Research Roundup - April 2018


Are ‘Useless’ Physician Education Exams Raising the Cost of Healthcare in Alabama?

Alabama Today | April 14, 2018

Every year, physicians are required to participate in the continuing medical education program, advertised as a way to keep doctors up to date on new findings and treatments for various healthcare needs. Although these requirements sound like a good idea many doctors find that some of the tests add no value to themselves or their patients, and some believe they are contributing to the rise of healthcare costs. According to an article in Alabama Today, one test that has come under fire lately is the Maintenance of Certification (MOC) test. According to The Hospitalist, the MOC program could cost $5.7 billion in physicians’ time and fees over the next decade.


Arizona Passes New PBM Law

By Alliance for Transparent & Affordable Prescriptions | April 10, 2018

A new Arizona law prohibits pharmacy benefit managers (PBMs) from restricting pharmacists from providing information regarding the amount of patients’ cost share and the clinical efficacy of available alternatives, reports the Alliance for Transparent & Affordable Prescriptions. The law also prohibits PBMs from requiring pharmacies to charge or collect copayments that exceed the cost of the drug. Arizona is one of a slew of states that have recently passed similar legislation.


California Takes on Health Giant over High Costs

By Chad Terhune and Ana B. Ibarra | Kaiser Health News | April 1, 2018

California’s Attorney General has filed a lawsuit against Sutter Health, accusing the hospital system of illegally stifling competition and overcharging consumers and employers, reports Kaiser Health News. The antitrust suit asks the court to prohibit Sutter from engaging in the alleged anticompetitive practices and “overcharges,” including gag clauses on prices, “punitively high” out-of-network charges and “all-or-nothing” contract terms that require all of the system's facilities to be included in insurance networks. California’s lawsuit may portend similar litigation in other states amid concerns about the financial implications of industry consolidation.

California Bill Would Put the State in Charge of Controlling Prices in the Commercial Healthcare Market

By Melanie Mason | Los Angeles Times | April 9, 2018

A new California measure would put the state in charge of setting prices for hospital stays, doctor's visits and most other medical services covered by commercial insurers, according to the Los Angeles Times. The proposed legislation would establish a commission that would set prices for healthcare services based on Medicare-allowable rates. The commission would determine the rates for all services covered by commercial health plans, including those offered by employers and those sold in the individual marketplace. The prices charged for services provided under public health programs, such as Medicare and Medicaid, would not be affected.

Consolidation in California’s Healthcare Market 2010-2016: Impact on Prices and ACA Premiums

By D.J. Wilson | State of Reform | March 26, 2018

Recent consolidation among hospitals, physician groups and insurance companies have resulted in people paying more for healthcare, reports State of Reform. Researchers at UC Berkeley found that inpatient prices in highly concentrated northern California were 70 percent higher than those in less-concentrated southern California. Outpatient prices and ACA premiums were also positively associated with level of concentration.


Watch your Paychecks: Colorado Employers are Pushing Higher Healthcare Costs to Workers

By John Ingold | The Denver Post | April 20, 2018

A new report released this week reveals that the cost of health insurance for employers in Colorado is increasing faster than the national average — and that employers are often pushing that added cost onto their workers, according to an article in The Denver Post. People who get health insurance through their work generally haven’t had to deal with the extreme price increases that have impacted people who buy insurance themselves. But the new reports show they are still being squeezed — just more slowly. Employers have increasingly pushed higher premiums and deductibles onto workers, encouraged greater use of telemedicine and switched to limited networks of doctors, or, in some cases, switched insurance companies altogether.


Illinois Lawmakers Discuss Prescription Drug Legislation

By Cole Lauterbach | Illinois News Network | April 10, 2018

Illinois legislators are debating a bill that would ban insurers from modifying an enrollee's drug coverage during the plan year if the drug was previously approved for coverage, according to an article in Illinois News Network. Currently, insurance companies are able to change what drugs they cover midway through a year, possibly forcing patients to pay thousands of dollars for an off-plan drug or switch to a different one. Opponents warned that the bill would cause prices to go up for select drugs in which the bill applied to, allowing for price gouging with little recourse.  


