The Daily Briefing

News for Health Care Executives

A second look at primary care access

January 26, 2012

One in six cancers linked to preventable infections

80% of infection-linked cancers occur in developing countries

May 10, 2012

Preventable or treatable infections cause about 2 million cancers per year—or one in six cancers worldwide—and 80% of those cancers occur in the developing world, according to a study in The Lancet Oncology.

For the study, researchers at the International Agency for Research on Cancer in France examined data on 27 cancers across 184 countries in 2008. They estimated the incidence of cancers caused by viral, bacterial, and parasitic infections, such as the human papilloma virus (HPV) and hepatitis.

They found that:

  • 1.5 million of the 7.5 million global cancer deaths in 2008 were caused by potentially preventable or treatable infections;
  • The number of cancer deaths caused by infections increased by 500,000 deaths from 1990 to 2008;
  • 23% of cancer cases in developing countries in 2008 were related to infections, compared to just 7% in developed countries; and
  • About 4% of 2008 cancers in North America were caused by infections.

According to the study, 1.9 million of the 2 million infection-related cancer cases involved:

  • HPV (which can cause cervical, anal, and penile cancers);
  • Helicobacter pylori (which can cause stomach cancers);
  • Hepatitis B (which can cause liver cancer); and
  • Hepatitis C (which can cause liver cancer.

In an accompanying editorial, Harvard School of Public Health's Goodarz Danaei suggested that the cancer incidence rate would fall if more patients received vaccinations for HPV and hepatitis B, which are available at relatively low cost. The findings "show the potential for preventive and therapeutic programs in less developed countries to significantly reduce the global burden of cancer and the vast disparities across regions and countries," Danaei added (Preidt, HealthDay, 5/9; Maugh, "Booster Shots," Los Angeles Times, 5/9;  Moisse, "Medical Unit," ABC News, 5/9).


Competing plans: Mass. Senate proposes less-aggressive payment reforms

State Senators would impose less oversight of hospital cost-cutting efforts

May 10, 2012

Massachusetts Senate leaders on Wednesday unveiled legislation to control health care costs, outlining a plan that grants hospitals and physicians more leeway on cost-cutting efforts than the plan outlined in a House bill released last week.

Lawmakers hope to address issues left out of 2006 reform

The new legislation comes after more than five years of debate over how best to control health care costs. Notably, architects of the Bay State's 2006 health care overhaul—which expanded health coverage in Massachusetts and subsequently served as a model for the Affordable Care Act—have consistently warned that the state would need further reforms to rein in health cost growth.

Massachusetts Democrats have now introduced a pair of competing bills intended to control health costs. A House bill released on Friday would:

  • Set a cap on health care spending tied to the state's economic growth;
  • Create a quasi-governmental agency called the Division of Health Care Cost and Quality to monitor the shift from a fee-for-service payment structure to global payments for health care providers; and
  • Authorize a 10% tax on hospitals that charge more than 20% above the state median price for a specific service if they cannot justify the higher price.

Senate legislation gives hospitals, providers more leeway

Meanwhile, the Senate legislation would take a "less-aggressive approach" to controlling health care costs, the Boston Globe reports. Namely, the Senate proposal would:

  • Impose less oversight over hospitals' and physicians' efforts to control costs. (For example, the Senate bill does not impose a penalty on high-cost hospitals that do not justify their costs); and
  • Not require that health care industry in the state grow at a slower rate than the overall state economy. (The House proposal would limit health care spending to 0.5% less than the growth of the gross state product.)

The House and Senate proposals do resemble each other in many ways. For example, both the House and Senate plans include provisions to expand the use of electronic health records, primary care services, and consumer information on the costs and quality of various treatments (Kowalczyk, Boston Globe, 5/9; Zimmerman/Goldberg, WBUR, 5/9).


Moody's: How high-performing hospitals are doing more with less

Report outlines five most prominent features of high-performing hospital strategies

May 10, 2012

Moody's Investors Service suggests that high-performing hospitals—coping with a "transition period" where not-for-profit hospitals must do more with less—are focused on strategies that address five key issues.

A need to strategize in the 'transition period'

Moody's notes that hospitals will continue to face slow revenue growth due to:

  • Federal health reform initiatives that reduce Medicare revenue for hospitals;
  • Decreased patient volumes;
  • Increased efforts to recuperate Medicare overpayments; and
  • Tightened federal budgets.

