The efforts were triggered by the actions of a group of orthopedists critical of the Choosing Wisely guidelines for their specialties.
Specialist groups working with the Lown Institute, a Boston-based nonprofit that seeks to transform healthcare systems and improve the health of communities, are offering an alternative to the ABIM Foundation's Choosing Wisely campaign.
Members of the Lown Institute are producing their own lists of "dos and don'ts" based on their analyses of overuse in their fields of care. Their efforts were triggered by the actions of a group of orthopedists who are critical of the Choosing Wisely guidelines for their specialties.
The specialty councils, which make up make up Lown's "Right Care Alliance," are charged with identifying and raising awareness of problems of "overuse, underuse, and misuse in their specialties," according to the group's website.
The group's Radiology and Cardiology councils are working on papers they plan to publish in medical journals outlining the issues of overuse in their specialties, according to the group's newsletter. Another 10 councils are creating "top ten lists" in their specialties. The group plans to release the lists in early 2017.
Over the past four years, about 70 specialty groups with the Choosing Wisely campaign "have released recommendations with the intention of facilitating wise decisions about the most appropriate care based on a patients' individual situation."
The Right Care Alliance move comes after the Society for Patient Centered Orthopedics created a list of overused procedures in response to the Choosing Wisely orthopedic surgery list "which has been the target of widespread criticism for not going after some of the most obvious cases of overuse in orthopedics, such as spinal fusion," according to the newsletter.
The founding members of the Lown musculoskeletal council also belong to Society for Patient Centered Orthopedics.
"The Top Ten Lists can serve as building blocks for thinking about significant, actionable policy initiatives, such as creating the infrastructure needed for more widely available primary care" according to the Right Care Alliance's newsletter.
"Ideally, the Top Ten Lists will generate debate in the health care community and public forums."
Most of the 60 physician societies and medical specialty groups participating in the American Board of Internal Medicine Foundation's Choosing Wisely campaign to curb unnecessary tests or treatments do not list high-revenue services, according to the New England Journal of Medicine.
Fewer than 7% reported taking advantage of "take-back" programs to turn in unused pain medication to pharmacies, police departments, or the Drug Enforcement Administration for disposal.
Opioid overuse is already at a crisis level, but a compounding factor is that leftover pills aren't being disposed of properly.
Often, pills are saved for later and even shared with others, according to a study in JAMA Internal Medicine by researchers at Johns Hopkins Bloomberg School of Public Health.
The nationally representative survey of 1,032 people who had used opioids in the past year found that among those who were no longer using prescription pain relievers (592 respondents):
60.6% reported having leftover pills
61.3% of those with leftover pills said they had kept them for future use rather than disposing of them
20% reported they'd shared their medication with another person. Nearly 14% said they were likely to share their prescription painkillers with a family member in the future, and nearly 8% said they would share with a close friend
"The fact that people are sharing their leftover prescription painkillers at such high rates is a big concern," the study's senior author, Colleen L. Barry, PhD, MPP, said in a statement.
"It's fine to give a friend a Tylenol if they're having pain, but it's not fine to give your OxyContin to someone without a prescription."
Barry directs Bloomberg's Center for Mental Health and Addiction Policy Research.
Improper Pill Disposal
Researchers also found that improper storage and disposal of opioids is a problem, and nearly half or respondents said they weren't given information about either.
Nearly half of those surveyed reported receiving no information on how to safely store their medications, either to keep them away from young children who could accidentally ingest them, or to keep them from adolescents or other adults looking to get high. Fewer than 10% said they kept their opioid pain medication in a locked location.
Patients were also not given information on how to safely dispose of their medications. Fewer than 7% of people with extra pills reported taking advantage of "take-back" programs that enable patients to turn in unused pain medication to pharmacies, police departments, or the Drug Enforcement Administration for disposal.
Fewer than 10% reported throwing out leftover medication in the trash after mixing it with an inedible such as used coffee grounds, which is considered a safe method for disposing of medication.
The Johns Hopkins study comes as organizations ranging from the CDC to private insurance companies ratchet up their efforts to curb opioid use and abuse.
Cigna has set a goal to cut opioid use by 25% among its customers over three years, which would restore usage to 2006 levels.
It says it will limit the quantity of painkillers when appropriate and treat substance abuse like other chronic diseases.
A transition program aims to reduce readmissions by arranging for or providing non-clinical services for recently discharged hospital patients.