Federal Appeals Court Finds Maryland's Drug Price-Gouging Law Unconstitutional

By Shefali Luthra | NPR | April 17, 2018

The U.S. Fourth Circuit Court of Appeals invalidated Maryland's law to limit "price-gouging" by generic drug manufacturers, according to NPR. The law had been hailed as a model for other states hoping to combat rapidly rising drug prices, giving the state attorney general power to intervene if a generic or off-patent drug's price increased by 50 percent or more in a single year. The appeals court held that Maryland's law overstepped limits on how states can regulate commerce — specifically, a constitutional ban on states controlling business that takes place outside their borders. The majority ruling argues that since most manufacturers of generic drugs and medication wholesalers engage in trade outside Maryland, the state cannot control what prices they charge. The attorney general is currently evaluating options for next steps.

Alcohol and Cigarette Taxes Led to Decreases in Binge Drinking and Smoking in Maryland

By Keshia Pollack Porter, Shannon Frattaroli, and Harpreet Pannu. | The Abell Report | April 2018

Taxes on cigarettes and alcohol in Maryland led to decreases in both binge drinking and smoking among adults and teenagers, according to a study by the Abell Foundation. The researchers offer additional recommendations for maximizing public health gains through the use of state policy, including transparency in how the revenue generated by these taxes is spent. 

Changes in Hospital Utilization Three Years into Maryland’s Global Budget Program for Rural Hospitals

By Eric T. Roberts, et al. | Health Affairs | April 2018

Maryland implemented global budgets in 2010 to control rural acute care hospitals’ service utilization and spending. But a study in Health Affairs found that, by 2013, global budgets had not reduced rural hospital use or price-standardized spending among Medicare beneficiaries as anticipated. Despite these findings, the authors noted that programmatic adjustments implemented after 2013 could lead to more positive results. Ongoing evaluation will be important to assess whether or not the model can successfully reduce spending and change how care is delivered.


Massachusetts Health Policy Commission Recommends Curbs on Spending

By Anne-Gerard Flynn | MassLive | April 5, 2018

The Massachusetts Health Policy Commission released its 2017 cost trends report, which proposes numerous recommendations to decrease rising health costs, according to MassLive. The report shows that state spending on healthcare grew at an average of 3.55 percent annually over the last four years, exceeding the commission's spending growth benchmark of 3.1 percent. Prescription drug and hospital outpatient spending were the highest growth areas in 2016. To curb spending growth, the commission recommends enhancing the Executive Office of Health and Human Services' authority to negotiate directly with drug manufactures for additional supplemental rebates, impose robust transparency requirements and exclude certain drugs from the MassHealth formulary. The report also proposes to establish limits on physicians' offices that can bill as hospital outpatient departments and implement site-neutral payments for selected services.


Univ. of Nebraska Medical Center Releases Report on the Condition of Rural Healthcare

The Grand Island Independent | April 7, 2018

The number of physicians in Nebraska has increased 11 percent increase during the last 10 years, according to an article in The Grand Island Independent. However, the rural healthcare workforce report by the University of Nebraska Medical Center noted that there are still 13 counties that do not have a primary care physician. The study was commissioned and funded by the Nebraska Area Health Education Center and used the most recent data from the UNMC Health Professions Tracking Service and the state of Nebraska.

New York

New York to Expand Use of Doulas to Reduce Childbirth Deaths

By Luis Ferre-Sadurni | New York Times | April 22, 2018

Gov. Andrew Cuomo announced a series of initiatives aimed at addressing a disturbingly high rate of maternal mortality among black women, who are four times more likely to die in childbirth than white women in New York, according to an article in The New York Times. The plan includes a pilot program that will expand Medicaid coverage for doulas, birth coaches who provide women with physical and emotional support during pregnancy and childbirth. Studies show the calming presence and supportive reinforcement of doulas can help increase birth outcomes and reduce birth complications for the mother and the baby. Still, only a small percentage of women use doulas nationwide.


Medical Cost Transparency Bill Dies in Oklahoma Legislature

By Dale Denwalt | NewsOK | April 11, 2018

The Oklahoma House Public Health Committee blocked a measure that would have created a state-run website featuring the average cost of the most popular medical procedures by hospital, reports NewsOK. The bill's sponsor says that the law could have reduced prices by encouraging competition among medical providers. But the Oklahoma Hospital Association argues that gross hospital charges do not reflect the prices that patients actually pay and would not meaningfully inform patients' choice of provider. 


Innovative Population Health Model Associated with Reduced Emergency Department Use and Inpatient Hospitalizations

By Donald Wesson, et al. | Health Affairs | April 2018

Population health strategies that improve access to healthcare and address social determinants of health may reduce the use of costly emergency services. A study in Health Affairs describes a strategy that integrated a level three primary care clinic - supported by a multidisciplinary team –onto the campus of a Dallas Park and Recreation Department facility in an underserved Dallas community, home to many people with low socioeconomic status. The strategy led to a reduction in ED use of 21.4 percent and a reduction in inpatient care use of 36.7 percent, with an average cost decrease of 34.5 percent and 54.4 percent, respectively. These data support the use of population health strategies to reduce the use of emergency services.


