the total number of deaths involving opioids relatively stable between 2016 and 2017.
Other data released by the AMA Opioid Task Force show that physicians are increasing their use of state-level prescription drug monitoring programs (PDMPs).
In 2017, there were 1.5 million physicians registered to use state PDMPs. That number rose to 1.97 million in 2019. And the physicians are using PDMPs. In 2018, physicians made 460 million PDMP queries, up 56% from 2017 and up 651% from 2014.
More education about opioid prescribing is being sought, with 700,000 physicians completing CME training and accessing other training related to opioid prescribing, pain management, screening for substance use disorders, and other related topics.
While the report does show positive trends, the task force is calling for more action, including more access to naloxone and better access to mental health treatment.
The report notes that more than 66,000 physicians and other health professionals have a federal waiver to prescribe buprenorphine, up more than 28,000 since 2016.
A number of policy recommendations are made in the report, including removing inappropriate administrative burdens or barriers that delay access to medications used in medication-assisted treatment (MAT); removing barriers to comprehensive pain care and rehabilitation programs, and reforming the civil and criminal justice system to help ensure access to high-quality, evidence-based care for opioid use disorder.
“We are at a crossroads in our nation’s efforts to end the opioid epidemic,” AMA Opioid Task Force Chair Patrice A. Harris, MD, stated in the report. “It is time to end delays and barriers to medication-assisted treatment – evidence based care proven to save lives; time for payers, [pharmacy benefit managers] and pharmacy chains to reevaluate and revise policies that restrict opioid therapy to patients based on arbitrary thresholds; and time to commit to helping all patients access evidence-based care for pain and substance use disorders.”
Dr. Harris continued: “Physicians must continue to demonstrate leadership, but unless these actions occur, the progress we are making will not stop patients from dying.”
Medicaid expansion associated with lower cardiovascular mortality
Counties in states that expanded Medicaid coverage under the Affordable Care Act have experienced a significantly smaller increase in cardiovascular mortality rates among middle-aged adults, compared with counties in states that did not expand coverage, according to findings from a new study.
In expansion-state counties, the change in cardiovascular mortality was stable between the pre-expansion (2010-2013) and postexpansion (2014-2016) periods, at 146.5-146.4 deaths per 100,000 residents per year, compared with mortality rates in nonexpansion counties during the same periods (176.3-180.9 deaths per 100,000), Sameed Ahmed M. Khatana, MD, and colleagues wrote in JAMA Cardiology.
“After accounting for demographic, clinical, and economic differences, counties in expansion states had 4.3 fewer deaths per 100,000 residents per year from cardiovascular causes after Medicaid expansion than if they had followed the same trends as counties in nonexpansion states,” Dr. Khatana, of the University of Pennsylvania, Philadelphia, and colleagues wrote..
That translated into 2,039 fewer total deaths per year in residents aged between 45 and 64 years from cardiovascular causes after Medicaid expansion, the authors noted.
In all, 29 states, plus Washington, D.C., were included in the expansion group, and 19 states were in the nonexpansion (control) group. During the study period, from 2010 to 2016, the number of expansion counties ranged between 912 and 931, and for the nonexpansion counties, between 985 and 1,029. About half of the residents in each group were women. The percentage of black residents was lower in expansion states, but the percentage of Hispanic residents did not differ. Compared with nonexpansion counties, expansion counties also had a lower prevalence of diabetes (8.5% vs. 9.7% in the nonexpansion counties), obesity (26.2% vs. 29.1%), and smoking (17.1 vs. 18.9%); a lower mean percentage of poor residents (14.4% vs 16.6%; all with P less than .001); and a higher median household income.
Expansion counties also fared better when it came to health insurance coverage. In 2010, 14.6% of their residents had no coverage, compared with 19.5% of residents in nonexpansion counties. During the study period, the decrease in the percentage of middle-aged residents without health coverage was larger in expansion than in nonexpansion counties (7.3% vs. 5.6%, respectively), as was the decrease in low-income residents without coverage (19.8% vs. 13.5%).
However, the authors cautioned that, given the observational nature of the study, they were “not able to make a causal association between expansion of Medicaid eligibility and differences in the cardiovascular mortality rates between the two groups of counties. It is possible that there were other unmeasured time varying factors that can explain the observed association.”
Despite that limitation of the study, which observed adults in all income categories and was not limited to low-income residents, the researchers noted that, given the association between Medicaid expansion and cardiovascular mortality rates, as well as the “high burden of cardiovascular risk factors among individuals without insurance and those with lower socioeconomic status,” policy makers might consider the results in future discussions about changes to eligibility for and expansion of Medicaid.
