Topics for Second Health Policy Brief 2015
1. ACGME Chief Sees 'Huge' Risk of Error in Proposed Assistant Physician
Licensure
Cheryl Clark, for HealthLeaders Media, July 11, 2014
http://healthleadersmedia.com/content/QUA-306297/ACGME-Chief-Sees-Huge-Risk-of-Errorin-Proposed-Assistant-Physician-Licensure##
The CEO of the Accreditation Council for Graduate Medical Education calls Missouri's move to license
assistant physicians "precedent-setting and very concerning on a number of fronts." Missouri doctors are
pushing for a new physician workforce to help solve the state's dire physician shortage.
And to put it mildly, Thomas Nasca, MD, CEO of the Accreditation Council for Graduate Medical
Education doesn't like the idea one bit. Nasca runs the organization that oversees accreditation of 9,300
U.S. residency programs in the U.S. and another 1,000 international programs that assure a steady supply
of doctors.
Endorsed by the Missouri State Medical Association, the bill was signed into law Thursday by Gov. Jay
Nixon. It sets up rules by which medical school graduates who haven't yet passed their final credentialing
exam can treat patients in primary care settings.
The new law requires these doctors to be supervised on site by a "collaborative" physician for 30 days,
after which the assistant physician could treat patients without that collaborator's presence in settings 50
mile away. These young assistant physicians will be able to prescribe Schedule III, IV, and IV drugs.
Beyond that 30-day period, the collaborative physician is required to perform chart reviews on 10% of the
assistant physician's cases every two weeks, but little else.
Here, edited for clarity, is what Nasca has to say about the assistant physician role: “So I'm very
concerned about what's going on in Missouri. What's proposed is precedent-setting, and very concerning,
on a number of fronts. The question for the public is, do we want to be in a circumstance where we are
back in the 1950s? With physicians caring for patients without accredited U.S. graduate medical
education? That's the fundamental question.”
2. Missouri Primary Care Doctors Face Substantial Medicaid Cut
http://kaiserhealthnews.org/news/missouri-primary-care-doctors-face-substantial-medicaid-cut/
By Jordan Shapiro, The St. Louis Post-Dispatch November 7, 2014
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Justin Puckett, an osteopathic physician from Kirksville, MO (and a TIPS graduate) will have a
major decision to make at the start of 2015 — whether his family medicine practice can continue
to treat Medicaid patients.
Looming over Puckett and other primary care doctors is a cut to their reimbursement rate that is
set to take effect at the end of this year, barring action from a lameduck Congress reeling from
Tuesday’s Republican electoral wave.
“We are still crossing our fingers,” he said.
Under President Barack Obama’s health care overhaul, primary care doctors across the country
were paid more for treating Medicaid patients during the last two years. But that boost is set to
expire, leaving some providers and their patients in a tough spot.
As part of an expansion of Medicaid coverage authorized under Obama’s health law, the
reimbursement rates were temporarily lifted in an effort to get more doctors to accept those
patients.
“It was imperative that the people caring for these patients be reimbursed at a rate where it didn’t
cost them money to see patients,” said Brian Bowles, the executive director of the Missouri
Association of Osteopathic Physicians and Surgeons.
About 3,200 physicians are designated as general practitioners for the Missouri Medicaid
program. It’s unclear how many providers expanded their Medicaid services because of the
higher rates. The Centers for Medicare and Medicaid Services isn’t collecting data.
But those doctors who did take on additional patients are looking for relief and making some
tough decisions.
3. Most Illinois Medicaid Patients Denied New Hepatitis C Drugs
By Wes Venteicher, Chicago Tribune November 19, 2014
Revolutionary new drugs are curing hepatitis C, halting a disease that can corrode the liver to the
point of cirrhosis, cancer and death. But state restrictions on who can get the costly drugs are
keeping them out of reach for some of the poorest patients.
Treatment with new drugs Sovaldi and Harvoni, the first reliable cures for hepatitis C, costs
more than $94,000 per patient. The high price of Sovaldi drove Illinois Medicaid’s hepatitis C
spending to $22 million for the fiscal year ending June 30, 2014, up from $6.7 million the
previous year, according to the Illinois Department of Healthcare and Family Services.
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Facing higher costs, Medicaid officials stopped paying for any but the sickest patients to get the
new drugs, drawing criticism from some liver doctors who have said the state is preventing them
from properly treating their patients.