Seeking to Determine the “Value” in Value-Based Care

By Center for Consumer Engagement in Health Innovation | April 2018

Preliminary survey findings conducted by the University of Utah illustrate how difficult it is to find agreement on the definition of value, according to a story by the Center for Consumer Engagement in Health Innovation. The authors find very different opinions of what constitutes value across physicians, patients and other stakeholders, speculating that differences may be contributing to the slow progress in the reduction of low-value care services. The study suggests there is also a mismatch in who is responsible for improvements in health, with physicians feeling as though they are responsible, and patients feeling as though it is the patient and physician responsibility equally. The study offers some difficult, yet straightforward strategies to align expectations of value for these stakeholders.


A Balanced Portfolio Model for Improving Health: Concept and Vermont’s Experience

By James Hester | Health Affairs | April 2018

Improving population health requires a portfolio of interventions that act in several sectors. These interventions should be tailored to communities' needs, in addition to satisfying other key aspects, such as appropriate time frame, level of risk and target population. A new article in Health Affairs profiles Vermont's population health initiative, which offers valuable lessons to other states. These include the need for: a swift transition to all-payer value-based payment models; payment models that incorporate explicit population health goals; and accountable health communities emphasizing care coordination.


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Recent Reports

Healthcare Spending in the United States and Other High-Income Countries

By Irene Papanicolas, et al. | JAMA | March 2018

The U.S. spends more per capita on healthcare than any other nation, substantially outpacing even other very high-income countries. However, despite its higher spending, the U.S. performs poorly in areas such as healthcare coverage and health outcomes, according to a study in JAMA. The Organization for Economic Co-operation and Development and the Commonwealth Fund have recently collected and made available increasingly comparable data on inputs and performance of the healthcare systems across high-income countries. Using these and related data, researchers compared performance of the U.S. with 10 other high-income countries on key metrics that underpin healthcare spending. By examining granular data, the authors sought to understand why U.S. healthcare costs are so much higher and where policymakers might target their efforts to encourage a more efficient system.



Myth and Measurement – The Case of Medical Bankruptcies

By Carlos Dobkin, et al. | NEJM | March 2018

While there is compelling evidence for a number of personal bankruptcies due to medical costs, it is not as high as previously claimed, according to a study in NEJM. The authors argue that many policymakers cite research from two high-profile articles in which the percentage of people identified as filing bankruptcy due to medical bills is artificially high (60%). When controlling for the population of people that did not file for bankruptcy as well as those that did, the authors find that only 4 percent of bankruptcies filed were due to medical bills. Suggesting that earlier studies have flawed methodologies that conflated the number of personal bankruptcies filed because of medical bills. 



Meal Delivery Programs Reduce the Use of Costly Healthcare in Dual Eligible Medicare and Medicaid Beneficiaries

By Seth A. Berkowitz, et al. | Health Affairs | April 2018

Delivering food to nutritionally vulnerable patients is important for addressing these patients’ social determinants of health, according to a study published in Health Affairs. Specifically, the study found that low-income seniors or disabled younger people who received home-delivered meals — particularly those tailored to recipients’ medical needs — had fewer emergency department visits and lower medical spending than a similar group of people who did not receive meal deliveries. These findings suggest the potential for meal delivery programs to reduce the use of costly healthcare and decrease spending for vulnerable patients.


Physician Payments Linked to Scripts for Cancer Drugs from Novartis, Pfizer, and More

By Arlene Weintraub | Fierce Pharma | April 10, 2018


Oncologists who treat metastatic kidney cancer or chronic myeloid leukemia were more likely to prescribe drugs from manufacturers who have paid them (in the form of meals, consulting, travel, or other activities), according to FiercePharma. The study, conducted at the University of North Carolina, notes that physicians who received any industry payment were twice as likely to prescribe that company’s drug.



Costs for Antibiotic-Resistant Infection Treatment Have Doubled Since 2002

By Kenneth E. Thorpe, Peter Joski and Kenton J. Johnston | Health Affairs | April 2018


Rising infection rates add to the costs of healthcare and compromise the quality of medical and surgical procedures, but little is known about the national healthcare costs attributable to treating these antibiotic-resistant infections. A study published in Health Affairsestimated that antibiotic resistance added $2.2 billion to the cost of treating patients with bacterial infections in 2014. This number has doubled since 2002, making the need for innovative infection prevention programs, antibiotics and vaccines to prevent and treat antibiotic-resistant infections a national priority.



