Association of Electronic Prescribing of Controlled Substances With Opioid Prescribing Rates

“[Introduction] In this study, we aim to build on the existing research by analyzing the association of the adoption of EPCS [electronic prescribing of controlled substances] with opioid prescribing across the United States. We specifically examine trends in the adoption and use of EPCS and 2 measures of opioid prescribing across the United States from 2010 to 2018. In doing so, we aim to provide policy makers, prescribers, and patients with evidence of the association of the use of EPCS with the opioid epidemic. [..] [Methods] [..] We used data from annual reports published by Surescripts, a near-monopoly supplier of … Read More

Building a Better Clinician Value-Based Payment Program in Medicare

“The QPP [Medicare Quality Payment Program] has 2 tracks: (1) the Merit-Based Incentive Payment System (MIPS), which is the default track, and (2) the advanced alternative payment models track, which includes novel payment models like accountable care organizations (ACOs). Both tracks reward or penalize clinicians based on their performance on cost and quality measures. The initial results on the MIPS, which accounted for 95.7% of participating clinicians in the first year (2019), were disappointing from a social equity and quality improvement perspective. Studies that examined publicly reported data from Centers for Medicare & Medicaid Services (CMS) showed that clinicians who … Read More

Trends in Diagnosis Related Groups for Inpatient Admissions and Associated Changes in Payment From 2012 to 2016

“[Introduction] [..] There are a total of 761 Medicare Severity–DRGs [Diagnosis Related Group], which are organized into families (eg, heart failure) with 2 or 3 levels, most commonly with a base Medicare Severity–DRG (hereafter referred to as DRG) and 1 or 2 higher-complexity DRGs. Assignment to these latter DRGs occurs if 1 or more complications or comorbidities (CC) or major complications or comorbidities (MCC) are present. Of importance, hospital payment for DRGs with CCs or MCCs is often substantially greater. For example, payment for DRG 291 (heart failure and shock with MCC) is approximately twice that for DRG 293 (heart … Read More

International Reference Pricing: A Lazy, Misguided, Bi-Partisan Plan To Lower US Drug Prices

“Recent legislative proposals, including US Senate Bill S.2543, US House of Representatives Bill HR 3, and various Trump Administration proposals and plans, have advanced some form of international reference pricing (IRP) to lower drug prices. As its name suggests, IRP seeks to benchmark US drug prices to prices of similar or comparable drugs in other counties. Some proposals would have the federal government develop a reference price index based on prices paid by a select group of high-income countries, and then restrict prices to a narrow range of the index. [..] American drug pricing policy rewards large capital investments and … Read More

Possible Consequences of the Approval of a Disease-Modifying Therapy for Alzheimer Disease

“While the aducanumab clinical trial data are complicated and the path to approval far from clear, approval is certainly possible, and other promising antibodies (such as Biogen’s BAN-2401 and Genentech’s gantenerumab) are just steps behind. Thus, the long-awaited advent of disease-modifying therapy for AD [Alzheimer disease] may be soon upon us, representing a major advance in the battle against AD and a beacon of much-needed hope for patients. [..] The approval of aducanumab or any disease-modifying therapy for AD likely will result in a considerable immediate demand for capacity to provide formal diagnoses of AD dementia, including cognitive and AD … Read More

The Bottom of the Health Care Rationing Iceberg

“Since February, like ethicists around the world, I have spent most of my time thinking about the tip of the health care rationing iceberg. As Covid-19 cases exploded across epidemiologic maps, I scrambled to write new guidelines for my health network for the ethical allocation of mechanical ventilators, just in case we ran out. [..] Despite that heady challenge and the urgency of the Covid-19 pandemic, I couldn’t shake the feeling that this effort was all a distraction. Here I was, trying to do a perfect job allocating a handful of mechanical ventilators for an unprecedented viral pandemic, while every … Read More

The Paradox of STEMI Regionalization: Widened Disparities Despite Some Benefits

“In this issue of JAMA Network Open, Hsia et al sought to determine whether efforts to improve access, treatment, and outcomes for patients with ST-elevation myocardial infarction (STEMI) by means of cardiac care regionalization were associated with widened or narrowed disparities between minority and nonminority communities at the zip code level across the state of California. Access was defined as admission to a hospital with percutaneous coronary intervention (PCI) capability; treatment was defined as receiving coronary angiography or PCI (as clinically indicated) the day of admission or at any time during hospitalization; and outcomes were defined as all-cause mortality at … Read More

Understanding The Latest ACO “Savings”: Curb Your Enthusiasm And Sharpen Your Pencils—Part 1

“In a recent post, the administrator of the Centers for Medicare and Medicaid Services (CMS) reported that the Medicare Shared Savings Program (MSSP) generated $2.6 billion in gross savings in 2019 and $1.2 billion in net savings after accounting for shared-savings payments to participating accountable care organizations (ACOs). Achieving this level of savings would constitute remarkable progress in a short time. Relative to CMS’s own estimates, total net savings rose by $876 million over 2017 levels. Moreover, compared to savings estimated in prior evaluations based on counterfactual spending instead of benchmarks, the 2019 reported net savings is more than three … Read More

When Actions Speak Louder Than Words — Racism and Sickle Cell Disease

“SCD [sickle cell disease] is a life-threatening, inherited blood disorder, affecting more than 100,000 Americans. Painful vaso-occlusive crises, the hallmark of SCD, result in substantial suffering and lead to associated stigma. Without adequate treatment, SCD affects all organs and is associated with decreased quality of life and a shortened life span. Among the dozens of conditions that are screened for in state newborn-screening programs, SCD is the most commonly detected condition, regardless of ethnicity. It is thus important to recognize SCD as a common and important medical condition among Americans, and not “just Black Americans.” [..] Although SCD is a … Read More

How ACOs In Rural And Underserved Areas Responded To Medicare’s ACO Investment Model

“To help establish ACOs in more areas of the country, the Centers for Medicare and Medicaid Services (CMS) developed the ACO Investment Model (AIM) to provide participating ACOs with up-front and ongoing monthly payments over 24 months to fund ACO infrastructure investments and staffing. As part of the Medicare Shared Savings Program (SSP), the payments were to be recouped through any shared savings earned by the ACOs that sufficiently decreased costs relative to a financial benchmark, as specified by SSP regulations. Forty-one new SSP ACOs, primarily located in rural and underserved health care markets, joined AIM in 2016. [..] A … Read More