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Wednesday, January 4, 2017

On Call by Casey Ross
Good morning! The new year is off to a fast start. Here's the latest news on hospitals and health care. For more coverage, follow @statnews on Twitter or like us on Facebook.

Obamacare term of the day: 'Universal access'

That's the GOP's buzz phrase to describe efforts to replace the law with less extensive coverage and drive down costs. Today, President Obama will meet with Democrats to discuss ways to shield his signature legislation, while Vice President-elect Mike Pence gathers with Republicans to figure out how to shove a sword through it.

The law’s repeal is a foregone conclusion, but efforts to replace it will fuel a pitched battle. In an open letter to Congress, the AMA's chief executive, Dr James L. Madara, is calling on lawmakers not to dismantle it until they've provided details about the replacement plan.  

Which brings us back to "universal access." In general, it will mean fewer mandates and a free-market approach to providing insurance, but it will also likely mean less generous coverage. Democrats are already warning that Republicans want to roll back benefits gained by 20 million Americans and turn health care over to insurance companies.

Meanwhile, Senator Rand Paul is urging Republicans to replace the law immediately with “freedom,” which would include allowing unlimited contributions to health savings accounts and the sale of insurance across state lines.

Welcome to 2017.

Hacking a defibrillator? FDA says it could happen.

Stealing patient data is one thing. But what if a hacker worms into a patient’s defibrillator and reprograms it?

In a new guidance, FDA paints a number of chilling scenarios in which devices with networked software could be hacked and manipulated remotely. In the most extreme cases, the patient could be killed. Regulators urge medical device manufacturers to constantly check for IT flaws in their devices and fix them. They talk about practicing good "cyber hygiene" and being transparent with customers. 

In other words, they're saying, do a better job than hospitals and insurers do in shielding patient records from attack. 

Should patients own their medical data?

In an op-ed for the New York Times, cardiologist Dr. Eric Topol teams up with federal prosecutor Kathryn Haun to ask, why can cybercriminals access health records better than patients can? 

Tell us what you think. How would patients owning their data affect health care delivery? Would it make record-keeping easier or harder? What about clinical decision-making? Email your thoughts to casey.ross@statnews.com and we may feature them in an upcoming edition.

Amid rural closures, a tiny Texas hospital offers a recipe for success

Since 2005, Texas has lost more than 500 hospital beds, mostly due to the closure of rural hospitals that provided scarce medical services and jobs.

But STAT contributor Charlotte Huff reports today about how one hospital has bucked the trend. Childress Regional Medical Center, a public nonprofit more than 200 miles from Fort Worth, is not just solvent; it’s expanding its services.

The tiny hospital’s success, using telemedicine and carefully targeted specialty care, offers a financial roadmap for pint-sized counterparts across the country.

Read more.

New research: Zeke Emanuel finds big savings in bundled payments

Let the battle over bundled payments begin.

In one corner, Zeke Emanuel, an architect of Obamacare and fan of bundled care. In the other, Tom Price, Trump's pick to run HHS, foe of bundled care. 

Emanuel has a new study out in JAMA that says bundled care for joint replacements cut costs by more than 20 percent at the hospital he and his colleagues studied. Price argued in this letter to CMS that mandatory bundling doesn't cut costs and could hurt quality of care by reducing the number of doctors who would participate in Medicare. 

Emanuel et al. looked at Medicare's mandatory joint replacement program at Baptist Health System in San Antonio. In the cases of 3,492 patients, prolonged hospital stays fell by 67 percent and hospital costs for implants dropped by an average of  $1,921. Inpatient rehab costs fell an average of $1,416 per case.

In the meantime, Medicare just finalized new rules to expand its joint replacement bundles, focusing on hips and hearts. Whether this new study will bolster its case to a skeptical Trump administration remains to be seen.

Referrals

  • Cancer centers getting cut out of marketplace coverage (Kaiser)
  • Trump may allow vets to bypass the VA for private hospitals (The Daily Briefing)
  • Lengthen your telomeres, and maybe your life (STAT)
  • Will changing health care delivery be an enduring legacy of Obama? (New York Times)
  • Cleveland Clinic CEO opts out of VA post (FierceHealthcare)

Have a news tip or comment you want to send me?

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Stay well, and come back tomorrow.
Casey

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