Dr. Khatana is supported by a grant from the National Institutes of Health. Two authors reported relationships with drug companies outside of the reported study; the rest of the authors had no disclosures to report.
SOURCE: Khatana SAM et al. JAMA Cardiol. 2019 Jun 5. doi: 10.1001/jamacardio.2019.1651.
Counties in states that expanded Medicaid coverage under the Affordable Care Act have experienced a significantly smaller increase in cardiovascular mortality rates among middle-aged adults, compared with counties in states that did not expand coverage, according to findings from a new study.
In expansion-state counties, the change in cardiovascular mortality was stable between the pre-expansion (2010-2013) and postexpansion (2014-2016) periods, at 146.5-146.4 deaths per 100,000 residents per year, compared with mortality rates in nonexpansion counties during the same periods (176.3-180.9 deaths per 100,000), Sameed Ahmed M. Khatana, MD, and colleagues wrote in JAMA Cardiology.
“After accounting for demographic, clinical, and economic differences, counties in expansion states had 4.3 fewer deaths per 100,000 residents per year from cardiovascular causes after Medicaid expansion than if they had followed the same trends as counties in nonexpansion states,” Dr. Khatana, of the University of Pennsylvania, Philadelphia, and colleagues wrote..
That translated into 2,039 fewer total deaths per year in residents aged between 45 and 64 years from cardiovascular causes after Medicaid expansion, the authors noted.
In all, 29 states, plus Washington, D.C., were included in the expansion group, and 19 states were in the nonexpansion (control) group. During the study period, from 2010 to 2016, the number of expansion counties ranged between 912 and 931, and for the nonexpansion counties, between 985 and 1,029. About half of the residents in each group were women. The percentage of black residents was lower in expansion states, but the percentage of Hispanic residents did not differ. Compared with nonexpansion counties, expansion counties also had a lower prevalence of diabetes (8.5% vs. 9.7% in the nonexpansion counties), obesity (26.2% vs. 29.1%), and smoking (17.1 vs. 18.9%); a lower mean percentage of poor residents (14.4% vs 16.6%; all with P less than .001); and a higher median household income.
Expansion counties also fared better when it came to health insurance coverage. In 2010, 14.6% of their residents had no coverage, compared with 19.5% of residents in nonexpansion counties. During the study period, the decrease in the percentage of middle-aged residents without health coverage was larger in expansion than in nonexpansion counties (7.3% vs. 5.6%, respectively), as was the decrease in low-income residents without coverage (19.8% vs. 13.5%).
However, the authors cautioned that, given the observational nature of the study, they were “not able to make a causal association between expansion of Medicaid eligibility and differences in the cardiovascular mortality rates between the two groups of counties. It is possible that there were other unmeasured time varying factors that can explain the observed association.”
Despite that limitation of the study, which observed adults in all income categories and was not limited to low-income residents, the researchers noted that, given the association between Medicaid expansion and cardiovascular mortality rates, as well as the “high burden of cardiovascular risk factors among individuals without insurance and those with lower socioeconomic status,” policy makers might consider the results in future discussions about changes to eligibility for and expansion of Medicaid.
Dr. Khatana is supported by a grant from the National Institutes of Health. Two authors reported relationships with drug companies outside of the reported study; the rest of the authors had no disclosures to report.
SOURCE: Khatana SAM et al. JAMA Cardiol. 2019 Jun 5. doi: 10.1001/jamacardio.2019.1651.
Counties in states that expanded Medicaid coverage under the Affordable Care Act have experienced a significantly smaller increase in cardiovascular mortality rates among middle-aged adults, compared with counties in states that did not expand coverage, according to findings from a new study.
In expansion-state counties, the change in cardiovascular mortality was stable between the pre-expansion (2010-2013) and postexpansion (2014-2016) periods, at 146.5-146.4 deaths per 100,000 residents per year, compared with mortality rates in nonexpansion counties during the same periods (176.3-180.9 deaths per 100,000), Sameed Ahmed M. Khatana, MD, and colleagues wrote in JAMA Cardiology.
“After accounting for demographic, clinical, and economic differences, counties in expansion states had 4.3 fewer deaths per 100,000 residents per year from cardiovascular causes after Medicaid expansion than if they had followed the same trends as counties in nonexpansion states,” Dr. Khatana, of the University of Pennsylvania, Philadelphia, and colleagues wrote..
