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10/11/2018

Upcoming Interview: Jessica Wolff Discusses Health Care Without Harm's Work To Reduce The Health Care Industry's Carbon Footprint (October 24th)

Earlier this week the Inter-governmental Panel on Climate Change (IPPC) concluded that we have just 12 years, or until 2030, to avoid global temperatures rising above 1.5 degrees Celsius.  We've already warmed by 1 degree Celisius.   This means we will have to reduce carbon emissions by 50% by 2030 and reach net zero emissions by 2050.  (The US is historically the largest emitter of greenhouse gasses and currently second behind China.  Worldwide, we currently dump 42 billion tons of greenhouse gasses into the atmosphere annually and the amount has been again climbing since last year.)  As I noted in the 3 Quarks Daily essay cited below, there is no climate analog for this century for at least the past 50 million years.  Should the atmosphere warm by 2 degrees (the Paris Climate Accord goal was between 1.5 to 2), the earth as we know it will, largely, cease to exist.  

Health Care Without Harm's (HCWH) mission is to reduce the health care industry's carbon footprint.  HCWH's task is daunting since the health care industry, with rare exception, is doing nothing to address the so called climate penalty. 

Listeners may recall last November I posted my 3 Quarks Daily essay, "As the World Burns" that lent evidence to this fact.  It is at: http://www.3quarksdaily.blogs.com/3quarksdaily/2017/11/as-the-world-burns-.html

Last August 3rd, I interviewed David Wallace Wells regarding his July 2017 New York Magazine essay, "The Uninhabitable Earth."  His essay is at http://nymag.com/intelligencer/2017/07/climate-change-earth-too-hot-for-humans.html?gtm=bottom&gtm=top 

10/04/2018

150th Interview: Tim Gronniger Discusses the Current Proposed Medicare Accountable Care Organization (ACO) Rule: October 3rd

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Currently, CMS is accepting public comment on a proposed Medicare Shared Savings Program (MSSP), known more commonly as the Accountable Care Organization (ACO) program, rule.  The MSSP, created under the 2010 Affordable Care Act, is Medicare's flagship pay or performance program currently providing care to over 10 million Medicare beneficiaries.  MSSP or ACO performance, or to the extent the program has reduced Medicare spending growth, has been widely debated largely because CMS has failed to evaluate the program  Under this administration the program has come under substantial criticism.  The proposed rule, published this past August 17 in the Federal Register, is this administration's effort to improve the program's performance moreover by reducing the number of years an provider can participate in the program, from six years to two, without taking financial risk or participate in what are termed upside only contracts.  The administration argues absent financial risk providers do not fully engage in practice reforms to reduce spending.  This assumption is also widely debated.  Absent other substantial payment innovations, the success of the MSSP or ACO program is vital to the Medicare program, now forcasted to go bankrupt in 2026. 

During this 30 minute conversation Mr. Gronniger begins with a a brief overview of Caravan's work, he discusses or explains what success the ACO program has achieved to date and the program's background.  He moves onto discussing numerous elements of the proposed rule including earned shared savings percents, risk adjustment, aspects of financial benchmarking, low and high revenue ACOs, and beneficiary engagement and incentives, among others.     

Mr. Tim Gronniger is currently the Senior Vice President of Development and Strategy at Caravan Health.  Previously, he Gronnigerserved as Chief of Staff and Director of Delivery System Reform at CMS.  Previous to that, Mr. Gronniger  was Senior Adviser for Health Care Policy for the White House Domestic Policy Council.  Before that he served as senior professional staff to the Ranking Member of the House Committee on Energy and Commerce, Rep. Henry Waxman (D-CA, now retired).  Mr. Gronniger began his career in Washington, D.C. at the Congressional Budget Office where he studied or scored Medicare and Medicaid legislation.  Mr. Gronniger holds a Masters in Public Policy and Health Services Administration from the University of Michigan and a BA in Biochemical Sciences from Harvard. 

The proposed ACO rule is at: https://www.federalregister.gov/documents/2018/08/17/2018-17101/medicare-program-medicare-shared-savings-program-accountable-care-organizations-pathways-to-success

For information concerning Caravan Health go to: https://caravanhealth.com/

09/28/2018

Utah's Alliance for the Derterminants of Health Initiative: A Conversation with Mikelle Moore (September 27th)

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Despite the fact social circumstances and environmental factors account for approximately 20% of an individual's health status, twice that of medical care at approximately 10%, social circumstances or social determinants of health are frequently unaddressed by health or medical care providers.  This is largely because medical care providers are neither trained to provide social service supports such as housing and transportation nor compensated for doing so.   As a result persons left with unmet health-related social needs suffer more disease burden leaving them to over-utilize or seek comparatively more health care services, for example ED visits, - or services that could have been avoided had their health-related social needs been initially addressed.      

