Viewpoints: Doctors’ Frustrations With EHRs; The Blame Game On Subsidies

The Washington Post: Why Doctors Quit
The newly elected Barack Obama told the nation in 2009 that “[electronic health records] just won’t save billions of dollars” — $77 billion a year, promised the administration — “and thousands of jobs, it will save lives.” He then threw a cool $27 billion at going paperless by 2015. It’s 2015 and what have we achieved? The $27 billion is gone, of course. The $77 billion in savings became a joke. Indeed, reported the Health and Human Services inspector general in 2014, “EHR technology can make it easier to commit fraud,” as in Medicare fraud, the copy-and-paste function allowing the instant filling of vast data fields, facilitating billing inflation. That’s just the beginning of the losses. Consider the myriad small practices that, facing ruinous transition costs in equipment, software, training and time, have closed shop, gone bankrupt or been swallowed by some larger entity. (Charles Krauthammer, 5/28)

The Washington Post's Plum Line: GOP Plans Would Destroy Obamacare To Save It, New Study Finds
If the Supreme Court guts subsidies for millions, Republicans will probably try to pass some form of “contingency fix” plan that would keep those subsidies going — at least, until after the 2016 elections. But that would likely be packaged with repeal of the individual mandate, which suggests the real GOP game plan may be to draw a presidential veto — allowing Republicans to claim they tried to save all those people’s health insurance, but mandate-crazed Barack Obama wouldn’t let them. (Greg Sargent, 5/28)

Bloomberg View: The Next Obamacare Fight: Who To Blame
The more significant impact of the debate over intent, if the [Supreme Court] rules for King, comes in two parts. The first involves the Republican Party's image: If a consensus forms that conservatives stripped 8 million people of health insurance because they insisted on litigating a typo, that plays into the Democratic narrative of a party that's poorly attuned to the financial concerns of middle-class voters. On the other hand, if Obamacare's opponents can convince the public that Democrats brought this on themselves (by trying to coerce state governments and then changing their story when that approach didn't work), those opponents can try to avoid taking the blame for people losing their insurance. ... That fight could also influence the way Americans view the legitimacy, and limits, of Democrats' efforts to expand the social safety net. (Christopher Flavelle, 5/29)

The Wall Street Journal's Washington Wire: What’s Going On With Spending On Health Insurance Overhead?
In a Health Affairs blogpost published Wednesday, David Himmelstein and Steffie Woolhandler use actuarial estimates from the Centers for Medicare and Medicaid Services to project that between 2014 and 2022, national spending on private insurance overhead and government administration will rise by $273.6 billion related to the health-care overhaul. (Chris Jacobs, 5/28)

Bloomberg View: FTC'S Drug Settlement A Win For The Lawyers
Is Thursday's $1.2 billion antitrust settlement between the Federal Trade Commission and Teva Pharmaceutical Industries a victory for consumers? Or is it a sign of government enforcement run amok? The answer to that question, it turns out, goes back to a 2013 U.S. Supreme Court case, FTC v. Actavis, in which five justices allowed the FTC to pursue a new kind of antitrust litigation. And the issue at the heart of that case was fascinating: What happens when the good kind of monopoly created by a patent runs headlong into the bad kind of monopoly created by collusion between merchants? (Noah Feldman, 5/29)

The New England Journal of Medicine: Screening For Lung Cancer With Low-Dose CT — Translating Science Into Medicare Coverage Policy
The [National Lung Screening Trial ] provided the initial evidence to support lung-cancer screening with low-dose CT. The next step is to address the challenges ahead to ensure that population screening confers similar benefits over time and minimizes risk. By creating a new preventive benefit with specific evidence-based coverage criteria, CMS has established a mechanism to provide responsible access to high-quality lung-cancer screening with low-dose CT in the Medicare population while trials continue .... However, the primary responsibility for ensuring appropriate integrated screening in which benefits outweigh harms ultimately rests with practicing physicians, informed patients, and the multidisciplinary stakeholders involved in screening efforts. (Joseph Chin, Tamara Syrek Jensen, Lori Ashby, Jamie Hermansen, Joseph D. Hutter and Patrick H. Conway, 5/28)

JAMA: Paying For Prevention: A Novel Test Of Medicare Value-Based Payment For Cardiovascular Risk Reduction
Traditionally, federal strategies to enhance uptake of preventive care, such as screening mammography, have relied on improved access by expanding insurance coverage for services, reducing or eliminating patient co-payments, and investing in public media campaigns. ... Designing payment incentives that properly encourage prevention is more complex .... the Center for Medicare & Medicaid Innovation recently announced a large, novel model test to determine whether financially rewarding reductions in 10-year predicted risk for atherosclerotic heart disease (defined as initial myocardial infarction or stroke) across a physician’s patient population is an effective model for value-based prevention. ... Termed the Million Hearts Cardiovascular Risk Reduction Model, this model will represent the largest test of value-based prevention payment ever conducted by CMS. (Darshak M. Sanghavi and Patrick H. Conway, 5/28)