It's an idea foreign to many hospitals and health systems. But over time, they've been getting used to the fact that their responsibility for a patient's health no longer stops at the hospital's front door following an acute episode discharge.
Many are finding that to effectively prevent readmissions, they need to recognize and react to the social determinants of health.
Such a realization is behind Thursday's launch of the Safe Transitions Home program at Cedars-Sinai Medical Center in Los Angeles.
Safe Transitions is a partnership between the 886-bed academic medical center and Santa Monica, CA-based HomeHero, a nonmedical home care provider.
HomeHero focuses on patients' non-medical needs, such as transportation to and from medical appointments, medication management, safety assessments of patients' home environments, and evaluations of patients' support systems, among other variables.
The company is empowered to improve those variables in an attempt to address the issues that can cause re-hospitalization.
Cedars-Sinai believes that such services improve the health of the patient generally and specifically prevent readmissions, for which hospitals and health systems are financially penalized.
Bradley T. Rosen, MD, director of Care Transitions and Complex Medical Management at Cedars-Sinai, in a press release, calls the company "a mature team with impressive individuals on both the healthcare and tech sides," who are "thinking creatively about how best to tackle fundamental challenges in patient care."
Caregivers from HomeHero provide comprehensive assistance with activities of daily living such as personal care, housekeeping and medication management.
The Safe Transition Home program covers additional services such as transportation to and from follow-up appointments with the patient's physicians. Caregivers also conduct guided safety checks in the home, record patient health information, monitor social determinants, and deliver critical real-time data back to families and case managers in the hospital.
Reacting to the annual Trustees report on the projected financial status of the Medicare program, the president of the Healthcare Leadership Council says keeping the status quo "is not an option."
Congress must act soon and with conviction if there is any chance of heading off the projected collapse of Medicare in 2028, the president of the Healthcare Leadership Council says.
Medicare's Trustees have projected that the program will reach insolvency in 2028, two years earlier than last year's estimates, and HLC president Mary R. Grealy says that creates even greater urgency for Congress to modernize and strengthen Medicare.
The HLC is a coalition of chief executives from all disciplines within the healthcare system that works to develop policies, plans, and programs.
The release of the trustees' report drove drug stocks higher, with the Nasdaq Biotechnology Index up 2.5 percent. It had fallen in anticipation of the report. Analysts had predicted that prescription drug prices would be cut if the Independent Payment Advisory Board (IPAB) was triggered, and they were relieved when it was not.
The trustees also said that the combined Social Security and disability trust fund reserves are estimated to run out in 2034, the same projection they made last year.
Medicare spending in 2015 totaled $647.6 billion, and the program's trust fund for hospital care is still scheduled to have sufficient funding 11 years longer than the estimate given before the Affordable Care Act was passed, the trustees said.
The trustees attributed the shorter timeline to changes in estimates of income and cost. Grealy says the trustees' report should encourage change in the healthcare industry.
Action Required
"If we are to preserve the program for future generations, keeping the status quo is not an option. As Medicare Advantage and the Medicare Part D prescription drug program have demonstrated for years, consumer choice and competition can drive greater value and better patient outcomes," Grealy says.
Grealy pointed out that Congressional Budget Office projections have shown that a Medicare reform approach allowing beneficiaries to choose from competing private health plans would reduce costs to the program as well as out-of-pocket costs for beneficiaries.
"It will take time for Congress to develop and enact structural, patient-centered, consumer-driven Medicare modernization, which makes it all the more important to begin that bipartisan discussion now," she says.
The IPAB remains a concern even though the Medicare Trustees' projections did not trigger its activation in the coming year, Grealy said.
She stressed that IPAB repeal must remain a priority action for lawmakers. IPAB is potentially harmful, Grealy says, because it transfers decision-making power from elected officials to unelected appointees and would lead to harsh across-the-board cuts to payments for medical goods and services that would have a severe impact on quality and access to care.
"Although it's currently hibernating, IPAB remains a flawed, dangerous concept," she said. "Congress needs to act before this bear awakens and does serious harm to beneficiaries and the healthcare system."
More than 60 licensed medical professionals were among the suspects arrested in a series of raids across 23 states and charged with fraud in cases totaling more than $900 million in false billing.
Federal officials on Wednesday provided details on a series of sweeping nationwide raids that netted 301 people who allegedly took part in various Medicare and Medicaid schemes involving more than $900 million in false billings.