These pressures mean that hospitals must learn to deliver high-quality care amid lower reimbursement rates, the agency concludes.  Moody's further warns that organizations "that cannot navigate the payment reductions or reduce their expense structures quickly enough to mitigate the impact may see negative rating pressures."

Focus areas for strategies

Hospitals' transition strategies will require flawless execution and robust financial planning, Moody's concludes.

The agency also says "the most meaningful cost-reduction strategies will involve standardization of clinical care and elimination of variation in patient procedures."

The report notes that management teams at many high-performing hospitals are focusing their transition strategies on:

  • New payment models: Moody's says top hospitals are "targeting the next phase of expense reduction strategies, which are more difficult to implement because they involve process redesign or service line reconfiguration." For example, the report says that some hospitals are transitioning some services to outpatient settings and shutting down unprofitable service lines.
  • Physician alignment: The best-performing hospitals are "executing employment contracts with clear productivity standards and, in most cases, no longer paying for good-will," according to the report.
  • Growth strategies: Top-performing hospitals are "evaluating potential changes in their corporate and governance structure to enable different and faster growth strategies." For example, the report says hospitals are considering consolidation and expansion plans that focus on ambulatory care.
  • Balance sheet growth: Hospitals are working to "build balance sheet reserves" during the transition period through revenue cycle management, conservative capital spending, and other strategies, according to the report. They also are addressing the affordability of their pension plans.
  • Governance and leadership: Moody's says hospitals are looking to improve the skills of their leadership teams. Many hospitals are adding board members with investment, consolidation, and compliance backgrounds and management team members with manufacturing, engineering, and technology experience (Moody's report, 5/9 [subscription required]; Evans, Modern Healthcare, 5/9 [subscription required]; Lambert, Reuters, 5/9).


Passing the bucks? Hospitals, device companies spar over tax

Rare public fight between health care sectors

May 10, 2012

Hospital associations are pushing the IRS to strictly impose a new tax on medical devicemakers, in a rare public fight between different sectors of the health care industry.

The fight centers on whether device companies can shift new costs related to the federal health reform law, CQ HealthBeat reports.

Hospitals contend that a wide variety of health care stakeholders were "asked to contribute" to the Affordable Care Act by accepting lower Medicare payments or new taxes that help fund the ACA's reforms. One of those taxes is a new 2.3% excise tax on medical device companies—which is slated to take effect in January—but hospital lobbyists warn that the device firms may simply raise prices to offset the tax's cost.

In a 10-page letter sent to the IRS on Monday, five hospital associations—including the Federation of American Hospitals and the American Hospital Association—argued that medical device companies must not "sidestep their ACA financial contribution by passing the tax through to their customers, including hospitals." The associations want federal officials to "specifically prohibit devicemakers from passing on the tax by raising prices," CQ HealthBeat reports.

According to a spokesperson for Advanced Medical Technology Association (AdvaMed), the association is "puzzled" by the hospitals' letter. "Like the share of Medicare cuts [that] hospitals shift to privately insured or uninsured patients, the incidence of excise taxes has always been determined by market forces," AdvaMed's David Nexon told CQ HealthBeat (Adams, CQ HealthBeat, 5/8)


Giving earplugs to ICU patients reduced delirium, confusion by more than 50%

Greatest improvement within first 48 hours of ICU arrival

May 10, 2012

Patients who used earplugs while sleeping in the ICU improved their sleep reduced their confusion and risk of delirium, according to a new study published in Critical Care.

For the study, researchers from the University of Antwerp in Belgium found that patients who were given earplugs within the first 24 hours of admission had a 50% less chance of becoming confused or developing delirium and those patients reported having a better night's sleep. The researchers noted that patients that did develop confusion or delirium experienced it later than patients who did not use earplugs.

"The greatest improvement was observed in the risk of confusion, and seems to be strongest within the first 48 hours of admittance to the ICU," according to study leader Bart van Rompaey. "The beneficial effect of earplugs in the ICU—especially in the first few days—clearly demonstrates the advantage of using them."

Rompaey noted that the onset of delirium was also influenced by age, smoking. and the severity of the disease. However, he concluded that "earplugs are a cheap and easy-to-use means of improving a patient's sleep and preventing confusion" (Preidt, Health Day, 5/7).  


