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Will Medicare Ever Cover Telehealth & Remote Monitoring? A Conversation with Krista Drobac (November 18th)

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Telehealth and remote monitoring services generally enable physicians to treat patients and monitor their health status remotely.  Because of advances in wireless communication and biosensor technology these services are increasingly being used in the commercial health care market and as well in the Medicaid program and the VA because research shows these services can reduce acute care visits and lengths of stay, iatrogenic harm and improve patient adherence to care.  Nevertheless, the Medicare program restricts reimbursement for these services largely because CMS (the Congress and the CBO) see them moreover as duplicative (v. substitutive) services.   For example, in 2014 Medicare spent just $14 million on telehealth service reimbursement.  (Total Medicare spending in 2014 was well north of $500 billion).    

During this 18 minute conversation Ms. Drobac discusses in part how and why reimbursement for telehealth and remote monitoring services are limited under Medicare, how other payers and providers are using telehealth and remote monitoring, what the research literature suggests regarding clinical effectiveness and cost efficiency, proposed Congressional legislation and related regulatory action to broaden Medicare coverage and chances for legislative and regulatory success. 

Krista Drobac leads the Alliance for Connected Care, a 501(c)(6) coalition formed to create a statutory and regulatory Drobacenvironment in which providers are able to deliver and be adequately compensated for providing telehealth and remote monitoring services regardless of delivery location or technological modality.   Ms. Drobac was previously Director of the Health Division at the National Governors Association's Center for Best Practices.  Prior to that she was senior adviser at CMS, Deputy Director of the Illinois Department of Healthcare and Family Services and spent five years on Capital Hill where she was a Health Adviser to the Senate Majority Whip Senator Richard Durbin and served as a John Heinz Senate Fellow for Senator Debbie Stabenow.  Ms. Drobac earned her BA from the University of Michigan and her MPP from the Kennedy School of Government at Harvard. 

For information on the Alliance for Connected Care go to: 


The Jimmo Settlement: Its Importance and Implementation to Date: A Conversation With Margaret Murphy (November 10th)

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In 2011 a 78 year old blind, amputated Vermont woman, Ms. Glenda Jimmo, was denied physical therapy services under Medicare because her condition was determined to not likely improve. Because Medicare therapy services via skilled nursing, home health and outpatient care never required the patient "improve" in order to receive services and because thousands of other Medicare beneficiaries along with Ms. Jimmo had been denied therapy the Center for Medicare Advocacy and Vermont Legal Aid filed a class action suit against the federal government, i.e., Jimmo vs. Katheleen Sebelius.  After 11 months of negotiations, a settlement agreement was reached in late 2012 that affirmed there is no "improvement standard" required to be met for beneficiaries to receive therapy services.  That is care would no longer be denied due to a Medicare beneficiary's lack of restoration potential. 

During this 18 minute discussion Ms. Murphy explains the impetus for the case, speculates why DHHS did not act on its own in resolving the problem, how well or effectively CMS has implemented the terms of the settlement agreement (not very well) and why the decision has received so little attention over the past three years.   

Margaret Murphy is the Associate Director of the Center for Medicare Advocacy where she works to develop the Center's legal policy and litigation strategies.  Ms. Murphy has been counsel or co- Murphycounsel in several of the Center's federal class action suites.  She serves on the Steering Committee of the Complex Care Committee of the Connecticut Medicaid Medical Assistance Program Oversight Council.  She has also been appointed by the Connecticut probate courts to represent incapacitated adults. She has also taught as an adjunct professor at Quinnipiac University Law School.   Prior to joining the Center Ms. Murphy worked for more than 20 years a a trust and estate attorney.   She is a member of the Connecticut Bar Association, serves as the Secretary of the Executive Committee of the Elder Law Section and is a member of Swift's Inn in Hartford.  Ms. Murphy earned her JD degree from the University of Connecticut School of Law and her BA from Mt. Holyoke College.  


How Well Are Accountable Care Organizations Performing? (October 26th)

For those interested in the Medicare Shared Savings Program (or ACOs), please see my Health Affairs blog post (co-authored with Greg Berger) that summarizes ACO performance year two (2014).  The essay is titled, "MSSP Year Two: Medicare ACOs Show Muted Success" and can be found at:



Is the Intensive Use of Herbicides on Genetically Modified Food Crops Endangering the Public's Health? A Conversation with Charles Benbrook (October 20th)

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Beyond numerous other benefits derived by genetically modifying foods is herbicide resistance. This allows farmers the ability to control for weed growth without killing their crop, for example, corn and soybeans.  While a foreseeable unintended consequence, the increasing or intensive use of the herbicides, specifically glyphosate, the primary ingredient in the widely used product Roundup, has caused weeds to develop resistance.   As a result glyphosate is now beginning to be used in combination with another herbicide, 2,4-D, a component of the defoliant Agent Orange, under the product name Enlist Duo.  The question begged is to what extent do these herbicides, used independently and in combination, pose a public health risk.