The operation is the largest in Medicare Fraud Strike Force history, both with respect to the numbers of people arrested and the value of the alleged false billings. The raids involved prosecutors in 36 federal districts and 23 state Medicaid Fraud Control Units.
More than 60 licensed professionals, including physicians and nurses, were swept up in the arrests, the Department of Justice and the Department of the Department of Health and Human Services said in a joint announcement.
"Millions of seniors depend on Medicare for essential health coverage, and our action shows that this administration remains committed to cracking down on individuals who try to defraud the program," HHS Secretary Sylvia Mathews Burwell said in a media statement.
The defendants face healthcare fraud-related crimes, including conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering, and aggravated identity theft.
The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment and prescription drugs.
More than 60 of the defendants arrested were charged with fraud related to the Medicare Part D prescription drug benefit program, which is the fastest-growing component of Medicare.
"As this takedown should make clear, healthcare fraud is not an abstract violation or benign offense. It is a serious crime," Attorney General Loretta E. Lynch said in a statement released by the department.
"The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people, many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust—between doctor and patient; between pharmacist and doctor—between taxpayer and government—and pervert them to their own ends."
The Watson Health collaborative aims to extract insights from unstructured data and other sources to address breast, lung, and other cancers; diabetes; eye health; brain disease; and heart disease.
Some academic medical centers and ambulatory radiology providers are joining forces with the healthcare imaging industry to apply IBM's Watson technology toward creating more effective imaging services and reduce the amount of unnecessary imaging.
Pulling data from EHRs, radiology and pathology reports, clinical guidelines, lab results, medical journals and other outcome studies, the Watson Health collaborative, announced Wednesday, aims to extract insights from unstructured imaging data, combined with data from other sources.
The founding academic medical centers in the effort are UC San Diego Health, Eastern Virginia Medical School, University of Miami Health System, and University of Vermont Health Network.
Other participating health systems are Baptist Health South Florida, Sentara Healthcare, and Sheridan Healthcare, a physician management group.
IBM's Watson technology uses cognitive computing to analyze vast quantities of data and provide insight to clinicians. The imaging collaborative aims to help doctors address breast, lung, and other cancers; diabetes; eye health; brain disease; and heart disease and related conditions, such as stroke.
Members of the collaborative could train Watson to detect commonly overlooked heart health conditions such as congestive heart failure or heart attack.
IBM says participants could train and score a coronary angiogram for physician review to detect early heart disease. The company is encouraging ophthalmologists in the cooperative to use Watson to help detect diabetic retinopathy and common eye diseases.
The medical imaging cooperative follows efforts by IBM to promote the use of Watson among diverse settings such as oncology and matching patients to clinical trials for a variety of disease states.
Radiology-specific participants of the collaborative are Radiology Associates of South Florida and vRad, a teleradiology company owned by the publicly-traded company Mednax.
Industry participants include Agfa HealthCare, Hologic, ifa systems AG, inoveon, Topcon, and Merge Healthcare, an IBM company.
An examination by health economists of price and quality of care aims to provide information to physicians, hospitals, and consumers about the effects of physician-hospital integration.
Hospitals and health systems are falling all over themselves to foster it in their organization. The Patient Protection and Affordable Care Act encourages it.
Everyone, it seems, believes that physician-hospital integration is a win-win in that it improves outcomes and reduces costs.
But the empirical evidence supporting the widely held view is missing.
Now, Rice University health economists say they plan to find out, launching what they call a "first-of-its-kind" study of the association between physician-hospital integration and the quality and price of healthcare.
"The project will provide valuable information to physicians, hospitals, and consumers about the effects of physician-hospital integration," said Vivian Ho, chair in health economics at Rice University's Baker Institute for Public Policy and a co-investigator of the study, in a media statement.
"In addition, analysis results could lead policymakers to modify regulations involving the formation of accountable care organizations, which were introduced into Medicare as part of the Affordable Care Act."
Ho, who is also director of the institute's Center for Health and Biosciences, a professor of economics at Rice, and professor of medicine at Baylor College of Medicine, says the type of coordinated care promised by ACOs should improve patient outcomes while slowing cost growth, but integration could also enable hospitals to raise prices.
Examining both price and quality of care is necessary to determine the implications of physician-hospital integration for consumers.
Ho and her co-investigator, Marah Short, associate director of the Center for Health and Biosciences, will conduct a before-and-after comparison of integration using data for 2008-2013 drawn from the American Hospital Association Annual Survey, the Medicare Hospital Compare database and multiple state databases that collect detailed hospital-level financial reports.
