Health Care Reform Memo:
The health care reform memos are issued on a weekly basis, highlighting news from the previous week's activities in the administration and implications for the C-suite and various stakeholder groups.
From Paul Keckley, Executive Director, Deloitte Center for Health Solutions
For as long as I can remember, I’ve been fascinated by TV’s depiction of physicians in prime time: it’s a lens to how the profession is viewed albeit often distorted for dramatic effect. A few of my favorites:
The early days: Alex Reed worked from his home and did house calls (The Donna Reed Show). Milburn Stone was Doc Adams of Gunsmoke fame—Dodge City revered him as much as Sheriff Dillon (James Arness).
The 70’s and early 80’s: physicians as people: Jim Kildare (Richard Chamberlain), Ben Casey (Vince Edwards), and Marcus Welby (Robert Young) reinforced the esteem and invincibility of the profession. They had warmth, approachability: priestly characters.
The ‘90s: hospital-based medicine: the ensemble casts St. Elsewhere, Medical Center, and others introduced us to institutional medicine—interaction among peers, conflicts with administrators and lawyers, ego issues, medical negligence, big facilities, and complex clinical problems that defied “the usual and customary.” Physicians led care commando squads while sacrificing normalcy.
And House—a new prototype: no series has prompted more dissonance about the profession than House with lead character, Dr. Gregory House, alternating between clinical genius and dysfunctional dictator in each episode. Last week, its successful eight year run ended. For his portrayal of the vicodin addicted Dr. House, the Oxford, England-born Hugh Laurie earned two Golden Globes, two Screen Actors Guild, six Emmy Awards, and $700,000 per episode—highest in drama TV.
What amazed me most about series creator David Shore’s weekly storylines were its dependence on interpersonal conflict and its central focus on Dr. House’s frailty: House had no patience for medical residents who failed to see the medical problem accurately or quickly. He was thoroughly dismissive of administrative protocol at Princeton-Plainsboro Teaching Hospital and brutal when dealing with a physician unless they were clinically superior. He advocated for patients but often strong-armed their decisions to suit his premonition about an appropriate treatment, never apologized and rarely smiled. And in the end, he was always right.
Sometimes lost in the fierce debate about health reform is the future of the medical profession: more specifically, how future generations of physicians will learn, train, and serve. The 137 schools of medicine training 80,279 medical students this year are ground zero for the health system’s transformation. In many ways, they are the bridge to tomorrow’s health system.
Dr. House’s ego-centricity and harsh behavior was tolerated because he was an exceptional clinician. Tomorrow, physicians will practice in large groups that use team based models and electronic medical records with powerful clinical algorithms to aid in their decision-making. “Patients” will be “consumers” linked to “Big Data” with their mobile devices to know their treatment options and costs and how their care team performs. Clinical judgment will be shared among the care team and consumer, and delivery of services embedded in a customized, coordinated treatment plan will be built around the individual’s needs, values, capabilities, and stage of healthiness. Not patients, clinical trial subjects, or cases, they will be consumers: actively participating in decisions and costs associated.
I will miss House. It offered a glimpse about medicine rarely seen. For Dr. House, the end always justified the means. I must admit to yelling at the tube on occasion when House berated his residents and strong-armed his patients. But that’s TV. In many ways, it’s not real.
What’s real is medical education for the future. The challenge facing today’s medical school deans and residency directors is to harness the keenest judgment of tomorrow’s clinicians toward a lifelong commitment to learning and listening. It is to create tools that reward outcomes and construct pedagogy and practicum that embrace nursing, spirituality, nutrition, and self-care. And it is to identify and intervene when personal foibles like Dr. House’s are given latitude to treat others harshly and get a pass because they’re right. And it is to equip tomorrow’s physicians to a world where medical care is not a command and control model.
I am sure the next physician TV series is on the drawing board already. And it will no doubt provide pop culture yet another chapter in the unfolding recasting of American medicine as noble profession practiced by imperfect mortals.