During this 24 minute conversation Ms. Moore begins by noting the current state of Medicaid expansion efforts in Utah.  She proceeds to explain Intermountain's reasons or motivations for creating the Alliance, she provides an overview of the Alliance's programming activities in Ogden and St. George that will address, for example, housing, transportation, food security and behavioral health services related, in part, to interpersonal violence, the initiative's relation to Intermountain's Medicaid insurance plan, SelectHealth, to the Medicare program's Accountable Health Communities demonstration, and what the Alliance's evaluation will measure in tracking the initiative's progress or success.  

Ms. Mikelle Moore is the Senior Vice President for Community Health at Intermountain Healthcare.  Her work is moreover focused on prevention and population health.  Prior to her current position, she served as Administrator of the LDS Hospital.  She joined Intermountain as an Administrative Fellow in 1998, serving as Assistant Administrator and Operations Officer in the Moore  Mikelle-06Central Region.  She is a Fellow in the American College of Healthcare Executives and serves on the national Advisory board for the Association for Community Health Improvement. She is also active on other not for profit boards and community initiatives.  Ms. Moore earned her MBA in health services administration from Arizona State University and her undergraduate degree in physiology from the University of Arizona.  

For more information on the Alliance go to, e.g., https://intermountainhealthcare.org/blogs/topics/transforming-healthcare/2018/07/new-alliance-seeks-to-address-the-social-determinants-of-health/.

 

09/23/2018

Accelerating Telehealth Adoption: A Conversation with Jonathan Shankman (September 21st)

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In the recent past the federal government has made several efforts to expand the use of telehealth and Remote Patient Monitoring (RPM) services.  Related provisions can be found, for example, in the 2017 CONNECT Act, the Bipartisan Budget Act of 2018 and in federal regulatory rule making, for example, the current 2019 proposed Medicare Physician Fee Schedule (PFS) rule, and in payment waivers for certain Medicare pay for performance models, for example, ACOs, where telehealth "originating site" and service area use restrictions are waived.  Even with these reforms telehealth/RPM spending in, for example, the Medicare program still amounts to approximately $30 million annually, or an almost immeasurable fraction of the program's $700 plus billion in annual spending.   Increased spending under Medicare (and Medicaid) aside, few are convinced adoption of these technologies should occur at the so called speed of government, where old or current IT solutions are largely validated, is adequate.   

During this 24 minute conversation Mr. Shankman briefly describes AMC Health's work, what explains the lag in telehealth/ RPM adoption and why now or what circumstances today hold promise for far more rapid adoption or use of telehealth/RPM.  He provides several examples or telehealth/RPM use and what outcomes are or can be achieved. 

Jonathan Shankman is currently Senior Vice President of Clinical Innovation at AMC Health, a New York-based remote and Jon Shankman Headshotreal time healthcare monitoring company.  Mr. Shankman has more than 25 years of experience as a research gerontologist, developing and analyzing new paradigms of chronic care delivery for the elderly and disabled across all segments of the care continuum.  At AMC Health, Mr. Shankman is responsible for development of products that weave technology and clinical best practices into virtual care solutions that address a broad array of chronic and acute illness challenges.  He also focuses on the application of analytics that support the development of clinical decision support tools.  Previously, at the Metropolitan Jewish Health System, Mr. Shankman held progressive leadership positions with the nonprofit, geriatric services organization serving the New York metropolitan area.  Mr. Shankman was graduated from Columbia University with a Masters of Public Health in gerontology, an MBA and a BA.  

For more on AMC Health go to: www.amchealth.com

 

09/03/2018

Essay: Salvaging the Merit-Based Incentive Payment System (MIPS): August 28th

This past August 28th, the Health Affairs Blog posted my essay, "Salvaging MIPS."  Followers of this podcast may recall last August I wrote a related essay for Health Affairs concerning the problems with the high MIPS exclusion thresholds.  I certainly does not appear we are making any progress in moving Medicare Part B (physician reimbursement) closer to higher quality and greater value.

