About healthcare quality and safety
‘Nudge’ letters prompt sustained drop in antibiotic prescribing: From Australia: “Comparing GP antibiotic prescribing rates to peer averages led to a 12% drop in prescribing, and the effect has now shown to be maintained a year afterwards, according to a recent update from the Federal Government’s Behavioural Economics Team (BETA).
The effect remained surprisingly strong after a year, with a 9% reduction seen – or around 190,000 fewer prescriptions.”
Safer Together: A National Action Plan to Advance Patient Safety: An IHI consensus statement. Start at least with pages 6 and 7 that summarize the areas of importance and suggested initiatives.
About the public’s health
World in Disorder. Global Preparedness Monitoring Board Annual Report 2020: From the WHO’s report on disaster preparedness. One interesting finding: “Expenditures for prevention and preparedness are measured in billions of dollars, the cost of a pandemic in trillions. It would take 500 years to spend as much on investing in preparedness as the world is losing due to COVID-19.”
Costs of COVID-19:
More than US$ 11 trillion, and counting, to fund the response. Future loss of US$ 10 trillion in earnings.
Versus: Additional US$ 5 per person annually in preparedness.
'We Had To Take Action': States In Mexico Move To Ban Junk Food Sales To Minors: “Picture this: You're 17, you walk into a corner store and grab a Coca-Cola and Doritos, but the cashier refuses to sell them to you because you're underage.
That rule is expected to soon become reality in parts of Mexico, as lawmakers in several states push legislation to keep junk food away from children, partly in response to the coronavirus pandemic.”
Cuba punches above weight with 'white coat army' during pandemic: “Nearly 40 countries across five continents have received Cuban medics during the pandemic, as the island nation - home to just over 11 million inhabitants - has once more punched far above its weight in medical diplomacy…
Not that its brigades are purely altruistic. Cuba has exported doctors on more routine missions in exchange for cash or goods in recent decades, making them its top source of hard currency.”
UK tests if COVID-19 vaccines might work better inhaled: “In a statement on Monday, researchers at Imperial College London and Oxford University said a trial involving 30 people would test vaccines developed by both institutions when participants inhale the droplets in their mouths, which would directly target their respiratory systems.”
About health insurance
CMS releases Part I of the 2022 Medicare Advantage and Part D Advance Notice: “The CY 2022 Advance Notice is being published in two parts due to requirements in the 21st Century Cures Act that mandate certain changes to Part C risk adjustment and a 60-day comment period for these changes…
For CY 2022, CMS is proposing to fully phase in the CMS-HCC model first implemented for CY 2020 (i.e., the 2020 CMS-HCC model), as required by the 21st Century Cures Act. Specifically, per the 21st Century Cures Act, the 2020 model adds variables that count conditions in the risk adjustment model (“payment conditions”) and includes for payment additional conditions for mental health, substance use disorder, and chronic kidney disease. This represents a change from the blend for 2021 of 75% of the risk score calculated using the 2020 CMS-HCC model and 25% of the risk score calculated using the older 2017 CMS-HCC model.
CMS calculates risk scores using diagnoses submitted by MA organizations and from Medicare fee-for-service (FFS) claims. Historically, CMS has used diagnoses submitted into CMS’ Risk Adjustment Processing System (RAPS) by MA organizations for the purpose of calculating risk scores for payment. In recent years, CMS began collecting encounter data from MA organizations, which also includes diagnostic information. CMS began using diagnoses from encounter data to calculate risk scores for CY 2015, and has since continued to use a blend of encounter and RAPS data-based scores through 2021, when risk scores will be calculated with 75% encounter data and 25% RAPS data.
With the proposed full phase-in of the 2020 CMS-HCC model, which is designed to calculate risk scores using diagnoses from encounter data submissions, the Part C risk score used for payment in 2022 would rely entirely on encounter data as the source of MA diagnoses.”
Chicago church pays off $19 million in medical debt for area residents: “VIVE Chicago, a nondenominational church that is one of many VIVE campuses across the country, raised $100,000 to pay off area residents' medical debt, according to an announcement shared with The Christian Post.
The church partnered with the New York-based nonprofit RIP Medical Debt, which was able to use the donation to pay off $19 million in medical debt.”
Trump administration backing off Medicaid rule that states warned would lead to cuts: “The rule was intended to overhaul the complex payment arrangements states use to raise money for their Medicaid programs — funding that is then matched by the federal government.
The administration argues some states use questionable methods of raising funds so they can leverage more money from Washington. One approach used by states consists of taxing providers that stand to benefit from more Medicaid funds flowing into the state.
But governors and state Medicaid directors argue those long-standing arrangements are both legal and necessary as states look for ways to keep up with escalating health care costs.”
Quest Analytics to Measure Adequate Access to Care for Medicare Advantage, Medicare-Medicaid and Pharmacy Plans: This article is not so much about the specific company but a reminder about the review process.