That translated into 2,039 fewer total deaths per year in residents aged between 45 and 64 years from cardiovascular causes after Medicaid expansion, the authors noted.
In all, 29 states, plus Washington, D.C., were included in the expansion group, and 19 states were in the nonexpansion (control) group. During the study period, from 2010 to 2016, the number of expansion counties ranged between 912 and 931, and for the nonexpansion counties, between 985 and 1,029. About half of the residents in each group were women. The percentage of black residents was lower in expansion states, but the percentage of Hispanic residents did not differ. Compared with nonexpansion counties, expansion counties also had a lower prevalence of diabetes (8.5% vs. 9.7% in the nonexpansion counties), obesity (26.2% vs. 29.1%), and smoking (17.1 vs. 18.9%); a lower mean percentage of poor residents (14.4% vs 16.6%; all with P less than .001); and a higher median household income.
Expansion counties also fared better when it came to health insurance coverage. In 2010, 14.6% of their residents had no coverage, compared with 19.5% of residents in nonexpansion counties. During the study period, the decrease in the percentage of middle-aged residents without health coverage was larger in expansion than in nonexpansion counties (7.3% vs. 5.6%, respectively), as was the decrease in low-income residents without coverage (19.8% vs. 13.5%).
However, the authors cautioned that, given the observational nature of the study, they were “not able to make a causal association between expansion of Medicaid eligibility and differences in the cardiovascular mortality rates between the two groups of counties. It is possible that there were other unmeasured time varying factors that can explain the observed association.”
Despite that limitation of the study, which observed adults in all income categories and was not limited to low-income residents, the researchers noted that, given the association between Medicaid expansion and cardiovascular mortality rates, as well as the “high burden of cardiovascular risk factors among individuals without insurance and those with lower socioeconomic status,” policy makers might consider the results in future discussions about changes to eligibility for and expansion of Medicaid.
Dr. Khatana is supported by a grant from the National Institutes of Health. Two authors reported relationships with drug companies outside of the reported study; the rest of the authors had no disclosures to report.
SOURCE: Khatana SAM et al. JAMA Cardiol. 2019 Jun 5. doi: 10.1001/jamacardio.2019.1651.
FROM JAMA CARDIOLOGY
Key clinical point:
Major finding: Counties in expansion states had 4.3 fewer deaths from cardiovascular causes per 100,000 residents per year after Medicaid expansion, compared with counties in nonexpansion states.
Study details: In this longitudinal, observational study from 2010 to 2016, researchers used a difference-in-difference approach with county-level data for adults from 48 states (excluding Massachusetts and Wisconsin) and Washington, D.C., who were aged between 45 and 64 years. The county-level data were obtained from the Centers for Disease Control and Prevention’s Online Data for Epidemiologic Research mortality database.
Disclosures: Dr. Khatana is supported by a grant from the National Institutes of Health. Two authors reported relationships with drug companies outside of the reported study; the rest of the authors had no disclosures to report.
Source: Khatana SAM et al. JAMA Cardiol. 2019 Jun 5. doi: 10.1001/jamacardio.2019.1651.
House committee debates single-payer health care design
House Budget Committee Chairman John Yarmuth (D-Ky.) opened a May 22 hearing on the prospect of moving to some kind of single-payer health care system with a bold prediction.
“I strongly believe it’s not a matter of if we will have universal coverage, but when,” Rep. Yarmuth said, adding that the “trick is closing the information gap on what single-payer health care truly is, so that we can close the health coverage gap for millions of American families.”
The hearing was held to review a Congressional Budget Office report ordered by Chairman Yarmuth, which examines the key design elements to be considered in establishing a single-payer system.
Mark Hadley, deputy director of the Congressional Budget Office, highlighted two key points with regard to establishing a single-payer system.
“First, moving to a single-payer system would be a major undertaking,” he said. “It would involve significant changes for all participants – individuals, providers, insurers, employers, and manufacturers of drugs and medical devices. Because health care spending currently accounts for about one-sixth of the nation’s economic activity, those changes could significantly affect the overall U.S. economy. And the transition toward a single-payer system could be complicated, challenging, and potentially disruptive.”
Mr. Hadley continued: “Second, to establish a single-payer system, lawmakers would need to make many decisions and would face complex trade-offs.”
And because of the multitude of trade-offs related to the design of a single-payer system, questions related to coverage, cost, and access to health care services were generally met with vague answers.
For example, would a single-payer system create access issues because of the potential increased burden on providers by providing health care coverage to all?
