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#WWBR Week of March 23, 2015

by John Moore lll | March 27, 2015

The CMS and ONC NPRMs
Micky Tripathy and John Halamka for Life as a Healthcare CIO
“One of the more balanced views of the proposed MU3 regs from those that know the inside of regulation sausage making; and the outside, what providers actually deal with day to day.” – John

Anthem Arrogantly Refuses Audit Processes. Twice.
Fred Trotter in The Healthcare Blog
“Fred Trotter rightly rips the folks at Anthem for their arrogant corporate policy of noncompliance with federal OIG Audit after two major security breaches in as many years. The fact that Anthem not only doesn’t encrypt patient data, but also refuses an audit for evaluating their security policies is incredibly fishy and inconsiderate of their membership.” – John 3

Solving The Sustainable Growth Rate Formula Conundrum Continues Steps Toward Cost Savings And Care Improvements
James D. Reschovsky, Larisa Converse, and Eugene C. Rich in Health Affairs
“The annual crescendo in the tragicomedy known as the SGR fix arrives at the end of this month. This comprehensive, if dense, discussion (10 minutes to read) of the current state of the fix is first-rate. It also summarizes the distortions and inaccuracies introduced by the relative value scales pointing out how these could be cured through better use of alternative payment models. In the summary it links relative values to the ability of the SGR fix to accomplish its goals. The current SGR fix would be a substantive positive move by Congress. We can only hope that it takes it.” – Brian

Data Silos: Healthcare’s Silent Shame
David Shaywitz in Forbes
“While much discussion swirls around the data silos of EHRs and how they hinder care coordination activities, this article looks at data silos from another vantage point: hindering patients’ ability to find others with a similar rare disease. This also goes for providers who can struggle with diagnosing rare diseases. This time, however, rather than pointing the finger at software vendors, the author takes aim at the competitive practices of healthcare organizations.” – John

Necessary Steps: How Health Care Fails Older Patients, And How It Can Be Done Better
Louise Aronson in Health Affairs
“This longish article (4 minutes to read) in Health Affairs is well worth the time. It describes how FFS and disjointed care contributes to poor health for elders. Amazingly, it also demonstrates the durability of FFS thinking when it points out that the $41 per month paid for care coordination for Medicare beneficiaries fails to compensate clinicians for all of the beneficial care coordination activities they could be providing. It stops just short of suggesting that each care coordination activity be compensated.” – Brian

Will Today’s Payer Have the Role they Want Tomorrow?
Frank Ingari for Navinet blog
“Frank raises a great point here – while partnering with industry is clearly a part of the long-term vision for the feds, leaving payers out of the interoperability roadmap is clearly shortsighted. We agree that there is a value-add that payer data can play in the short term, even if it comes with its own can of administrative and technical worms. The broader question to ponder here – what will the role of the payer even look like in 10 years?” – Naveen

Rethinking the Hospital Readmissions Reduction Program (PDF)
American Hospital Association Trendwatch
“AHA issued a new TrendWatch report which heavily criticizes several design and payment aspects of the current Readmissions program including the lack of SES risk adjustment, hospitals being held accountable for readmissions which can not be prevented, and the “multiplier effect” that makes the penalties greater than the revenue for readmission. AHA isn’t just defending its constituents here either. A lack of insufficient risk adjustment for socioeconomic factors has been well documented in medical literature the past year along with being highlighted by MedPAC. Several commentaries have also questioned what should be included in the denominator portion of the readmissions measure too. As CMS continues to shift towards fairly aggressively towards VBP, better and more careful thought needs to be placed on program design especially regarding risk adjustment and exactly what a provider can or cannot sufficiently control & influence.” – Matt

Most consumers are in the dark about health care costs
Mark Huffman for Consumer Affairs
“Consumer Affairs’ article covers a new poll that shows most Americans do not know what their provider charges. Embarrassingly, the difference was almost nil between insured and uninsured patients, meaning that for the consumer today, health insurance and healthcare delivery remain separated by a veritable chasm. While there is much ballyhoo about price transparency tools, these are not actually available or comprehensive enough to help all interested shoppers. Where prices were available up front, consumers tended to shop around and make decisions based on out-of-pocket costs. It’s becoming clear that healthcare providers are the weakest link in this broken value chain.” – Naveen

Medical expansion has led people worldwide to feel less healthy
Jeff Grabmeier for Ohio State University Newsroom
“Really interesting counterfactual analysis which was done by a researcher at Ohio State that is set to be published in Social Science Research. Basically what the researcher found between 1981 and 2007 in 28 OECD using several large data sets was that people reported feeling less healthy despite often having greater access to medical coverage. In the US, the percentage of Americans reporting very good health decreased from 39 percent to 28 percent from 1982 to 2006. It is not overly clear why this has occurred although the researcher posited several possible theories including unrealistic expectations of health by patients given health coverage expansions, the greater risk of disease due to the amount of new ‘diseases’ that are discovered as a result of more coverage, and more aggressive screening for diseases. While not having access to health insurance coverage is a serious issue, it does raise several issues with how American medicine is practiced including the aggressive over-utilization of preventative medicine in the form of disease screenings.” – Matt

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