During this 30 minute discussion Dr. Benbrook discusses in part the evolution of the use of these herbicides, the federal governments efforts to risk assess their use, the IRAC's (International Agency for Research on Cancer) recent finding these products are probable or possible human carcinogens, the pending National Academy of Sciences' report (scheduled to be published next year) and his thoughts regarding what can be done to safeguard exposed populations.

Dr. Charles (Chuck) Benbrook, Benbrook Consulting, is a recognized expert in pest management
sytsems, pesticide use and regulation and the environmental and  public health consequences of farming system choices.  Dr. Benbrook worked in Washington, D.C. on agricultural policy issues Searchfor nearly twenty years as the agricultural staff expert on the Council for Environmental Quality, as Executive Director of the Subcommittee on Department Operations, Research and Foreign Agriculture for the House of Representatives and as the Executive Director for the Board on Agriculture at the National Academy of Sciences.   He also served for six years as Chief Scientist of the Organic Center and for three years as a Research Professor at Washington State University.  Dr. Benbrook holds a Ph.D. in agricultural economics from the University of Wisconsin at Madison, an undergraduate degree from Harvard and is the author of nearly three dozen peer-reviewed articles.        

The New England Journal of Medicine essay noted during this conversation, co-authored by Dr. Benbrook and Dr. Philip Landrigan and titled "GMOs, Herbicides and Public Health," is at:





Bundled Payment and CMS's Proposal To Mandate Bundled/Episodic Payment for Hip & Knee Surgery: A Conversation with Harold Miller (September 29th)

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Bundled or episodic health care payment for a clinically defined medical episodes of care has been used since at least the 1980s.  However, recently CMS has initiated two bundled payment demonstrations, the Bundled Payment for Care Improvement Demonstration (BPCI) that bundles care for 48 (DRG) episodes of care began in 2013 and more recently CMS proposed the Chronic Care for Joint Replacement (CCJR) demonstration this past July.   Considered the middle ground between fee for service reimbursement and capitated payment the jury is still out whether bundled payments can be designed to reduce cost growth and improve care quality and patient outcomes.      

During this 22 minute conversation, Mr. Miller addresses five aspects of bundled payment and how well or not these aspects are addressed in CMS's recent CCJR proposal to mandate bundled payment for hip and knee replacement surgeries in 75 markets nationally.  Theses aspects are: how well or not bundled payment addresses the underlying problems of fee for service reimbursement and whether bundled payments incent or not care innovation; what types of patients are best served under bundled payment arrangements; how best providers can organize to be effective and efficient under these arrangements; how well bundled payments address over-utilization; and, how episodic payments can be integrated with wider care coordination and whole person care.   

HaroldMillerHarold D. Miler is the President and CEO of the Center for Healthcare Quality and Payment Reform.  He also serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University.   From 2008 to 2013, Mr. Miller served as President and CEO of the Network for Regional Healthcare Improvement, the national association of the Regional Health Improvement Collaboratives.   From 2006 to 2010, Mr. Miller serves as the Strategic Initiatives Consultant to the Pennsylvania Governor's Office of Policy Development, Associate Dean of the Heinz School of Public Policy and Management at Carnegie Mellon, Executive Director of the PA Economy League, Director of the SW PA Growth Alliance and the President of the Allegheny Conference on Community Development.   Mr. Miller has worked in more than 30 states and metropolitan regions to help physicians, hospitals, employers, health plans, and government agencies design and implement payment and delivery system reforms.  He assisted CMS with the implementation of its Comprehensive Primary Care Initiative in 2012.  Mr. Miller also serves on the Board of Directors of the National Quality Forum.

