Congressional Budget Office,Harvard Medical School,RAND Corporation,telemedicine

Use of telemedicine for mental health in rural areas on the rise but uneven

Newly published research by Harvard Medical School and the RAND Corporation reveals a dramatic growth in the use of telemedicine for the diagnosis and treatment of mental health disorders in rural areas, but strikingly uneven distribution of services across states.

The results, published in Health Affairs, stem from analysis of telemedicine use among Medicare beneficiaries nationwide over10 years.

The study shows an average 45 percent jump per year in telemedicine visits between 2004 and 2014, among rural patients, with striking variation across states. Four states had no such visits in 2014, while in nine states, there were more than 25 telemedicine visits per 100 patients with serious mental illness.

The reasons for the dramatically uneven distribution remain unclear, but the study investigators say state laws that regulate the provision and reimbursement of telemedicine services for mental health appear to play some role.

“Our results highlight the growing importance of telemedicine in the treatment of mental health disorders in rural settings where access to mental health care is often problematic,” said study lead investigator Ateev Mehrotra, associate professor in the Department of Health Care Policy at Harvard Medical School.

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Bose Corp,FDA,hearing aids,hearing loss

Selling hearing aids over the counter could help millions of Americans

One company aims to shift views on the devices from being a sign of aging to “something that’s hip and cool,” as Congress considers a bill that would urge the FDA to allow hearing aids to be sold in drug stores.

NPR: Is it time for hearing aids to be sold over the counter?
Four out of five older Americans with hearing loss just ignore it, in part because a hearing aid is an unwelcome sign of aging. But what if hearing aids looked like stylish fashion accessories and could be bought at your local pharmacy like reading glasses? That’s the vision of Kristen “KR” Liu, who’s the director of accessibility and advocacy for Doppler Labs, a company marketing one of these devices. She thinks a hearing aid could be “something that’s hip and cool and people have multiple pairs and it’s fashionable.” (Neighmond and Greenhalgh, 4/24)

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Trump set to extend flawed ‘fix’ for VA health scandals

It was a fix that didn’t fix much — but Veterans Choice is expected to be extended anyway, with a stroke of President Donald Trump’s pen that could come as early as Wednesday.

Veterans Choice is a $10 billion response to the 2014 scandal in which Veterans Affairs health facilities altered records to hide months-long waits for care in Phoenix and elsewhere. The troubled Choice program pays for private-sector health care for veterans and was set to expire in August, but the VA and some of the program’s harshest critics in Congress have agreed to extend it, with a few changes, until January. They said that will give the VA time to propose a more comprehensive package of reforms — fixes for the fix.

Montana Democratic Sen. Jon Tester authored the extension bill, which won bipartisan support in the House and Senate this month. It will become law when Trump signs it.

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California,California Hospital Association,quality of care

California hospitals lose ground in quality of care, report card shows

Nearly half of California hospitals received a grade of C or lower for patient safety on a national report card aimed at prodding medical centers to do more to prevent injuries and deaths.

The Leapfrog Group, an employer-backed nonprofit group focused on health care quality, issued its latest scores last week. The report card is part of an effort to make consumers and employers aware of how their hospitals perform on key quality measures, so they can make better-informed health care decisions. The scores are updated twice a year, in spring and fall.

After steady improvement in recent years, California hospitals lost ground in last week’s report card. Two years ago, 37 percent of California hospitals received a C, D or F grade. That increased to 46 percent of the 271 California hospitals rated in the most recent report.

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Advanced Alternative Payment Models,APMs,MACRA,Medicare Access and CHIP Reauthorization Act,Merit-based Incentive payment system,MIPS,Stoltenberg Consulting

MACRA considerations for physicians in 2017

Joncé Smith, Vice President of Revenue Cycle Management, Stoltenberg Consulting

Written by: Joncé Smith

Entering 2017 brings a huge degree of uncertainty amid major healthcare industry changes. In particular, the Medicare Access and CHIP Reauthorization Act (MACRA) holds several options for Medicare physician payment paths as healthcare providers interpret implications and exemption possibilities.

MACRA replaces the old sustainable growth-rate (SGR) formula for physician payment, shifting focus from the fee-for-service model to value-based care. Physicians must now pick from one of two reimbursement tracks: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

To help you better understand MACRA, we’ve outlined the program’s tracks below.

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artificial intelligence

Viewpoints: Another fight on healthcare coming; Artificial intelligence in the hospital

A selection of opinions on health care from around the country.

Huffington Post: Democrats Say They Will Fight Trump Over Health Insurance Subsidies
Get ready for another big congressional fight over Obamacare. The flashpoint this time is a key funding stream for the program ― one that subsidizes insurers so they can offer low-income consumers plans with reduced out-of-pocket expenses. President Donald Trump suggested in a Wednesday Wall Street Journal interview that he and other Republicans might cut off the funds. Now Democrats are saying they’ll fight this by demanding that Congress include the money as part of a spending bill that is supposed to keep the government running past April. (Jonathan Cohn, 4/13)

The New York Times: Can Trump Take Health Care Hostage?
Three weeks have passed since the Trumpcare debacle. After eight years spent denouncing the Affordable Care Act, the G.O.P. finally found itself in a position to do what it had promised, and deliver something better. But it couldn’t. And Republicans, President Trump very much included, had nobody but themselves to blame. (Paul Krugman, 4/14)

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Massachusetts,medical prices

Massachusetts to create website to help consumers navigate tricky healthcare world

Part of the goal of the site is to get patients to shop around like they would with any other service.