“Whether the supply of providers would be adequate to meet the greater demand would depend on various components of the system,” Mr. Hadley said. “If the supply of services was not sufficient to meet the demand for care, patients might face increased wait times and reduced access to care. The government, however, could implement policies to encourage the provision of services, and in the longer run, providers might deliver care more efficiently.”
Republican lawmakers on the panel focused on a detail lacking in the report: a cost estimate for implementing a single-payer system.
“What’s noticeably missing from the report is a cost estimate for specific proposals,” said Rep. Steve Womack (R-Ark.), the committee’s ranking member. “My friends across the aisle didn’t ask for one. I think I know why. While the score would be useful, we already know how much a one-size-fits-all health care system would cost the American people. Independent analyses from economists across the ideological spectrum, including George Mason University, the Urban Institute, [and] the American Action Forum have projected single-payer type proposals, such as Medicare-for-all, to cost at least $32 trillion.”
Rep. Womack also said that the report “has been especially helpful in showing that these ideas will never work in America.”
He noted that the report warns that a single-payer system could end up “reducing payment rates for providers. That is payments for doctors, hospitals, and so on. The report explains there will not only be a reduction in the quality of care, there would be a reduction in the supply of care, hampering access to the treatments and services people need.”
The report does caution that using cost-containment measures, such as global budgets and utilization management, “could adversely affect access to and quality of care by causing providers to supply less care to patients covered by the public plan. Less spending on medical services could also alter manufacturers’ incentive to develop new technologies or providers’ incentive to invest in capital, which could affect patients’ choices over the long term.”
Additionally, the report notes that the structure of a single-payer system could result in lower reimbursement for health care services. “Proposals like Medicare-for-all will chase a lot of doctors out of health care,” Rep. Womack said.
House Budget Committee Chairman John Yarmuth (D-Ky.) opened a May 22 hearing on the prospect of moving to some kind of single-payer health care system with a bold prediction.
“I strongly believe it’s not a matter of if we will have universal coverage, but when,” Rep. Yarmuth said, adding that the “trick is closing the information gap on what single-payer health care truly is, so that we can close the health coverage gap for millions of American families.”
The hearing was held to review a Congressional Budget Office report ordered by Chairman Yarmuth, which examines the key design elements to be considered in establishing a single-payer system.
Mark Hadley, deputy director of the Congressional Budget Office, highlighted two key points with regard to establishing a single-payer system.
“First, moving to a single-payer system would be a major undertaking,” he said. “It would involve significant changes for all participants – individuals, providers, insurers, employers, and manufacturers of drugs and medical devices. Because health care spending currently accounts for about one-sixth of the nation’s economic activity, those changes could significantly affect the overall U.S. economy. And the transition toward a single-payer system could be complicated, challenging, and potentially disruptive.”
Mr. Hadley continued: “Second, to establish a single-payer system, lawmakers would need to make many decisions and would face complex trade-offs.”
And because of the multitude of trade-offs related to the design of a single-payer system, questions related to coverage, cost, and access to health care services were generally met with vague answers.
For example, would a single-payer system create access issues because of the potential increased burden on providers by providing health care coverage to all?
“Whether the supply of providers would be adequate to meet the greater demand would depend on various components of the system,” Mr. Hadley said. “If the supply of services was not sufficient to meet the demand for care, patients might face increased wait times and reduced access to care. The government, however, could implement policies to encourage the provision of services, and in the longer run, providers might deliver care more efficiently.”
Republican lawmakers on the panel focused on a detail lacking in the report: a cost estimate for implementing a single-payer system.
“What’s noticeably missing from the report is a cost estimate for specific proposals,” said Rep. Steve Womack (R-Ark.), the committee’s ranking member. “My friends across the aisle didn’t ask for one. I think I know why. While the score would be useful, we already know how much a one-size-fits-all health care system would cost the American people. Independent analyses from economists across the ideological spectrum, including George Mason University, the Urban Institute, [and] the American Action Forum have projected single-payer type proposals, such as Medicare-for-all, to cost at least $32 trillion.”
Rep. Womack also said that the report “has been especially helpful in showing that these ideas will never work in America.”
He noted that the report warns that a single-payer system could end up “reducing payment rates for providers. That is payments for doctors, hospitals, and so on. The report explains there will not only be a reduction in the quality of care, there would be a reduction in the supply of care, hampering access to the treatments and services people need.”
The report does caution that using cost-containment measures, such as global budgets and utilization management, “could adversely affect access to and quality of care by causing providers to supply less care to patients covered by the public plan. Less spending on medical services could also alter manufacturers’ incentive to develop new technologies or providers’ incentive to invest in capital, which could affect patients’ choices over the long term.”
