Viewpoints: A Tool To Help The Mentally Ill; VA Bonuses; Shifts On Medicaid Expansion

The New York Times: How To Help Save The Mentally Ill From Themselves
I do know that for many, [mental health] treatment saves lives. The true insanity is that our laws leave those who suffer to fend for themselves. But Congress is now ready to grapple with the issue in a bipartisan bill .... The bill is not perfect. But it does many things to improve the financing, treatment and delivery of services across the range of mental illnesses, and in particular it has provisions aimed directly at helping those like my son. Most critically, the Murphy-Johnson bill provides incentives to fund expanded treatment, called assisted outpatient treatment, or A.O.T., only for those with a long history and pattern of proving a danger to themselves or others. The specifics of A.O.T. vary by state, but judges can order patients to undergo treatment while they live in the community instead of in prison or a hospital. It has been proven to reduce crime by or against those with illnesses, as well as suicide. (Norman J. Ornstein, 11/17)

USA Today: How Can VA Reward Employees In Scandal?: Our View
Despite scandals that engulfed the Department of Veterans Affairs — outrageous waits for medical care, a culture of coverups and a billion dollar construction fiasco in Colorado — 2014 was a banner year at the VA for one thing: performance bonuses. The agency doled out more than $140 million in taxpayer-funded awards for performance to nearly half of the VA’s 340,000 employees, according to data provided to USA TODAY by the House Veterans' Affairs Committee. Rewarding excellence is a proven way to motivate workers and attract top talent, but it’s hard to fathom that half of the employees at the scandal-plagued agency were deserving, particularly several recipients who have been called to account in various scandals. (11/16)

USA Today: VA: Awards Help Us Retain Top Talent
The vast majority of employees at the Department of Veterans Affairs provide America’s veterans exceptional service. The performance awards described in USA TODAY’s article are more than a year old — October 2013 to September 2014. All were granted according to Office of Personnel Management standards. They are based on performance during that period, not on events occurring after it. The majority who received awards were rank-and-file workers. (VA Secretary Bob McDonald, 11/16)

Bloomberg: More Red States Open Door To Obamacare
States with Republicans in charge have mixed records of adopting [Medicaid expansion]. But once a state goes along with Medicaid expansion, it doesn’t go back on it even if a strongly conservative Republican is elected governor. That means Medicaid expansion remains a one-way street, and eventually all 50 states will accept it. We’re already up to 30 states with Montana’s recent agreement to sign up. ... Of course, battles over Medicaid won't end even when the last state signs on. Expect to see plenty of fights, at both national and state levels, about any number of issues: how the program is administered, how generous the benefits are, how doctors and hospitals are treated. (Jonathan Bernstein, 11/16)

Forbes: Government Mandates, Like Obamacare, Mean A $7.25 Minimum Wage Is Effectively $10.46
Proponents of more than doubling the current minimum wage of $7.25 appeared to have overlooked a simple fact. Thanks to government mandates such as Obamacare, today’s minimum wage already effectively amounts to $10.46 an hour . If we more than double the nominal minimum wage to $15, we actually will be requiring employers to pay $18.31 an hour. (Chris Conover, 11/16)

Des Moines Register: Keep Fighting Medicaid Plan, Iowa
The Centers for Medicare & Medicaid Services hosted its first telephone “listening session” last week to hear from Iowans about Gov. Terry Branstad’s plan to privatize management of Medicaid. Hundreds of people called in. They jammed the phone lines, talked over each other and begged the federal government to stop the governor. It was a mess. That session for consumers and three others for providers were rescheduled for this week. ... Consumers should call again — and give CMS another earful. (11/17)

Health Affairs: CMS Initiative For Hip And Knee Replacements Supports Quality And Care Improvements For Medicare Beneficiaries
In 2014, more than 400,000 Medicare beneficiaries received a hip or knee replacement, costing more than $7 billion for the hospitalizations alone. The quality and cost of care for these surgeries varies significantly by region and by hospital. This is true both for the care received inside the hospital and for post-acute care received outside the hospital during the critical period of recovery. In part, this variation is due to the way Medicare pays for this care today — spread among multiple providers, with no single entity held accountable for the total patient experience. As a result, care can be fragmented, leading to adverse outcomes. ... the [a mandatory bundled payment model] seeks to incentivize Medicare providers and suppliers to work together to improve the quality and reduce the costs of care for patients undergoing lower extremity joint replacement procedures. (Patrick H. Conway, Rahul Rajkumar, Amy Bassano, Matthew Press, Claire Schreiber, and Gabriel Scott, 11/16)

The New York Times' The Upshot: How To Decrease Prices For An Expensive Class Of Drugs
Competition among generic drug makers pushes drug prices downward. But such competition is weak for a growing and expensive class of drugs called biologics. A big reason has to do with the science that underlies them. Biologics — large-molecule, protein-based drugs — are made by living organisms, not by chemical processes, which are the source of non-biologic, or small-molecule, drugs. Their complexity makes them harder to reverse engineer than small-molecule drugs, making generic versions of them — called biosimilars — more costly to bring to market. (Austin Frakt, 11/16)

Forbes: Here's How Hospitals Cheat Medicare, And Why They Should
Because of complicated reimbursement rules ... such hospitals often delay discharge until patients have been in the facility for 30 days, the point at which Medicare reimbursement rates rise sharply. In order to maximize their income, long-term care hospitals keep some patients “in house” longer than necessary. Without such delays, these facilities could face dire financial consequences. Medicare needs to change the way it pays for long-term care. (Peter Ubel, 11/16)

The Kansas City Star: Caregivers Deserve Needed Attention For Their Service To Others
The 40 million people who take care of older, ill, frail or disabled adults don’t often get enough thanks or attention for the work they do to benefit others. The November issue of AARP Bulletin helps corrects that oversight in a special report headlined “Caregiving in America 2015.” The volunteer army of folks who took care of other adults in 2013 alone contributed a collective 37 billion hours in unpaid service worth $470 billion, notes AARP’s recent report “Valuing the Invaluable.” That’s up from $450 billion in 2009. (Lewis Diuguid, 11/16)

JAMA: Measurement Is Essential For Improving Diagnosis And Reducing Diagnostic Error
Nearly all patients will experience a diagnostic error in their lifetime, sometimes with devastating consequences. That conclusion by the Institute of Medicine (IOM) of the National Academies of Sciences, Engineering, and Medicine in a recently released report, “Improving Diagnosis in Health Care,” should mobilize collaboration among patients, health care professionals and organizations, government, and the private sector to improve the diagnostic process. Diagnostic errors have received less attention than other medical errors, even though correct diagnosis is fundamental to subsequent choices. (Elizabeth A. McGlynn, Kathryn M. McDonald and Christine K. Cassel, 11/16)

JAMA Neurology: The McDonaldization Of Medicine
As put forth in The McDonaldization of Society, “the principles of the fast-food restaurant are coming to dominate more and more sectors of American society,” including medicine. While designed to produce a rational system, the 4 basic principles of McDonaldization—efficiency, calculability, predictability, and control—often lead to adverse consequences. Without measures to counter McDonaldization, medicine’s most cherished and defining values including care for the individual and meaningful patient-physician relationships will be threatened. (E. Ray Dorsey and George Ritzer, 11/16)