“There’s a difference between prescribing (hepatitis C) drugs and actually being able to get these
drugs for our patients,” said Dr. Andrew Aronsohn, a liver specialist at the University of Chicago
Medical Center. “It’s becoming a very complicated issue.”
The cash-strapped state faces a growing dilemma over how to balance public health and the
spending of taxpayer dollars, as new specialty drugs emerge for hepatitis C and other sicknesses
and more people are eligible for Medicaid under the Affordable Care Act.
4. Soda Tax Succeeds In Berkeley, Fizzles In San Francisco (jumping off point to
explore the role of local, and state and federal legislators in addressing public health issues)
By Lisa Aliferis, KQED November 5, 2014
Voters in Berkeley, Calif., have passed the nation’s first soda tax with a resounding 75 percent of
the vote. The measure aims to reduce the effects of sugar consumption on health, especially
increased rates of obesity and diabetes.
Across the bay in San Francisco, however, a similar proposal failed to get the two-thirds
supermajority it needed.
More than 30 cities and states across the country have attempted but failed to enact such a tax, at
least in part because of well-funded opposition from the soda industry.
Soda bottles are displayed in a food truck’s cooler on July 2014 in San Francisco. A ballot
measure to tax soda failed in San Francisco, but a similar one passed in Berkeley, Calif. (Photo
by Justin Sullivan/Getty Images)
Berkeley’s Measure D needed only a simple majority to pass. It will levy a penny-per-ounce tax
on most sugar-sweetened beverages and is estimated to raise more than $1 million per year.
Proceeds will go to the general fund; Measure D calls for the creation of a health panel to advise
Berkeley’s City Council on appropriate health programs to receive funding.
Campaign Co-Chair Josh Daniels called Berkeley’s win a tipping point. “I think you will now
see many, many other cities and communities around the country looking at this as a genuine
public policy to address the diabetes and obesity crisis that we face,” he said.
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5. Ebola volunteers wrestle with quarantine mandates
By JENNIFER PELTZ November 8, 2014 9:28 AM
NEW YORK (AP) — Dr. Robert Fuller didn't hesitate to go to Indonesia to treat survivors of the
2004 tsunami, to Haiti to help after the 2010 earthquake or to the Philippines after a devastating
typhoon last year. But he's given up on going to West Africa to care for Ebola patients this
winter.
He could make the six-week commitment sought by his go-to aid organization, International
Medical Corps. But the possibility of a three-week quarantine afterward adds more time than he
can take away from his job heading UConn Health Center's emergency department.
"I'm very sad that I can't go, at this point," said Fuller, who's helping instead by interviewing
other prospective volunteers. Nine weeks or more "gets to be a pretty long time to think about
being away from your family and being away from your job."
As Ebola-related quarantine policies have arisen around the United States, some health workers
are reassessing whether, or how long, they can be among the hundreds that officials say are
needed to fight the outbreak.
Potential volunteers are anxious about what they might come back to, especially after seeing new
rules arise so rapidly that nurse Kaci Hickox was sequestered in a medical tent for days because
New Jersey announced new regulations the day she flew back from Sierra Leone. Others are
facing family qualms. And as the year winds down, some aid workers wonder whether they'll be
able to go home for the holidays.
Aid organizations say it's too soon to tell whether quarantine rules are significantly shrinking the
number of volunteers, but the measures are complicating an already challenging search for help
treating a disease that has killed nearly 5,000 people, including about 310 health care workers.
6. Being Mortal: Medicine and What Matters in the End
Atul Gawande, MD (October 7, 2014)
In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession:
how medicine can not only improve life but also the process of its ending.
Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from
harrowing to manageable. But in the inevitable condition of aging and death, the goals of
medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes,
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preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the
dying, checking for vital signs long after the goals of cure have become moot. Doctors,
committed to extending life, continue to carry out devastating procedures that in the end extend
suffering.
Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that
quality of life is the desired goal for patients and families. Gawande offers examples of freer,
more socially fulfilling models for assisting the infirm and dependent elderly, and he explores
the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and
dignified. Full of eye-opening research and riveting storytelling, Being Mortal asserts that
medicine can comfort and enhance our experience even to the end, providing not only a good life
but also a good end. Amazon review 11/14/14
7. Protecting Progress against Childhood Obesity — The National School
Lunch Program
N Engl J Med . Jennifer A. Woo Baidal, M.D., M.P.H., and Elsie M. Taveras, M.D., M.P.H.