Both say the Medicare Hospital Compare database provides a novel opportunity to examine quality of care measured by timeliness and effectiveness of care for specific conditions, such as acute myocardial infarction, heart failure and stroke care, and readmission rates within 30 days of a patient being treated for such conditions.
The study is at least partially funded by the federal Agency for Healthcare Research and Quality.
Off-setting inflationary and deflationary factors will hold growth of year-over-year medical service costs flat again in 2017, according to PricewaterhouseCoopers.
A PwC report pegs growth in the cost of medical services next year at 6.5%, which is the same level of cost growth that PwC predicted for this year.
The medical cost trend report, released Tuesday, was prepared by PwC's Health Research Institute and applies to about 155 million Americans in the employer-sponsored insurance market.
Medical cost trend is defined as the forecasted annual percentage hike in the costs of treating patients. The cost trend has been moving steadily lower since 2007, with the exception of one year, 2015.
"The forces that increase health costs are being tempered by a demand for value in the New Health Economy. Compared with a period of double-digit trend growth in the last decade, flat growth may feel like a win to health industry leaders," the report says.
It identifies two primary inflationary pressures on medical service costs next year, both of which are expected to boost utilization:
Expansion of retail service locations such as urgent care centers, and
While treating patients in retail locations is driving services to less costly settings, convenience is expected to drive service utilization higher.
"Clinics could be drawing people who may have forgone care in the past, or they could be leading some to seek care in more than one place. Even if higher use of these alternative sites reduce overall spending in the future, the savings may not reduce the short-term cost of more visits."
A spike in behavioral health service utilization next year could lead to similar short-term pain and long-term gain in annual medical costs, PwC suggests.
"A raft of new efforts aimed at enforcing the Mental Health Parity and Addiction Equity Act of 2008 are under way to make it easier to get care… As these changes go into effect, they will unlock pent-up demand, inflating medical cost trend in the short term, but should also help reduce costs in the long term."
In terms of deflationary pressures, analysts identify a pair of factors expected to cut the costs of medical services next year: more aggressive efforts by pharmacy benefit managers (PBMs) to drive down drug costs, and growth of narrow provider networks.
The emergence of competition in the specialty drug market such as competing medications for treating hepatitis C is among the factors expected to help PBMs to contain spending on drugs next year, the report says.
"Pharmacy benefit managers are aggressively negotiating drug costs, in part, because their employer clients have more of an appetite for narrow formularies, and, in part due to public and political pressures to hold down drug prices. When there is competition, PBMs can win bigger rebates that act as a counterweight to higher drug spending."
Next year, employers are forecast to step up their efforts to deploy narrow provider networks as a cost-containment strategy, the report says.
3 Strategies
"As more employees push back against high cost sharing due to their inability to pay their deductibles, employers are exploring other ways to control costs, such as high performance networks that have more limited provider choices and may feature outcomes-based payments. Forty-three percent of employers are considering implementing this type of network in 2016, up from 37% the prior year."
PwC suggests three strategies for healthcare providers to respond to medical service cost trends next year: establishing partnerships with payers such as deals that generate shared savings, embracing retail clinics and telemedicine to boost convenience for patients, and collaborating with PBMs to maximize the value of drug treatments.
AMA delegates debated the merits of incentives for direct-to-consumer drug advertising, and adopted several new policies during the group's annual meeting in Chicago this month.
A proposal to eliminate a tax incentive for direct-to-consumer prescription drug ads, presented at the AMA annual meeting in Chicago this month, was ultimately rejected.
Delegates at the meeting bandied about the idea of "eliminating their marketing costs as a federal tax deduction," reports MD Magazine. But an outright ban of direct-to-consumer ads would "raise complex freedom of speech issues," the FDA says.
Although the AMA has no direct power to ban drug advertising—that power lies with the FDA—it has long been critical of prescription DTC ads, and in November, formally called for their ban.
AMA Board Chair-elect Patrice A. Harris, MD, MA, in a statement in November, said that month's "vote in support of an advertising ban reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices."
Among delegates who opposed the tax idea, was one who said he didn't think that the AMA could "impose our wishes on the IRS, it's a valid business expense…should we not allow ice cream ads, since ice cream may contribute to obesity?"
The AMA might not have to impose its wishes on the IRS, though.
