CMS has finalized their proposed Medicare rule (regulation) for how hospitals are paid that includes a new measure assessing the quality of hospital informed consent documents given to patients before elective procedures. (The relevant section, Potential Inclusion of the Quality of Informed Consent Documents for Hospital-Performed, Elective Procedures Measure starts here on p. 373 of the pdf file – p. 38362 of the Federal Register Rules and Regulations 82:155, 8/14/17). The rule will make an important difference in supporting patient-centered care in hospitals across the US. The current state of hospital informed consent documents is embarrassingly poor. Under this rule, the 4,700 US hospitals that treat Medicaid members will be paid, in part, based on the quality of their informed consent documents. The measure may also be included in public quality comparisons such as Hospital Compare, allowing patients to use this measure in choosing between hospitals for their care.
Both Democratic and Republican state legislators from across the US agree on the need to control health care costs, according to a new survey published in the American Journal of Public Health. However, other top priorities between the parties differ strongly. Republicans prioritized smaller government along with reducing costs while Democrats prioritize improving health equity with cost control. Republicans were split among themselves between prioritizing improving overall health and reducing government involvement in health care. The authors suggest that this reflects a split in the party between moderates and conservatives. There was no difference between legislators based on geography or legislative chamber. The results suggest opportunities for bipartisan progress on health reform, especially on controlling costs. The survey was supported by the Commonwealth and Milbank Memorial Funds.
The growing Bioscience industry holds great potential to improve the region’s economy and health , according to speakers at “Bioscience Initiatives: Improving Health and Growing the Economy” at this week’s CSG-ERC Annual Meeting in CT. Panelists included Mostafa Analoui, PhD, Executive Director, UConn Venture Development, Mike Hyde, Vice President, External Affairs, The Jackson Laboratory, and Jon Soderstrom, Ph.D., Managing Director of the Office of Cooperative Research, Yale University. The Northeast has a unique bio-medical ecosystem with considerable capacity to spawn innovative new bioscience companies and to meet those companies’ need for talented workers. Bioscience has attracted hundreds of millions of dollars in private equity and venture capital funding to CT alone. New companies are driving research, developing new drugs and treatments, and leading cutting edge fields such as genomic medicine. UConn has created a Technology Incubation Program supporting dozens of new bioscience ventures across industries. The 88-year old nonprofit scientific research institute, Jackson Labs, has brought 320 well-paying jobs and hundreds of millions of dollars to their new CT site. Yale has created 40 new biotech companies in the Greater New Haven area and more are forming.
At this week’s CSG-ERC Annual Meeting in CT, state policymakers from across the Northeast got updates from experts on the federal health care landscape, state options to adapt. CT’s Lieutenant Governor Nancy Wyman pulled it all together describing CT’s progress toward health reform. Mitchell Stein gave a detailed summary of federal activity including CHIP reauthorization (ends Sept. 30 without action), tax bills and raising the debt limit which all could impact Medicaid and/or the Affordable Care Act. He re-capped ACA repeal efforts and the status of insurance exchanges including cost-sharing reduction payments, underserved counties, premium levels and degradation of the risk pool. It’s estimated that about half of premium rates for next year are due to uncertainty about ACA implementation. He outlined what is likely to happen this fall and potential state responses including reinsurance waivers and creating a Medicaid buy-in option.
Policymakers then heard from Chris Koller, President of the Milbank Memorial Fund, on the big picture and states’ capacity to address the quickly changing environment. He reminded policymakers about the importance of social services in health outcomes and America’s poor performing health system that costs more and delivers less than other countries. He outlined concerns about slow economic growth’s impact on the health of poorer populations and government’s ability to address that stress, rising health disparities, and political changes. Probably his most popular slide described the results of a Milbank survey of state legislators finding that Democrats and Republicans have very different goals and values for health reform. Republicans are most interested in reducing costs while Democrats prioritize improving health and equity. The federal government is delegating more health policymaking to states, while Medicaid costs rise, crowding out other priorities. In good news, he highlighted Georgia’s progress in reducing infant mortality, and Delaware’s success in addressing chronic illnesses, with lessons learned. He emphasized that states need to get creative in building state health policy capacity and shared a roadmap to get there.
Lieutenant Governor Nancy Wyman ended the meeting by recapping what we heard and describing CT’s long history of success in reforming health care and expanding access. She outlined work creating AccessHealthCT, outreach efforts that cut CT’s uninsured rate in half, Medicaid reforms, and support for primary care and prevention with the state employee plan’s Health Enhancement Program.