Additionally, the report notes that the structure of a single-payer system could result in lower reimbursement for health care services. “Proposals like Medicare-for-all will chase a lot of doctors out of health care,” Rep. Womack said.
House Budget Committee Chairman John Yarmuth (D-Ky.) opened a May 22 hearing on the prospect of moving to some kind of single-payer health care system with a bold prediction.
“I strongly believe it’s not a matter of if we will have universal coverage, but when,” Rep. Yarmuth said, adding that the “trick is closing the information gap on what single-payer health care truly is, so that we can close the health coverage gap for millions of American families.”
The hearing was held to review a Congressional Budget Office report ordered by Chairman Yarmuth, which examines the key design elements to be considered in establishing a single-payer system.
Mark Hadley, deputy director of the Congressional Budget Office, highlighted two key points with regard to establishing a single-payer system.
“First, moving to a single-payer system would be a major undertaking,” he said. “It would involve significant changes for all participants – individuals, providers, insurers, employers, and manufacturers of drugs and medical devices. Because health care spending currently accounts for about one-sixth of the nation’s economic activity, those changes could significantly affect the overall U.S. economy. And the transition toward a single-payer system could be complicated, challenging, and potentially disruptive.”
Mr. Hadley continued: “Second, to establish a single-payer system, lawmakers would need to make many decisions and would face complex trade-offs.”
And because of the multitude of trade-offs related to the design of a single-payer system, questions related to coverage, cost, and access to health care services were generally met with vague answers.
For example, would a single-payer system create access issues because of the potential increased burden on providers by providing health care coverage to all?
“Whether the supply of providers would be adequate to meet the greater demand would depend on various components of the system,” Mr. Hadley said. “If the supply of services was not sufficient to meet the demand for care, patients might face increased wait times and reduced access to care. The government, however, could implement policies to encourage the provision of services, and in the longer run, providers might deliver care more efficiently.”
Republican lawmakers on the panel focused on a detail lacking in the report: a cost estimate for implementing a single-payer system.
“What’s noticeably missing from the report is a cost estimate for specific proposals,” said Rep. Steve Womack (R-Ark.), the committee’s ranking member. “My friends across the aisle didn’t ask for one. I think I know why. While the score would be useful, we already know how much a one-size-fits-all health care system would cost the American people. Independent analyses from economists across the ideological spectrum, including George Mason University, the Urban Institute, [and] the American Action Forum have projected single-payer type proposals, such as Medicare-for-all, to cost at least $32 trillion.”
Rep. Womack also said that the report “has been especially helpful in showing that these ideas will never work in America.”
He noted that the report warns that a single-payer system could end up “reducing payment rates for providers. That is payments for doctors, hospitals, and so on. The report explains there will not only be a reduction in the quality of care, there would be a reduction in the supply of care, hampering access to the treatments and services people need.”
The report does caution that using cost-containment measures, such as global budgets and utilization management, “could adversely affect access to and quality of care by causing providers to supply less care to patients covered by the public plan. Less spending on medical services could also alter manufacturers’ incentive to develop new technologies or providers’ incentive to invest in capital, which could affect patients’ choices over the long term.”
Additionally, the report notes that the structure of a single-payer system could result in lower reimbursement for health care services. “Proposals like Medicare-for-all will chase a lot of doctors out of health care,” Rep. Womack said.
REPORTING FROM A HOUSE BUDGET COMMITTEE HEARING
N.J. law, EMR alerts appear effective at reducing opioid prescriptions
WASHINGTON –
Researchers looked at prescribing patterns of doctors in the Penn Medicine health system, which straddles both the Philadelphia area and southern New Jersey, following the implementation of prescribing limits in New Jersey.
The law in question is a 5-day limit on new opioid prescriptions, which was passed in February 2017 and implemented in May 2017. Penn Medicine implemented an EMR alert in their New Jersey locations to alert physicians within the Penn Medicine system of the change in their state law 2 months after the law went into effect. Researchers looked at prescribing patterns before passage, during the transition between passage and the implementation of the EMR alert and following implementation of the EMR alert, as well as secondary outcomes such as rate of refills, telephone calls, and utilization.
“The implementation of the prescribing limit and EMR alert was associated with a decrease in the volume of opioids prescribed in acute prescriptions without changes in the rates of refills, telephone calls or utilization,” Margaret Lowenstein, MD, of the University of Pennsylvania, Philadelphia, said at the annual meeting of the Society of General Internal Medicine.
