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Price vows to protect people with pre-existing conditions


Republican Congressman Tom Price, M.D., President Trump’s nominee to run the U.S. Department of Health and Human Services, told the Senate Finance Committee  on Jan. 24 that he wants to ensure  that people with pre-existing conditions have access to health insurance, though he did not specify how this would work under the Trump administration’s plan to kill the Affordable Care Act.

Dr.  Price, a Georgia orthopedic surgeon, said “nobody ought to be priced out of the market for having a bad diagnosis.”

“I commit that we will not abandon individuals with preexisting illness or disease.”

One of the ACA’s most popular parts is the ban on insurers using patients’ pre-existing conditions to deny them coverage.

Report cites ACA for big drop in hospital-acquired conditions


A new federal report says that fewer patients  died because of hospital-acquired conditions after the Affordable Care Act was enacted, and hospitals saved more than $28 billion in healthcare costs during the period covered in the report as a result of the progress in combating these illnesses.

The U.S. Department of Health and Human Services credits the 21 percent decline in hospital-acquired infections in part to  the Affordable Care Act.

The report, “National Scorecard on Rates of Hospital-Acquired Conditions,” by the Agency for Healthcare Research and Quality, finds that about 125,000 fewer patients died  as a result of these conditions during 2010 to 2015. In total, hospital patients had more than 3 million fewer hospital-acquired conditions, such as adverse drug events, catheter-associated urinary-tract infections, central-line-associated bloodstream infections, pressure ulcers and surgical-site infections, during that period.

To read the report, please hit this link.

To read the FierceHealthcare analysis of it, please hit this link.

Hospitals should update Business Associate Agreements

A HIPAA privacy case involving Care New England’s Women & Infants Hospital, in Providence, shows the importance of updating Business Associate Agreements.

Late last month, the U.S. Department of Health and Human Services (HHS) announced that Care New England  had agreed to pay a $400,000 fine, and implement a corrective action plan, to settle HIPAA violations. The investigation by HHS’s Office for Civil Rights (OCR) started back on Nov. 5, 2012.

Physicians Practice reported  that HHS found “unencrypted back-up tapes containing nearly 14,000 patients’ protected health information,”  as well as other  violations.

OCR’s director, Jocelyn Samuels, said: “[t]his case illustrates the vital importance of reviewing and updating, as necessary, business associate agreements, especially in light of required revisions under the Omnibus Final Rule.”

Physicians Practice said: “Despite CNE and Woman & Infants Hospital of Rhode Island having a Business Associate Agreement (BAA) in place in March 2005, it had not been updated until Aug. 28, 2015 — nearly two-and-a-half years after the Omnibus Rule was published in the Federal Register.”

To read the Physicians Practice piece, please hit this link,

Big mental-health-reform bill is filed

Senators Bill Cassidy (R.-La.) and Chris Murphy (D.-Conn.) have proposed a bipartisan mental-health reform bill with an eight-point agenda intended to shore up the U.S.  mental-health system ( Among other measures, the bill proposes to designate an Assistant Secretary for Mental Health and Substance Use in the U.S. Department of Health and Human Services, require audits on mental- and physical-health-parity law implementation, and establish new grants for early mental-health intervention.

Of course, given the close connections among behavioral health, mental heath and “physical health” (as if the brain isn’t an organ!) such a bill, if it becomes law, could have a huge impact across the healthcare system.

Senator Murphy’s office sent us this summary of the bill:

The Cassidy-Murphy Mental Health Reform Act will do the following:

Integrate Physical and Mental Health

  • Encourages states to break down walls between physical and mental health care systems by requiring states to identify barriers to integration. States would be eligible for grants of up to $2 million for five years, prioritizing those states that have already taken action. States taking part are eligible with additional federal funds to treat low-income individuals who have chronic conditions or serious and persistent mental illness. 

Designate an Assistant Secretary for Mental Health and Substance Use

  • Elevates the issue of mental health by establishing an Assistant Secretary for Mental Health and Substance Use Disorder within the U.S. Department of Health and Human Services who will be responsible for overseeing grants and promoting best practices in early diagnosis, treatment, and rehabilitation. The Assistant Secretary will work with other federal agencies and key stakeholders to coordinate mental health services across the federal system and help them to identify and implement effective and promising models of care.

