Medicare changes policies in response to comparative effectiveness research

The Medicare administrator for most of New England has changed policy to approve coverage of Transcranial Magnetic Stimulation (TMS) for people suffering with treatment-resistant depression. The new policy, effective in March, reverses a November 2011 policy of non-coverage and is the first in the nation Medicare TMS coverage policy. It is estimated that 14 million Americans suffer from major depressive disorder in a year; 30 to 50% of patients who seek treatment do not respond to medication. TMS is a relatively new alternative to electroconvulsive therapy with less severe side effects for patients whose depression has not responded to medication. In December CEPAC, a public New England comparative effectiveness council of clinicians, researchers and patient advocates, met to consider evidence of the effectiveness and efficiency of TMS among other treatments. The CEPAC vote to approve TMS in December was cited by the Medicare contractor in its decision to change policy and approve coverage.

Webinar: engaging patients to lower costs and improve care

As states implement health delivery reform, many are intrigued by the promise of shared decision making. Not only is shared decision making central to patient engagement but it is also a paradigm shift in informed consent. Washington, Vermont and Maine have taken the direct step of promoting shared decision making through legislation and pilots. Several states are integrating shared decision making through standards for Medical Home or Accountable Care Organizations. Others argue that states should capitalize on their roles as purchasers and regulators to incorporate shared decision making as part of clinical practice. CMS sees shared decision making as important to achieving better care and health delivery reform. Learn more about how your state can play an active role. Join the CSG/ERC Health Policy Committee Webinar " The Promise of Shared Decision Making" February 7 at 1:00 PM EST with Ben Moulton of the Foundation for Informed Medical Decision Making.

Percent uninsured Americans up but under age 26 going down, Bronx hospital allows artists to trade art for health care

A new Gallup poll finds that 17.1% of Americans were uninsured last year, up every year since 2008 when it was 14.8%. The rates in December and July of last year were tied for the highest ever recorded by Gallup at 17.7%. The bright spot was a decline of 2.7% in the uninsured rate among Americans ages 18 to 26. Still the most likely to be uninsured at 24.5%, their rate was the only group of Americans that declined since 2008. The decrease coincided with implementation of the Affordable Care Act’s provision allowing children to age 26 to remain covered on their parents’ policies.

Lincoln Hospital in the Bronx has launched the “Lincoln Art Exchange” allowing New York City artists to barter their art for medical care. Artists are a critical component of the quality of life in a community but often are inconsistently employed and average $24,000 in annual income, making health coverage difficult. Under the program artists can earn “health credits” for providing creative services to use for doctor visits, dental care, prescriptions, emergency room visits and other care at the hospital. Artists gain approximately $40 in health care services for every hour of creative services.

Advocates protest at last week’s Exchange Board meeting

Last Thursday’s Board meeting was attended by dozens of consumer advocates protesting insurance domination of the Board’s membership and the absence of consumer voices. The advocates wore Band Aids over their mouths and stood with signs protesting the lack of even one voting consumer member; federal regulations say the majority of voting members should represent consumers and small businesses.

First HIT privacy committee meeting

The HITE-CT privacy committee held its first meeting last week. While mainly organizational, the consensus of the group was that developing a patient consent model – opt-in vs. opt-out – was foundational to our work. Most other policies flow from that decision. Efforts to limit discussion to just tracking federal privacy issues were considered but the membership agreed that it was critical to develop a consent model that respects consumer rights and provider time constraints. Concerns were raised about providers’ ability and time to accurately flag legally protected sensitive health information as required in an opt-out system, especially in small practices, and to accept liability for that process. Concerns were raised about the quality of information and consent management across practices – the pool of information is only as strong the weakest contributor. The need for extensive patient education was raised, particularly in light of HITE-CT’s plans to devote only $35,000 of the total $7 million budget to patient education. Concerns were raised about plans to upload everyone’s private information to the system, with or without permission, and plans to allow providers to over-ride even an affirmative opt-out decision by a patient to access that information against the patient’s wishes. Concerns were raised about HITE-CT’s proposed narrow definitions of security breaches, lax reporting parameters and leaving the decision about what is a breach to the providers who would have to pay the penalty. Advocates noted that the committee’s first meeting is being held seven months after the bill passed, despite numerous requests to DPH over those months. This raises concerns that consideration of the patient consent model could be further delayed until after the legislative session and that the delay could be used by opponents of consumer rights to kill any legislative remedies to protect patients. The committee decided to research other states’ policies, particularly our surrounding states and those that have recently switched from opt-out to opt-in policies, and other policies in CT. The next meeting of the committee will be Jan. 25th at 3:30 at the LOB.

Medicaid Council meeting

The news from Friday’s Medicaid Council meeting was that there was no news. Unlike previous HUSKY transitions, the shift from three capitated HMOs to only one entity, Community Health Network (CHN), running the program was uneventful. There had been concerns that many providers previously participating in the HMO networks were not enrolled in regular Medicaid, potentially compromising continuity of care. However, only a small fraction of providers were not already enrolled in Medicaid, and 82% of those chose to enroll in the new program. Less than 0.1% of all HUSKY patients had been seen in the past by a provider who is not now enrolled in Medicaid, and may have to find another provider. DSS and CHN have instituted an impressive array of reforms recommended by providers and practice managers in a recent study of barriers to provider participation including better communications, easing payment and credentialing hassles, and significantly improved provider recruitment.