“This combination of the policy and the EMR alert may be an effective strategy to influence prescriber behavior,” she added.
Researchers compared outcomes before and after the implementation of the law in New Jersey, using prescribing patterns in Pennsylvania as the control. The cohort of patients was those with a new opioid prescription within Penn Medicine ambulatory nonteaching practices. It excluded specialties not represented in both states as well as patients with cancer, those in hospice and palliative care and those in treatment for opioid use disorder, since the law does not apply to those groups.
In New Jersey, there were 434 patients receiving new prescriptions in the 12 months prior to the implementation of the law, with 234 patients receiving new prescriptions in the 9 months after the EMR alert was implemented in New Jersey. In Pennsylvania, the cohort included 2,961 patients prior to the law going into effect and 1,677 after the EMR intervention went live in New Jersey.
For New Jersey, the morphine milligram equivalent (MME) per prescription was steady at about 350 during the period prior to the law’s implementation, but dropped to nearly 250 by the end of the postintervention period examined. In Pennsylvania, the prelaw implementation period had an MME per prescription a little higher than 200, which leveled off at around 200 during the postintervention period.
“In New Jersey, there is a significantly higher MME than in Pennsylvania and this difference persists in the transition period but what you see in the post period is a significantly greater decline in the MME per prescription in New Jersey as compared to the rate of change in Pa.,” Dr. Lowenstein said. “That difference was statistically significant.”
She said similar results were seen regarding the quantity of tablets prescribed. In New Jersey before the law’s passage, the number of tablets per prescription was close to 50, dropping down to about 35 post period. Pennsylvania saw a slight decrease from about 35 pills per prescription to about 33 during the same period.
No significant changes occurred in the other outcomes measured following implementation of the EMR alert.
Dr. Lowenstein noted that, because the transition period between the law going into effect and the implementation of the EMR alert was so short, whether the greater decreases in opioid prescriptions in New Jersey relative to Pennsylvania was because of the law alone, the EMR alert alone, or both changes is unclear.
Based on the limited amount of change in prescribing patterns during the transition period, it appears that the EMR intervention may be driving the change, “but we weren’t powered to make that determination,” she added.
Dr. Lowenstein and her colleagues reported no disclosures.
WASHINGTON –
Researchers looked at prescribing patterns of doctors in the Penn Medicine health system, which straddles both the Philadelphia area and southern New Jersey, following the implementation of prescribing limits in New Jersey.
The law in question is a 5-day limit on new opioid prescriptions, which was passed in February 2017 and implemented in May 2017. Penn Medicine implemented an EMR alert in their New Jersey locations to alert physicians within the Penn Medicine system of the change in their state law 2 months after the law went into effect. Researchers looked at prescribing patterns before passage, during the transition between passage and the implementation of the EMR alert and following implementation of the EMR alert, as well as secondary outcomes such as rate of refills, telephone calls, and utilization.
“The implementation of the prescribing limit and EMR alert was associated with a decrease in the volume of opioids prescribed in acute prescriptions without changes in the rates of refills, telephone calls or utilization,” Margaret Lowenstein, MD, of the University of Pennsylvania, Philadelphia, said at the annual meeting of the Society of General Internal Medicine.
“This combination of the policy and the EMR alert may be an effective strategy to influence prescriber behavior,” she added.
Researchers compared outcomes before and after the implementation of the law in New Jersey, using prescribing patterns in Pennsylvania as the control. The cohort of patients was those with a new opioid prescription within Penn Medicine ambulatory nonteaching practices. It excluded specialties not represented in both states as well as patients with cancer, those in hospice and palliative care and those in treatment for opioid use disorder, since the law does not apply to those groups.
In New Jersey, there were 434 patients receiving new prescriptions in the 12 months prior to the implementation of the law, with 234 patients receiving new prescriptions in the 9 months after the EMR alert was implemented in New Jersey. In Pennsylvania, the cohort included 2,961 patients prior to the law going into effect and 1,677 after the EMR intervention went live in New Jersey.
For New Jersey, the morphine milligram equivalent (MME) per prescription was steady at about 350 during the period prior to the law’s implementation, but dropped to nearly 250 by the end of the postintervention period examined. In Pennsylvania, the prelaw implementation period had an MME per prescription a little higher than 200, which leveled off at around 200 during the postintervention period.
“In New Jersey, there is a significantly higher MME than in Pennsylvania and this difference persists in the transition period but what you see in the post period is a significantly greater decline in the MME per prescription in New Jersey as compared to the rate of change in Pa.,” Dr. Lowenstein said. “That difference was statistically significant.”
