What’s New in Health Care Reform: May 4


What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.

Medicare Pays Bonuses to 231 Hospitals with Lower Quality Because of Cheaper Costs

The federal government paid bonuses to 231 hospitals with subpar quality because their patients tend to be less expensive for Medicare, new research shows. The bonuses are small, generally a fraction of a percent of their Medicare payments. Nonetheless, rewarding hospitals of mediocre quality was hardly the stated goal when the Affordable Care Act created financial incentives to encourage better medical care from hospitals, doctors and other health care providers. Via Kaiser Health News.

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CMS Looks to Simplify Insurance Shopping with Simple Choice Plans, Quality Star Ratings on Exchanges

The federal insurance exchanges will offer standardized health plans and display a five-star ratings system as pilot program during the fourth open enrollment period, scheduled to open later this year. The agency hopes to make it easier for people to shop for insurance plans, Kevin Counihan, CEO of HealthCare.gov, and Patrick Conway, the principal deputy administrator of the Centers for Medicare and Medicaid Services, wrote in a blog post. Via Morning Consult. 

Health Care’s Next Big Issue: Drug Costs

The No. 1 health policy challenge facing the next administration—of either party—may well be the cost of drugs, according to a top administration health official. "If we don't address this problem in the next four or five years, and prescription drug costs grow as they've been growing, this will be one of the top three issues for my successor, if not the No. 1 issue," Centers for Medicare & Medicaid Services acting administrator Andy Slavitt said in an exclusive interview. Via Politico.

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Medicare Battle Brewing on Capitol Hill

An Obama administration proposal aimed at fighting high drug prices is facing a backlash on Capitol Hill. Republicans say the pilot program that would change how Medicare pays for certain drugs should be scrapped, while congressional Democrats are expressing serious concerns and seeking changes, but generally do not want to terminate it completely. Via The Hill.

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Feds Propose Docking or Rewarding Medicare Doctors for Quality

Federal regulators proposed a rule that will adjust hundreds of thousands of physicians' Medicare payments to reward or penalize them based on how healthy they keep their patients. The announcement by the Department of Health and Human Services comes a year after Congress passed a law that was known as the "doc fix" bill and prevented a huge cut in Medicare payments. It also authorized HHS to come up with more streamlined ways of paying doctors that emphasize quality over quantity of services. Via USA Today.

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CMS Proposal Would Tie Medicare Payments to Quality Care

The Centers for Medicare and Medicaid Services released its first proposed rule on how to tie Medicare provider payments to quality patient care. This is the first step the Obama administration has taken in implementing provisions of the Medicare Access and CHIP Reauthorization Act, passed last year. The law, known as MACRA, replaced the Medicare sustainable growth rate, which became commonly known as the “doc fix.” Via Morning Consult.

The Striking Variation of Commercial Health Care Prices

Price and utilization are the two essential elements of the nation's health spending tab, and seemingly wild differences in prices for common medical procedures appear to be driving that bill up a lot. One of the most comprehensive, independent studies of commercial health care prices shows that employers and insurers that provide private health coverage can pay a lot more for services depending on the state where people live. Those price differences even exist for routine procedures, like MRIs and ultrasounds, which should not be much different in theory. Via Modern Healthcare.

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AHA: Limited Coverage, Geographic Restrictions Pose Major Barriers to Telehealth Adoption

The Centers for Medicare & Medicaid Services must include telehealth in value-based payment models and lift geographic restrictions on its use, a new brief published by the American Hospital Association argues. Currently, the AHA points out, limited coverage remains a major hurdle to more robust adoption by providers. Via FierceHealthIT.

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Colorado Weighs Replacing Obama’s Health Policy with Universal Coverage

For years, voters in this swing state have rejected tax increases and efforts to expand government. But now they are flirting with a radical transformation: whether to abandon President Obama’s health care policy and instead create a new, taxpayer-financed public health system that guarantees coverage for everyone. The estimated $38-billion-a-year proposal, which will go before Colorado voters in November, will test whether people have an appetite for a new system that goes further than the Affordable Care Act. Via NY Times.

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Paul Ryan’s Risk Pools Hit on Obamacare Criticism

House Speaker Paul Ryan’s recent proposal to shift sick people to their own health insurance could place a sizable financial burden on the government, but it also gets at a question that Obamacare supporters are contemplating: How to keep the cost of covering sick people from significantly increasing the cost of insurance for the healthy. Ryan’s plan, which he floated to a student audience at Georgetown University last week, would separate people with preexisting conditions from the regularly insured market. His remarks offer a glimpse into one way Republicans would “repeal and replace Obamacare” under a Republican administration. Via Morning Consult.


Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Medical Laboratories. He leads strategies for corporate communications, public relations, and new media innovations. Andy has worked at Mayo Clinic since 2003. Outside of work, Andy can be found running, hiking, snapping photos, and most importantly, spending time with his family.