Boston Globe: State Aims At Elusive Goal: An Online Guide To Health Care Prices 
After years of delay, Massachusetts is taking another crack at a job that has proven especially tough: creating a one-stop online shop to help consumers make educated choices about their health care. The state’s Center for Health Information and Analysis has hired a vendor to design and launch a user-friendly website that includes the average prices of dozens of common health care procedures, safety and quality measures for individual hospitals, and basic information about obtaining insurance and getting care. (Dayal McCluskey, 4/14)

In other news —

New Orleans Times-Picayune: How Much Will That Cost? Finding Out Medical Prices In Advance
If you’re insured, ask your provider or check the company’s website for pricing tools. Many insurers now offer them, though not all are extremely useful. Some states have terrific pricing tools, such as Minnesota and New Hampshire, but a lot of the state resources are not so great. In Ohio, for example, the prices are simply the list or “chargemaster” prices, which are the top-end rates, and thus not very useful. The National Conference of State Legislatures has a scorecard of those resources. (4/13)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. 

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Longer looks: Martin Shkreli; Howard Dean; and faulty mammogram advice

Each week, KHN’s Shefali Luthra finds interesting reads from around the Web.

The New Yorker: Martin Shkreli Is Still Talking
On a recent evening, Martin Shkreli was drinking beer at Tuttles, a bar in the Murray Hill neighborhood of Manhattan that has sticky wooden tables and sports playing on TV. He was taking a break from two activities that now consume much of his time: writing computer code for a new company he heads and meeting with his lawyers in anticipation of his upcoming criminal fraud trial. (Sheelah Kolhatkar, 4/9)

Vox: Howard Dean Was Warning People About The Opioid Crisis A Decade Ago
Certainly it’s hard to imagine the unexpected success of Bernie Sanders and Barack Obama’s campaigns without Howard Dean’s insurgent 2003-2004 presidential run. Dean inspired thousands of new youth organizers, pioneered the use of digital technologies for political campaigns, and amassed sizable funds through many modest donations. … The doctor turned popular Vermont Governor’s catchphrase was that he was from “the Democratic wing of the Democratic Party,” and he was blunt about both his own side’s and the Bush administration’s failings. (Alexander Bisley, 4/12)

New York Magazine: We Need To Talk About Frankie
Prescribing anti-psychotics to children is not uncommon. A 2015 Journal of the American Medical Association study found that in 2010, 418,000 kids under 12 were prescribed an anti-psychotic annually, which is not to say that that many children have psychotic disorders. According to a 2011 Pediatrics study of foster-care children given anti-psychotics, only a quarter were diagnosed with a psychotic disorder. More than half of them were diagnosed with ADHD. An increasing number of children receiving these drugs are toddlers. (Dyan Neary, 4/11)

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Precision Medicine

Viewpoints: ‘Precision health’ rather than ‘precision medicine’; The curious idea of guns in hospitals

A collection of public health opinions from around the country.

Fortune: Why ‘Precision Medicine’ Isn’t Precise Enough
Every time I talk with Lloyd Minor, the Dean of Stanford University School of Medicine, I come away with a sharper, fresher, more illuminated perspective on one topic or another. And such was the effect of our conversation on Thursday. This time, Dean Minor made a good case that the goal of “precision medicine” — the meme célèbre in healthcare circles today — is the wrong one. The right goal is “precision health.” (Clifton Leaf, 4/10)

The Kansas City Star: Why Do Kansas Lawmakers Think Guns In Hospitals Are A Good Idea?
Nearly 20 years ago, the Kansas Legislature had the foresight to take steps that would save what was then known as the University of Kansas Hospital from impending ruin. By allowing it to split from state control, they gave the now sprawling health care system a competitive edge. It has flourished ever since. … Today, the same political body’s lack of vision is threatening to undermine the massive institutional improvements that lawmakers’ predecessors made possible. Talk about coming full circle. The state’s senators and representatives have failed to exempt the University of Kansas Health System from a law that will allow concealed weapons to be carried in the state’s public buildings starting in July. (4/10)

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Affordable Care Act,care coordination,Centers for Medicare & Medicaid Services,CMS,Cognosante,Enrollment Broker,managed care organizations,Medicaid

Effective Medicaid consumer engagement: Thinking outside the box

Rebecca Bruno, MPM, Director of Policy and Regulatory Affairs, Cognosante

Person-centered approach

Many individuals enrolled in Medicaid also access services from other state human services agencies and community-based providers. Deploying a “whole person” approach for enrollees – supported by modern tools and one-to-one support – can increase beneficiary engagement while lowering a state’s overall costs and administrative burden.

The Medicaid landscape is changing

Since implementation of the Affordable Care Act (ACA) in January 2014, Medicaid enrollment has been steadily increasing. As of August 2016, the latest period for which data is available, more than 73 million Americans were covered by Medicaid.[i] This is approximately a 28 percent increase from the enrollment period just prior to the first Marketplace Open Enrollment period in October 2013.[ii] In addition to Medicaid’s traditional coverage of low-income families, low-income elderly individuals, and individuals with disabilities, in many states Medicaid now covers adults without dependent children. Also, more Medicaid beneficiaries in need of long-term services and supports (LTSS) are being served in home and community-based settings rather than nursing homes and institutions.

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