Last week's essay is at: https://www.healthaffairs.org/do/10.1377/hblog20180822.309498/full/

The August 2017 essay is at: https://www.healthaffairs.org/do/10.1377/hblog20170803.061372/full/ 

 

08/22/2018

Essay Concerning the United Nations' Recent Extreme Poverty in the US Report (August 22nd)

Today, the Health Care Blog posted my essay, "The UN's Extreme Poverty Report: Further Evidence US Healthcare Is Divorced From Reality."  It is at: http://thehealthcareblog.com/blog/2018/08/22/the-uns-extreme-poverty-report-further-evidence-us-healthcare-is-divorced-from-reality/.

It begins: In May Philip Alston, the United Nation’s Special Rapporteur on Extreme Poverty, and John Norton Pomeroy Professor of Law at New York University Law School released his, “Report of the Special Rapporteur On Extreme Poverty and Human Rights on His Mission to the United States.”  The 20-page report was based, in part, on Alston’s visits this past December to California, Georgia, Puerto Rico, West Virginia and Washington, D.C.  After reading the report and the response to it, one is again forced to question how legitimate is our concern for the health and well being of the poor, or those disproportionately burdened with disease.

 

 

08/09/2018

Medicare For All: A Conversation with Professor Gerald Friedman (August 8th)

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According to a recent Kaiser/Washington Post survey 59 percent of Americans support Medicare for All (M4A).  Per a March New England Journal of Medicine poll 61 percent of physicians said single payer would make it easier for them to deliver cost-effective, quality health care.   Currently, before the House is legislation titled the "Expanded and Improved Medicare for All Act" with over 120 sponsors.  (The legislation has been introduced every session since 2003.)   The House has recently also formed a Medicare for All caucus with 70 Democratic members and if the Democrats win back the House this November they have promised M4A hearings.  The Senate has a parallel bill, the "Medicare for All Act of 2017," currently with 16 cosponsors, several of whom are potential 2020 presidential candidates.  Though there is, again, substantial criticism of M4A, e.g., CMS Administrator, Seema Verma, recently denounced it as "government run socialized health care" (an odd complaint since that is exactly what the current Medicare and Medicaid programs are).  Because of the disruption, dismantling or sabotage of the ACA under the Trump administration and moreover because health care continues to be ever increasingly unaffordable (and bankrupt, the Medicare Part A Trust Fund is now projected to be insolvent in 2026), as is frequently phrased, M4A is, again, on the table. 

During this 37 minute conversation Professor Friedman provides a general definition of Medicare for All healthcare, how it would be financed and how savings be derived and what amount.  He explains what is current public opinion, what are credible criticisms of M4A and what promising single payer efforts are underway in the states.   

Dr. Gerald Friedman is Professor and Undergraduate Program Director of Economics at the University of Massachusetts at Friedman
Amherst.  Prior to, he worked as research staff for the International Ladies' Garment Workers' Union.  Professor Friedman is the author of multiple books and articles on labor relations and healthcare economics.  He has been a correspondent to television and media outlets, a consultant to labor unions and has drafted funding plans for campaigns for single payer health insurance in several states including New York, Maryland, Pennsylvania, Colorado, Oregon and Washington and a federal plan for the US.  He serves on the Board of Advisers to the Business Initiative for Health Policy.  Professor Friedman earned his undergraduate degree from Columbia College and his Ph.D. in economics from Harvard. 

08/01/2018

Reforming the Physician Self-Referral Law (Stark Law): A Conversation with Amy Hooper Kearbey (July 31st)

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Over the past several years the Congress and Medicare regulators have discussed reforming the 1989 Ethics in Patient Referral Act.  Otherwise known as the physician self-referral or more commonly termed Stark law (named after the former California House member, Pete Stark, the initial sponsor of the bill).  Stark law is today widely viewed as an impediment to care coordination or payment models that financially incent providers to improve care, care coordination and reduce spending growth, or moreover Accountable Care Organizations (ACOs) and bundled payment arrangements, because as implied the law prohibits physicians from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician or immediate family member has a financial relationship.  Beyond the complexity of the law, its strict liability provision, potential substantial fines imposed under the law, exposure to False Claims liability and Medicare exclusion, there has been increasing sentiment the law generally does not have a place in today's pay for performance or pay for value world.   Most recently, this past June 25th DHHS published a Request for Information (RFI) soliciting stakeholders to offer comments on improving Stark law and most recently, or on July 17th, the House Ways and Means heard related testimony.      

During this 27 minute conversation Ms. Hooper Kearbey discusses her work related to Stark law, the numerous current problems with the law and areas where the law can be improved.  She notes the current DHHS Stark RFI, e.g., to what extent improved transparency about a physician's financial relationships could help improve the law and and makes comment on the use of gainsharing in current pay for performance arrangements.    