(November 13, 2014).
http://www.nejm.org/doi/full/10.1056/NEJMp1409353?query=TOC
Nutrition science has advanced greatly since the inception of the National School Lunch
Program in 1946. Yet when a 2008 Institute of Medicine (IOM) committee comprising 14 childnutrition experts examined data on the content of school lunches in the United States, its
findings were stark. Children ate strikingly few fruits and vegetables, with little variety.
Potatoes accounted for one third of vegetable consumption. Intake of refined grains was high.
Almost 80% of children consumed more saturated fat than was recommended, and sodium
intake was excessive in all age groups. Children ate more than 500 excess calories from solid
fats and added sugars per day.1
In response to these findings, Congress enacted the Healthy, Hunger-Free Kids Act of 2010
(HHFKA), which called for a revision of school-nutrition standards. The updated standards
aligned school meals with the 2010 Dietary Guidelines for Americans by increasing quantities
of fruits, vegetables, and whole grains; establishing calorie ranges; and limiting trans fats and
sodium. Previous and Current Federal Requirements for Meal Components and Nutrients in
School Lunches.). The HHFKA also provided an incentive for schools to adhere to the
regulations: a much-needed increase in meal reimbursement. Implementation of the new
standards has been proceeding gradually since 2012, and we have an unprecedented opportunity
to improve the quality of meals consumed by U.S. children. Children consume almost half of
their total calories at school, and the National School Lunch Program provides low-cost or free
lunch to more than 31 million students at 92% of U.S. public and private schools.
But now, just 2 years after its implementation began, the HHFKA is at risk of being undermined
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in substantial ways. Some school officials, food-industry advocates, and the School Nutrition
Association (SNA, a professional organization that represents school-lunch programs and
whose members include food manufacturers) have raised concerns about increased food waste,
decreased school-lunch participation, difficulties in meeting whole-grain and sodium goals, and
potential for increased operating costs. In response, the House of Representatives included
waivers for school-lunch nutrition standards in its fiscal-year 2015 Agriculture Appropriations
Bill. The provision would allow schools with a 6-month net loss of revenue to opt out of
providing the healthier meals outlined by the HHFKA. A deficit of any amount from any cause
could allow schools to return to the same meals that the IOM found in 2008 to be nutritionally
lacking. The possibility of such waivers remains real: after elections this November,
appropriations bills and reauthorization of child-nutrition standards will be on the congressional
agenda, and waivers will probably be back on the table.
8. Health Care For $4: Are You Ready For Walmart To Be Your Doctor?
Dan Diamond, Forbes 8/8/14
http://www.forbes.com/sites/dandiamond/2014/08/08/health-care-for-4-walmart-unveils-newprimary-care-clinics/2/
Goodbye, doctor’s office. Hello, Walmart? Based on Walmart’s latest moves, it’s not as unlikely
as it sounds.
After years of “Will they or won’t they?” discussion, Walmart is making its long-awaited move
into delivering primary care: The retailer has quietly opened a half-dozen primary care clinics
across South Carolina and Texas, and plans to launch six more before January.
The clinics will be staffed by nurse practitioners, in a partnership with QuadMed.
Walmart watchers know that the company already has more than 100 “retail clinics” across its
stores, a strategy it’s pursued for years. So why fuss over a handful of new clinics?
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Because unlike those retail clinics — which Walmart hosts through leases with local
hospitals, resulting in mixed success — these new clinics are fully owned by the
company and branded explicitly as one-stop shops for primary care.
Because the clinics will be open longer and later than competitors: 12 hours per day
during the week and another 8-plus hours per day on weekends.
And because of the company’s size and scale: Walmart potential as a disruptive innovator
in healthcare is essentially peerless.
The company’s move comes at an ideal time to capture consumers: Millions of Americans are
getting insurance coverage through Obamacare, and seeking new, convenient sources of care.
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Walmart’s stressed that their clinics will be a low-cost alternative to traditional options: Walk-in
visits will cost just $40. And for the hundreds of thousands of Walmart employees covered by
the company health plan, well, it’s even cheaper.
“For our associates and dependents on the health plan, you can come and see a provider in the
Wal-Mart Care Clinic for $4. Four dollars!” Jennifer LaPerre, a company official, said last week.
“That is setting a new retail price in the health care industry,” she added.