I have deep respect for the profession of medicine and deep concern that it continues to attract and keep the best and brightest. It must adapt to a brave new world of Big Data, technology, transparency, care teams, and consumers, and I believe it will.
Paul Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutions
P.S. For the past three and a half years, I have written the Monday Memo and each week shared it with Clint Stretch in draft form for comment and sometimes correction (always over the weekend). Clint retires as the Managing Principle, Tax Policy, in the National Office of Deloitte Tax LLP this week. I know no one in the industry I trust and respect more than Clint. He is a professional in every sense, and I will forever treasure his friendship. Tax is complicated. Health reform is complex. And Clint brought valuable insight on both to readers of this weekly missive for which I will always be indebted.
GAO: small businesses not using premium tax credit per ACA
Last Monday, the Government Accountability Office (GAO) released a report finding that only 170,300 businesses applied for the health insurance premium tax credit in 2010. According to the report, most of the small businesses that did apply for the credit did not seek the maximum amount allowed because they did not offer health insurance. The report concluded that “while some small employers could be eligible for the credit if they began to offer health insurance, small business group representatives and discussion group participants told us that the credit may not offset costs enough to justify a new outlay for health insurance premiums.”
Note: per Section 1421 of the Affordable Care Act (ACA), small employers with fewer than 25 full-time equivalent workers in an applicable tax year, pay less than $50,000 a year in average wages, and pay at least 50 percent of their employees’ premiums are eligible for a tax credit. The premium tax credit offers up to 35 percent of small businesses’ health insurance premium costs and will rise to 50 percent in 2014. The President’s Council of Economic Advisers projected in April 2010 that up to four million small businesses would be eligible for the tax credit.
Study: majority of individual health plans do not meet ACA standards
A study of individual insurance plans published last week concluded that the majority of individual insurance health plans fall short of the standards created through ACA Section 1302. Researchers found that the average actuarial value of group plans in 2010 was 83 percent (gold level coverage under Section 1302), and the average for individual plans was 60 percent (bronze level coverage under Section 1302). However, more than half (51 percent) of persons covered through individual plans fell into the “tin” level of coverage—those plans whose actuarial values fall below 60 percent. The average annual out-of-pocket expenses for a family with group coverage were $1,765 as compared to the average of $4,127 for those with individual coverage.
Source: Jon Gabel, et al, Health Affairs, “More Than Half Of Individual Health Plans Offer Coverage That Falls Short Of What Can Be Sold Through Exchanges As Of 2014,” May 2012
Study: 88 percent of uninsured veterans eligible to access subsidized coverage through exchanges, Medicaid expansion in 2014
Various provisions of ACA will increase the coverage for up to 88 percent of uninsured veterans: nearly half (48.8 percent) qualify under the Medicaid expansion and an additional 40 percent without access to employer sponsored insurance (ESI) could be eligible for subsidized coverage through health insurance exchanges (HIXs).
Note: an estimated 10 percent (1.3 million) veterans go without health insurance. Including their 950,000 family members, U.S. veterans and their families make up 4.8 percent of the nation’s 47.3 million uninsured.
Source: Jennifer Haley & Genevieve Kenney, Robert Wood Johnson Foundation, “Uninsured Veterans and Family Members: Who Are They and Where Do They Live?,” May 2012
Catholics sue over contraceptive mandate
Last Monday, 43 Roman Catholic institutions including the University of Notre Dame and 13 dioceses filed suit against the federal government challenging the ACA requirement that employers provide contraceptive coverage as part of “essential health benefits”. The suits were filed in 12 district courts and are being coordinated by U.S. Conference of Catholic Bishops.
Note: 182 dioceses chose not to participate in the lawsuit for unknown reasons.
PCORI funds studies to integrate evidence in practice
Wednesday, the Patient-Centered Outcomes Research Institute (PCORI) announced $96 million in awards for four of its research priorities included in its National Research Agenda.
- Assessing prevention, diagnosis, and treatment options: approximately 54 contracts totaling up to $48 million for projects that address critical decisions that face patients, their caregivers, and clinicians every day and with too little information.