Ms. Amy Hooper Kearbey is a attorney and partner with the DC-based law firm, McDermott Will & Emery.  Her practice Kearbey_amy_07935_tfocuses on providing Medicare regulatory coverage, coding, reimbursement and compliance as well as advice regarding federal fraud and abuse regulations and clinical research compliance.   She is a member of the District of Columbia Bar Association, the American Health Lawyers Association and the National Blood Clot Alliance.  She earned her law degree from the Duke University School of Law and her AB from Dartmouth. 

The Stark RFI is at: https://www.gpo.gov/fdsys/pkg/FR-2018-06-25/pdf/2018-13529.pdf and related July 17 testimony by four witnesses before the House Ways and Means Committee is at: https://waysandmeans.house.gov/event/hearing-on-modernizing-stark-law-to-ensure-the-successful-transition-from-volume-to-value-in-the-medicare-program/.  

 

07/18/2018

HCCI's President, Mr. Niall Brennan, Discusses Employer-Sponsored Insurance (July 19th)

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While coverage under the Affordable Care Act (ACA), Medicare and Medicaid enjoy, deservedly, a great deal of discussion and debate, employer-sponsored insurance (ESI) insures approximately 55% of the non-Medicare eligible population, or approximately 152 million Americans.  (Medicaid insures 19.5% of the population and Medicare 16%).  Larger employers, or those with over 500 employees, are moreover (82%) self insured, 26% of smaller employers are as well.  What we know about ESI and what further we can learn is therefore of substantial importance.   

During this 25 minute conversation among other comments Mr. Brennan outlines HCCI's research, he explains what drives ESI spending growth, what employers are doing to control prices, he provides an overview of his recent testimony before the Senate HELP Committee and makes comment on data transparency and the employer health insurance tax exclusion. 

Mr. Niall Brennen is the President and Executive Director of the Health Care Cost Institute (HCCI) since June 2017.  BrennanImmediately previously, he served as the Chief Data Officer at CMS.  He has also worked at the Brookings Institution, the Medicare Payment Advisory Commission (MedPAC), the Congressional Budget Office (CBO), the Urban Institute and Price WaterhouseCoopers.  He has published widely in leading academic journals including The New England Journal of Medicine and Health Affairs.  Mr. Brennan received his MPP from Georgetown University and his BA from the University College Dublin, Ireland.   

For more on HCCI go to: http://www.healthcostinstitute.org/

06/28/2018

"Integrating Behavioral Health Into the Medical Home: A Rapid Implementation Guide," A Conversation with the Lead Author, Dr. Kent Corso (June 27th)

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As listeners may be aware well over 50 million Americans suffer from a mental or behavioral health disorder.  Less than half of these individuals actually receive treatment.  This reality is substantially worse for minorities.  For example, African Americans and Hispanic whites are half as likely as non-Hispanic whites to receive treatment.  Primary care practices, more than any other setting, are the cite for behavioral health treatment.  Despite federal parity legislation to improve coverage for behavioral health diagnoses and improvements under the Affordable Care Act, for example, payment models intended to provide more comprehensive and coordinated care, or to better integrate behavioral with physical healthcare, behavioral health patients remain under-diagnosed and under-treated and primary care practice settings too frequently remain  un- or ill-equipped to provide behavioral health services.   

During this 26 minute conversation Dr. Corso begins by defining the difference between mental and behavioral health, he explains why there is a shortage of behavioral health clinicians (it's a distribution problem) and moreover provides an overview of his 2016 work, Integrating Behavioral Health Into the Medical Home: A Rapid Implementation Guide, including summarizing healthcare outcomes and spending reductions associated with six IBH examples provided in work.  He concludes the conversation by explaining why IBH helps address or mitigate the stigma (still) associated with a behavioral health diagnoses. 

Dr. Kent Corso is a licensed clinical health psychologist and a board certified behavior analyst.  He is the President of National Capital Region Behavioral Health.   He is also an Adjunct Assistant Professor, Department of Family Medicine, at the CorsoUniformed Services University of Health Sciences (USUHS).  Dr. Corso has co-authored over 25 peer-reviewed papers on primary care behavioral health.  He is, again, the lead author of Integrating Behavioral Health Into the Medical Home: A Rapid Implementation Guide.  

For information on Integrating Behavioral Health go to: https://greenbranch.com/store/index.cfm/product/1470/integrating-behavioral-health-into-the-medical-home-a-rapid-implementation-guide.cfm.

For information on National Capital Region Behavioral Health go to: http://ncrbehavioralhealth.com/about.php