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3 posts from September 2019


Catalyst for Payment Reform's Suzanne Delbanco Discusses State Health Care Innovation (September 23rd)

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Largely with the exception of the 2010 passage of the ACA, federal legislative (and regulatory) efforts to reform health care over the past few decades has lagged.   This is the result of an increasingly dysfunctional Congress.  For example, Congressional productivity, measured by the number of enacted laws, has decreased every decade since 1990 by over 20 percent.  For this reason and because states are required to balance their annual budgets (with the exception of Vermont and possibly North Dakota and Wyoming as well), health care policy innovation has shifted substantially to the states.  For example, the 2019 legislative session resulted in 29 states passing Medicaid-related legislation, 13 states passing health insurance legislation and 10 states passing health care assignment and billing legislation. 

During this 24 minute conversation, Dr. Delbanco begins by briefly explaining the Catalyst for Payment Reform's mission and members.  She moreover discusses state policy reforms related to data (i.e., All Payer Claims Databases) and price transparency, efforts to improve state market competition, delivery and payment reforms, for example, reference pricing or benchmarking to Medicare reimbursement and she identifies states that are particularly noteworthy in their efforts to improve care delivery and lower spending growth.

Dr. Suzanne F. Delbanco is the Executive Director of Catalyst for Payment Reform (CPR), an independent, non-profit corporation working to catalyze employers, public purchasers Delbanco-headshot-200x200and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace.  In addition to her duties at CPR, Suzanne serves on the advisory board of the Blue Cross Blue Shield Institute.  Previously, Suzanne was the founding CEO of The Leapfrog Group.  Suzanne holds a Ph.D. in Public Policy from the Goldman School of Public Policy and a M.P.H. from the School of Public Health at the University of California, Berkeley. 

For information on CPR go to: https://www.catalyze.org/

Dr. Delbanco (and colleagues') recently published article, "The State of State Legislation Addressing Health Care Costs and Quality," is at: https://www.healthaffairs.org/do/10.1377/hblog20190820.483741/full/.

Per Dr. Delbanco's reference to The Source, U. of CA Hastings College of Law's recently posted online database of state laws impacting health care cost and quality, go to: https://sourceonhealthcare.org/legislation/


Harvard's Michael Chernew Discusses the Administration's Hospital Price Transparency Efforts (September 12th)

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In CMS' proposed hospital outpatient rule published in the Federal Register in early August, the agency proposed requiring hospitals to make public a list of its negotiated rates for common items and services.   The proposed rule is based on two White House executive orders and is an expansion of a related regulatory rule that went into effect this past January 1st that requires hospitals to make publicly available a list of current standard hospital charges (on their so called chargemaster list).  Despite the administration's enthusiasm for price transparency (and state's - approximately half have passed price transparency legislation) the evidence to date demonstrates that price transparency has not led to or enabled patients to lower their out of pocket costs, lower health care prices, improve market competition creating greater care value.   

During this 24 minute conversation Professor Michael Chernew begins by discussing related anti-trust enforcement.  He moreover discusses his research findings concerning price transparency, alternative practices providers have or can exhibit that have demonstrated success in lowering patient out of pocket spending and potential unintended negative consequences, e.g., hospitals may demonstrate less willingness to make price concessions for fear of having to extent them to all payers, should CMS' rule go final as proposed in November. 

Professor Michael Chernew is the Leonard D. Schaeffer Professor of Health Care Policy and the director of the Healthcare Markets and Regulation (HMR) Lab in the Department of ChernewHealth Care Policy at Harvard Medical School.  Professor Chernew is a member of the Congressional Budget Office’s Panel of Health Advisors and of the Institute of Medicine’s Committee on National Statistics (CNSTAT).  He is also a research associate at the National Bureau of Economic Research.  In 2011, he served on the Institute of Medicine’s Committee on Determination of Essential Health Benefits and in 2010 was elected to the Institute of Medicine of the National Academy of Sciences.  Prof. Chernew is the former Vice Chair of the Medicare Payment Advisory Commission (MedPAC).  In April 2015, Massachusetts Governor Charlie Baker appointed Professor Chernew to the Massachusetts Health Connector Board of Directors.  Dr. Chernew is currently a co-editor of the American Journal of Managed Care and editor of the Journal of Health Economics.  He is a former senior associate editor of Health Services Research.  Professor Chernew earned his undergraduate degree from the University of Pennsylvania and his PhD in economics from Stanford University.

The White House's related, "Reforming America's Health System" paper is at: https://www.hhs.gov/sites/default/files/Reforming-Americas-Healthcare-System-Through-Choice-and-Competition.pdf
CMS' current proposed rule discussing expanding hospital price transparency regulations is at: https://www.govinfo.gov/content/pkg/FR-2019-08-09/pdf/2019-16107.pdf . See pages 39571, ff. 

The summary of Prof. Chernew, et al. April 2018 New England Journal of Medicine price transparency research article noted during this podcast is at: https://newsatjama.jama.com/2019/08/22/jama-forum-price-transparency-in-health-care-has-been-disappointing-but-it-doesnt-have-to-be/ 


Dr. Lewis Cohen Discusses His Just-Published Book, "A Dignified Ending, Taking Control Over How We Die" (August 29th)

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Medical aid in dying is now legal in nine states and the District of Columbia or is available to approximately one-fifth of the US population.  State medical societies allow physicians to provide treatment that comports with their conscience, survey data shows the practice enjoys substantial public support and the option is available in numerous foreign countries including the Netherlands where it is available to children with their parents' consent.  Nevertheless, the practice remains controversial.  Listeners may be aware I've discussed end of life care during several previous podcasts dating back to June 2013 when I discussed advanced care directives with the American Bar Association's Charlie Sabatino.  

During this 35 minute discussion, Dr. Cohen begins our discussion by explaining how suicide became defined as a mental illness and life insurance coverage in instances where aid in dying has been exploited.  the problems associated with medical aid in dying for patients with disabilities and those suffering with Alzheimer's or related cognitive impairments and whether aid in dying should be restricted to the terminally ill.  He discusses several case histories including the aid in dying deaths of Admiral Chester J. and Joan Nimitz, Jack Kevorkian's work and efforts by the Hemlock Society, Caring Friends and the Final Exit Network.  

Dr. Lewis Cohen is a Professor of Psychiatry at the University of Massachusetts-Baystate School of Medicine, and an Adjunct Professor of Psychiatry at the Tufts University School of Cohen-lewis-1679597439
Medicine.  He is the recipient of a Guggenheim Fellowship for Medicine and Health, two Rockefeller Foundation Bellagio Residency awards, and a Bogliasco Fellowship for the Arts and Humanity, as well as the Eleanor and Thomas Hackett Award from the Academy of Consultation-Liaison Psychiatry.  He is the author or co-editor of several previously published books, including No Good Deed.  Dr. Cohen earned his MD at the State University of New York Upstate Medical University and is board certified by the American Board of Psychiatry and Neurology.

For more information on A Dignified Ending go to: https://rowman.com/ISBN/9781538115749/A-Dignified-Ending-Taking-Control-Over-How-We-Die.

For information on Compassion and Choices and Final Exit Network (successor organizations to the Hemlock Society) go to: https://compassionandchoices.org/ and http://www.finalexitnetwork.org/.