Welcome to the Falling Leaves edition of the Health Wonk Review! Grab your pumpkin-flavored whatever and pull up a chair – we’ve got lots of good stuff from the health wonks this week. The election is coming – don’t forget to vote! – and so is open enrollment, so there’s lots to talk about when it comes to the ongoing story of Obamacare. And of course Ebola is on a lot of minds lately too. But there’s also plenty of other interesting stuff going on in the world of health policy, and we’ve got a little something for everyone here. Enjoy!
Healthcare reform
We’re starting things off with a post from Charles Gaba, writing at HealthInsurance.org. A lot of you probably already know Charles from his ACA Signups site. It’s been a go-to resource for me all year long, and I know others rely on it too as a great place to find all sorts of enrollment updates – and lots of other stuff – all in one place. Now, writing at HealthInsurance.org, Charles brings us The human face of a health reform debate and it’s a great reminder of how important Medicaid expansion is (there are still 23 states that have not expanded Medicaid) and what a difference the “affordable” part of the Affordable Care Act makes in people’s lives. There’s also a link in there to his outstanding transcript of Mitch McConnell’s ACA commentary… complete with all of the lies highlighted in yellow. Some are absurd, but some could easily be missed by people who aren’t well-versed in the nuances of healthcare reform. Luckily for all of us, Charles highlighted them all so they’re easy to spot.
Joe Paduda of Managed Care Matters tackles the elephant in the room now that our uninsured rate is finally starting to decline: Are all these newly-insured people clogging up our medical system? Opponents of the ACA have sometimes 
thrown around the perplexing argument that getting the whole population insured would just lead to delays and limit access to care (implying that it’s fine for tens of millions of people to have no realistic access to care at all, in order for the rest of us to not experience hypothetical delays?) Joe’s got good news though. It looks like even though millions of people are newly-insured, the spike in demand for healthcare is relatively short-lived after people get health insurance. They get treatment for the issues that have been building up while they were uninsured, and then for most of them – all but the chronically ill – their utilization drops back down. In short, the “clogging up the system” argument doesn’t hold much water. Especially long term, since the economy is pretty good at keeping up with supply and demand when given an adequate time frame: as more medical providers are needed in the future, more people will obtain training and seek out jobs in the industry.
John R. Graham from the NPCA’s Health Policy Blog writes about health outcomes for people on Medicaid, and addresses ways that we can improve those outcomes going forward. His piece is a fascinating look at the dichotomy that often pops up when people refer to studies on Medicaid outcomes: One side says that Medicaid is worse than no coverage at all in terms of how patients fare, while the other side points out that Medicaid does a good job of managing numerous health conditions. So how do we reconcile such diverse claims? It appears that it’s mostly a factor of what groups are being studied. The majority of elderly and disabled Medicaid beneficiaries (who account for most Medicaid spending and tend, not surprisingly, to have the worst health outcomes) are enrolled in the government-run fee-for-service Medicaid program. But the majority of the rest of the Medicaid population (including pregnant women, children, and the newly-eligible non-disabled adults), are enrolled in coverage through private plans that contract with the government to provide Medicaid managed care (MCOs) or primary care case management (PCCMs). Comparing the outcomes of those two groups isn’t particularly helpful. But John suggests that increasing enrollment in private Medicaid plans and increasing focus on the needs of very ill Medicaid patients could help to improve the 
outcomes of the group that’s currently the subject of the claims that Medicaid is no better than no insurance at all (by the way, that’s a rallying cry for people who would prefer to simply leave millions of Americans with no insurance at all – it suits their needs to make such claims without digging further to find out more about the underlying causes).
Les DelPizzo, writing at Healthcare Lighthouse, describes three recent policy changes that apply to post-acute care providers (rehab facilities or in-home care to provide additional support for a patient who no longer needs to be in the hospital, but is not yet ready to be fully independent at home). The IMPACT Act will integrate post-acute care providers into the new value-based payment system that is rapidly replacing fee for service payment models. The Nursing Home Compare system that rates nursing homes on a five star basis will be undergoing changes that will essentially beef up the ratings: Self-reporting for staffing will be replaced with automatic electronic reporting, and facility surveys will include additional standardized data. And third, Medicare is implementing changes to the conditions for providers to participate as home health agencies. Post-acute care providers are an undeniably important part of our healthcare system, so it makes sense that they’re getting an administrative and reimbursement overhaul along with most other providers. But as with any significant changes, there are likely to be growing pains.
Ebola
Roy Poses, of Health Care Renewal takes on hospital management in his latest in a series of posts about Ebola. Roy acknowledges that the sudden appearance of Ebola in our healthcare system makes it understandable that mistakes were made. But the way the whole process was handled by Texas Health Presbyterian’s upper management (the hospital is part of Texas Health Resources hospital system) has called into focus the reliability and trustworthiness of the business-trained leaders who run many of our hospitals. Not only does it appear that managers were overconfident in the hospital’s ability to provide care for an Ebola patient while maintaining worker safety, there are new concerns that leadership might have tried to silence nurses who wanted to speak with the media, threatening them with the loss of their jobs if they did so. Roy sums it up by pointing out that CEOs who are paid millions of dollars for their business sense – not their medical knowledge – are running our hospital systems. And their goal might not be transparency and accurate information, but rather sprucing up the image of their business – which happens to be a hospital.