FDA calls for new imaging devices for kids

Draft guidance is part of a broader agency effort to reduce radiation exposure

May 10, 2012

FDA on Wednesday proposed guidelines that would urge manufacturers to design new imaging devices for pediatric patients intended to reduce unnecessary radiation exposure for children.

The draft guidance—which is part of the organization's Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging—would cover all X-ray imaging, which includes CT scans, fluoroscopy, and conventional X-ray scans.

The proposed rules also would require manufacturers to label imaging devices that have not been proven safe and effective for children. However, the guidelines would not apply to existing scanners.

FDA in its initiative to reduce unnecessary radiation exposure also has:

  • Launched a website with information on the benefits and risks of imaging procedures for children; and
  • Collaborated with the Alliance for Radiation Safety in Pediatric Imaging and the Medical Imaging and Technology Alliance to create educational materials for pediatric imaging radiation safety.

FDA is soliciting public comments on the draft guidance over the next four months (FDA release, 5/9; AP/Sacramento Bee, 5/9).


What Obama's endorsement of same-sex marriage means for health care

Roundup of reaction to president's announcement

May 10, 2012

In a historic first for a sitting president, President Obama on Wednesday endorsed same-sex marriage. "I think same-sex couples should be able to get married," the president told ABC News.

Given that some health care providers have faced charges of discrimination, and CMS recently instituted policies to protect same-sex rights, does the president's announcement have implications for health care?

  • The president's endorsement has symbolic importance but little practical effect, analysts note. By clarifying that marriage is a civil issue—not a matter of federal law—there will be no new national impact on how health care providers must treat patients in same-sex relationships.
  • However, the adminstration's talking points focus on how Obama's health care policies have already helped protect the rights of gay patients. For example, "insurers can no longer turn someone away just because he or she is lesbian, gay, bisexual, or transgender" thanks to the Affordable Care Act, according to a White House memo that was leaked on Wednesday.
  • The Obama administration in 2010 also instructed CMS to update its Conditions of Participation in Medicare and Medicaid to better protect LGBT patient rights, and offered further guidance in September 2011. Under the new terms, nearly every U.S. hospital must allow all patients to choose who can visit them during their stay, a rule that extended new rights to patients who are in same-sex relationships.
  • Meanwhile, a handful of studies suggest that same-sex marriage may be beneficial for public health, the Los Angeles Times' "Booster Shots" reports. A study in the American Journal of Public Health found that gay men in Massachusetts were in better physical and mental health—requiring about 13% fewer visits for medical care and mental health care—after the state recognized same-sex marriage in 2003. Similarly, an ongoing study at the University of California-Los Angeles found that gay men in legal marriages were in better mental health than gay men in domestic partnerships. According to a UCLA social psychologist, "marriage appears to confer a number of benefits, psychological and otherwise." (CNN, 5/9; Kaplan, "Booster Shots," Los Angeles Times, 5/9; Smith, BuzzFeed, 5/9).


PCPs may get 34% Medicaid pay bump

CMS proposal would increase Medicaid reimbursements by $11B over two years

May 10, 2012

HHS on Wednesday released a proposed rule that would implement a two-year increase to Medicaid reimbursements for primary care physicians (PCPs).

The proposal, which was included in the federal health reform law, would increase Medicaid funding to states by more than $11 billion in 2013 and 2014, and bring PCP Medicaid reimbursement rates in line with Medicare rates. CMS estimates that PCP Medicaid reimbursement rates will increase by 34%.  

Per the rule, the federal government would cover the entire cost of the increase.

The provision in the health reform law is one of many intended to address the looming PCP shortage, which will have a significant impact on Medicaid beneficiaries.

Overall, the PCP shortage is projected to reach 45,400 by 2020, according to the Association of American Medical Colleges (AAMC). The health reform law is expected to put further strain on the primary care workforce, as more than 30 million U.S. residents are expected to gain health coverage through the law beginning in 2014.

Acting CMS administrator Marilyn Tavenner said the funds "will be an important tool for states to ensure their primary care networks are prepared for increased enrollment as the health care law is implemented" (Aizenman, Washington Post, 5/9; Viebeck, "Healthwatch," The Hill, 5/9; Norman, CQ HealthBeat, 5/9 [subscription required]; Fox, National Journal, 5/9; Daly, Modern Healthcare, 5/9 [subscription required]).


