Google’s Coming to the Rescue on HealthCare.gov

From Gizmodo:

The “tech surge” that President Obama promised to fix the very broken HealthCare.gov portal just got a lot more tech-savvy. According to Bloombergcompanies like Google, Oracle and Red Hat are now swooping in to lead the recovery effort. But is it enough?

Study: Medicare’s additional $3B to rural hospitals unnecessary

From Fierce Healthcare:

The $3 billion a year in special payments Medicare pays to rural healthcare providers might not be necessary, concludes a Health Affairs study.

The findings come after researchers debunked the assumption that rural beneficiaries receive less care than urban beneficiaries. Rather, researchers found that the region the Medicare beneficiary lives in–not whether he or she lives in an urban or rural area–has more of an effect on the use of services, according to a Health Affairs blog post.

Senators seek to fix ER reimbursement loophole for new vets

From the Navy Times:

A loophole in veterans’ healthcare that is leaving some Iraq and Afghanistan veterans facing big medical bills for emergency room treatment is under study by a Senate committee and the Veterans Affairs Department.

Fixing the problem has raised larger issues about the long waiting times for initial medical examinations required before a veteran is fully eligible for VA health care benefits.

VA has a requirement, set in law, that prohibits reimbursement of emergency room care at non-VA facilities for anyone who has not had a medical appointment in the previous 24 months at a VA hospital or clinic.

Congressional Efforts to Repeal and Replace Medicare Reimbursement Formula Continue

From the Emergency Department Practice Management Association (EDPMA):

In an environment of partisan bickering and gridlock, there is one important issue that has bipartisan support – replacing the Medicare reimbursement formula that poses deep cuts to Medicare physician reimbursement rates. Reimbursement rates are scheduled to be cut by 24-25% on January 1, 2014 unless Congress either repeals and replaces the current reimbursement formula (which is based on the SGR) or, at minimum, delays the scheduled cut for another year. Both parties oppose the cut, but the cost of repealing or delaying the cut is very expensive. 

In earlier Advocacy newsletters, EDPMA summarized legislation that was unanimously supported by members of both parties in the House Energy and Commerce Committee (HR 2810). Yesterday, the two other key committees with jurisdiction over this issue – the Senate Finance Committee and House Ways and Means Committee – have released a joint framework for repealing the SGR formula. The framework is available here

Under this new proposal, physicians could opt to stay in the FFS system, but their reimbursement rates would be frozen for ten years. Alternatively they can get reimbursed under an approved alternative payment model (which may include payment models applicable to ACOs and medical homes). 

Those who remain in traditional Medicare would be eligible for value-based incentives under a quality program. However the three existing quality programs would become one budget-neutral program. Under a budget neutral program, physicians with lower quality scores can expect to see lower reimbursement rates while those with higher scores will see their reimbursement rates increase. If this proposal were adopted, the performance period for that program would likely begin in 2015, with incentive payments starting in 2017. 

This new proposal is not as generous to physicians as the Energy and Commerce proposal. It freezes payments for ten years instead of providing yearly updates. Leadership in the Finance and Ways and Means committees hopes this change will keep the cost down and thereby improve its chances of passage.   

This proposal is expected to help create momentum behind efforts to repeal and replace the formula this year. But, many in Congress are focused on other issues – such as negotiations surrounding the budget and debt ceiling. Moreover, there are few legislative vehicles moving at the end of the calendar year. So, legislation to either repeal the formula or delay the cut might not be addressed until early next year when Congress is forced to address the budget and debt ceiling. In addition, these proposals still face the all important question – what proposals can both parties agree on that can offset the significant cost of repealing or delaying the scheduled cut.   

EDPMA is holding its Leadership Lobby Day on November 6, 2013 on this important issue. EDPMA members will urge Congress to repeal the SGR formula which continues to mandate deep cuts and ensure that any offsets for the repeal or delay do not negatively impact access to quality ED care.

2013 Hospital and Physician Professional Liability Benchmark Analysis

From AON (via Becker’s)

The Hospital and Physician Professional Liability Benchmark Analysis, now in its 14th edition, is published by Aon Risk Solutions in conjunction with the American Society for Healthcare Risk Management. This annual study details the growth of integrated self-insurance strategies and highlights the challenges faced by systems as they pursue cost of risk savings.

According to findings in the 2013 Hospital and Physician Professional Liability Benchmark Analysis, the cost of medical malpractice is growing at the slowest rate in the fourteen year history of the Aon/ASHRM Hospital and Physician Professional Liability Benchmark report.

