Thursday, January 19, 2017

On Call by Casey Ross & Max Blau
Good morning! Many details remain sketchy, but team Trump is beginning to assert itself in health care policy, with big implications for hospitals and caregivers. Here's what you need to know today. For more coverage, follow @statnews on Twitter or like us on Facebook.

On today's agenda: GOP governors plot Medicaid strategy

The Senate Finance Committee will circle up with GOP governors today to discuss the future of Medicaid. First on the agenda is how to give states more flexibility to run the program as they see fit.

There is hardly unanimity on this subject within the GOP. Several of the party’s governors expanded Medicaid under Obamacare, and have opposed any rollback in coverage. Among those trying to pump the brakes are Governors Rick Snyder of Michigan, John Kasich of Ohio, Brian Sandoval of Nevada, and Charlie Baker of Massachusetts. Even Arizona Governor Doug Ducey, a harsh Obamacare critic, has cautioned against repealing coverage without a ready replacement.

But while they support Medicaid funding, many want more flexibility to design their own programs. Snyder, for example, has touted his state’s income-based premiums for beneficiaries, an idea popular with many Republican governors. The Trump administration is certain to grant states more leeway to implement such proposals.

In non-expansion states, many GOP governors are supporting Medicaid block grants that would allow them to use federal dollars as they see fit. Among vocal backers of that approach are Scott Walker of Wisconsin and Florida’s Rick Scott, who once said, “You give me a block grant, let me do whatever I want, and I will cover the right people. If I don’t, I won’t get reelected.”  

Price pledges health access, drawing rebuke from Dems

Democratic senators yesterday tried pinning down Congressman Tom Price, Donald Trump’s pick for HHS secretary on key issues. They didn't have much luck. Price sidestepped questions about whether he supported Trump’s campaign promise to avoid cuts to Medicare and Medicaid funding.

“I have no reason to believe that [Trump’s] position has changed,” Price told Senator Bernie Sanders.

Price also spoke broadly of his commitment to health care access. That drew a sharp reply from Sanders, who champions universal coverage. “I have access to buying a $10 million home,” Sanders told Price. "I don’t have the money to do that.”

Senator Susan Collins, a Maine Republican opposed to repealing Obamacare without a replacement, was among the few lawmakers to push Price on policy specifics, including his support for biomedical research and NIH funding. Saying she was “baffled” by what CMS reimburses, Collins also asked the Georgia congressman if he would reevaluate those policies so payments are more in line with those of private insurers.

“Absolutely,” Price replied. “It’s imperative that we’re constantly looking at whether or not we’re getting the outcomes we want.”

Hundreds of health care researchers, however, are convinced that Price would do more harm than good for patient outcomes. In a new letter, they wrote that Price’s plan "would allow states to dismantle the safety net" for close to 70 million citizens.

Colorado hospitals are refusing to implement the state's aid-in-dying law

Colorado’s new aid-in-dying law is running into a problem: Nearly one-third of the state’s hospitals are refusing to implement it.

Judith Graham reports for STAT on the implications of those refusals, which are coming from both faith-based and secular institutions. The opt-outs could make it hard for some terminally ill patients to seek medical help in ending their lives. 

Read more.

Changing the conversation on EHRs

Late in Tom Price’s wide-ranging Senate hearing, Senator Bill Cassidy of Louisiana used the recent layoffs at MD Anderson to ask about the government's role in managing electronic health records. Cassidy noted that the hospital system had attributed the layoffs in part to lost productivity because of EHRs.

"What can we do about this time and productivity suck that has become EHRs and meaningful use?" Cassidy asked, referring to the multi-tiered set of incentives surrounding electronic records.

Price said EHRs are important because they "allow patients to have their health history with them at all times."

But he pledged to start a conversation with doctors: “What is it that we could ask you to measure that would really correlate with the outcome and quality of care being provided?'" Price said. “That’s something we could use."

Want to slow rising health costs? Teach med students an 'ounce of prevention'

One in four American adults suffers from multiple chronic health conditions, a fearsome problem that is driving US health care spending into the stratosphere. Yet medical students are not learning enough about preventive medicine to turn those numbers around. 

So what should they be taught? In a First Opinion for STAT, Dr. Thomas J. Van Gilder, chief medical officer for the population health company Transcend Insights, and Dr. Patrick Remington, associate dean for public health at the University of Wisconsin, argue that students need to connect clinical practice to public health. They also need to learn humility and teamwork.

Read more.


  • Members of Senate health committee reject Trump’s doubts on vaccine safety (STAT)
  • A doctor appointment that feels more like a trip to an Apple store (Associated Press)
  • If confirmed, HHS nominee Tom Price could easily do away with CMS' cost-saving experiments (Axios)
  • A doctor experiments with putting his family on a high-deductible policy (Marketplace)
  • MedPAC says doctors should get a reimbursement boost (Advisory Board Daily Briefing)

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