News & Commentary
The U.S. Preventive Services Task Force says there’s not enough evidence to recommend for or against pediatric high-cholesterol screening among asymptomatic children or teenagers. In reaching this conclusion, the USPSTF reaffirmed its recommendation statement from 2007.

Eleven private insurers wrote a letter to the Congressional Budget Office asking that their data on the effectiveness of telemedicine be included when the CBO calculates cost savings created by the technology. CMS is considering paying for telemedicine services as they relate to dialysis for end-stage renal disease, advance care planning and critical care consultations. The insurers currently can include telemedicine in Medicare Advantage plans only as a supplemental benefit.

Primary care physicians don’t practice in a vacuum, and a new report says that Medicare payments do not take into account socioeconomic factors doctors must deal with such as income, marital status, education, and ethnicity, reports AAFP. Most of this data could be collected by CMS when people apply for Medicare. The report, by the National Academies of Sciences, Engineering and Medicine, also suggests that CMS should look at patients’ neighborhoods and take into account things like transportation options, violence, and housing.

Calling out hospitals for overcharging doesn’t work, according to a study in the Journal of Health Care Finance. University of Florida researchers found that a year after U.S. hospitals being publicly taken to task for marking up prices by 1,000%, the 20 Florida hospitals on the list continued to raise prices even after the negative publicity. Hospitals can charge whatever they want, and that’s the problem, say researchers. That, and a lack of transparency and market competition.

Some daunting news for parents who’ve ever used television as a make-shift babysitter while Mom and Dad prepare dinner, pay bills, or do any number of grownup things. (Managed Care conducted a totally unscientific poll and found that that accounts for 70% 80% 85%; well, a whole bunch of parents, let’s say.) The American Academy of Pediatrics (AAP) released new guidelines on how much screen time toddlers should have. The guidelines are actually looser than the old ones, which recommended no screen time for children under 2, and two hours a day for older children.

News & Commentary
They are too often bogged down by redundancies and bureaucratic muck from beginning to end, according to a report issued jointly by the American Society of Clinical Oncology (ASCO) and the Association of American Cancer Institutes (AACI). The organizations launched the Cancer Clinical Trials Initiative as a way to break the logjam.

The expansion of Medicaid under the ACA has been celebrated in a lot of quarters because it brings care to a population that needs it badly and which too often used the emergency department (ED) as its primary care provider. Studies have shown that gaining coverage did indeed encourage beneficiaries to see the doctor more often and reduced rates of depression. Not to mention they could now afford getting care.

Blogger Britt Hermes pulls no punches in going after her former profession, reports STAT. An alternative medicine treatment, naturopathy includes the use of acupuncture, herbs, and homeopathy. Some of Hermes’s former colleagues have taken issue, and it’s a debate that factors in policy and tax dollars. Supporters of the practice staged a rally in May. Their goal? A federal pilot program that would allow Medicare to pay naturopaths for doing their thing.


There’s a battle raging in the public health arena and, unfortunately, STDs seem to be advancing. Rates of gonorrhea, syphilis, and chlamydia infections rose significantly in 2015 compared to 2014: 19% for syphilis, 13% for gonorrhea, and 6% for chlamydia, according to a new CDC study. And the total number for the three reached their highest levels ever. Factor in herpes and human papillomavirus infections, which the CDC doesn’t track, and it’s estimated that there are 110 million cases of STD in the United States, with many people having more than one.  

Thomas Reinke

Jonathan Friedlaender

Meet Jonathan Friedlaender, a cancer survivor whose 20-year-long struggle helps illustrate drug pricing’s important role in this arena.

Citing a recent analysis that says that 42% of adults don’t understand their health care choices, the leading lobbying organization for health insurance plans teamed with a consumer advocacy group to create a tool that might cut through the confusion, according to Morning Consult. AHIP and the National Consumers League launched on Tuesday.

Primary care physicians (PCPs) have been noticeably absent in the battle against opioid addiction, but the medical system seems to be discouraging better engagement, STAT reports. Most PCPs don’t have the training to deal with addiction and punt; referring patients to addiction centers or Narcotics Anonymous. That’s a shame, because PCPs are uniquely positioned to catch the problem early. In addition to lack of training (for which there are few incentives), Medicaid in many states will not pay PCPs for providing opioid addiction treatment.

Retooling Cancer Management
Ed Silverman

Caroline Pearson, Avalere Health

Perhaps with some justification. The organizations that develop these techniques do so with patients and doctors in mind, not health insurers.

Seven health plans try to discourage people with HIV from becoming members by making drugs to treat the disease either unavailable or they price the medications too high, alleges Harvard Law School’s Center for Health Law and Policy Innovation. The law school filed complaints with HHS’s Office of Civil Rights, reports Kaiser Health News. 

When weighted for enrollment, more than 68% of enrollees in 2017 will be in Medicare Advantage (MA) plans with a prescription drug benefit and that are four- or five-starred plans, according to CMS. That represents a 3-percentage point drop from 2016. In addition, 178 of the country’s 364 MA plans have been rated four- or five-star plans. Also, weighted for enrollment, over 90% of MA-PD enrollees are in contracts with ratings of 3.5 or more stars.

In its efforts to bring more transparency hospice care, CMS has released a data set that includes information on 4,025 hospice providers, over 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments. The Hospice Utilization and Payment Public Use File (PUF) will dig deeper, officials hope, to obtain information about services offered to Medicare beneficiaries. It’s all about transparency, says CMS Chief Data Officer Niall Brennan.

There’s no link between the occurrence of a full moon and an increase in bizarre mishaps and admissions in hospitals, science has proven, but many hospital personnel respond with, “Science be damned,” the Wall Street Journal reports. Researchers hoped to dismiss that myth as far back as 1996, when the American Journal of Emergency Medicine analyzed 150,999 admissions and found that a full moon did not once increase admissions.

Cover Story
Thomas Reinke
CMS’ Oncology Care Model program is bringing bundled payments to cancer care. With drug costs so high and hard to control, the 195 participating practices will have to figure out other ways to control costs if they want to beat financial benchmarks and earn bonuses.

For the most part, the effort to shift health care into being a value-based system have been a single-edged sword. Physicians have been rewarded for making benchmarks but haven’t, for the most part, been financially on the line for not performing up to snuff. That’s about to change for Medicare. CMS last Friday unveiled a complicated 2,400-page long regulation that will penalize poor performance, the New York Times reports. CMS wants half of Medicare outlays to go through alternative payment models tied to value by 2018.

The effort to create an engaged consumer has resulted in a metric in the making: patient reported outcomes, STAT reports. It springs from an assumption that the answer patients might give to what they want from their health care experience might be more complex than “to get better.” The story uses as an example the father with the bad knee who just wants to dance at his daughter’s wedding. The nationwide effort is being spearheaded by researchers at the University of Utah Health Care System, and it’s too early to determine whether it will improve clinical outcomes.