For more on bundled payment see Mr. Miller's, "Bundling Better, How Medicare Should Pay for Comprehensive Care" published September 2015, at:


Medicare, Home Health and Value-Based Purchasing: A Conversation with Sherill Mason (September 23rd)

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This past July CMS announced a proposed demonstration that would either reduce or increase a Medicare home health agency's reimbursement based on quality performance.   With a rapidly aging and growing Medicare population home health utilization and costs have risen significantly over the past decade.  Per MedPAC, between 2000 and 2012 total Medicare home health spending increased 64 percent.  However, home health agency quality performance has been limited.  For example, again per MedPAC, less than half of all Medicare home health patients in 2013 showed improvement in medication management and only 65 percent showed improvement in pain management.    

During this 22 minute discussion Ms. Mason explains the several, if not numerous reasons, why CMS announced this demonstration, how it will work, e.g., how quality will be measured or what quality metrics will be used, what are the specific financial incentives, in what states the demo will be conducted, when it will begin and for how long, and what are some of the perceived pros and cons of the demonstration as proposed.   

Sherill Mason is currently Principal, Mason Advisers, where she provides strategic planning, Sherill-mason[1]program development and operations analysis for post acute care providers including senior living and nursing home facilities, home health, hospice, long term acute care hospitals, in patient rehabilitation facilities, and long term care pharmacy.  Previously, Sherill she served as a Vice Presient to the Marwood Group, a healthcare industry consultant, as Senior Vice President at Sunrise Senior Living and as a Director at KPMG.   Among other current professional activities Sherill currently is a Guest Lecturer at the University of Pennsylvania School of Nursing.  She received her RN diploma and training at the Englewood Hospital School Nursing and a BA in American Studies from Eckerd College.  

For information regarding CMS's proposed value-based home health demonstration go to:



The White House's July Conference on Aging: A Conversation with Anne Montgomery (August 18th)

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This past July 13th the White House convened its sixth Conference on Aging.   The meeting's purpose is to identify elder care needs over the next 10 years.  More specifically the meeting is, or is typically, held to discuss improvements to the Older Americans Act (OAA).  The OAA was  signed into law in 1965 by President Johnson and has historically enjoyed Congressional support having been amended over ten times.   This Conference, the 6th, however was held despite the fact the Congress has failed to reauthorize the OAA over the past four years.  The OAA expired in 2011 though the Congress has appropriated funding since then to continue to fund OAA programming.   Among other purposes the OAA established the federal Administration on Aging and provides moneys to state agencies on aging that in turn fund health care services including nutritional programming, social service support programs (termed Long Term Services and Supports) and employment and legal protection programs.  

During this 21 minute discussion  Ms. Montgomery discusses what issues President Obama discussed during the meeting, other or additional meeting discussion topics, what was not or insufficiently discussed, the future/near future health and social service support needs for this country's rapidly growing senior (and frail elderly) population (10,000 Americans age into Medicare every day) and what are the prospects for Congressional renewal (with adequate funding) of the OAA this fall or going into the 2nd session of Congress in 2016.    

Anne Montgomery is a Senior Policy Analyst at Altarum Institute’s Center for Elder Care and MontgomeryAdvanced Illness and is a Visiting Scholar at the National Academy of Social Insurance.  From 2007 to 2013, Ms. Montgomery served as Senior Policy Adviser for the U.S. Senate Special Committee on Aging.  She has also served as a Senior Health Policy Associate with the Alliance for Health Reform in Washington, as a Senior Analyst in public health at the U.S. Government Accountability Office and as a Legislative Aide for the House Ways & Means Health Subcommittee.   As an Atlantic Fellow in Public Policy based London in the early 2001-2002, Ms. Montgomery undertook comparative policy analysis of the role of family caregivers in the development of long-term care in the United Kingdom and the United States.  During the 1990s, she worked as a health and science journalist covering the National Institutes of Health and Congress.  Ms. Montgomery earned her MS at Columbia and her BA  at the University of Virginia.

For information about the Altarum's Center for Elder Care and Advanced Illness go to:




Tracking Implantable Medical Devices with a UDI: A Conversation with Ben Moscovitch (July 31st)

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For the past eight years the federal government has been working to create a unique medical device identification (UDI) number that would identify a medical device's manufacturer, the device's make and model, its expiration date and other information for the purposes of improving or ensuring patient safety and product improvement.   While progress has been made in establishing a UDI tracking system, we have still not implemented the use of UDIs in medical claims forms and in electronic health records (EHRs).  A UDI is particularly important since it would allow health care providers, researchers and others to track particularly implantable medical devices.   For example, annually over one million Americans receive an artificial hip or knee.  These devices can and do fail and can cause serious cognitive and neurological impairment, bone deterioration and in severe cases, amputation.  