She said similar results were seen regarding the quantity of tablets prescribed. In New Jersey before the law’s passage, the number of tablets per prescription was close to 50, dropping down to about 35 post period. Pennsylvania saw a slight decrease from about 35 pills per prescription to about 33 during the same period.
No significant changes occurred in the other outcomes measured following implementation of the EMR alert.
Dr. Lowenstein noted that, because the transition period between the law going into effect and the implementation of the EMR alert was so short, whether the greater decreases in opioid prescriptions in New Jersey relative to Pennsylvania was because of the law alone, the EMR alert alone, or both changes is unclear.
Based on the limited amount of change in prescribing patterns during the transition period, it appears that the EMR intervention may be driving the change, “but we weren’t powered to make that determination,” she added.
Dr. Lowenstein and her colleagues reported no disclosures.
WASHINGTON –
Researchers looked at prescribing patterns of doctors in the Penn Medicine health system, which straddles both the Philadelphia area and southern New Jersey, following the implementation of prescribing limits in New Jersey.
The law in question is a 5-day limit on new opioid prescriptions, which was passed in February 2017 and implemented in May 2017. Penn Medicine implemented an EMR alert in their New Jersey locations to alert physicians within the Penn Medicine system of the change in their state law 2 months after the law went into effect. Researchers looked at prescribing patterns before passage, during the transition between passage and the implementation of the EMR alert and following implementation of the EMR alert, as well as secondary outcomes such as rate of refills, telephone calls, and utilization.
“The implementation of the prescribing limit and EMR alert was associated with a decrease in the volume of opioids prescribed in acute prescriptions without changes in the rates of refills, telephone calls or utilization,” Margaret Lowenstein, MD, of the University of Pennsylvania, Philadelphia, said at the annual meeting of the Society of General Internal Medicine.
“This combination of the policy and the EMR alert may be an effective strategy to influence prescriber behavior,” she added.
Researchers compared outcomes before and after the implementation of the law in New Jersey, using prescribing patterns in Pennsylvania as the control. The cohort of patients was those with a new opioid prescription within Penn Medicine ambulatory nonteaching practices. It excluded specialties not represented in both states as well as patients with cancer, those in hospice and palliative care and those in treatment for opioid use disorder, since the law does not apply to those groups.
In New Jersey, there were 434 patients receiving new prescriptions in the 12 months prior to the implementation of the law, with 234 patients receiving new prescriptions in the 9 months after the EMR alert was implemented in New Jersey. In Pennsylvania, the cohort included 2,961 patients prior to the law going into effect and 1,677 after the EMR intervention went live in New Jersey.
For New Jersey, the morphine milligram equivalent (MME) per prescription was steady at about 350 during the period prior to the law’s implementation, but dropped to nearly 250 by the end of the postintervention period examined. In Pennsylvania, the prelaw implementation period had an MME per prescription a little higher than 200, which leveled off at around 200 during the postintervention period.
“In New Jersey, there is a significantly higher MME than in Pennsylvania and this difference persists in the transition period but what you see in the post period is a significantly greater decline in the MME per prescription in New Jersey as compared to the rate of change in Pa.,” Dr. Lowenstein said. “That difference was statistically significant.”
She said similar results were seen regarding the quantity of tablets prescribed. In New Jersey before the law’s passage, the number of tablets per prescription was close to 50, dropping down to about 35 post period. Pennsylvania saw a slight decrease from about 35 pills per prescription to about 33 during the same period.
No significant changes occurred in the other outcomes measured following implementation of the EMR alert.
Dr. Lowenstein noted that, because the transition period between the law going into effect and the implementation of the EMR alert was so short, whether the greater decreases in opioid prescriptions in New Jersey relative to Pennsylvania was because of the law alone, the EMR alert alone, or both changes is unclear.
Based on the limited amount of change in prescribing patterns during the transition period, it appears that the EMR intervention may be driving the change, “but we weren’t powered to make that determination,” she added.
Dr. Lowenstein and her colleagues reported no disclosures.
REPORTING FROM SGIM 2019
CMS targets ‘spread pricing’ to help lower drug costs
The Centers for Medicare & Medicaid Services is clarifying how Medicaid and Children’s Health Insurance Program (CHIP) managed care plans calculate the medical loss ratio in a effort to reign in drug costs.
The medical loss ratio is set at 85%, meaning that managed care plans can spend only 15% of revenue on administrative costs and profits, with 85% being used for beneficiary care, including paying for claims, expenditures for activities that improve health care quality, and fraud prevention activities.