Health Reform Cabinet meeting

The highlight of last week’s Health Reform Cabinet was a report by Frances Padilla of the Universal Health Care Foundation of CT, Co-Chair of the Business Plan Development Committee, outlining efforts to develop option(s) to offer quality, affordable health benefits to individuals and small businesses, possibly including a public option. The Committee is also Co-Chaired by OPM Secretary Ben Barnes and Nancy Yedlin of the Donaghue Foundation and is currently gathering and analyzing data on CT’s insurance market, competitiveness, consumer needs and other states’ models. The next meeting of the Business Plan Committee is Monday Jan. 23rd at 3pm.

Dual eligible care and payment model development committee update

Last week the Medicaid Council sub, sub-committee developing a payment and delivery model for a new Medicaid program serving dual eligible met. The committee is considering shared savings payment options in which savings from coordinating care, reducing duplication and emphasizing quality would be captured and shared with providers. The project grew from a CMS planning grant to DSS received last year. Discussions centered on options available under the Affordable Care Act, integration with other Medicaid and other payer initiatives, and getting reasonable numbers of potentially eligible people. The next meeting is Tuesday Jan. 24th at 1pm in Room 1D of the LOB.

Health Care Workforce forum

It is estimated that CT will need 9,000 more direct health care workers in the next five years. The CT Commission on Aging is sponsoring “The Direct Care Workforce: Meeting the Demand and Responding to the Needs of CT Residents” Friday Jan. 27th from 10 am to noon in Room 1D of the LOB. The forum will include a panel of experts on workforce development and long term services and supports for paid and unpaid direct care workers. The Commission will also release their Direct Care Workforce Strategic Plan at the forum. To RSVP contact coa@cga.ct.gov or call (860) 240-5200.

Legal aid suing over Medicaid delays

Yesterday New Haven Legal Assistance Association filed a federal class action lawsuit against DSS over extreme delays in processing Medicaid applications. The application for one plaintiff, a 27-year old man with a seizure disorder, has been in process for almost six months. He has provided all the information requested and was told by the Department that he is likely eligible. Delays in processing applications have been growing, from 38% overdue in September 2010 to 55% in November 2011. Due to the economic downturn, the number of Medicaid applications has also grown significantly. Delays are affecting not only initial applications, but also eligibility for people with high medical bills in the “spend down” category. Attorneys blame reductions in the number of eligibility workers at DSS. In the last ten years, the number of Medicaid enrollees has grown 52% but the total number of eligibility workers has dropped 30%. Attorneys largely blame neglect by previous Commissioners and are optimistic that the current administration will remedy the problem and avoid jeopardizing federal funds.

Upcoming health policy meetings

CT’s health policy community is making up for the holiday lull in meetings. Next week’s meetings include:

Patrick Hollander, former CFO of the MA Health Connector will speak at the Speaker’s Working Group on Small Business Health Care Monday Jan. 9th at 3pm in Room 1D of the LOB.

Also Monday, the Complex Care Model Design Group of the CT MMAPOC (formerly the Medicaid Managed Care Council) will meet to discuss payment reform models for state residents eligible for both Medicare and Medicaid at 1pm in Room 1E of the LOB.

Tuesday the SustiNet/Governor’s Health Reform Cabinet will meet from 9 to 11am also in Room 1D of the LOB. The agenda is here.

Wednesday the CT MMAPO Council’s Care Management (formerly PCCM) committee will meet from 10am to noon, thankfully in Room 2A of the LOB.

Later that day, at 12:30, the Privacy Committee of the HITE-CT Board will hold its first meeting to discuss protecting consumer privacy in electronic health record exchange and building a sustainable exchange for CT. Room TBD.

We get a day off Thursday, thankfully.

On Friday, the full CT MMAPO Council will meet from 9:30 to noon in Room 1E of the LOB.

Sen. Blumenthal’s survey finds hospital drug shortages harming care

Yesterday, Sen. Blumenthal released a survey documenting serious drug shortages at CT hospitals. The number of drug shortages grew by 76% from 2009 to 2010. Some of the drugs in short supply are used for anesthesia, pain management, treating cancer, and acute asthma attacks. Shortages have led to drug hoarding and price gouging, according to the Senator. In some cases, shortages have led to delays in care and use of less effective medications.
Ellen Andrews

CT consumers can’t get prices for health care; CT hospital costs for the same treatment vary widely

A pair of articles from CT Health I-Team highlights problems with CT’s health care market. Unlike in other states, CT consumers trying to comparison shop have difficulty finding prices for health care services. Consumers in states, like NH and ME, can go online to get prices by payer for most treatments because those states have all-payer claims databases and information is online for consumers. CT is in the earliest stages of planning such a database; fourteen states are well ahead of us.

An accompanying article highlights the wide variation in prices Medicare pays CT hospitals for the same procedure. Dempsey Hospital gets the highest rate for most procedures. For example, the cost of heart valve surgery is 39% higher at Dempsey than at Danbury Hospital (the least expensive). Yale New Haven, Bridgeport and Windom also receive high prices. Variation in cost is based on the type of hospital (teaching vs. not), regional wages, income and acuity of patients, and the number of tests and procedures provided. Cost is not based on quality of care or healthy outcomes.
Ellen Andrews