“CMS regulations stipulate that ‘Plans are required to maintain and monitor a network of appropriate providers, that is sufficient to provide adequate access to covered services to meet the needs of the population served’. This means that plans must maintain an adequate network of pharmacies and health care providers and facilities that are accurately listed in their Health Services Delivery Tables. CMS reviews every health plan that applies, MMPs [Medicare and Medicaid Plans] annually, and reviews participating plans every three years utilizing adequacy requirements (minimum number and time & distance criteria) applied to 40 specialties and facilities across five-county types based on population density. CMS uses Quest Analytics solutions to score plans against the standards and to inform them of any noncompliance issues.”
2019 Medicare Shared Savings Program [MSSP] ACO Performance: Lower Costs And Promising Results Under ‘Pathways To Success’: CMS Administrator Varma reports the summary results from the MSSP for 2019.
”In 2019, 541 ACOs in the Medicare Shared Savings Program generated $1.19 billion in total net savings to Medicare, the largest annual savings for the program to date. This is also the third year in a row that the program has achieved net program savings. Consistent with prior years, ACOs with shared savings continued to reduce post-acute care spending, along with hospitalizations and emergency department visits.
The ACOs under Pathways to Success participation options performed better than legacy track ACOs, showing net per-beneficiary savings of $169 per beneficiary compared to $106 per beneficiary for legacy track ACOs. While ACOs with more experience continued to achieve greater savings, new entrant ACOs under Pathways to Success achieved net per-beneficiary savings of $150. This is the first time ACOs new to the program had lower spending relative to their benchmarks in their first performance year. We look forward to gaining further program experience to evaluate program dynamics, benchmark incentives, and counterfactual program impacts…
ACOs (both legacy track and those in the new participation options established under Pathways to Success) that took on ‘downside risk’ or responsibility for additional costs under the program continued to outperform ACOs that did not [emphasis added], with net per beneficiary savings of $152 per beneficiary compared to $107 per beneficiary. These legacy track ACO trends informed our approach in Pathways to Success to encourage ACOs to take on downside risk sooner. And similarly, ACOs under the Pathways to Success policies that took on downside risk performed better than those that did not, achieving net per beneficiary savings of $193 per beneficiary compared to $142 per beneficiary for those that did not…
92 percent of eligible ACOs earned quality improvement reward points in 2019, with ACOs showing the greatest improvements in the patient safety and care coordination quality domain. ACOs continued to show comparable or better quality performance on measures compared to other physician group practices.”
See, also, 10 ACOs with the most shared savings in 2019.
With no legal guardrails for patients, ambulances drive surprise medical billing: The article is a good summary of the problems with relatively unregulated billing for ambulance services.
About pharma
Eli Lilly's drug cuts COVID-19 recovery time in remdesivir-combo study: “Eli Lilly and Co said on Monday its rheumatoid arthritis drug shortened the time to recovery in hospitalized COVID-19 patients when used along with Gilead Sciences Inc’s remdesivir.
The drug baricitinib, branded as Olumiant, cut the median recovery time by about a day when added to remdesivir, compared to patients treated with the antiviral alone, Lilly said…
Lilly said it plans to discuss the potential for an EAU for baricitinib with the U.S. Food and Drug Administration, based on the results from the trial, which tested more than 1,000 patients.”
Non-Prescription Fentanyl Abuse Up During Pandemic: “Abuse of non-prescription fentanyl was up during the first 2 months of the pandemic shutdown over earlier in the year and 2019, according to an analysis of Quest Diagnostics data.
As presented at the virtual PAINWeek conference, the study showed that non-prescription fentanyl abuse increased by 35% across a time spanning March 15 to May 16, 2020 (P<0.01).”
Merck & Co. pays $600 million upfront for rights to Seattle Genetics' ladiratuzumab vedotin: “Merck & Co. agreed to pay $600 million upfront as part of a deal to develop and commercialise Seattle Genetics' experimental antibody-drug conjugate (ADC) ladiratuzumab vedotin…”
MIT researchers tap liquid dopamine for easier drug delivery in the gut: Fascinating new technology that enables coating of the small intestine to enhance medication delivery.
List prices for newer diabetes drugs up to 360 times higher than older ones: The headline speaks for itself; the article has examples.
About healthcare IT
Centene and Samsung Team up to Enable Virtual Care Options for Underserved Communities: “Centene Corporation today announced it is working with Samsung Electronics America to expand access to telehealth for individuals living in rural and underserved communities. The initiative will supply providers with Samsung Galaxy A10e smartphones to disseminate to patients who would not otherwise have the ability to receive their healthcare virtually. Additionally, some providers will receive Samsung Galaxy tablets to use to conduct telehealth visits.”
Trinity Health, Texas Children's + 7 more health systems affected by Blackbaud breach: An update on the previously reported huge breach.
Industry Voices—Why digital quality measurement should become healthcare's next tech goal: A good review of the topic with examples.