SCOTUS sides against Vermont in all-payer data case | The Advisory Board Daily Briefing

March 1, 2016

The Supreme Court in a 6-2 decision on Tuesday struck down Vermont’s requirement that self-funded insurers submit claims data to the state’s all-payer claims database (APCD).FROM OUR EXPERTSUsing claims to analyze physician performance? First, check your data. At issue in the case—Gobeille v. Liberty Mutual Insurance—was whether Vermont could require self-insured employer health plans to provide claims data for the state’s APCD, or whether the federal Employee Retirement Income Security Act (ERISA) prevented the state from doing so.The case has national implications: 18 states have such databases, and about 20 others are considering creating them, according to National Academy for State Health Policy Executive Director Trish Riley.

Source: SCOTUS sides against Vermont in all-payer data case | The Advisory Board Daily Briefing


Entry Regulation and Rural Health Care: Certificate-of-Need Laws, Ambulatory Surgical Centers, and Community Hospitals | Mercatus

February 20, 2016

Certificate-of-need (CON) laws in 36 states and the District of Columbia restrict competition in healthcare facilities markets by requiring healthcare providers to obtain permission before adding or expanding any regulated facilities or services. One such CON program, currently implemented by 26 states, regulates the establishment and expansion of ambulatory surgical centers (ASCs), “hospital substitutes” that provide select out-patient surgeries and procedures.

Proponents of regulating ASCs through a CON program express concern that ASCs will engage in “cream skimming,” selectively treating more profitable, less complicated, well-insured patients and leaving hospitals to treat the less profitable, more complicated, and uninsured patients. Under these circumstances, ASCs might cause hospitals to close, especially rural hospitals with slim profit margins—thus depriving rural populations of important medical services.

In a new empirical study for the Mercatus Center at George Mason University, scholars Thomas Stratmann and Christopher Koopman evaluate the impact of ASC CON regulations on the availability of rural health care. Their research shows that, despite the expressed goal of ensuring that rural populations have access to health care, CON states have fewer hospitals and ASCs on average—and fewer in rural areas—than non-CON states.

Source: Entry Regulation and Rural Health Care: Certificate-of-Need Laws, Ambulatory Surgical Centers, and Community Hospitals | Mercatus


HEALTH CARE 2.0, Part 1: How to Think About Market Forces in Health Care | Manhattan Institute

January 24, 2016

The Manhattan Institute’s HEALTH CARE 2.0: USHERING IN MEDICINE’S DIGITAL REVOLUTION series delves into the details of how government policy stifles innovation in the delivery of health care. This paper, Part 1, surveys the key economic principles that drive innovative, dynamic sectors of the economy—and explains why American health care does not live up to those principles.

KEY FINDINGS

  • Health care-market distortions have considerably worsened since Kenneth Arrow famously described them in 1963; but in other industries less dominated by misguided government intervention, similar distortions have gradually eroded, thanks to technology, especially the rise of the Internet.
  • The tech world is full of stories of individuals who dropped out of college to design software and hardware that changed the world; but such innovation is far less common in health care—for reasons largely determined by public policy.
  • Each current barrier to a more innovative, competitive, affordable health care system was created for a reason; but the cumulative weight of these policies has been to make U.S. health care less innovative, less patient-centered, and less affordable.

Source: HEALTH CARE 2.0, Part 1: How to Think About Market Forces in Health Care | Manhattan Institute


Are Certificate-of-Need Laws Barriers to Entry? How They Affect Access to MRI, CT, and PET Scans | Mercatus

January 13, 2016

KEY FINDINGS

CON Regulations Have a Negative Effect on Nonhospital Providers

  • The association of a CON regulation with nonhospital providers is substantial, ranging from −34 percent to −65 percent utilization for MRI, CT, and PET scans.
  • Nonhospital providers in CON states experience significant decreases in the utilization of imaging services compared to hospital providers.

CON Regulations Have No Effect on Hospitals, Thus Increasing Their Market Share

  • CON regulation has no measurable effect on hospitals’ utilization of imaging services. The volume of services provided in hospitals is not affected by CON regulation.
  • This may explain why hospital providers have a stronger market presence in CON states than in non-CON states.

Consumers Are Driven to Seek Imaging Services in Non-CON States

  • CON regulations are associated with 3.93 percent more MRI scans, 3.52 percent more CT scans, and 8.13 percent more PET scans occurring out of state.
  • CON regulations may have a negative effect on consumers because patients living in CON states have to travel out of state more often than patients living in non-CON states. This propensity for traveling out of state to obtain medical services might be attributable to any of several factors: higher costs, a smaller selection of services, or restricted access to care.

CONCLUSION

CON laws act as barriers to entry for nonhospital providers and favor hospitals over other providers. In consequence, consumers of MRI, CT, and PET scanning services are driven to seek these services either out of state or in hospitals. More research is needed to determine whether additional costs and barriers in the healthcare industry restrict specific market providers and affect where procedures occur.

Source: Are Certificate-of-Need Laws Barriers to Entry? How They Affect Access to MRI, CT, and PET Scans | Mercatus


The Future of Healthcare Reform in the United States, Malani, Schill

November 2, 2015

In the years since the passage of the Patient Protection and Affordable Care Act (PPACA, or, colloquially, Obamacare), most of the discussion about it has been political. But as the politics fade and the law’s many complex provisions take effect, a much more interesting question begins to emerge: How will the law affect the American health care regime in the coming years and decades?

This book brings together fourteen leading scholars from the fields of law, economics, medicine, and public health to answer that question. Taking discipline-specific views, they offer their analyses and predictions for the future of health care reform. By turns thought-provoking, counterintuitive, and even contradictory, the essays together cover the landscape of positions on the PPACA’s prospects. Some see efficiency growth and moderating prices; others fear a strangling bureaucracy and spiraling costs. The result is a deeply informed, richly substantive discussion that will trouble settled positions and lay the groundwork for analysis and assessment as the law’s effects begin to become clear.

Source: The Future of Healthcare Reform in the United States, Malani, Schill


What Are the Best Hospitals? Rankings Disagree – WSJ

March 3, 2015

What makes a top hospital? Four services that publish hospital ratings for consumers strongly disagree, according to a study in the journal Health Affairs.

No single hospital received high marks from all four services—U.S. News & World Report, Consumer Reports, the Leapfrog Group and Healthgrades—and only 10% of the 844 hospitals that were rated highly by one service received top marks from another, the study published Monday found.

The measures were so divergent that 27 hospitals were simultaneously rated among the nation’s best by one service and among the worst by another.

via What Are the Best Hospitals? Rankings Disagree – WSJ.


A Surgery Standard Under Fire – NYTimes.com

March 3, 2015

Dr. Macip presented the case on Saturday to a meeting of the American Academy of Hospice and Palliative Medicine. The presentation’s dispiriting title: “The 30-Day Mortality Rule in Surgery: Does This Number Prolong Unnecessary Suffering in Vulnerable Elderly Patients?”

Like Dr. Macip, a growing number of physicians and researchers have grown critical of 30-day mortality as a measure of surgical success. That seemingly innocuous metric, they argue, may actually undermine appropriate care, especially for older adults.

via A Surgery Standard Under Fire – NYTimes.com.


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