- Improving health care systems: approximately 27 contracts totaling up to $24 million for projects that address critical decisions that face health care systems, the patients and caregivers who rely on them, and the clinicians who work within them.
- Communicating and disseminating research: approximately 14 contracts totaling up to $12 million for projects that address critical elements in the communication and dissemination process among patients, their caregivers and clinicians.
- Addressing disparities: approximately 14 contracts totaling up to $12 million for projects that for projects that will inform the choice of strategies to eliminate disparities.
PCORI also set aside for $24 million to fund studies about accelerating patient-centered outcomes research and methodological research.
HHS awards $4.9 million for family-to-family health centers
Wednesday, the U.S. Department of Health and Human Services (HHS) awarded $4.9 million in grants to nonprofit organizations run by and for families with children that have special health care needs. Section 5507 of the ACA established a demonstration program through competitive grants to provide aid and support services to low-income individuals with the opportunity to obtain education and training in the health care field. In total, 51 organizations across the country received amounts of $95,700 to go toward this project.
Note: The family-to-family centers are state-wide family-led organizations that provide information, education, training, outreach, and peer support to families of children and youth with special health care needs and the professionals who serve them.
Medicaid seeks collaboration with CMMI to innovate in service delivery; states seeking flexibility
Tuesday, the Medicaid and Children's Health Insurance Program Payment and Access Commission (MACPAC), met with the Center for Medicare and Medicaid Innovation (CMMI) to plan and review demonstration projects with the potential to reform Medicaid. MACPAC members also suggested that Medicaid adopt the following policies:
- Allow state eligibility for CMMI’s health care innovation grants
- Require midwife hospital privileges for hospital participation in Medicaid
- Remove institutions for mental disease exclusion for federal matching payments
Note: per Section 2801 of ACA, MACPAC is tasked with reviewing state and federal Medicaid and CHIP access and payment policies and making recommendations to Congress, the Secretary of HHS, and the states on a wide range of issues affecting Medicaid and CHIP populations. The commission includes appointed experts, government officials, executives and medical professionals.
GAO appoints five new members to MedPAC
Thursday, the GAO appointed five new members to the Medicare Payment Advisory Commission (MedPAC):
- Alice Coombs, MD, critical care specialist and anesthesiologist at South Shore Hospital in Weymouth, MA
- Jack Hoadley, research professor at the Georgetown University Health Policy Institute in Washington, DC
- David Nerenz, director of the Center for Health Policy & Health Services Research at the Henry Ford Health System in Detroit, MI
- Rita Redberg, professor of clinical medicine at the University of California at San Francisco Medical Center
- Craig Samitt, president and chief executive officer at Dean Health System in Madison, WI
Note: MedPAC is an independent U.S. federal body established by the Balanced Budget Act of 1997 (P.L. 105-33) to advise Congress on issues affecting the administration of the Medicare program. Specifically the 17-member commission's charter is to advise on payments to private health plans participating in Medicare and health providers serving Medicare beneficiaries. It produces two major reports to Congress each year that contain recommendations to improve Medicare. Congress is not obligated to follow its recommendations. Commissioners serve three year terms and include health services research, health economists, and industry experts.
Report: Summary of Benefits should help enrollees and applicants understand their coverage
Approximately 173.5 million people (65.1 percent of the non-elderly population in the U.S.) will benefit from the Summary of Benefits and Coverage requirements per Section 2715 of ACA. By September 23, 2012 (18 months from passage) insurers must provide the summary to applicants for coverage as well as policyholders or certificate holders and enrollees. It also requires insurers to provide explanations of common terms used in policy documents. The report also found that more than 90 percent of those enrolled in ESI and 18.7 million people with coverage through the individual market will benefit from the Summary of Benefits.