In March, Senator Al Franken (D-MN), a member of the Senate Health Committee, introduced legislation to end a tax deduction that allows pharmaceutical companies to write off the money they spend on prescription drug advertising.
"As it stands now, prescription drug companies have been spending billions of advertising dollars trying to encourage Americans to buy the most expensive drugs—even when cheaper, equally effective drugs are on the market," Franken said in a statement.
"My bill would end tax breaks that encourage brand name drug advertising, and I'm going to be fighting to get it passed into law. This is just a commonsense measure to help cut down healthcare costs."
"Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate."
AMA Meeting Recap
The AMA did adopt several new policies on the final day of its annual meeting on June 15. It called for:
The pharmaceutical industry to fund a program to dispose of unwanted medications as hazardous waste
Parity laws to require private insurers to cover telemedicine-provided services comparable to that of in-person services
A warning on lawyer ads about the dangers of pharmaceuticals that patients should consult with a physician before discontinuing medication
Requiring physical therapists and other non-physicians practicing dry needling to have standards that are similar to the ones for training, certification and continuing education that exist for acupuncture
Educating consumers on the safety benefits of protective eyewear when using air guns
It also supports:
The American Board of Preventive Medicine's establishment of addiction medicine as a multispecialty-sponsored subspecialty
Legislation to remove all sales tax on feminine hygiene products. Five states no longer charge a sales tax on these products and more are considering similar legislation.
The AMA also called gun violence a "public health crisis" and "resolved to actively lobby Congress to overturn legislation that for 20 years has prohibited the Centers for Disease Control and Prevention (CDC) from researching gun violence."
The adoption of value-based reimbursement models is fast-paced and expected to dwarf the fee-for-service model by 2020, survey data shows.
Value-based reimbursement models in healthcare have graduated from the wave of the future to the tsunami of the present.
Data from the second survey commissioned by McKesson to gauge the prevalence of value-based reimbursement models among hospitals and payers nationwide was released this week at the annual conference of America's Health Insurance Plans (AHIP).
"Overall, the fast pace of change in healthcare payment continues unabated since 2014, with payers reporting they are now 58% along the continuum toward full value-based reimbursement, a sharp 10% increase since 2014. Hospitals aren't far behind at 50% along the value continuum, up 4% in the past two years," McKesson's survey report says.
Information was collected from 465 hospitals and payers.
The report shows that providers and payers are making fundamental changes to their business models to support value-based healthcare.
The vast majority of providers have either joined an accountable care organization or plan to join an ACO in the near term, the survey found. This year, 63% of hospitals are members of ACOs, which is an 18% increase over 2014, according to the survey. Among hospitals that are not participating in an ACO this year, 47% plan to join an ACO in the next five years, the survey says.
An equally large majority of payers have transformed their network management strategies to align them with value-based reimbursement, the survey found.
More than 60% of payers say they have changed their network strategies over the past two years, with 53% using tiered networks and 42% using narrow networks, the survey says.
The 2016 McKesson survey report includes several other significant trend insights:
Bundled payments are the fast-growing model of value-based reimbursement, with both hospitals and payers predicting that 17% of medical payments will be through the episode-of-care model within five years.
Readiness to adopt bundled payments is questionable at many hospitals and payers, with 40% of hospitals reporting they are ready to administer episodes of care and 52% of payers reporting they are ready.
Payers are more optimistic about the financial impact of value-based reimbursement models on their organizations. For payers, 61% of those surveyed forecast a positive financial impact. For hospitals, 41% forecast a positive financial impact.
The percentage of hospitals reporting that they are participating in tiered or narrow networks with payers increased 13% since 2014. This year, 60% of hospitals report they are in tiered or narrow networks with payers.
For hospitals and payers, improvement in patient outcomes is the most common metric to gauge the success of value-based reimbursement models. Among hospitals, 63% report tracking improvement in patient outcomes to assess the impact of value-based reimbursement models. For payers, 74% report tracking improvement in patient outcomes.
For both hospitals (77%) and payers (82%), care coordination was identified as the most important capability linked to value-based reimbursement models.
For both hospitals (56%) and payers (57%), establishing incentives for patients or health plan members were identified as the least important capability linked to value-based reimbursement models.
This year, providers say 55% of their payment models are based on fee-for-service, with the remainder of their payment models based on some form of value-based reimbursement. Providers say the share of their payment models tied to fee-for-service will decline to 39% within five years.