ACO roundup: Key news from May 4-May 10

KHN examines the potential market power of ACOs

May 10, 2012

The Daily Briefing editorial team rounds up the top accountable care stories of the week.

  • Kaiser Health News last week examined ACOs' potential to change the health care industry. Stakeholders question whether the new model will reform health payments and patient responsibility: ACOs could prove too weak to change an entrenched payment model, or they could be too politically disruptive to survive (Millenson, Kaiser Health News, 5/2). 
  • Iowa: Mercy Medical Center-Des Moines and Wellmark Blue Cross and Blue Shield have formed an ACO with 20,000 enrollees. Under the five-year ACO contract, Mercy will receive bonuses for meeting quality and cost targets in the first two years and penalties for poor performance in the final three years (Evans, Modern Healthcare, 5/8 [subscription required]).
  • Florida: Baptist Health South Florida, oncology practice Advanced Medical Specialties (AMS), and a Jacksonville-based Blue Cross and Blue Shield division have established an ACO that focuses on cancer treatment. According to AMS chair Leonard Kalman, the program will lead to "better-coordinated, more cost-effective" cancer care (Kutscher, Modern Healthcare, 5/4 [subscription required]).
  • Michigan: Blue Cross and Blue Shield of Michigan and Novi-based Trinity Health last week announced they will enter into an ACO contract by 2015. Under the ACO agreement, Trinity's 12 Michigan hospitals will share savings obtained by reaching quality and cost-control targets (Evans, Modern Healthcare, 5/3 [subscription required]).


Daily roundup: May 10, 2012

Bite-sized hospital and health industry news

May 10, 2012

  • Connecticut: State lawmakers over the weekend approved a bill legalizing medical marijuana with strict cultivation and distribution regulations. The bill now requires Gov. Dannel Malloy's (D) signature to become law. Malloy has said he will sign the bill, noting that it would "avoid the problems encountered in some other states" (AP/USA Today, 5/5).
  • Pennsylvania: The University of Pennsylvania this week announced a $25 million gift from alumni Mindy and Jon Gray to establish the Basser Research Center, which will focus on treatment and prevention of cancers linked to hereditary BRCA mutations. "We hope that the Basser Research Center will eliminate BRCA-related cancers and, in doing so, provide a road map for curing other genetic diseases," the two alumni said (George, Philadelphia Business Journal, 5/8).
  • Washington: Washington Gov. Chris Gregoire (D) last week made available $90,000 in emergency funds to slow the spread of a whooping cough epidemic through a vaccination awareness campaign. The state Department of Health also plans to spend $200,000 on the campaign, and the federal government has agreed to divert federal funds to provide 27,000 of the whooping cough vaccine. So far this year, Washington has recorded 1,132 cases of the disease, 10 times more than it had recorded this time last year (Baker, AP/USA Today, 5/4).


Why physician surveying matters

May 10, 2012

While gathering physician feedback through the physician engagement survey is an important first step, acting on the survey results is critical to realizing a return on engagement. Join Jane Callahan, VP of Physician Services at Community Health Network in Indianapolis, as she discusses the post-survey steps being taken at her organization to drive results. Learn more.

 


DSM-V panel pulls back on two diagnoses

An American Psychiatric Association (APA) panel is pulling back from a pair of controversial changes to its new diagnostic manual, but is standing behind its recommended changes to the definition of autism.

The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is scheduled to be released in May 2013. The panel, which had posted its recommendations for the DSM-V online, made changes after receiving more than 10,500 comments, mostly critical.

Panel members eliminated two proposed diagnoses from the manual that would have increased the number of patients identified as psychotic or depressed. The proposals were for "attenuated psychosis syndrome," which supposedly identifies individuals at risk for developing psychosis, and "mixed anxiety depressive disorder," a mix of two other mood disorders.

Meanwhile, the panel remained steadfast in its recommendation to streamline the definition of autism by eliminating related terms, including Asperger's syndrome and "pervasive developmental disorder."

That recommendation has been heavily criticized, particularly after a Yale University study found that about half of individuals who currently are diagnosed on the high end of the "autism spectrum" would no longer qualify as having the disorder and could lose government-sponsored benefits (Carey, New York Times, 5/8).