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Feds giving health centers over $260 million for facilities improvements

 

Federally Qualified Health Centers, a sector in which  Cambridge Management Group has worked intensely, provide an essential service to millions of patients, especially to the still-uninsured.  The information below from HealthcareDIVE was good news for many of them.

  • “HHS announced Wednesday a total of more than $260 million in funding granted to 290 health centers across 45 states, the District of Columbia, and Puerto Rico for building construction, expansion or renovation.
  • “The funding is intended to help health centers increase their patient capacity and bolster their provision of comprehensive primary and preventive healthcare to medically underserved communities.
  • “HHS notes that since 2009, nearly 1,400 health centers operating 9,800 service delivery sites have absorbed an additional 6 million patients to serve almost 23 million every year.

“With some rural health centers closing and the uprise in the insured, some hospitals have noted that it may be hard to deal with an uptick in admissions and HHS is noting that physical space to handle the increase is important.

“Helping health centers improve and expand their clinical space will make it possible for them to serve more than 800,000 new patients nationwide, HHS says, noting the investment builds on a previous $150 million awarded to 160 health centers for building and renovation in September 2015. ”


CMS chief’s tour d’horizon

 

Acting CMS Administrator Andy Slavitt discussed a wide range of issues at a forum in Boston this week, including new CMS payment systems, soaring drug prices and physicians overwhelmed by new regulations. As The Boston Globe noted in its coverage of Mr. Slavitt’s talk:

“The federal government has imposed numerous new healthcare regulations in recent years, prompting doctors to describe them regulations as time-consuming burdens that hamper patient care. Earlier this year, Slavitt acknowledged regulators have lost the ‘hearts and minds’ of physicians. ‘I do think it can be won back,’ he said Tuesday.


House GOP research group outlines ACA replacement

dumptruck

The research arm of House Republican conservatives have laid out a roadmap for how the GOP could structure a replacement for the Affordable Care Act, which they have long vowed to dump.

With the 2016 elections coming up, presidential candidates are under pressure to offer detailed replacement plans, which they have assiduously avoided doing so far.

The plan would rely “on conservative principles and increased state flexibility to transform our top-down healthcare system,” the Republican Study Committee (RSC) says.

The program calls for:

  • Fully repealing the ACA to try to increase competition in the marketplace and widen consumer choices.
  • Increasing access to affordable and portable healthcare with a standard  tax deduction for health insurance.
  • Improving  insurance access for low-income Americans by expanding federal support for high-risk pools.
  •  Letting citizens buy health insurance  across state lines and small businesses to pool together to negotiate better rates.
  •  Reforming medical-liability law.
  •  Investing more in developing biomedical breakthroughs .
  •  Prohibiting any funds that provide coverage  for abortions and continuing to bar federal funds that do, except in certain cases.
  • Curbing Medicaid spending by combining some programs and enacting rules to make it more difficult for able-bodied people to get coverage.

 


Despite federal policy, illegals get full healthcare in many places

 

Despite federal law barring extending Medicaid or Medicare to illegal immigrants, many local jurisdictions are providing a lot of healthcare to these people.

 

A Wall Street Journal survey of the 25 U.S. counties with the largest unauthorized immigrant populations found that 20  have programs that pay for the low-income uninsured to have visits to physicians, shots, prescription drugs, lab tests and surgeries. These include many illegal aliens.

The services usually are inexpensive or free to participants, “who must prove they live in the county but are told their immigration status doesn’t matter,” the WSJ reported.

The paper noted: “Many voters believe it is unfair to use tax dollars to help immigrants when American citizens struggle, and that doing so encourages illegal immigration. At the same time, American hospitals have long been required by law to screen and stabilize any patient, regardless of his or her ability to pay, which means taxpayers already are committed to paying for care in its most expensive setting.”

“{Local} politicians figure it is cheaper, safer and easier to give basic health services to immigrants who can’t get insurance than to treat them only in the county’s emergency rooms.”


English make progress toward more value-based payment system

 

miltonkeynes

Scenes from Milton Keynes, in  England.

The National Health Service in England  may have some  big lessons for the U.S. in adopting a value-based healthcare payment system, reports this HealthAffairs piece. Among the authors’ remarks:

“The first attempts at incentive change were relatively small scale. In 2011, payers in Milton Keynes… sought to improve substance misuse and sexual health services. They devised and developed a new form of contract to align financial incentives with system goals.

“The key elements of the new payment mechanism were that the contracts:

  • “Were multi-year as opposed to annual.
  • “Were based on capitation payments rather than fee for service.
  • “Included outcome indicators that attracted annual additional payments of up to 20 percent for improved performance. Significantly the incentivized outcomes were identified through dialogue with people who used services.

“These capitated outcome-based and incentivized contracts (also known as COBIC) quickly resulted in better coordinated services, delivered at lower cost, and produced better outcomes.