9. Is There an Economic Rationale for Socialized Medicine for Veterans?
By Vivian Ho, contributor, The Hill. November 13, 2014, 06:30 am
http://thehill.com/blogs/pundits-blog/defense/223940-is-there-an-economic-rationale-forsocialized-medicine-for
Each fall, I teach an undergraduate class in health economics at Rice University. It's important to
discuss the many ways that government intervenes in the healthcare sector and measure the costs
and benefits of these interventions. Often this exercise works best with references to articles and
editorials from the media. As I was going through the collection of media pieces I saved from
last year, I came across one on socialized medicine. It was written in 2012 by Uwe Reinhardt,
who is one of the most thoughtful and well-known health economists in the country.
Reinhardt begins his piece by noting that many U.S. policymakers vigorously criticize Britain's
National Health Service, which is the epitome of socialized medicine. All United Kingdom
residents have access to healthcare services financed by taxes, healthcare facilities are
government-owned, and physicians are employees of the government. In contrast, America is the
land of free competition, where most hospitals are privately owned and physicians are not
employees of the government. The government intervenes to provide healthcare for the elderly
through Medicare and for low-income populations through Medicaid. But most Americans with
insurance are privately insured.
Then Reinhardt mentions an important instance where socialized medicine has gained a foothold
in the U.S.: the Department of Veterans Affairs (VA) health system. Care for veterans is
financed by taxpayers, and the VA facilities are owned and operated by the federal government.
Reinhardt observes that both political parties have supported this form of socialized medicine for
decades as the best health system for military veterans. Reinhardt ends his editorial with a
reference to multiple studies praising the high quality of the VA healthcare system.
Fast-forward to the present, and the VA is no longer the darling of policymakers that it was in
the past. A combination of patient and physician whistle-blowers, Government Accountability
Office reports and internal investigations have revealed long wait times, inadequate scheduling
processes and attempts by some top VA officials to hide significant deficiencies. While the VA
can point to many examples of high-quality care for veterans, there are clearly important
instances of deficient care as well.
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So what did I decide to tell my students about the VA this year? There are many other examples
in healthcare where there is a clear economic justification for government intervention. For
example, governments can levy taxes on cigarettes to compensate for the many costs that
smokers impose on nonsmokers, such as the negative health effects of secondhand smoke, or the
government can intervene to challenge hospital mergers that will give providers unfair pricing
power. However, the justification for the VA healthcare system is much less clear.
10. An Economic Framework For Preventive Care Advice
Health Affairs. Mark V. Pauly, Frank A. Sloan, Sean D. Sullivan (November 2014)
http://content.healthaffairs.org/content/33/11/2034.full.pdf
Abstract
Under the Affordable Care Act, preventive care measures, including vaccinations and screenings,
recommended by the Advisory Committee on Immunization Practices and the US Preventive
Services Task Force must be covered in full by insurance. These recommendations affect the
cost of medical care. Yet neither organization explicitly incorporates measures of efficiency or
cost-effectiveness in making its recommendations. To redress this shortcoming, we propose a
decision-making framework for these two organizations based on the principles of economic
efficiency. Our analysis suggests that routine use of a preventive service should be recommended
for full insurance coverage if the service’s cost-effectiveness exceeds a socially determined
threshold. For less cost-effective services, we suggest that information about effectiveness and
cost should be provided to consumers by physicians or government, but the choice of care and
insurance coverage for care should be made by individuals. For the least cost-effective services,
the two organizations should discourage public and private insurers from covering such services
and report their unfavorable cost-effectiveness.
11. Trends In The Black-White Life Expectancy Gap Among US States,
1990–2009
Health Affairs. Sam Harper, Richard F. MacLehose and Jay S. Kaufman (August 2014)
http://content.healthaffairs.org/content/33/8/1375.abstract
Abstract
Nationwide differences in US life expectancy trends for blacks and whites may mask
considerable differences by state that are relevant to policies aimed at reducing health
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inequalities. We calculated annual state-specific life expectancies for blacks and whites from
1990 to 2009 using age-specific mortality counts and census-based denominators. Nationally, the
black-white difference in life expectancy at birth shrank during the period by 2.7 years for males
(from 8.1 to 5.4 years) and by 1.7 years for females (from 5.5 to 3.8 years). We found
considerable variation across states in both the magnitude of the life expectancy gap
(approximately fifteen years) and the change during the past two decades (about six years).
Decomposition analysis showed that New York made the most profound contribution to reducing
the gap, but less favorable trends in a number of states, notably California and Texas, kept the
gap from shrinking further. Large state variations in the pace of change in the racial gap in life
expectancy suggest that state-specific determinants merit further investigation.
