Is your health plan “grandfathered” or does it fall under ObamaCare? Do you have “good” genes or mutants?
Health Policy Briefs
Compiled by Benita M. Dodd
The fault lies in our genes: Normal, healthy people are walking around with a surprisingly large number of mutations in their genes, according to researchers. It’s been well known that everyone has flaws in their DNA, though, for the most part, the defects are harmless. It’s been less clear, however, just how many mistakes are lurking in someone’s genes. Researchers analyzed the DNA of 179 people from the United States, Japan, China and Nigeria who had volunteered to have their entire genetic blueprints deciphered through the 1,000 Genomes project. Now, in a paper appearing in the American Journal of Human Genetics, the researchers are reporting a big surprise. Their analysis found the average person has around 400 defects in his or her genes, including at least a couple that are associated with disease. And about one in 10 has a genetic mutation that should cause a disease but hasn’t. Source: NPR
We’re from the government and we’re here to help? The American Hospital Association maintains that hospitals today spend too much time and devote too many resources to comply with federal regulations that are “outdated, duplicative, unfair or even counterproductive.” Writing in The Wall Street Journal, AHA President and CEO Rich Umbdenstock noted that four separate federal programs “conduct redundant reviews” of hospital payments to identify and false claims or improper billing patterns. The AHA acknowledges that regulation is essential to protecting patients and building public trust and confidence in the health care system, but asserts that “unnecessary, poorly targeted or poorly implemented regulation may be of little benefit to the public, often frustrates health care providers and the patients they serve, and can interfere with appropriate care delivery.” Read the association’s recommendations here: www.aha.org/smartregs. Of course, we’re sure that the situation will improve as ObamaCare is fully implemented … said no one ever.
Cost shifting instead of cost-cutting: Reducing Medicare and Medicaid reimbursement rates has generated savings for the federal government by shifting costs to patients and employers, but that’s not reducing overall spending, notes Kenneth C. Frazier, the chairman, president and CEO of Merck. More such cuts to drug makers will reduce investment in cutting-edge research for conditions such as Alzheimer’s, he warns in a column in Forbes.
Where grandfathered plans go to die: If you get your health insurance from your employer, there’s a good chance you are in a “grandfathered plan,” and that means some of the ObamaCare changes do not affect you – yet – Kaiser Health News reports. Framers of the Patent Protection and Affordable Care Act allowed some health plans to be exempt from some of the law’s rules and protections in the interests of a smooth transition and to allow businesses and individuals to keep current policies without having to make substantial changes. Almost half of all Americans who get insurance through their jobs are enrolled in such plans, although that number is expected to decline every year.
Health impact of the fiscal cliff: Health-related federal agencies face billions of dollars in budget cuts if Congress fails to agree on a new budget that avoids automatic 8.2 percent cuts. The results include thousands of jobs lost, slower drug reviews and lower reimbursements to drugmakers and doctors, leading to retractions in venture capital and an overall slowing of biomedical innovation, experts say. “Making cuts to these programs could actually cost our nation more in the long run,” said BIO President and CEO Jim Greenwood. “The unintended consequences could impact our economic health, as well as our public health.” The agencies include the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control and Prevention and the National Science Foundation.
Targeting waste: The rising cost of health care can be slowed by reducing waste in the system, according to a health policy brief in the journal Health Affairs. A study in the Journal of the American Medical Association estimated that waste accounts for 18-37 percent of total health spending in 2011, according to the brief. The brief outlines six categories of waste: failures of care delivery; failures of care coordination; overtreatment; administrative complexity; pricing failures, and fraud and abuse. When it comes to overtreatment, the Georgia Public Policy Foundation has highlighted the practice of “defensive medicine,” which adds to costs and costs lives physicians try to avoid the threat of lawsuits.
Targeting readmissions: Beginning in fiscal year 2013, under the Hospital Readmissions Reduction Program, the feds will reduce Medicare reimbursements to hospitals with high levels of preventable 30-day readmissions for three high-volume conditions: acute myocardial infarction, heart failure and pneumonia. Another program, the Hospital Value-Based Purchasing Program, includes measures for readmissions and also will penalize hospitals for high rates of preventable readmissions. It’s not just the cost, according to Becker’s Hospital Review: Preventable readmissions rates are increasingly being used as a quality indicator subject to scrutiny by commercial payors and consumers alike, which can affect hospitals’ bottom line. Becker’s offers tips on reducing readmissions, and they are a clear sign that health care costs and pressure on the system will rise: Research suggests Medicaid patients and uninsured patients are at increased risk of preventable hospital readmissions compared to privately insured patients. Specifically, “research showed maternal readmission rates were approximately 50 percent higher for uninsured and Medicaid patients than for privately insured patients.”