Evaluating State Innovations to Reduce Healthcare Costs

By Thomas Huelskoetter | Center for American Progress | April 6, 2018

States are using a number of tools to reduce healthcare costs, including innovative payment and delivery system reforms that do not shift costs to patients or cut Medicaid benefits. These innovative payment and delivery reforms are the focus of this report from the Center for American Progress. The report reviews results in four states (MD, MA, OR, and AR) who have had promising results of reducing healthcare costs while maintaining or improving healthcare quality.



Feds Raked in Billions by Cracking Down on Healthcare Fraud

By HHS and Justice Department | April 2018

More than $2.4 billion was won or negotiated in healthcare fraud settlements and judgments in 2017, according to a report from the Department of Health and Human Services and the Justice Department. There were more than 960 criminal cases for healthcare fraud opened in 2017. Nearly $1.4 billion was returned to the Medicare Trust Funds and federal Medicaid received more than $400 million.



How Cutting Salt Consumption Could Curb Health Costs

By Jonathan Pearson-Stuttard, et al. | PLOS Medicine | April 2018

If the food industry fully complied with an FDA 10-year sodium reduction goal it could prevent an estimated 450,000 cases of cardiovascular disease and save $40 billion over 20 years, according to an article published in PLOS Medicine.


The Affordable Care Act’s Marketplace Expanded Insurance Coverage for Adults with Chronic Health Conditions

By Michael Karpman, et al. | Health Affairs | April 2018

From July – December in 2014 and 2015, 45 percent of non-elderly, Marketplace enrollees were treated for chronic conditions, according to a study in Health Affairs. The study also indicates that Marketplace enrollees had higher service usage than privately insured adults. The authors argue that as the repeal of the ACA individual mandate begins in 2019, protection of the coverage for these adults with chronic conditions will depend on individual state efforts, in order to protect coverage for these patients and to balance the insurance pool. 



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Healthcare is an Investment, and the U.S. Should Start Treating It Like One

Anupam Jena, Daniel Blumenthal, and Sachin Kamal-Bahl | Harvard Business Review | April 2, 2018

There is too much spent on low-value care services in the U.S., crowding out the ability to invest in high-value services, according to an article in Harvard Business Review. The authors argue that we should begin thinking about healthcare services as investors, which would require wresting with factors that promote the continued use of low-value care services while recognizing that high-value care services often require financial outlays that only reap benefits in the long term.  



While the Administration Mulls How to Curb Prescription Costs, State Legislatures Take the Lead

By Trish Riley | NASHP | April 2018

This year, more than 160 bills that address drug costs were introduced in 42 states, despite short legislative sessions in most of them, according to an article from NASHP. Sixteen states have already adjourned and another 16 will do so by the end of May. There will be more to report for those still in session, but even as many legislatures wind down, it is clear that the issue of drug costs has saliency in red, blue, and purple states and legislators appear positioned for a long-term engagement, recognizing that challenging the pharmaceutical industry and making major changes can take time. The most common approach advanced in state legislatures this year addressed pharmacy benefit managers (PBM). Eighty-eight PBM bills were introduced and (at the time of the article) nine have been enacted.


CMS Urges Hospitals to Disclose Prices, Revamps Meaningful Use Program

By Virgil Dickson | Modern Healthcare | April 2018

CMS has proposed an overhaul of the meaningful use program and wants hospitals to disclose their prices to patients, according to an article in Modern Healthcare. The changes were outlined in the proposed annual inpatient hospital rule. Overall, the CMS estimates the rule's various provisions will give hospitals $4.1 billion more in Medicare inpatient funding next year. CMS already requires hospitals to either publicly list their standard charges or give them to the public upon request. The new rule would require hospitals to post this information.


Is Healthcare the Number One Issue in America?

By Glenn Kessler | The Washington Post | April 24, 2018

Politicians often use polling data to site the number one issues faced with Americans, but the findings are dependent on how the question is asked, according to a story in The Washington Post. The article examines different polls conducted by various methods to uncover the top concerns or worries of the American people. How you ask a question, the words used (are you worried or are you concerned), and the method of asking, (open-ended question or choosing from a list) impact the results. Understanding how the poll was conducted and how the questions were asked will help provide meaning to the findings.