Fresh take: The executive order on ACA and its impact on hospitals
President Trump’s order
to scale back Obamacare is far from the end of the health law. But it could trigger a wide array of changes. A few things to watch:
Patient readmissions/quality: The Trump administration now has the power to change the rules of the CMS-administered readmissions program, with an array of data reporting requirements that have contributed to hundreds of millions of dollars in penalties against providers. In a Senate hearing last week, Tom Price, Trump’s pick to lead HHS, said he wants to overhaul quality reporting rules, lamenting that the law has turned physicians into “data entry clerks.”
CMS Innovation Center: Established by the law, the innovation center has also drawn sharp criticism from Price, who has cited it as an example of government overreach into treatment decisions by providers. If confirmed, he could pull back government rules and new payment models that affect how hospitals treat certain diseases and conditions.
Insurance coverage: Both Medicaid and individual insurance coverage could change quickly, reducing the number of people with coverage. Trump’s pick for CMS chief, Seema Verma, is the architect of multiple state Medicaid waivers that require beneficiaries to pay premiums and work to maintain coverage. The Obama administration rejected some waiver applications, but Trump will likely give states more flexibility. In the individual insurance markets, the new administration could quickly pull back on the law’s mandate and cost-sharing subsidies, which would likely cause insurers to hike premiums or exit the market.
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Pressing question: Would you prescribe medical marijuana?
A recent survey
of medical students at the University of Colorado revealed a telling dichotomy — they overwhelmingly supported the legal use of marijuana
, but would be hesitant to prescribe it to patients.
So we asked our partner, Figure 1, to put the same question to a broader audience of health professionals. More than 400 responses poured in, reflecting a variety of viewpoints — and a lack of consensus — on a political issue with significant public health implications. A couple of responses that reflect the divide:
Family physician: “I practice evidence-based medicine. Anecdotes are not evidence. And until the evidence is there with clear guidelines in terms of dose, monitoring, effect, etc., I will not prescribe it.”
Emergency medicine physician: “Yes, absolutely, especially for detoxification from opiates.”
A Kentucky trauma unit kicks its opioid habit
Three years ago, UK Healthcare in Kentucky joined the growing movement of emergency departments reducing the amount of opioids prescribed to patients. “We don’t have the luxury of saying no to narcotics, period,” Dr. Phillip Chang, UK Healthcare’s chief medical officer, tells STAT. “But we’re trying to make it tolerable.” Now he has his eyes set on bringing those guidelines to the health system’s clinics throughout Kentucky, the state with the third-highest drug death rate in 2015.
On the front lines: Navigating a technology minefield
Dr. Steven Chan has a rare combination of specialties: He is a psychiatrist and a fellow in the UCSF clinical informatics program. He spoke to us about the rise of the latter specialty and how it can improve mental health care. (This interview is edited for clarity.)
Why is clinical informatics important in improving health care?
As doctors, we interface with a lot of technologies, but we’re not typically involved in the buying processes, or implementation, or evaluating whether they work. For any sort of physician who is going through typical medical training, the education system is not there yet to equip them with these skills. That’s why this new training program exists at UCSF. The subspecialty gives us training to evaluate technologies and cut through a lot of the marketing hype.
How does the work apply to psychiatry?
Behavioral health and psychiatry have been underfunded for so long. I’d say they’re five or ten years behind other medical specialties when it comes to digital technologies. For instance, in the HITECH Act, they didn’t fund medical record systems for behavioral health or substance abuse. That needs to change.
How could adoption of these technologies help mental health care?
One of the things that needs advancement is behavioral health access. A lot of patients don’t get the care that they need, for depression, anxiety or PTSD. You think of an anxious patient, someone with social anxiety, they don’t want to come out of the house very often. So what I’m hoping to explore is what works for such patients and what’s just hype.
What are some of the promising technologies you’ve seen?
Things like telepsychiatry and video are the most promising at the moment because we can implement them much more easily. The second one would be apps for cognitive behavioral therapy. The more successful examples have been touted by the VA health system, where they are creating applications to help therapists and patients keep track of symptoms of mental illness.
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- Trump's plans for Obamacare revive talk of high-risk insurance pools (New York Times)
- Andrew Wakefield triggers backlash with Periscope video from Trump inaugural ball (STAT)
- A dying man's wish hits a hospital ethics hurdle (Seattle Times)
- Measles outbreak grows despite California's strict vaccination law (Los Angeles Times)