Telemedicine taking off: Kudos to the Georgia Department of Public Health (DPH), which plans to transform its statewide telemedicine program into one of the most comprehensive in the nation. It’s driven by DPH Commissioner Dr. Brenda Fitzgerald’s vision to expand the network to all of the state’s health districts and county health departments. In January, DPH will begin distributing 13 telemedicine carts to health districts around the state, each equipped with a stethoscope, endoscope and a basic exam camera. The department also will put the finishing touches on the videoconferencing infrastructure it has been consolidating, updating and expanding over the past year. Why is expanded technology important in health care outreach? Because 57 Georgia counties currently have no practicing physician. The state ranks 40th in the nation when it comes to adequate distribution of doctors by specialty and geographic location. And an October 2012 report by the American Association of Medical Colleges noted, “Without changes in the state’s medical education system, Georgia will rank last in the United States in physicians per capita by 2020.”
Reprogramming immune systems: A girl with acute lymphoblastic leukemia experienced remission after being treated with an experimental therapy that involved a disabled form of HIV to reprogram her immune system genetically to fight cancer cells. The girl is considered the first child to undergo the treatment, and some experts said could someday serve in place of bone marrow transplants. Novartis has expressed interest in the treatment and has pledged $20 million for the establishment of a research center at the University of Pennsylvania. Source: New York Times
Quotes of Note
“[R]ather than shifting costs through short-term cuts, we instead need to make difficult structural changes in our health care programs. These changes should expand competition, encourage provider integration, and create incentives for better, more efficient care. These efforts should include consideration of how the appropriate use of innovative medicines can impact outcomes and help to moderate overall health care spending by preventing more costly illnesses and invasive treatments down the road.” – Kenneth C. Frazier, Merck CEO
“Although the world is full of suffering, it is also full of the overcoming of it.” – Helen Keller
“It is the tension between creativity and skepticism that has produced the stunning and unexpected findings of science.” – Carl Sagan
Benita Dodd, Vice President, Georgia Public Policy Foundation
Health Policy Briefs
Compiled by Benita M. Dodd
The fault lies in our genes: Normal, healthy people are walking around with a surprisingly large number of mutations in their genes, according to researchers. It’s been well known that everyone has flaws in their DNA, though, for the most part, the defects are harmless. It’s been less clear, however, just how many mistakes are lurking in someone’s genes. Researchers analyzed the DNA of 179 people from the United States, Japan, China and Nigeria who had volunteered to have their entire genetic blueprints deciphered through the 1,000 Genomes project. Now, in a paper appearing in the American Journal of Human Genetics, the researchers are reporting a big surprise. Their analysis found the average person has around 400 defects in his or her genes, including at least a couple that are associated with disease. And about one in 10 has a genetic mutation that should cause a disease but hasn’t. Source: NPR
We’re from the government and we’re here to help? The American Hospital Association maintains that hospitals today spend too much time and devote too many resources to comply with federal regulations that are “outdated, duplicative, unfair or even counterproductive.” Writing in The Wall Street Journal, AHA President and CEO Rich Umbdenstock noted that four separate federal programs “conduct redundant reviews” of hospital payments to identify and false claims or improper billing patterns. The AHA acknowledges that regulation is essential to protecting patients and building public trust and confidence in the health care system, but asserts that “unnecessary, poorly targeted or poorly implemented regulation may be of little benefit to the public, often frustrates health care providers and the patients they serve, and can interfere with appropriate care delivery.” Read the association’s recommendations here: www.aha.org/smartregs. Of course, we’re sure that the situation will improve as ObamaCare is fully implemented … said no one ever.
Cost shifting instead of cost-cutting: Reducing Medicare and Medicaid reimbursement rates has generated savings for the federal government by shifting costs to patients and employers, but that’s not reducing overall spending, notes Kenneth C. Frazier, the chairman, president and CEO of Merck. More such cuts to drug makers will reduce investment in cutting-edge research for conditions such as Alzheimer’s, he warns in a column in Forbes.