12. Too High a Price: Out-of-Pocket Health Care Costs in the United States:
Findings from the Commonwealth Fund Health Care Affordability Tracking Survey,
September–October 2014
Commonwealth Fund: Sara R. Collins, Petra W. Rasmussen, Michelle M. Doty, and Sophie
Beutel
http://www.commonwealthfund.org/~/media/files/publications/issuebrief/2014/nov/1784_collins_too_high_a_price_out_of_pocket_tb_v2.pdf
Abstract: Whether they have health insurance through an employer or buy it on their own,
Americans are paying more out-of-pocket for health care now than they did in the past decade. A
Commonwealth Fund survey fielded in the fall of 2014 asked consumers about these costs. More
than one of five 19-to-64-year-old adults who were insured all year spent 5 percent or more of
their income on out-of-pocket costs, not including premiums, and 13 percent spent 10 percent or
more. Adults with low incomes had the highest rates of steep out-of-pocket costs. About three of
five privately insured adults with low incomes and half of those with moderate incomes reported
that their deductibles are difficult to afford. Two of five adults with private insurance who had
high deductibles relative to their income said they had delayed needed care because of the
deductible.
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13. Ending SNAP Subsidies For Sugar-Sweetened Beverages Could Reduce
Obesity And Type 2 Diabetes
Health Affairs. Sanjay Basu, Hilary Kessler Seligman, Christopher Gardner, Jay Bhattacharya
(June 2014)
http://content.healthaffairs.org/content/33/6/1032.full.pdf Abstract
To reduce obesity and type 2 diabetes rates, lawmakers have proposed modifying Supplemental
Nutrition Assistance Program (SNAP) benefits to encourage healthier food choices. We
examined the impact of two proposed policies: a ban on using SNAP dollars to buy sugarsweetened beverages; and a subsidy in which for every SNAP dollar spent on fruit and
vegetables, thirty cents is credited back to participants’ SNAP benefit cards. We used nationally
representative data and models describing obesity, type 2 diabetes, and determinants of food
consumption among a sample of over 19,000 SNAP participants. We found that a ban on SNAP
purchases of sugar-sweetened beverages would be expected to significantly reduce obesity
prevalence and type 2 diabetes incidence, particularly among adults ages 18–65 and some racial
and ethnic minorities. The subsidy policy would not be expected to have a significant effect on
obesity and type 2 diabetes, given available data. Such a subsidy could, however, more than
double the proportion of SNAP participants who meet federal vegetable and fruit consumption
guidelines.
14. Health Care Transparency: Actions Needed to Improve Cost and Quality
Information for Consumers
Government Accountability Office: GAO-15-11: Published: Oct 20, 2014. Publicly Released:
Nov 18, 2014.
Report Highlights: http://www.gao.gov/assets/670/666571.pdf
Full report: http://www.gao.gov/assets/670/666572.pdf
Why GAO Did This Study
The cost and quality of health care services can vary significantly, with high cost not necessarily
indicating high quality. As consumers pay for a growing proportion of their care, they have an
increased need for cost and quality information before they receive care, so they can plan and
make informed decisions. Transparency tools can provide such information to consumers and
others.
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What GAO Found
Results obtained from two selected private consumer transparency tools GAO reviewed—
websites with health cost or quality information comparing different health care providers—
show that some providers are paid thousands of dollars more than others for the same service in
the same geographic area, regardless of the quality of such services. For example, the cost for
maternity care at selected acute care hospitals in Boston, all of which rated highly on several
quality indicators, ranged between $6,834 and $21,554 in July 2014.
The Centers for Medicare & Medicaid Services (CMS) operates five transparency tools—
Nursing Home Compare, Dialysis Facility Compare, Home Health Compare, Hospital Compare
and Physician Compare—that are limited in their provision of relevant and understandable cost
and quality information for consumers. In particular, GAO found that the tools lack relevant
information on cost and provide limited information on key differences in quality of care, which
hinders consumers' ability to make meaningful distinctions among providers based on their
performance. Because none of the tools contain information on patients' out-of-pocket costs, they
do not allow consumers to combine cost and quality information to assess the value of health
care services or anticipate the cost of such services in advance. Additionally, GAO found
substantial limitations in how the CMS tools present information, such as, in general, not using
clear language and symbols, not summarizing and organizing information to highlight patterns,
and not enabling consumers to customize how information is presented.