During this 19 minute conversation Mr. Ben Moscovitch discusses the development of a UDI over the past eight years, current efforts to include a UDI data field on the medical claims form and in EHRs, why UDI adoption has not, or still not, been achieved and chances it will be achieved.    

As Officer of The Pew Charitable Trust's medical devices project, Ben Moscovitch works on federal BenMoscovitchinitiatives to enhance the data available on product performance to support medical device innovation and quality improvement.   Prior to joining Pew, Mr. Moscovitch worked on public policy communications at the National Association of Chain Drug Stores and was previously a journalist covering medical product regulation and legislation.   Mr. Moscovitch received his Master of Arts degreee from Tel Aviv University and his Bachelor's from Georgetown University.

For more on Pew's work regarding medical devices see:




"Person-Centered" Health Analytics: A Conversation with Dwight McNeill (July 14th)

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Health care analytics has typically referred to modeling insurer or payer risk or to predict patient utilization or to segment patient populations.  However, because of advances in personal or wearable medical devices, supporting software applications and the increasing use of electronic health records, individuals or patients now have the opportunity to gather their own health and medical data and information and use it to better manage their health status and/or medical needs.  This opportunity is what's become termed the democratization of health care or alternatively the emancipation of the patient.  

During this 25 minute conversation Dr. Dwight McNeill provides an overview of his recently published work, "Using Person-Centered Health Analytics to Live Longer," i.e., he unpacks four domains he identifies ("knowing me," "protecting health," "minding illness," and "managing data") that can empower, enable and equip an individual to manage their health and medical needs.  Dwight also discusses barriers to the adoption to "person-centered" analytics  and near future potential of these tools.          

Dr. Dwight McNeill is Lead Faculty for the International Institute for Analytics.  He is also President of WayPoint Health Analytics which provides consultation to organizations on health and McNeillhealthcare analytics.  During his 30-year career, he has worked in corporate settings, most recently as global leader for business analytics and optimization for the healthcare industry for IBM and previously as director of healthcare information at GTE Corporation (Verizon).  Earlier, Dwight worked for the federal Department of Health and Human Services and the Commonwealth of Massachusetts, for information companies, and in provider settings.  Dwight has published two related books on healthcare analytics in 2013: A Framework for Applying Analytics in Healthcare: What Can Be Learned from the Best Practices in Retail, Banking, Politics, and Sports; and, Analytics in Healthcare and the Life Sciences: Strategies, Implementation Methods, and Best Practices.   He has also published frequently in Health Affairs and other related journals. Dwight earned his PhD from Brandeis University in Health and Social Policy and his MPH degree from Yale University in Public Health and Epidemiology.  

For more on "Using Person-Centered Health Analytics to Live Longer" see:



"The Medical Industrial Complex": A Conversation with Rosemary Gibson (June 24th)

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With the health care industry now accounting for 18.5 percent of the nation's GDP, or a far greater percentage than any comparable nation, combined with ever continuing access, coverage (now possibly moreover the issue of under-insurance) and quality (including the frequency of patient or iatrogenic harm) health care policy students are left to wonder to what extent has health care delivery or legitimate health care delivery been compromised or even undermined by medical commerce.    

During this 27 minute conversation Ms. Gibson explains what's meant by the Eisenhower-inspired "medical industrial complex" and her use of the phrase "privatized gains and socialized losses" in this context.  She discusses the unwarranted influence of the health care industry in part by noting pharmaceutical industry behavior and the advent of so called "consumer directed health plans.  Ms. Gibson also evaluates to what extent the ACA will strike a better balance between health care and medical commerce or again the "medical industrial complex."  

Ms. Rosemary Gibson is a Senior Advisor at the non-profit Hasting Center, a research organization dedicated to addressing ethical issues in health, medicine and the environment.  Ms. Gibson is also Rosemary_gibson[1]an editor of JAMA Internal Medicine.  Previously, Ms. Gibson was a Program Officer at the Robert Wood Johnson Foundation where she addressed safety and quality issues particularly in palliative care.  Among other books Ms. Gibson is the author of Wall of Silence, The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans.  Ms. Gibson serves on numerous boards including the Consumers Union Safe Project and among others she received the Lifetime Achievement Award from the American Academy of Hospice and Palliative Medicine.  Ms. Gibson is a graduate of Georgetown University and the London School of Economics.

Information on Rosemary Gibson's book, noted during this interview (and coauthored by Janardan Prasad), The Battle Over Health Care, can be found at: