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.
CVS-Aetna Deal Could Start a Health Takeover Run
CVS Health Corp.’s deal to buy insurer Aetna Inc. for about $67.5 billion could be just the start of a new wave of health-care takeovers. The merger will leave one less independent player in the complex web of insurers, retailers and other middlemen that sit between patients and their care—and who are under pressure to reduce costs. Via Bloomberg.
Emergency Rooms Are Monopolies. Patients Pay the Price.
There are 141 million visits to the emergency room each year, and nearly all of them have a charge for something called a facility fee. This is the price of walking through the door and seeking service. It does not include any care provided. Emergency rooms argue that these fees are necessary to keep their doors open, so they can be ready 24/7 to treat anything from a sore back to a gunshot wound. But there is also wide variation in how much hospitals charge for these fees, raising questions about how they are set and how closely they are tethered to overhead costs. Via Vox.
CVS Agrees to Buy Aetna in $69 Billion Deal That Could Shake up Health Care Industry
Pharmacy giant CVS Health has agreed to buy Aetna in a $69 billion blockbuster acquisition that could rein in health care costs and transform its 9,700 pharmacy storefronts into community medical hubs for primary care and basic procedures, the companies announced. The pharmacy chain agreed to buy Aetna for about $207 per share, broken down into $145 in cash and the rest in stock. The deal—the biggest health care merger announced in more than a year—is expected to close in the second half of 2018, subject to approval by shareholders and regulators. Via Washington Post.
Rural Hospitals Balk as Insurers Narrow Coverage Sites
Critical-access hospital Margaret Mary Health in Batesville, Indiana, always has its imaging machines plugged in and waiting in case a stroke or trauma patient comes through the door. That can drive up costs for imaging services compared to free-standing imaging centers, which typically operate on set hours and don't handle emergency patients. That's why Tim Putnam, the hospital's CEO, says Anthem's decision to stop paying hospitals for outpatient MRI and CT scans hits small, rural hospitals like his especially hard. Via Modern Healthcare.
GOP Medicaid Work Rules Imperil Care for Opioid Abusers
Red states ravaged by the opioid crisis are pushing for Medicaid work requirements that could push people out of treatment as they try to get off drugs. Kentucky, New Hampshire, Maine, and Indiana are among at least eight GOP-led states seeking federal approval to require Medicaid enrollees to work as a precondition of their health coverage. All four states have been hard hit by drug addiction, which claims 140 lives a day nationally. Via Politico.
Trump Health Nominee Embraces Obamacare Programs
President Donald Trump’s nominee to oversee Medicare says he’s a fan of paying doctors and hospitals in new, potentially more efficient ways through experimental payment programs set up under Obamacare. The federal agency he’s been picked and that administers the programs to run just killed off three of them. Via Bloomberg.
Will GOP Finally Take Down Obamacare with a Tax Bill?
After spending nearly a year on a failed effort to repeal Obamacare, Republicans on Capitol Hill are on the verge of repealing the law’s individual mandate as a footnote to their rewrite of the American tax system. At least two of the three Senate Republicans who blocked the repeal effort over the summer have no problem undoing the requirement that nearly all Americans carry insurance—a provision Democrats say is vital to keeping the Affordable Care Act afloat. Via Politico.
53% of Docs Still Not Transitioning to Value-Based Care
There has been an uptick in the number of physicians making the leap to value-based care, but the majority of clinicians remain skeptical and reluctant to switch from traditional fee-for-service. Just 47% of clinicians surveyed for a joint American Academy of Family Physicians and Humana study on value-based payment are actively pursuing value-based purchasing opportunities, up 3 percentage points from their joint report two years ago, according to an analysis released. Via Modern Healthcare.
If Confirmed, HHS Secretary Nominee Alex Azar Plans to Take on EHRs, Care Delivery Reforms
If confirmed, Azar told the Senate Health, Education, Labor, and Pensions Committee that he'd want to delve into the regulations and the role that EHRs plays to contribute to the administrative burdens that are at the top of physicians' complaints. In an exchange with Sen. Lamar Alexander, R-Tenn., who chairs the committee, he agreed that there are steps that lawmakers can take to ease the burden on providers. Via Fierce Healthcare.
Doctors Make Big Money Testing Urine For Drugs, Then Ignore Abnormal Results
The nation’s opioid crisis has prompted an explosion in urine testing. The scourge has driven huge profits for many pain clinics across the U.S., an ongoing Kaiser Health News investigation shows. Spending on urine screens and related genetic tests quadrupled from 2011 to 2014 to an estimated $8.5 billion a year—more than the entire budget of the Environmental Protection Agency, according to a KHN analysis of billing data from Medicare and private insurance billing from the Mayo Clinic. Medicare and other insurers pay for urine tests with the expectation that clinics will use the results to detect and curb dangerous abuse. But some doctors have taken no action when patients are caught misusing pharmaceuticals, or taking street drugs such as cocaine or heroin. Via Kaiser Health News.