CMS, part of the Department of Health and Human Services (HHS), has taken some steps to
expand access to cost and quality information for consumers, but has not established procedures
or metrics to ensure the information it collects and reports meets consumer needs.
15.
Health-Related Options for Reducing the Deficit: 2014 to 2023
Congressional Budget Office Report
December 5, 2013
Full report: https://www.cbo.gov/sites/default/files/44906-HealthOptions.pdf
44906-HealthOptions.pdf
Read Complete Document (pdf, 1001.74 KB)
This document is a reprint of Chapter 5 of Congressional Budget Office, Options for Reducing
the Deficit: 2014 to 2023 (November 2013).
Most of the 16 options (PICK ONE) in this report would either decrease federal spending on
health programs or increase revenues (or equivalently, reduce tax expenditures) as a result of
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changes in tax provisions related to health care. Some options would result in a reallocation of
health care spending—from the federal government to businesses, households, or state
governments, for example—and most would give parties other than the federal government
stronger incentives to control costs while exposing them to more financial risk.
Eleven of the options are similar in scope to those in CBO’s previous volumes of budget options.
For each of those options, the text provides background information, describes the possible
policy change or changes, presents the estimated effects on spending or revenues, and
summarizes arguments for and against the changes. The other five options—Options 1, 6, 7, 10,
and 15—address broad approaches to changing federal health care policy, all of which would
offer lawmakers a variety of alternative ways to alter current law.
16. This Is How the New GOP Senate Will Try to Dismantle Obamacare
The New Republic. Jonathan Cohn. November 4, 2014
http://www.newrepublic.com/article/120125/republican-plans-obamacare-device-tax-mandates-riskcorridors
Most Republicans know that they can’t repeal Obamacare anymore. Mitch McConnell has said
as much and even Ted Cruz seems to get it, although he won’t quite admit repeal is a lost cause.
That’s why both have spoken about attacking the Affordable Care Act, piece by piece. They’ll
start with a symbolic vote for outright repeal. From there, Cruz says, Republicans will go after
Obamacare provisions “one at a time.”
Several of the ideas have potential to attract some Democratic votes, perhaps enough to clear the
filibuster and end up on the president's desk. But most of the ideas under discussion would also
have negative side effects, like raising the deficit or blatantly helping well-connected lobbying
groups. That would give the White House a legitimate reason to veto the measures.
Here’s what the GOP has in mind, based on conversations with health care experts and lobbyists:
Repealing the individual mandate
Repealing or modifying the employer mandate
Eliminating “risk corridors”
Repealing the device tax
Abolishing the Independent Payment Advisory Board (IPAB)
Introducing “Copper Plans”
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17. A Fresh Start for Health Care Reform
The Heritage Foundation. By Edmund F. Haislmaier, Robert E. Moffit, Ph.D., Nina
Owcharenko and Alyene Senger (October 30, 2014)
http://www.heritage.org/research/reports/2014/10/a-fresh-start-for-health-care-reform
Abstract
The need for health care reform has never been questioned by health care policy analysts on
either side of the political spectrum. Furthermore, the broad goals of controlling costs,
improving quality, and expanding access are widely shared. Yet, while both sides agree that
reform is necessary, the policy solutions differ dramatically, most importantly on the question of
who controls the key decisions in health care. During the public campaign in support of
President Obama’s health plan, the President made numerous promises to the American people
about the law’s effect on everyday Americans. Four years into its implementation, it is growing
ever apparent that these promises have all but vanished. Four Heritage Foundation health policy
experts detail the five main promises that President Obama broke, and present a fresh way for
sustainable and patient-centered, market-based health care reform.
Better Solutions. Those who reject the notion of increasing government control in health care
can pursue an alternative path—a path based on the principles of patient-centered, market-based
health care reforms. That alternative path not only gives individuals greater choice, but also
empowers them to make their own health care decisions.
For the Obama Administration and defenders of the PPACA, the common conviction is that for
major issues in health care, government officials should be the key decision makers. . .
In contrast, those who believe in a patient-centered, market-based approach to reform trust
individuals, not the government, to be the key decision makers in the financing of health care. To
achieve this goal, Congress should embark on a reform agenda that is grounded in the following
policy cornerstones: (PICK ONE) (1) reforming the tax treatment of health insurance so that
individuals choose the health care coverage that best fits their needs (not the government’s
dictates); (2) restoring commonsense regulation of health insurance by devolving it back to the
states; and modernizing (3) Medicare and (4) Medicaid by adopting policies that harness the
powerful free-market forces of choice and competition.