Source: Families USA, “Decoding Your Health Insurance: The New Summary of Benefits and Coverage,” May 2012
Ways and Means Committee questions cost of ACA public relations effort
Wednesday, Representative Charles Boustany Jr., MD (R-LA) of the House Ways and Means Subcommittee on Oversight wrote a letter to HHS Secretary, Kathleen Sebelius, requesting that by June 1st the agency provide details of its public relations campaigns including: the name of its contractors, descriptions of their work, and the amount of the contracts. The letter was written in response to media reports claiming the administration signed a $20 million contract for an advertising campaign to promote wellness benefits of ACA.
FDA user fee bill passed in Senate; includes expanded oversight
Thursday, the Senate voted (96-1) to pass the U.S. Food and Drug Administration (FDA) user fee bill after a week of markups and nearly 40 amendment proposals. The bill renews user fees for drug and medical devices and authorizes new payments for generic drugs, biosimilar products, as well as rare and pediatric disease drug development. The Senate rejected several controversial amendments including reducing exclusivity for companies at fault for fraud, imposing limits on so-called pay-for-delay drug patent settlements, and most notably Senator John McCain’s (R-AZ) amendment that would allow importation of drugs from Canada, which failed by a vote of 43 to 54. The Senate adopted several notable amendments that would:
- Increase drug information for underrepresented patient populations
- Require reports on small businesses and clinical trial funding disclosures
- Reclassify synthetic drugs under the Controlled Substances Act
- Set a deadline for compliance with FDA's new sunscreen rules
- Establish standards to facilitate exchange of drug information
- Require an independent assessment of the drug approval and review process
Note: the Congressional Budget Office (CBO) unveiled cost estimates for the House and Senate versions of the bill. CBO projected the House bill will increase federal deficits by $247 million and the Senate version will reduce the deficit by $363 million over ten years. Friday, the House Energy and Commerce Committee posted a new version of the FDA bill that the full House will vote on this week.
The Senate also voted on a student loan bill that passed the House (215-195) in April. Senators rejected the bill Thursday (34-62) which would eliminate $6 million in funding for the Prevention and Public Health Fund.
FDA response: Commissioner Margaret Hamburg: "FDA is pleased that the Senate has voted to reauthorize the prescription drug and medical device user fee programs and create new user fee programs for biosimilar biological products and generic drugs."
AdvaMed response: “We believe the strong bipartisan support this measure received today reflects the acknowledgement that this legislation will benefit not only FDA and the medical technology industry, but most importantly American patients. Through a combination of groundbreaking accountability and transparency measures and enhanced FDA resources, the user fee agreement has the potential to increase the predictability, consistency and efficiency of FDA’s decision-making, while maintaining the agency’s stringent product approval standards.”
Federation of American Hospitals (FAH): “Senate approval of bipartisan FDA user fee legislation is a significant step toward addressing our nation’s escalating prescription drug shortage crisis. FAH member hospitals are well aware of the significance and scope of this crisis. Increasingly, our hospitals are confronted by these shortages and challenged, without advance notice, to quickly procure supplies of vital prescription drugs that are indispensable for saving lives and providing quality patient care.”
CBO: sequester, Bush tax cuts reduce deficit $560 billion between FY2012 – FY2013
Per the CBO analysis last Monday, if Congress allows the Bush tax cuts to expire at the end of the 2012 and the sequester to take effect (Budget Control Act of 2011), the deficit will fall by $560 billion between fiscal year (FY) 2012 and 2013.
Source: CBO, “Economic Effects of Reducing the Fiscal Restraint that is Schedule to Occur in 2013,” May 2012
Health exchange update: CCIIO urges states to apply for federal partnership as Plan B
The Centers for Medicare and Medicaid (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) hosted a three-day HIX meeting for state and federal partners last week encouraging states to move forward with HIX planning. Per CCIIO, states anticipating operating their own HIXs should also apply for the federal partnership. CCIIO announced that draft rules on risk adjustment will be issued this fall, but final rules should not be expected until December 2012 or January 2013.
Reaction: state officials expressed concern that plan participation in HIXs will be low without final risk adjustment rules and have questions about the state-federal partnership HIX included in guidance that CCIIO recently released (see Monday Memo: May 21, 2012). CCIIO encouraged states to apply for a partnership HIX in addition to their state-run HIXs as a “Plan B.”
Note: Thursday, CCIIO posted frequently asked questions FAQ on the process for submitting blueprints and applications for state-based and state/federal partnership HIXs.
- Missouri’s House approved a bill (108 – 38) which will allow residents to vote on whether or not to establish a state HIX. The bill had already passed in the Senate, and will be placed on the state’s ballot in November.
- The Washington Health Benefit Exchange is estimated to have expenses ranging from $44.4 to $60.3 million beginning in 2015. The exchange board is currently reviewing ten options for financing the exchange including the assessment of percentage fees on qualified health plans (QHPs), assessment on all issuers, broad-based assessments (e.g., health care market, alcohol/tobacco taxes), replacing or repurposing an existing revenue stream, user fees for exchange members and/or employers, advertising space on the exchange’s website, and supplemental services. They will also consider implementing a combination of the mentioned options.
- Massachusetts is the first state making plans to implement the Basic Health Plan program, per Section 1331 of ACA, which provides states an alternative means to provide coverage through managed care plans for adults earning between 133 – 200 percent of the federal poverty level — slightly higher than the Medicaid cutoff in 2014. Individuals who enroll in the Basic Health Plan would not be eligible to enroll in HIXs, and states will receive a 95 percent Federal Medical Assistance Percentage (FMAP) for the program.
Pharmacists, health insurance plans encourage biosimilar naming, interchangeability
Last week, pharmacists and third-party payers cautioned the FDA about the use of a naming system for biosimilars being pushed by some manufacturers and are urging the agency to issue guidance on interchangeability and prescribing.
CMS seeks software to screen for “bad actors”
CMS announced a call for applications to the Provider Screening Innovator Challenge in an effort to curb fraud in the Medicaid system. The challenge encourages the private sector to develop new software that can screen potential Medicaid providers and keep “bad actors” from entering the program. Over the next eight to nine months, software developers will compete by creating enhanced screening products for the results of site visits, criminal background checks, and identity verification. A total of $600,000 is available for prizes and the first contest begins on May 30th.
Physician groups seek continuation of ACA provisions for accountable care
Friday, the American College of Physicians (ACP), the American Osteopathic Association (AOA), and the American Medical Association (AMA), sent letters to House Ways and Means Committee Republicans requesting that certain provisions of ACA are kept intact. The physician groups highlighted programs such as accountable care organizations, patient-centered medical homes, and new payment models as necessary to move the Medicare system away from the sustainable growth rate and toward a new, more sustainable payment model.
Study: health care costs caused by higher unit prices, not overuse
Per the Health Care Cost Institute analysis of insurance claims for 33 million enrollees (2007 – 2010):
- Out-of-pocket share of expenses rose for patients, although the cost-sharing rate on a per-capita basis did not change significantly.
- Prices increased across all categories of service, with the highest increase seen in outpatient services.
- Utilization of services generally decreased from 2009 to 2010, with the largest declines seen in outpatient visits and inpatient admissions.
- The average health care spending per capita for those younger than 65 in ESI plans was $4,255.
Contrary to other studies, the study claims that growth in spending was primarily due to unit price increases, rather than changes in the quantity or intensity of services. In 2010, the average facility price for an inpatient stay was $14,662, 5.1 percent growth from 2009. The average facility price for an outpatient visit or procedure was $2,224 in 2010, 10.1 percent growth from 2009.
Source: Health Care Cost Institute, “Health Care Cost and Utilization Report 2010”, May 2012
Note: other studies (RAND, Dartmouth) have shown a correlation between higher utilization, higher intensity of service in addition to unit costs as root causes of health cost increases.