Establish New Grant Programs for Early Intervention

  • Establishes a grant program focused on intensive early intervention for children as young as 3 years of age who demonstrate significant risk factors recognized as related to mental illness in adolescence and adulthood. A second grant program supports pediatrician consultation with mental health teams, which has seen great success in states like Massachusetts and Connecticut.

Establish Interagency Serious Mental Illness Coordinating Committee

  • Establishes a Serious Mental Illness (SMI) Coordination Committee under the Assistant Secretary to ensure documentation and promotion of research and treatment related to SMI and evaluate efficiency of government programs for individuals.

Establish New National Mental Health Policy Laboratory

  • New entity will fund innovation grants that identify new and effective models of care and demonstration grants to bring effective models to scale for adults and children.

Reauthorize Successful Research & Grant Programs

  • Reauthorizes key programs like the Community Mental Health Block Grants and state-based data collection. The bill also increases funding for critical biomedical research on mental health.

Strengthen Transparency and Enforcement of Mental Health Parity

  • Requires the U.S. Department of Labor, the U.S. Department of Health and Human Services, and the U.S. Department of the Treasury to conduct audits on Mental Health Parity implementation and issue guidance on how determinations are made regarding comparability mental health services and physical health services.

Improve Mental Health Services within Medicare/Medicaid

  • Makes critical reforms to allow for patients to use mental health services and primary care services at the same location, on the same day. Repeals the current Medicaid exclusion on inpatient care for individuals between the ages of 22 and 64 if the CMS actuary certifies that it would not lead to a net increase of federal spending.


In the end, these patients must manage own care


A look at how it works when patients with multiple chronic illnesses must take charge of managing their own care:

As a Wall Street Journal article notes: “Managing those people’s health care is often difficult. Integrated health systems, such as Kaiser Permanente and Mayo Clinic, aim to ensure that treatment for one condition doesn’t interfere with care the patient is receiving for other diseases. Often, however, the responsibility of coordinating treatments falls on the patients themselves.”

Trying to avoid serious complications from taking different medications and dealing with the fact that too  often physicians of a patient with multiple chronic illnesses don’t talk with each other about the patient’s case are among the biggest challenges.

Maybe it will help that the U.S. Department of Health and Human Services (HHS) has issued a curriculum for training healthcare professionals and others in caring for patients with multiple chronic conditions.

HHS has taken other steps to help patients with multiple chronic conditions. The Centers for Medicare and Medicaid Services,  a HHS agency, now reimburse providers for time spent coordinating chronically ill patients’ care  outside of regular office visits.

Obviously, many experts hope that electronic health records will increasingly help  physicians keep track of their chronically ill patients.

One recommendation is that patients create  their own  medical records by, for example, keeping  updated lists of medicines that  they are taking  and bringing  them to all visits to physicians.



Recommended repairs for ACO’s


They write that the recent  U.S. Department of Health and Human Services announcement by that Medicare will work to accelerate the transition to new payment models was  … ”an important step in the right direction. But without significant regulatory—and perhaps legislative—changes to current models, HHS’s ambitious goals are not likely to be achieved. ”
The writers conclude:
”First, the financial model for ACO’s should offer them a greater share of their initial savings (to help fund start-up costs), provide stronger incentives to induce and maintain participation from low-cost provider organizations, and foster alignment of payment schemes across all payer types—not just in Medicare. This strategy will encourage the growth of shared-savings models and motivate high-performing healthcare systems to join the ACO programs.”The second strategy would improve patient engagement in ACOs by modifying how Medicare beneficiaries are assigned to an ACO: Beneficiaries should be given the opportunity to choose to join their ACO; for those not actively choosing, those eligible should be assigned at the beginning of the year (so that their ACO can contact them). Medicare should also test a benefit design that uses modest financial incentives to encourage patients to seek care within their ACO or from providers outside the ACO whom the ACO recommends. Simultaneously, to make such incentives possible, supplemental Medicare plans should be restricted from covering first-dollar beneficiary costs for non-ACO services.”

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