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A Weekly Health Policy Round Up From Health Affairs
September 20, 2020
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FAST TRACK AHEAD OF PRINT
COVID-19
The Risk Of Severe COVID-19 Within Households Of School Employees
And School-Age Children
By Thomas M. Selden, Terceira A. Berdahl, and Zhengyi Fang
Thomas Selden and coauthors analyzed data from the Medical Expenditure Panel Survey for 2014–17 to examine how often persons with underlying health issues that place them at increased risk for severe COVID-19 were connected to elementary or
secondary schools, either as employees or by living in households with school employees or school-age children.
Read More >>
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IN THE JOURNAL
EYE ON HEALTH REFORM
A Hot Summer Brings More ACA Litigation
By Katie Keith
One week after the 2020 election, all eyes will be on the US Supreme Court as the justices hear the oral arguments for California v. Texas, the case testing the constitutionality of the Affordable Care Act. Katie Keith has
covered the many twists and turns this case has taken for the past two-plus years after Congress’s zeroing out of the individual mandate in the Tax Cuts and Jobs Act of 2017. Read More >>
AFFORDABLE CARE ACT
Marketplace Premiums Rise Faster For Tobacco Users Because Of Subsidy Design
By Karina C. Manz, Teresa M. Waters, and Cameron M. Kaplan
Karina Manz and coauthors examined individual premiums based on age, tobacco use, and geographic premium rating area for all health plans available through the federal health insurance Marketplace to describe trends over time in premium prices and affordability for tobacco users compared with nonusers. Read more >>
MEDICARE
Target Prices Influence Hospital Participation And Shared Savings In Medicare Bundled Payment Program
By Nicholas L. Berlin, Baris Gulseren, Ushapoorna Nuliyalu, and Andrew M. Ryan
Medicare’s Bundled Payment for Care Improvement initiative sets target prices for hospitals for selected services and provides financial rewards to hospitals that deliver those services at a lower cost. Nicholas Berlin and coauthors analyze hospital performance. Read More >>
The Beneficial Effects Of Medicare Advantage Special Needs Plans For Patients With End-Stage Renal Disease
By Brian W. Powers, Jiali Yan, Jingsan Zhu, Kristin A. Linn, Sachin H. Jain, Jennifer Kowalski, and Amol S. Navathe
Brian Powers and coauthors analyzed data related to patients with end-stage renal disease who moved from fee-for-service Medicare into a Medicare Advantage Special Needs Plan. Read More >>
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THE PRACTICE OF MEDICINE
Adjustment For Social Risk Factors Does Not Meaningfully Affect Performance On Medicare’s MIPS Clinician Cost Measures
By Alexander T. Sandhu, Jay Bhattacharya, Joyce Lam, Sam Bounds, Binglie Luo, Daniel Moran, Aimée-Sandrine Uwilingiyimana, Derek Fenson, Nirmal Choradia, Rose Do, Laurie Feinberg, Thomas MaCurdy, and Sriniketh Nagavarapu
Alexander Sandhu and coauthors investigate the portion of Medicare’s Merit-based Incentive-based Payment System (MIPS) that evaluates clinicians based on the risk-adjusted cost of each care episode. The authors readjust the current model from focusing solely on clinical conditions into different approaches to incorporate social risk. Read More >>
Clinicians With High Socially At-Risk Caseloads Received Reduced Merit-Based Incentive Payment System Scores
By Kenton J. Johnston, Jason M. Hockenberry, Rishi K. Wadhera, and Karen E. Joynt Maddox
Analyzing data from 2019, Kenton J. Johnston and coauthors find that there is an important link between clinicians, social risk, and MIPS scores. Read More >>
High Rates Of Partial Participation In The First Year Of The Merit-Based Incentive Payment System
By Nate C. Apathy and Jordan Everson
Nate Apathy and Jordan Everson focus on evaluations of clinicians from the first year of MIPS in 2017. Clinicians were evaluated across three categories but participation was not consistent. Read More >>
These papers appear in an ongoing Health Affairs article series, The Practice of Medicine, which is supported by The Physicians Foundation.
GLOBAL HEALTH POLICY
Restrictions On US Global Health Assistance Reduce Key Health Services In Supported Countries
By Jennifer Sherwood, Matthea Roemer, Brian Honermann, Austin Jones, Greg Millett, and Michele R. Decker
The 2017 expanded Mexico City Policy prohibits
non-US-based nongovernmental organizations from receiving US global health assistance if they either perform or refer for abortion services. Jennifer Sherwood and coauthors study the effects of the expanded policy on implementing partners of US-funded HIV programming by the President’s Emergency Plan for AIDS Relief (PEPFAR). Read More >>
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THIS WEEK ON THE BLOG
COVID-19
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QUALITY OF CARE
To Design Equitable Value-Based Payment Systems, We Must Adjust For Social
Risk
By Philip M. Alberti, Christie Teigland, and David R. Nerenz (9/17/20)
Using social risk adjustment in value-based payment programs would not mask poor quality of care nor would it disincentivize quality improvement. The absence of such adjustment does nothing to address racial inequities in health and health care; if anything, it makes the problems worse. Read More >>
ETHICS
Ethical Considerations In The Use Of AI Mortality Predictions In The Care Of People With Serious Illness
By Charlotta Lindvall, Christine K. Cassel, Steven Z. Pantilat, and Matthew DeCamp (9/16/20)
Having prognostic information in hand could spur patients, families, and health care professionals to have advanced care planning discussions and avoid nonbeneficial or unwanted interventions. Yet the rapid dissemination of
mortality algorithms by electronic health record software raises serious ethical concerns. Read More >>
DETERMINANTS OF HEALTH
The Role Of Racial Justice In Building A Culture Of Health
By Alonzo Plough and Gail Christopher (9/16/20)
A culture of racial injustice and a culture of health cannot coexist. Alonzo Plough and Gail Christopher share highlights from the Robert Wood Johnson Foundation’s 2020 Sharing Knowledge forum, which focused on racial injustice and health. Read More >>
MEDICARE
Sharing Drug Rebates With Medicare Part D Patients: Why And How
By Steven M. Lieberman, Paul B. Ginsburg, and Erin Trish (9/14/20)
The growth in rebates has
affected Medicare Part D patients. The challenges in the Medicare program regarding rebates differ from the challenges in commercial insurance, where some major steps have already been taken. Legislation should require that an approximation of the rebate amount for a drug is credited to patients. Read More >>
2019 Medicare Shared Savings Program ACO Performance: Lower Costs And Promising Results Under ‘Pathways To Success’
By Seema Verma (9/14/20)
Centers for Medicare and Medicaid Services Administrator Seema Verma takes readers through the latest results for accountable care organizations in the Medicare Shared Savings Program and describes how she and the administration view those results. Read More
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About Health Affairs
Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.
Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.
Copyright © Project HOPE: The People-to-People Health Foundation, Inc.
Health Affairs, 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814, United States
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