News & Commentary

There was a 17% drop in hospital-acquired conditions (HACs) between 2010 and 2014, according to data collected by the Agency for Healthcare Research and Quality. That translates into 2.1 million fewer HACs for hospital patients and about 87,000 fewer patients dying over those years.

News & Commentary
Penalties for readmission of some Medicare patients within 30 days of discharge have been applauded for driving down costs. However, a Wall Street Journal investigation last month revealed that many patients return, often for days, under observation status, which does not trigger the ACA penalties.
Legislation & Regulation
Richard Mark Kirkner

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Congress is holding hearings to probe how drug companies set their prices and proposing legislation that’s aimed at reining in spending on pharmaceuticals. Whether this leads to any meaningful reforms is anyone’s guess, especially when you take into account partisan divisions in a presidential election year.

Richard Mark Kirkner

Sabrina Corlette, Georgetown University

State and federal regulators want to make sure that patients have access to the care they need even as some health plans sold on ACA exchanges limit provider options for patients. This tough balance can be struck, and insurers can help themselves by monitoring their panels on an ongoing basis.

Viewpoint
Andrew J. Haig, MD

Not only is chronic back pain one of the most devastating and costly disorders our society faces, but doctors hate it. PCPs tire of ongoing arguments over narcotic treatment with patients who are often depressed and/or unemployed. A team approach featuring physiatrists can change the dynamic.

Managed Care Outlook

Drug spending in the U.S. will grow 34% from now until 2020, reaching $560–$590 billion, according to a study by IMS. Researchers cite the expected growth in the number of biologic treatments for diseases such as severe asthma.

News & Commentary

Sanjeev Arora, MD

Sanjeev Arora, MD, runs Project ECHO, which trains non-specialists to do the job specialists need to do in areas where there are few doctors. Arora argues that ECHO-trained clinicians, many of whom may be nurse practitioners, can supply “the same level of care as a specialist at an academic medical center.”

Robert Calandra

With new tools, beefed up benefits for providers and beneficiaries, and a capitation option in 2017, Next Generation is another small step in trying to make Medicare value-based. It’s still uncertain, however, whether Next Generation is smart and powerful enough to counteract a half-century of FFS health care.

News & Commentary

Better utilization management might be needed to help contain the costs of chronic pain treatment, according to a study in Pain Practice. The main culprit, say researchers with Pfizer, is an overuse of outpatient services driving both pharmacy and imaging costs.