What’s New in Health Care Reform: Aug. 31

an-elderly-woman-sitting-outside-with-her-son-and-granddaughter-original-1024x683What'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.

CMS May Crack Down on Third-Party Groups that Subsidize ACA Premiums

The CMS is asking the public for information about providers and organizations that may be steering Medicare- or Medicaid-eligible patients toward the Affordable Care Act's insurance exchanges in order to receive higher reimbursement rates. The move appears to be a response to complaints from insurers that some third-party organizations are undermining the risk pool in the Affordable Care Act by subsidizing premiums for high-cost patients who should be covered by another government program. Via Modern Healthcare.

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U.S. Personalized-Medicine Industry Takes Hit from Supreme Court

Rejections for U.S. patents related to personalized medicine have spiked after recent Supreme Court decisions tightened the rules for such claims, an analysis of more than 39,000 patent applications reveals. The data, presented at the Intellectual Property Scholars Conference in Stanford, California, address patent applications in eight categories that commonly include personalized-medicine patents. They show that following a key Supreme Court decision in 2012, the U.S. Patent and Trademark Office (USPTO) was nearly four times more likely to deem subjects of such applications unpatentable—and applicants were less than half as likely to overcome those rejections. Via Nature. 

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Medicare Part D Spending Rose 17% in 2014 Because of High-Cost Drugs

Medicare spending on prescriptions increased more than 17% in 2014, despite a claims increase of only about 3%, according to data released. The second annual set of data shows prescription drugs paid for under the Medicare Part D Prescription Drug Program, which has 38 million beneficiaries. The data include more than 1 million distinct providers. Via Modern Healthcare.

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U.S. Officials Move to End Duplicate Health Care Coverage

The Obama administration is moving to end duplicate coverage for tens of thousands of people who are enrolled in Medicaid and simultaneously receiving federal subsidies to help pay for private health insurance under the Affordable Care Act. In the last few days, consumers around the country have received letters warning, in big black type: “People in your household may lose financial help for their marketplace coverage.” Via NY Times.

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Some Small Businesses Restore Group Health Coverage

Some small companies that dropped group health insurance for their employees are reversing course, driven by a tightening labor market and rising costs and fewer choices for individual coverage. Via Wall Street Journal.

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Obamacare Options? In Many Parts of Country, Only One Insurer Will Remain

So much for choice. In many parts of the country, Obamacare customers will be down to one insurer when they go to sign up for coverage next year on the public exchanges. A central tenet of the federal health law was to offer a range of affordable health plans through competition among private insurers. But a wave of insurer failures and the recent decision by several of the largest companies, including Aetna, to exit markets are leaving large portions of the country with functional monopolies for next year. Via NY Times.

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Are Insurance Policies Saving Patients Money, or Keeping Them from the Treatment They Need?

Insurers have long relied on a cautious approach to control costs and spare patients from expensive medications they might not need. But in more than a dozen interviews with doctors and patients, a picture has emerged of insurers growing more aggressive as they respond to financial pressures. The result is a reliance on what is known as “step therapy,” whereby patients are forced to try cheaper treatments before they graduate to more expensive ones, even when health care providers are confident the inexpensive treatments will not work. Via STAT.

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Doctors, Hospitals Prepare for Difficult Talks Surrounding Medical Mistakes

Hospitals have traditionally been reticent to disclose to patients or their family members the specifics of how a medical procedure didn’t go as planned for fear of malpractice lawsuits. In recent years, though, many are beginning to consider a change. Instead of the usual “deny-and-defend” approach, they are revamping their policies to be more open. To help them move in this direction, the federal Agency for Healthcare Research and Quality released in an online toolkit designed to expand the use of the agency’s “Communication and Optimal Resolution” process, which establishes guidelines for adopting more transparency in communicating adverse events. Via Kaiser Health News.

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Fears for Competition Grow on Exchanges

Anybody want to sell some health insurance? It’s a question that consumers, health policy pundits and even some regulators are asking as concerns grow about the number of competitors on government-run exchanges that were established under the federal health law. Last week, Minnesota regulators issued a request for proposals from groups that might be willing to step in and sell coverage on the state’s MNsure exchange, particularly in counties outside the Twin Cities metro. It came after Blue Cross and Blue Shield of Minnesota announced in June a pullback that could cut options in 11 rural counties. Via Star Tribune.

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Nonprofit Hospitals’ Business Relationships Can Present Conflicts

Nonprofit hospitals have extensive business ties that can pose conflicts of interests for their administrators and board members, a Wall Street Journal analysis of newly released Internal Revenue Service data shows. While having relationships with companies doing business with a nonprofit hospital isn’t necessarily improper—as long as the deals are disclosed and at market rate—administrators and board members sometimes may be forced to choose between what’s best for the hospital and what’s best for their private interests. Via Wall Street Journal.

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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.