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18. A Vision for Using Digital Health Technologies to Empower Consumers
and Transform the U.S. Health Care System
Commonwealth Fund. Sarah Klein, Martha Hostetter, and Douglas McCarthy (October 2014)
http://www.commonwealthfund.org/publications/fund-reports/2014/oct/vision-digital-health-tech
Executive Summary
Unlike other sectors of the economy, the health care industry has yet to realize the potential of
digital technologies. These tools, which allow for the rapid exchange of text, images, and data,
have transformed the retail and travel industries by allowing companies to discover customers’
unique needs and preferences and leverage that information to deliver products and services in
new and more convenient ways.
The health care industry now has the opportunity to catch up, using tools ranging from
smartphones and tablet computers to remote sensors and monitoring devices to deliver care,
information, and support to patients where and when they need it. These technologies also can
play a key role in closing communication gaps between providers and patients and in forging
new relationships among providers and their peers.
Leading health care organizations have made inroads. Some are using cloud-based platforms to
create a connective web among providers, while others are using smartphone technology and
remote monitoring devices to detect changes in patients’ conditions and offer real-time feedback.
We expect some of the most transformational breakthroughs to result from combinations of
innovations. This is because to have a broad impact, care delivery innovations must accomplish
many things, including simplifying complex business and clinical models, engaging consumers,
and introducing new payment models to change systems and behaviors. By pursuing these goals
simultaneously, we may be able to achieve the triple aim of reducing costs and enhancing
outcomes and experiences for patients on a system-wide rather than individual basis.
19. Elizabeth Warren’s Bill to Refinance Student Loans Dies in the Senate.
Now what?
The Washington Post. By Danielle Douglas-Gabriel (June 11, 2014)
http://www.washingtonpost.com/blogs/wonkblog/wp/2014/06/11/elizabeth-warrens-bill-torefinance-student-loans-dies-in-senate-now-what/
Millions of Americans saddled with high interest on their student loans just lost a chance to have
the rate lowered as Senate Republicans shot down on Wednesday legislation that would have let
borrowers refinance their debt. But the fight ain't over.
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"We're not giving up," Sen. Elizabeth Warren (D-Mass.), who championed the Bank on Students
Emergency Loan Refinancing Act, said at a press conference Wednesday. "Homeowners are
refinancing. Small businesses are refinancing. We just want young people who got an education
to have their shot."
Warren failed to get the 60 votes needed to advance the legislation on Wednesday, with a 56-38
vote on the Senate floor. The bill would have let people with federal and private loans issued
prior to 2010 refinance at 3.86 percent--the interest rate that Congress set for federal student
loans a year ago.
Despite the public outcry against mounting student debt, Warren's bill was a long shot.
Republicans said the bill did nothing to reduce borrowing or lower education costs. They cast the
legislation as a thinly veiled attempt by Democrats to burnish their populist credibility in an
election year.
20. Legal Hurdles May Stall Telehealth’s Role in Work Force Crisis
Urology Times. By Ross E. Weber (February 12, 2014)
http://urologytimes.modernmedicine.com/urology-times/content/tags/aacu/legal-hurdles-maystall-telehealth-s-role-work-force-crisis
As thousands of baby boomers age into Medicare every day and millions of newly insured
Americans seek health care, analysts point to expanded utilization of telehealth services as one
way to alleviate physician shortages and ensure access to care. Because lawmakers and insurers
failed to update professional licensing and reimbursement standards as technology made remote
health care delivery possible, the health system is not prepared for such a transition. Policy
makers and private payers are therefore scrambling to incentivize provider and patient
participation in telehealth programs.
According to the National Conference of State Legislatures, Medicaid programs in 43 states and
the District of Columbia reimburse certain telehealth services. Commercial plans are required to
offer similar coverage in 19 states, with another 15 legislatures considering telehealth payment
parity insurance mandates in 2014.
These seemingly positive facts notwithstanding, most states have not fully integrated telehealth
into their health care delivery system. Remote providers’ appeals for relaxed licensure
procedures and fees are generally met with fierce resistance from in-state providers. The
American Telemedicine Association (ATA) estimates that physicians pay $300 million per year
to obtain additional licenses for telemedicine. Exceptions are made in a few states, but according
to the ATA, they are neither broad nor consistently defined.