Emergency rooms see too many elderly nursing home residents, researchers say

From McKnight’s:

A disproportionately high number of nursing home residents are being admitted to hospital emergency departments, and many of these admissions are potentially avoidable, according to recently published research.

Researchers from the University of California-San Francisco looked at 2001-2010 data from the National Hospital Ambulatory Medical Care Survey. The rate of emergency room admissions for elderly nursing home residents increased nearly 13% during that time frame, they found. The total number of ED admissions for this population reached 2.1 million in 2010.

The researchers had hypothesized that the rate of ED admissions would have declined, due to the government’s increasing focus on the quality of long-term care. Transfers to emergency rooms can erode care quality by causing trauma for residents, the authors noted. 

Active compression-decompression CPR has “no advantage and some drawbacks compared to standard cardiopulmonary resuscitation”

From The Cochrane Library:

During standard cardiopulmonary resuscitation (heart massage) for cardiac arrest (arrest of the heart), the chest is compressed manually and repeatedly by hand. This is a temporary method that pumps blood and oxygen to the brain via the heart. During standard cardiopulmonary resuscitation, the chest is not manually decompressed. Active chest compression-decompression is an alternative method of heart massage and uses a hand-held suction device to compress the chest, then decompress the chest after each compression. Comparison of these techniques showed active chest compression-decompression to have no advantage and some drawbacks compared to standard cardiopulmonary resuscitation.

Rural And Urban Medicare Beneficiaries Use Remarkably Similar Amounts Of Health Care Services

From Health Affairs:

Medicare payment policies for rural health care providers are influenced by the assumption that the limited supply of physicians in rural areas causes rural Medicare beneficiaries to receive fewer health care services than their urban counterparts do. This assumption has contributed to the growth in special payments to rural providers. As a result, Medicare pays rural providers $3 billion more each year in special payments than they would receive under traditional payment rates. To test the validity of the assumption that rural beneficiaries systematically receive less care, we analyzed claims data for all Medicare fee-for-service beneficiaries in 2008, stratified by rural/urban status and region. After adjusting for health status, we found no significant differences between rural and urban beneficiaries in either the amount of health care received or satisfaction with access to care. Although there were systematic differences in the amount of care used across regions of the country, there was very little difference within a region between rural and urban areas. To the extent that Medicare payment policies are designed to ensure access, they should be assessed on the basis of achieving similar service use rather than similar local physician supply. They should also be targeted to isolated rural providers needed to preserve access to care.

Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the United States

From the Annals of Emergency Medicine:

(Here’s the podcast)

Study objective

We determine the minimum mortality reduction that helicopter emergency medical services (EMS) should provide relative to ground EMS for the scene transport of trauma victims to offset higher costs, inherent transport risks, and inevitable overtriage of patients with minor injury.

Methods

We developed a decision-analytic model to compare the costs and outcomes of helicopter versus ground EMS transport to a trauma center from a societal perspective during a patient’s lifetime. We determined the mortality reduction needed to make helicopter transport cost less than $100,000 and $50,000 per quality-adjusted life-year gained compared with ground EMS. Model inputs were derived from the National Study on the Costs and Outcomes of Trauma, National Trauma Data Bank, Medicare reimbursements, and literature. We assessed robustness with probabilistic sensitivity analyses.

Results

Helicopter EMS must provide a minimum of a 15% relative risk reduction in mortality (1.3 lives saved/100 patients with the mean characteristics of the National Study on the Costs and Outcomes of Trauma cohort) to cost less than $100,000 per quality-adjusted life-year gained and a reduction of at least 30% (3.3 lives saved/100 patients) to cost less than $50,000 per quality-adjusted life-year. Helicopter EMS becomes more cost-effective with significant reductions in patients with minor injury who are triaged to air transport or if long-term disability outcomes are improved.

Conclusion

Helicopter EMS needs to provide at least a 15% mortality reduction or a measurable improvement in long-term disability to compare favorably with other interventions considered cost-effective. Given current evidence, it is not clear that helicopter EMS achieves this mortality or disability reduction. Reducing overtriage of patients with minor injury to helicopter EMS would improve its cost-effectiveness.

Nonmedical Prescription Opioid and Sedative Use Among Adolescents in the Emergency Department

From Pediatrics:

Unintentional overdose and emergency department visits secondary to nonmedical use of prescription drugs are on the rise with peak age of onset in midadolescence for these risk behaviors. Also, risk behaviors, such as substance use and violence, tend to cluster.

Approximately 1 in 10 adolescents or young adults using the emergency department endorse nonmedical prescription opioid or sedative use in the past year. Rates of current opioid or sedative prescriptions are low among this group.