But CMS officials said they are concerned that managed care plans are not properly accounting for “spread pricing” in their medical loss ratio calculations. Spread pricing occurs when pharmacy benefit managers (PBMs) keep a portion of money paid by the managed care plan instead of passing the payment to the pharmacy for filling the prescription on behalf of the beneficiary.
“If spread pricing is not appropriately monitored and accounted for, a PBM can profit from charging health plans an excess amount above the amount paid to the pharmacy dispensing a drug, which increases Medicaid costs for taxpayers,” the agency said in a statement issued May 15 in conjunction with new guidance on calculating the medical loss ratio to account for spread pricing.
Regulations require Medicaid and CHIP managed care plans to exclude drug rebates from actual claims costs used to calculate the medical loss ratio. The new guidance clarifies the definition of a drug rebate to include “any price concession or discount received by the managed care plan or its PBM, regardless of who pays the rebate or discount,” the agency said. “Therefore, the amount retained by the PBM under spread pricing would have to be excluded from the amount of claims costs used for calculating the managed care plan’s [medical loss ratio].”
CMS added that the reason for this is that spread pricing “should not be used to artificially inflate a Medicaid or CHIP managed care plan’s [medical loss ratio].”
The Centers for Medicare & Medicaid Services is clarifying how Medicaid and Children’s Health Insurance Program (CHIP) managed care plans calculate the medical loss ratio in a effort to reign in drug costs.
The medical loss ratio is set at 85%, meaning that managed care plans can spend only 15% of revenue on administrative costs and profits, with 85% being used for beneficiary care, including paying for claims, expenditures for activities that improve health care quality, and fraud prevention activities.
But CMS officials said they are concerned that managed care plans are not properly accounting for “spread pricing” in their medical loss ratio calculations. Spread pricing occurs when pharmacy benefit managers (PBMs) keep a portion of money paid by the managed care plan instead of passing the payment to the pharmacy for filling the prescription on behalf of the beneficiary.
“If spread pricing is not appropriately monitored and accounted for, a PBM can profit from charging health plans an excess amount above the amount paid to the pharmacy dispensing a drug, which increases Medicaid costs for taxpayers,” the agency said in a statement issued May 15 in conjunction with new guidance on calculating the medical loss ratio to account for spread pricing.
Regulations require Medicaid and CHIP managed care plans to exclude drug rebates from actual claims costs used to calculate the medical loss ratio. The new guidance clarifies the definition of a drug rebate to include “any price concession or discount received by the managed care plan or its PBM, regardless of who pays the rebate or discount,” the agency said. “Therefore, the amount retained by the PBM under spread pricing would have to be excluded from the amount of claims costs used for calculating the managed care plan’s [medical loss ratio].”
CMS added that the reason for this is that spread pricing “should not be used to artificially inflate a Medicaid or CHIP managed care plan’s [medical loss ratio].”
The Centers for Medicare & Medicaid Services is clarifying how Medicaid and Children’s Health Insurance Program (CHIP) managed care plans calculate the medical loss ratio in a effort to reign in drug costs.
The medical loss ratio is set at 85%, meaning that managed care plans can spend only 15% of revenue on administrative costs and profits, with 85% being used for beneficiary care, including paying for claims, expenditures for activities that improve health care quality, and fraud prevention activities.
But CMS officials said they are concerned that managed care plans are not properly accounting for “spread pricing” in their medical loss ratio calculations. Spread pricing occurs when pharmacy benefit managers (PBMs) keep a portion of money paid by the managed care plan instead of passing the payment to the pharmacy for filling the prescription on behalf of the beneficiary.
“If spread pricing is not appropriately monitored and accounted for, a PBM can profit from charging health plans an excess amount above the amount paid to the pharmacy dispensing a drug, which increases Medicaid costs for taxpayers,” the agency said in a statement issued May 15 in conjunction with new guidance on calculating the medical loss ratio to account for spread pricing.
Regulations require Medicaid and CHIP managed care plans to exclude drug rebates from actual claims costs used to calculate the medical loss ratio. The new guidance clarifies the definition of a drug rebate to include “any price concession or discount received by the managed care plan or its PBM, regardless of who pays the rebate or discount,” the agency said. “Therefore, the amount retained by the PBM under spread pricing would have to be excluded from the amount of claims costs used for calculating the managed care plan’s [medical loss ratio].”
CMS added that the reason for this is that spread pricing “should not be used to artificially inflate a Medicaid or CHIP managed care plan’s [medical loss ratio].”