Study: employer-sponsored coverage slips to 56 percent due to costs
Per an Employee Benefit Research Institute analysis, between December 2007 and August 2009, the percentage of employees with ESI coverage in their own name fell from 60.4 percent to 55.8 percent in April 2011. According to the report, the drop in coverage is a result of cost, rather than employers’ decisions: 70 – 90 percent of individuals from December 1995 – July 2011 reported they did not have coverage because the cost of obtaining coverage. For most years beginning in 1995, the percent reporting they were not covered because of difficulty paying for insurance stayed in the 70 to mid-80 percent range. In 2009, it reached 86 percent and continued to rise to 90 percent.
Source: Employee Benefit Research Institute, “Trends in Employment-Based Coverage Among Workers, and Access to Coverage Among Uninsured Workers, 1995‒2011,” May 2012
Preventive Services Task Force discourages PSA test for prostate cancer screening
Last week, the U.S. Preventive Services Task Force (USPSTF) issued a final recommendation against prostate cancer screening for healthy men giving the prostate-specific antigen (PSA) based screening, a final grade of “D”—indicating that the harm of testing outweighs the benefit. After reviewing outcomes of the U.S. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and the European Randomized Study of Screening for Prostate Cancer, the task force found that the U.S. trial did not demonstrate any prostate cancer mortality reduction and the European trial found a reduction in deaths of approximately 1 out of 1,000 men in a subgroup of men age 55-69.
Note: HHS Secretary Sebelius issued a statement in February: “while the department has discretion to modify or eliminate coverage for the PSA test based on the Task Force’s recommendation, I do not intend to eliminate coverage of this screening test under Medicare at this time.” Tuesday, CMS officials confirmed that this statement is still the agency’s position following the new recommendation. Per Section 4104 of ACA, health plans are required to cover 100 percent of costs for preventative services if such services are recommended with a grade of A or B by the USPSTF for any indication or population and are appropriate for the individual.
A new survey from John Hopkins School of Medicine found that of the 125 primary care physicians asked, a large number said that while they agreed with old recommendations to not screen men over 75 or those not expected to live over ten years, many faced significant barriers to stopping PSA testing. Over 74 percent of physicians cited that their patients expect to continue receiving annual PSA tests, and 66 percent said it would take more time to explain the reasoning behind not screening than to just continue screening.
Source: Craig Pollack, et al, Archives of Internal Medicine, “Primary Care Providers' Response to the U.S. Preventive Services Task Force Draft Recommendations on Screening for Prostate Cancer,” April 2012
FCC opens spectrum to facilitate wireless patient monitoring systems
Thursday, the Federal Communications Commission (FCC) voted (5 – 0) to open radio frequencies for medical body area networks (MBANs), wireless patient monitoring systems that use low-cost wearable sensors and allow physicians to monitor patients’ vital signs remotely, both in the hospital and at home. Wireless devices that operate on MBAN spectrum can be used to actively monitor a blood glucose and pressure, delivery of electrocardiogram readings, and even neonatal monitoring systems. The U.S. is the first country to allow MBAN use on airwaves. The airwave spectrum will now be shared between health care providers and commercial test pilots and new rules allow “distinct but compatible users to share [the] airwaves.” FCC Chairman Julius Genachowski said in a press conference that the new regulations "will increase the spectrum capacity and enhance the reliability of wireless medical technology."
“Ultimately, public policy is about making difficult choices. Today, there are serious debates underway about the direction of our country – debates about the size and role of government, about America’s role as a global economic and military leader, about the moral and economic imperative of providing health care to all our citizens. People have deeply-held beliefs on all sides of these discussions, and you, as public policy leaders, will be called on to help move these debates forward.”
— HHS Secretary Kathleen Sebelius, Georgetown Public Policy Institute Commencement, May 18, 2012
“With good communication between multiple specialists, convenient access in evenings and on weekends, and familiarity with local community resources, the retail clinic potentially could be an important component of coordination of care aimed at reducing disease exacerbations, unnecessary hospitalizations and adverse drug interactions.”