This was followed by a lively question and answer discussion touching on the relationship between health care industries and jobs, state options to create a reinsurance program and/or require all individual coverage be sold on the insurance exchange, the role of 1332 waivers, the role of family caregivers, end of life care costs, and comparisons with the Canadian system.
More information on state reinsurance programs and Medicaid buy-in options will be coming.
From CSG-ERC’s Annual Meeting in Connecticut
Mapping the first human genome in 2000 cost about $4 billion; today, it costs about $1,000.
The cost has come down because of investment, and because of the important role genomics is playing in medicine today, according to Dr. Murat Gunel, a professor of neurosurgery, genetics and neuroscience at Yale University, who spoke during Sunday’s luncheon plenary, “Genomics and Precision Medicine: Investing in the Future of Health Care.”
“We have all recognized the power of genomics,” Gunel said. “This is clinical. This is making a difference in our patients’ lives everyday.”
Plus, he said, “this is the new Internet race.” Various nations are investing in the research, recognizing the main race now is learning how to decode the genomic makeup of people to understand their diseases. It is one of four areas in which China is making multi-billion dollar investments. The U.S. also has made significant investments in the area, starting with the 2000 investment in mapping the first genome.
“You can imagine the impact it will have on our health care system if you can predict a disease before it starts,” he said.
Now, for the most part, while the ability to diagnose disease is evolving, treatments are often a best guess based on effectiveness over a general population. Genomic testing will allow for precision—also referred to as individualized—medicine to treat patients based on many factors.
But, Gunel cautioned, “genomics in isolation does not mean much.”
He said that information must be combined with what is known about the quality of the air or water in a person’s environment or about how much they exercise, for example.
Having that information for individuals can help them tailor their lifestyles to improve their health. Even so, Gunel said a bigger purpose would be to use that information in population health. Precision medicine has already seen some success, such as addressing newborn diseases, prenatal diagnosis, pharmacogenomics and individualized treatment for cancer, he said.
That’s because genomic testing has increased the number of genes that can be tested. Gunel said cancer patients are looked at with regard to their genomic makeup. That ability has helped bring a 30 percent cure rate for metastatic melanoma, he said.
It’s changing the way diseases are treated. For instance, now everyone diagnosed with lung cancer is given the same treatment, according to Gunel. With genomic testing, physicians are able to understand the baseline risks individuals have and make specific lifestyle recommendations to help prevent the diseases. Then, if the disease occurs, “we could diagnose it faster and give more effective and more individualized treatments.”
While precision medicine will have major impacts on health care, Gunel said it could also bring $1 trillion in economic growth. That could impact the development of things like new medicines and the creation of new fields to fill such roles as genetic counseling and computational biology—the people who can run the artificial intelligence (AI) in the data center.
“We think the number of people we are going to need in that field is going to ramp up tremendously,” said Rich Lisitano, vice president at Yale-New Haven Hospital.
Understanding high-need adults with complex conditions and their barriers to care are key to developing solutions that improve health and control costs. High-need adults have at least two chronic diseases and a functional limitation in their ability to care for themselves or perform routine daily tasks. A new report from the Commonwealth Fund outlines in depth the number of high-need adults and their challenges across states. Twelve percent of American adults have high medical needs but ERC states’ rates are at or below the US average. High-need adults tend to be older and have lower incomes than other Americans. High-need adults are less likely than the rest of the population to be uninsured, and that rate is even lower in states that chose to expand Medicaid. High-need adults are also more likely to have a usual source of care than other adults. Unfortunately high need adults are about twice as likely as other adults to have gone without needed care due to cost. Other than costs, the main reasons for missing needed care are transportation or not being able to get a timely appointment for care.
|High-need adults as share of total population||Uninsured rate among high-need adults||% of high-need adults who went without a provider visit due to cost||% of high-need adults who went without a prescription drug due to cost|
A bill introduced early this year that would allow Americans to import medications from Canada would save the federal government $6.8 billion over the next ten years, according to the Congressional Budget Office. The bill is a response to growing drug costs. A recent study found that US drug prices average higher than other countries including Canada. Lowering drug costs is now a top priority for the majority of Americans of all parties. Drug companies and others have raised concerns about the safety of imported drugs. According to the FDA, almost 40% of drugs Americans take are manufactured in other countries and 80% of active pharmaceutical ingredients for drugs manufactured in the US are imported from other countries.