Where grandfathered plans go to die: If you get your health insurance from your employer, there’s a good chance you are in a “grandfathered plan,” and that means some of the ObamaCare changes do not affect you – yet – Kaiser Health News reports. Framers of the Patent Protection and Affordable Care Act allowed some health plans to be exempt from some of the law’s rules and protections in the interests of a smooth transition and to allow businesses and individuals to keep current policies without having to make substantial changes. Almost half of all Americans who get insurance through their jobs are enrolled in such plans, although that number is expected to decline every year.
Health impact of the fiscal cliff: Health-related federal agencies face billions of dollars in budget cuts if Congress fails to agree on a new budget that avoids automatic 8.2 percent cuts. The results include thousands of jobs lost, slower drug reviews and lower reimbursements to drugmakers and doctors, leading to retractions in venture capital and an overall slowing of biomedical innovation, experts say. “Making cuts to these programs could actually cost our nation more in the long run,” said BIO President and CEO Jim Greenwood. “The unintended consequences could impact our economic health, as well as our public health.” The agencies include the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control and Prevention and the National Science Foundation.
Targeting waste: The rising cost of health care can be slowed by reducing waste in the system, according to a health policy brief in the journal Health Affairs. A study in the Journal of the American Medical Association estimated that waste accounts for 18-37 percent of total health spending in 2011, according to the brief. The brief outlines six categories of waste: failures of care delivery; failures of care coordination; overtreatment; administrative complexity; pricing failures, and fraud and abuse. When it comes to overtreatment, the Georgia Public Policy Foundation has highlighted the practice of “defensive medicine,” which adds to costs and costs lives physicians try to avoid the threat of lawsuits.
Targeting readmissions: Beginning in fiscal year 2013, under the Hospital Readmissions Reduction Program, the feds will reduce Medicare reimbursements to hospitals with high levels of preventable 30-day readmissions for three high-volume conditions: acute myocardial infarction, heart failure and pneumonia. Another program, the Hospital Value-Based Purchasing Program, includes measures for readmissions and also will penalize hospitals for high rates of preventable readmissions. It’s not just the cost, according to Becker’s Hospital Review: Preventable readmissions rates are increasingly being used as a quality indicator subject to scrutiny by commercial payors and consumers alike, which can affect hospitals’ bottom line. Becker’s offers tips on reducing readmissions, and they are a clear sign that health care costs and pressure on the system will rise: Research suggests Medicaid patients and uninsured patients are at increased risk of preventable hospital readmissions compared to privately insured patients. Specifically, “research showed maternal readmission rates were approximately 50 percent higher for uninsured and Medicaid patients than for privately insured patients.”
Georgia Telemedicine Map
Telemedicine taking off: Kudos to the Georgia Department of Public Health (DPH), which plans to transform its statewide telemedicine program into one of the most comprehensive in the nation. It’s driven by DPH Commissioner Dr. Brenda Fitzgerald’s vision to expand the network to all of the state’s health districts and county health departments. In January, DPH will begin distributing 13 telemedicine carts to health districts around the state, each equipped with a stethoscope, endoscope and a basic exam camera. The department also will put the finishing touches on the videoconferencing infrastructure it has been consolidating, updating and expanding over the past year. Why is expanded technology important in health care outreach? Because 57 Georgia counties currently have no practicing physician. The state ranks 40th in the nation when it comes to adequate distribution of doctors by specialty and geographic location. And an October 2012 report by the American Association of Medical Colleges noted, “Without changes in the state’s medical education system, Georgia will rank last in the United States in physicians per capita by 2020.”
Reprogramming immune systems: A girl with acute lymphoblastic leukemia experienced remission after being treated with an experimental therapy that involved a disabled form of HIV to reprogram her immune system genetically to fight cancer cells. The girl is considered the first child to undergo the treatment, and some experts said could someday serve in place of bone marrow transplants. Novartis has expressed interest in the treatment and has pledged $20 million for the establishment of a research center at the University of Pennsylvania. Source: New York Times
Quotes of Note
“[R]ather than shifting costs through short-term cuts, we instead need to make difficult structural changes in our health care programs. These changes should expand competition, encourage provider integration, and create incentives for better, more efficient care. These efforts should include consideration of how the appropriate use of innovative medicines can impact outcomes and help to moderate overall health care spending by preventing more costly illnesses and invasive treatments down the road.” – Kenneth C. Frazier, Merck CEO
“Although the world is full of suffering, it is also full of the overcoming of it.” – Helen Keller
“It is the tension between creativity and skepticism that has produced the stunning and unexpected findings of science.” – Carl Sagan