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For example, while every state allows remote post-surgical consultations, each defines
consultation differently and some require that such visits be provided free of charge. Similarly,
some states authorize reimbursement for telehealth services only if the doctor-patient
relationship was established face to face.
Neal Neuberger, executive director of the Institute for e-Health Policy at the Healthcare
Information and Management Systems Society, summed up telehealth advocates’ frustration
during a September 2013 Alliance for Health Reform Briefing, saying licensure requirements
have “nothing to do with science, technology, or health and has everything to do with state
business practices.”
21. The Impact of the Coverage Gap in States not Expanding Medicaid by
Race and Ethnicity
Kaiser Family Foundation Dec 17, 2013 http://kff.org/disparities-policy/issue-brief/the-impactof-the-coverage-gap-in-states-not-expanding-medicaid-by-race-and-ethnicity/
SUMMARY
One of the major vehicles in the Affordable Care Act (ACA) to increase health insurance
coverage is an expansion of Medicaid to adults with incomes at or below 138% of the federal
poverty level (FPL). While this expansion was intended to occur nationwide, it was effectively
made a state option by the Supreme Court decision on the ACA. In states that do not expand
Medicaid, many poor uninsured adults will not gain a new coverage option and will likely
remain uninsured. This brief examines the impact of this coverage gap by race and ethnicity. In
sum it finds:
• Today, there are significant racial and ethnic disparities in health coverage among adults.
Overall, among adults, people of color are more likely to be uninsured than Whites (27% vs.
15%), with Hispanics at the highest risk of lacking coverage (33%).
• Given these high uninsured rates, the Medicaid expansion offers a particularly important
opportunity to increase health coverage among people of color. Overall, more than half (53%) of
uninsured adult people of color have incomes at or below the Medicaid expansion limit.
• However, in states that do not expand Medicaid, millions of poor adults will be left without a
new coverage option, particularly poor uninsured Black adults residing in the South, where most
states are not moving forward with the expansion. Four in ten uninsured Blacks with incomes
low enough to qualify for the Medicaid expansion fall into the gap, compared to 24% of
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uninsured Hispanics and 29% of uninsured Whites. These continued coverage gaps will likely
lead to widening racial and ethnic as well as geographic disparities in coverage and access.
22. More Students Going to Medical School than Ever Before: Enrollment
Increases Urgency to Lift Federal Cap on Residency Training Positions
https://www.aamc.org/newsroom/newsreleases/411636/10282014.html and
GME Funding: How to Fix the Doctor Shortage
https://www.aamc.org/newsroom/keyissues/physician_workforce/
AAMC. Washington, D.C., October 29, 2014—The number of students who enrolled in the
nation’s medical schools for the first time in 2014 has reached a new high, totaling 20,343,
according to data released today by the AAMC (Association of American Medical Colleges).
The total number of applicants to medical school also rose by 3.1 percent, to a record 49,480.
First-time applicants—an important indicator of interest in medicine—increased by 2.7
percent to 36,697.
“In spite of the ongoing partisan debate around the nation’s health care system, it is gratifying
to see that increasing numbers of students want to become physicians. However, these results
show that our nation must act without delay to ensure an adequate number of residency
training positions for these aspiring doctors so they will be able to care for our growing and
aging population,” said AAMC President and CEO Darrell G. Kirch, M.D. “As we face a
worsening shortage of both primary and specialty physicians over the next two decades,
Congress must increase federal support for residency training by lifting the 17-year-old cap on
residency training positions imposed under the Balanced Budget Act.”
23. ACGME: Single Accreditation System for AOA Approved Programs
Program and Institutional Accreditation/ Requirements Submitted for Review and
Comments
The ACGME invites comments from the community of interest regarding the proposed
requirements listed below. As specified in the ACGME Manual of Policies and Procedures, the
following groups constitute the ACGME community of interest:


Member organizations of the ACGME
Appointing organizations of the Review Committee/Recognition Committee
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


Designated institutional officials
Review Committee Chairs and Executive Directors
Program directors in the specialty
At the discretion of the Review Committee, additional specialty organizations may be invited to
comment.
For specialty/subspecialty requirements, Review Committees are not permitted to alter Common
Program Requirement language, which appears in bold font. Therefore, comments are invited
only on requirements NOT in bold font.
Requirements for Osteopathic Recognition:
https://www.acgme.org/acgmeweb/Portals/0/PDFs/osteopathic-principles.pdf
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