— Christine Cassel, MD, “Retail Clinics and Drugstore Medicine,” Journal of the American Medical Association, May 2012
“If a State does not choose an Exchange model, HHS will assume that the State is not planning to operate as a State-based Exchange or a State Partnership Exchange. HHS will operate the Federally-facilitated Exchange in the State and will perform the Exchange-related programs of risk adjustment and reinsurance. Your State will work with the Center for Medicaid and CHIP Services within CMS to determine whether the Federally-facilitated Exchange will make eligibility determinations or assessments for these programs.”
— CCIIO guidance about role of exchanges posted Thursday, May 24, 2012
- Medical professionals in Congress: the 112th Congress of the United States, which convened on January 3, 2011, includes 31 medical professionals: three MDs and one OD in the Senate—all Republican; 27 in the House including 17 MDs, one physician’s assistant, two dentists, one psychologist, and six nurses—21 are Republican. (Source: MD News)
- Trust in online medical information: 30 percent of adults report that they “always” or “frequently” look to the Internet to provide answers to medical questions, 65 percent of those seeking information online say they trust the information, and 63 percent claim to have never misdiagnosed themselves when using online sources for medical information. (Source: Wolters Kluwer Health, “Survey: Consumers Show High Degree of Trust in Online Health Information, Report Success in Self-Diagnosis,” May 16, 2012)
- Organ donation: in 2011, individuals age 50 and over accounted for 32 percent of organ donors but received 60 percent of the total number of transplants. More than 114,000 people in the U.S. are waiting for an organ. (Source: HHS) Note: HHS launched a national campaign to educate older adults about organ donation and to dispel myths surrounding age concerns about donating organs.
- Unemployment: 37 states and DC (75 percent of all states) saw a decrease in unemployment in April. Five states saw increases and eight saw no change in unemployment. (Source: Bureau of Labor Statistics, “Regional and State Employment and Unemployment,” April 2012)
- Childhood obesity: U.S. adolescents age 12 – 19 are showing signs of cardiovascular heart disease: 14 percent prevalence of pre-hypertension/hypertension, 22 percent borderline high/high-low-density lipoprotein cholesterol, 6 percent low-high-density lipoprotein cholesterol, and 15 percent pre-diabetes/diabetes during 1999 – 2008. There was no significant change in the prevalence of pre-hypertension/hypertension or borderline-high/high low-density lipoprotein cholesterol, but the prevalence of pre-diabetes/diabetes increased from 9 percent to 23 percent. (Source: Ashleigh May, Elena Kuklina, Paula Yoon, Pediatrics, “Prevalence of Cardiovascular Disease Risk Factors Among U.S. Adolescents, 1999−2008,” May 2012)
- Emergency room (ER) visits: according to a new poll, 70 percent of Americans oppose the practice of health insurers denying payment for emergency department visits which are later deemed to be not medically urgent. (Source: American College of Emergency Physicians, “Seven in 10 Americans Oppose Health Plan Efforts to Deny Payments for ER Visits, New ACEP Poll Finds,” May 21, 2012) Note: when asked about the percent of health care costs that go to emergency care, 90 percent were surprised to learn that only 2 percent of health care costs in the U.S. can be attributed to emergency care ($47.3 billion)
- Injury prevention: California and New York ranked highest in state prevention of injuries, while Montana and Ohio were the lowest. New Mexico has the highest rate of injury-related deaths at a rate of 97.8 per 100,000 people, while New Jersey has the lowest rate at 36.1 per 100,000, compared to the national average of 57.9 per 100,000 people. (Source: Trust for Americas Health, Robert Wood Johnson Foundation, “The Facts Hurt: A State-by-State Injury Prevention Policy Report,” May 21, 2012)
National health reform: What now?
National health reform is here. The health reform bills (HR3590 and HR4872) are now law and will trigger sweeping changes and disruptions – some rather quickly and some over many years. The industry is asking, “What now?” At Deloitte, we continue to explore and debate the key questions facing the industry, and we look forward to helping our clients find and implement the right answers for their organizations. To learn more, visit www.deloitte.com/us/healthreform/whatnow today.
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