J. Stephen Morrison, writing at Health Affairs, provides a strong and eloquent defense of CDC head Dr. Thomas Frieden. This is an excellent article, and although I don’t personally know Frieden the way Morrison does, I absolutely agree with this take on the situation. It sometimes seems like our reactions to events are much more knee-jerk than they should be, and are often politically motivated. Certainly there have been some errors in the US response to Ebola (but I would posit that the most significant error is not in how the disease has been handled here at home, but in our delay in getting resources to West Africa), but it’s frustrating to see politicians and the public call for the ouster of a competent CDC chief who has already shown himself as a strong leader on this issue. Of course we also have absolutely ridiculous decisions like keeping children who recently moved from Rwanda (which is nowhere near West Africa and has had zero Ebola cases) out of a RI school for 21 days, and putting a teacher on leave after she attended a conference in Dallas but had no contact with anyone who is under Ebola monitoring. So maybe in the context of absurdities like that, it’s understandable that so much criticism has been directed at Dr. Frieden.
Julie Ferguson of Workers’ Comp Insider brings us a thorough compilation of insurance and workers’ comp information as it applies to Ebola. Her article includes numerous links to general info as well as sites that address worker safety in the face of Ebola (and to be clear, there is very little risk to the general public in the US – the people who are at risk of infection are the healthcare workers who are take care of very ill patients. So it makes sense that while Ebola has been blown way out of proportion in terms of the threat it presents to the public, it’s still an issue that needs to be taken very seriously by those in the workers’ comp industry. The safety and protection of healthcare providers must be paramount, and it appears that we’re getting a much better handle on that than we had a month ago. Julie includes a one minute video from Vox that does an excellent job of putting Ebola in perspective, while reminding us of the ongoing and desperate need for resources in West Africa as they fight the disease at its epicenter (Doctors Without Borders has been on the front lines from the start of the outbreak – you can donate here if you want to help them).
Peggy Salvatore, from Health System Ed, brings us Ebola and the Chicken Little Syndrome, and it’s a great look at our collective reaction to Ebola. I started noticing a lot of Ebola stories in the news sometime in the middle of the summer, but they were limited to news outlets that focused on world events, since the cases were all in West Africa at that point. But since Ebola was diagnosed at a US hospital, it seems that every tiny mundane detail about any Ebola story is run as a “breaking news” piece and every time someone appears ill on a plane or a train, crews in hazmat suits show up (people have been puking on planes for as long as there have been planes, and that will continue to be the case, regardless of Ebola). Peggy points out that there are rational, logical responses to Ebola, and then there are hysterical, “the sky is falling” responses. The latter are not helpful, but lots of politicians and media sources are taking that route anyway. Remember The Ryan White Story? Let’s do better at dealing with Ebola than we did with HIV in the 80s.
Healthcare innovation
Chris Langston, from Health AGEnda, addresses a recent JAMA study that found “virtual wards” (intended to reduce hospital readmissions) had no significant impact on readmission rates. But although Chris notes that it’s certainly important to publish studies that show interventions aren’t working as well as we thought they might, it’s also important to consider how we’re testing those results and the theory behind the interventions. He points out that you can’t realistically run the same sort of efficacy testing on something like virtual wards as you would on a new pharmaceutical product.
David Williams has a podcast for us at his Health Business Blog. It’s an interview he did with Michael Palmer, who is the Chief Innovation and Digital Officer at Aetna. They discuss a wide range of topics under the innovation umbrella, and it appears that innovation is certainly something that can set carriers apart from the crowd. Palmer notes that although their customers expect them to be “awesome at insurance” (ie, the basics), they also have numerous large customers who are “hungry” for innovation and ways they can change and improve things for their employees.
Everything else
Jason Shafrin, aka the Healthcare Economist, debunks five common myths about cancer treatment. It looks like survival rates have improved in the last 25 years, and better treatment is largely the reason. And although cancer treatment is certainly expensive, the patients who benefit from it tend to believe that it’s well worth the cost.
Brad Flansbaum, writing at The Hospital Leader, asks whether hospital-based doctors get sued more often. There’s a follow-up part two that you’ll definitely want to read (hint… that’s where the answer to the question is). Brad notes that although medical malpractice accounts for only a tiny segment of healthcare spending, it’s an issue that weighs heavy on doctors’ minds, and it plays a role in doctors’ decisions about ordering tests just to cover all of their bases.
Hank Stern, writing at InsureBlog, describes the healing prayer group that he’s participated in for many years, and the group’s premise that there’s a spiritual component to healing. For the number crunchers among us, the free price tag is a good bonus. Hank’s article is titled “Have faith (and insurance!) – which sums it up nicely. Faith certainly can’t hurt, but you don’t want to rely on it in lieu of insurance.
That does it for today. Thanks for stopping by! The next edition of the Health Wonk Review will be hosted by Jennifer Salopek at Wing of Zock on November 6. If you write about health policy, be sure to submit an article for consideration. Happy Fall y’all!