“Since 2011, this initiative has been built upon and extended elsewhere. The next wave of outcomes-based COBICs addressed problems with services for single groups of disorders, most commonly musculoskeletal services  …. As in the U.S., although not every initiative was successful, it was found that these contracts could quickly lead to better coordinated, more patient-centered care, with improved patient choice, good patient experience, and reduced costs.

“The concept is now being extended still further in both geography and ambition, with multi-year capitated outcomes-based COBICs being prepared and implemented for mental health care …, older people’s services …, and for people with long-term conditions…. One area, Somerset, has even begun to develop long-term per capita funded and outcomes-incentivized contracts for all the healthcare it buys for its whole population.

“The changes being catalyzed by these innovative approaches to payment are profound. They operationalize a value-based approach to healthcare, in which responsibility for population health is shared with providers. By placing more emphasis on achieving patient-defined outcomes, they make the whole system more patient-centric, shifting power from the providers to the people that use the system in terms not just of where and when services are provided, but what treatments and care an individual chooses to have in the first place.”

“The introduction of multi-year capitated outcome-incentivized contracts is a practical approach to operationalizing a value-based approach to care that can catalyze major change across a health economy at relative pace and scale (compared with the pace and scale of attempts at widespread transformation in the NHS’s recent past).”


Trump’s seven-point healthcare program

 

The Trump for president campaign offers a seven-part healthcare-reform program:

  1. “Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
  2. “Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
  3. “Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
  4. “Allow individuals to use Health Savings Accounts (HSAs).  {Editor’s note: These are already allowed — and used by millions.} Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
  5. “Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. (Editor’s note: Such transparency is already called for under the Affordable Care Act.} Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
  6. “Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
  7. “Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers. (Editor’s note: Many  U.S. patients now get their  prescription drugs from Canada, which are generally much cheaper than American drugs.}

 

 

 

 

 


Why are candidates ignoring healthcare?

 

This Medical Economics piece takes on why this year’s presidential candidates are paying so little attention in public to healthcare.


Healthcare lessons from India

kerala

Parasurama  commanding Varuna (the Hindu God of water) to part the seas and reveal Kerala.

This NEJM Catalyst presents four lessons from India in making healthcare more efficient.

It lists four problems and strategies to address them. (The full article, of course, gives much more elaboration. ) The authors are Mark D. Huffman, M.D., of Northwestern University’s Feinberg School of Medicine, and Padinhare P. Mohanan, M.D., director of the Department of Cardiology at the Westford-HiTech Hospital, in Thrissur, Kerala, India.

“Problem 1: High Patient Volumes”

“Strategy: Limit blood-pressure measurement to only systolic blood pressure (BP).”

“Problem 2: Unaffordable Services”

“Strategy: Post pricing information.”

“Problem 3: Limited Supply of Clinicians”

“Strategy: Use more nonphysician health workers.”

“Problem 4: Low Treatment Rates”

“Strategy: Explore fixed-dose, combination-therapy options.”

The authors conclude:

“Strategies for efficient healthcare exist in many low- and middle-income countries, often driven by necessity. Some of these strategies can be applied, to varying degrees, in high-income countries such as the United States, thereby driving improvements in efficiency without compromising quality of care. Much in medicine is done as a reflexive habit, but new ideas from other parts of the world can challenge the status quo with the goal of improving care.  What’s happening in India might give us some ideas for how to act differently.”

 


‘Teamwork on the fly’

teamwork

Photo by Clear Path International

Amy C. Edmondson writes in the Harvard Business Review about the new kinds of teams needed in today’s healthcare.
“For all the hard work to improve coordination and collaboration in healthcare, most hospitals are still organized into silos based on clinical specialties — and communication among them is uneven at best. Teams may function fairly well within silos, but coordination across them is often poor, which has potentially serious consequences for patients.”

“The solution to these problems is to shift focus from the structure to the activities of teamwork — what I call ‘teaming.’ Teaming involves fluid, collaborative, interdependent work across shifting projects and with a shifting mix of partners, often across organizational boundaries. Think of it as teamwork on the fly.”


Swiss healthcare system: Expensive and good

matterhorn

The Matterhorn.

This piece  in the New England Journal of Medicine looks at how the Swiss healthcare system combines  a strong emphasis on individual responsibility with community solidarity.

It concludes:

“Overall, the Swiss healthcare system is costly and has room for improvement, particularly in terms of accountability for the quality, appropriateness, and cost of health care services. Yet by and large, it has served the Swiss population very well. The combination of ‘liberalism,’ in the classic European sense {personal responsibility}, and solidarity — of respecting choice, autonomy, and individual responsibility while not letting anyone in need of health care suffer or die for lack of financial resources — seems to work, at least for Switzerland.”


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