Summary: “Quality measures are good, right? We all want our doctors and hospitals to follow best practices and be held to them,” writes Joanne Kenen, health editor at Politico, on the Association of Health Care Journalists blog. “It’s not so simple. Put aside for the moment whether the measure is accurate – we don’t always know or agree on what the best thing is in health care (Exhibit A: mammograms). There’s another quality problem. There too many quality measures. Oodles and oodles of quality measures. I first came to appreciate this a few months ago when I was doing some preparatory conference calls before moderating a panel with hospital and health system executives. They came from a variety of organizations – big, small, urban and rural. But all had some kind of accountable care organization or ACO-like value-over-volume arrangement. All were serious about trying to navigate a changing health care landscape. All took part in Medicare and Medicare Advantage and Medicaid (most had Medicaid managed plans). And, of course, they dealt with multiple private insurers. … Each of these payers had their own quality measures – some overlapping and some mutually exclusive. I’m not talking about 10 or 20 or 30 measures. They were dealing with 100, 110, 140 or more. They could not possibly meet those standards – or even measure and report their performance in so many sliced and diced ways. I remember wondering – but not getting a clear answer at the time – about how much money and work hours are being spent quantifying quality when the goal was, in part, to use quality to guide us toward a more efficient health care system.” Joanne Kenen, health editor at Politico, Look at how health quality measures have become a jungle,” Association of Health Care Journalists.
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Summary: Our MedPageToday post has brought us a lot of interesting visitors. Providers, payers, government officials, individuals, academic institutions — they’re all here. Also: Epic, AthenaHealth and others. Here’s a sampling from today. A lot of our visitors are apparently on their own devices, perhaps mobile, and therefore the analytics program (it’s called Clicky) can’t tell us where they are, only who their carrier is, while for others on a company or hospital system, we learn where they’re from.
Summary: “I live in metro NY and received a bill for $2200 (approx) for a mammo/Ultrasound, of which approximately $767 was covered by insurance. I was balance billed $1,712,” the email said. “I am a 42 y.o. female physician with a family history of ovarian cancer, and I am covered by Blue Cross/Blue Shield. I was frankly horrified by the costs.” Of course we were interested: our research shows that a mammogram price can range from free (preventive, under the Affordable Care Act) up to $2,786.95. So … how much does a mammogram cost? Click for more details, or …
Summary: “New projections from the Kaiser Family Foundation estimate that one in four employers (26%) offering health benefits could be subject to the Affordable Care Act’s tax on high-cost health plans, also known as the ‘Cadillac plan’ tax, in 2018 unless they make changes to their plans,” the Kaiser Family Foundation reported. “The analysis also estimates that the share of employers potentially affected by the tax could grow significantly over time — to 30 percent in 2023 and 42 percent in 2028 — if their plans remain unchanged and health benefit costs increase at expected rates. It’s likely that many employers will revise their plans to avoid the tax, at least initially, through modifications that could include reducing options for employees or shifting costs to workers in the form of higher deductibles and other patient cost sharing. The ACA’s high-cost plan tax, which takes effect in 2018, was meant to raise revenue to fund coverage expansions under the health care law and to help contain health spending. It taxes plans at 40 percent of each employee’s health benefits that exceed certain cost thresholds: In the first year, the thresholds are $10,200 for self-only coverage and $27,500 for other than self-only coverage. The thresholds increase annually with inflation.” “Analysis Estimates 1 in 4 Employers Offering Health Benefits Could Be Affected by the ‘Cadillac Tax’ in 2018 if Current Trends Continue,” The Henry J. Kaiser Family Foundation.
Summary: Through June of this year, the cholesterol-lowering drug rosuvastatin (Crestor, AstraZeneca) was the most prescribed branded drug in the United States, and the arthritis drug adalimumab (Humira, Abbott Laboratories) was the best-selling branded drug, according to the latest data from research firm IMS Health,” Megan Brooks reported in Medscape Medical News. Also in the top sellers: Enbrel for arthritis, Abilify, the antipsychotic; Lantus Solostar, insulin; Sovaldi, for hepatitis C; and Advair Diskus for asthma.
Summary: “Errors in medical bills are common. Seven steps noted below can help you reduce the odds of paying more than you should,” Elizabeth Bewley writes in The Daily Courier in Prescott, Ariz. “First, don’t pay cash in the doctor’s office. If you must pay a deductible, co-pay, or other charge in person, pay by check or credit card. That way, you’ll have more records (cancelled check image, credit card bill) to show that you paid. Second, if your doctor’s office asks you to pay on the spot for a balance due when you haven’t gotten a statement yet, explain that you prefer to have the paperwork before you pay, to keep your records straight. Third, when you get a bill, if you have health insurance, check the related Explanation of Benefits (EOB) your health insurer provides. (Medicare calls its EOBs ‘Medicare Summary Notices.’) If you have both primary and secondary insurance, such as Medicare and supplemental insurance, check both. Make sure that this paperwork shows that you owe the money. … ” For more, click on the link. Elizabeth Bewley, “How can you protect yourself against mistakes in doctors’ bills?” The Prescott Daily Courier, Prescott, Ariz.
Summary: “As options for cancer patients become increasingly complicated, and expensive, the most influential source for U.S. oncology treatment guidelines will for the first time offer a tool to assess the costs versus benefits of available therapies,” Deena Beasley of Reuters writes. “The National Comprehensive Cancer Network (NCCN) says its new tool will provide a clearer picture of the relative value of medication options, particularly in cases where a very expensive therapy does little to improve survival. Doctors developing the measures expect them to shift demand away from less effective treatments, influencing the prices drugmakers are able to charge. They say they are responding to the needs of patients who are having to pay much more for their own care, with higher health insurance premiums, co-payments and deductibles, and want to know the value of their treatments. The NCCN, an alliance of 26 cancer centers, envisions the new tool as a supplement to its widely followed guidelines for oncology care, which set out protocols for treating a range of cancers based on diagnosis, disease stage and other factors, such as age.” Deena Beasley, “New tool will compare costs and benefits of cancer treatments,” Reuters via Yahoo News.
Summary: We’re always interested when quality rankings make news. There’s been a burst of activity on this front lately, and — as if on cue — here’s a “Weekly Briefing” podcast on the topic from The Advisory Board. “This week, Dan Diamond, Rivka Friedman, and Rob Lazerow debate whether ‘Best Hospital’ rankings and physician scorecards are helpful or harmful, and argue over whether it’s too soon to pay attention to presidential candidates’ health care platforms. And as always, they close the show by sharing their Electives. You can listen to the show here or by clicking on the player below.” Source: The Weekly Briefing, Episode 3: Rank Amateurs and Rookie Mistakes
A guide to crowdsourcing: Our new project at Columbia University’s Tow Center for Digital Journalism
Summary: I have won a fellowship to create a guide to crowdsourcing at the Tow Center for Digital Journalism at Columbia University in New York, along with two other researchers, Jan Schaffer, head of the J-Lab at American University, and Mimi Onuoha, a researcher, artist and academic who is currently a Fulbright-National Geographic Digital Storytelling Fellow. Here’s a link to the announcement.
Summary: “Most British people have never had to think about paying for medical procedures. But what would happen if they did? I decided to find out by asking my British colleagues at BuzzFeed UK to guess what different health procedures would cost them if they were in the US,” Hannah Jewell of Buzzfeed UK wrote today. “I then revealed the answer to each question based on data from the website Clear Health Costs. This is how it went down.” This entire story is so funny it made me laugh until I cried. Highly recommend.