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Affordable Care Act (ACA)

KFF: Report: ACA Provisions, HIV, and the Cycle of Violence Against Women
HIV positive status is linked to violence against women. Report describes ACA provisions can help: individual mandate exceptions, special enrollment periods, free screening and counseling for IPV, etc
RAND: Eliminating Exchange Subsidies Would Increase Premiums and the Number of Uninsured
This report looks at potential changes to the ACA and finds that eliminating premium subsidies would increase the cost to consumers by roughly 43% and lead to 11 million Americans losing insurance.
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Employer Sponsored Insurance

WSJ: Employers Work to Avoid ACA Penalties
Employers are shifting employees to Medicaid and offering skinny plans to avoid fines under the ACA. The penalties can cost $2,000 per employee and will go into effect in 2015 after a one year delay.
KHN: Use of Reference Pricing for Cost Containment Grows
Employers and insurers are increasingly attempting to control costs by capping how much they will reimburse for specific medical services such as lab tests and knee replacements. Savings are modest.
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Doctors

NIH: Grants: Director's Early Independence Awards
Up to $4M in grant funding is available for "exceptional investigators who wish to pursue independent research directly after completion of their terminal doctoral [or] research degree or clinical residency, thereby forgoing the traditional post-doctoral training period and accelerating their entry into an independent research career." Applications are due by Jan. 30, 2015. For details, see here.
LA Times: Hospital Owned Physicians Groups Cost Roughly 10-20 Percent More in California
Comparing hospital-owned physician groups to doctor owned organizations, researchers in California found that total spending per patient was 10.3 percent higher.
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Prescription Drugs

Reuters: Judge Rules in Favor of Law Banning Abortion Pills in Oklahoma
Oklahoma judge is allowing a law banning abortion-inducing pills to take effect Nov 1. Proponents see the move as protection against off-label use; opponents argue it will increase surgical abortions.
NIH: NIH Announces Early Trial of New Ebola Vaccine; Manufacturers Prepare to Rush Production
NIH announced human testing of a second investigational Ebola vaccine candidate, VSV-ZEBOV. This is an early phase trial that will evaluate its “safety and its ability to generate an immune system response in healthy adults who are given two intramuscular doses, called a prime-boost strategy.” In addition, NIH notes that the Walter Reed Army Institute of Research (WRAIR) is simultaneously testing the vaccine candidate as a single dose. NIH explains that VSV-ZEBOV was developed by researchers at the Public Health Agency of Canada’s National Microbiology Laboratory and licensed to NewLink Genetics Corp through its subsidiary BioProtection Systems. VSV-ZEBOV is based on a genetically engineered version of a virus that “primarily affects rodents, cattle, swine and horses” and cannot cause a vaccinated individual to become infected with Ebola, the NIH notes. Staggered enrollment at each dose level allows for safety evaluations between dosing levels. All participants will be clinically evaluated 11 times over one year, with “initial safety and immune response data on the VSV-ZEBOV vaccine expected by the end of 2014.” In addition, since early September, researchers at the National Institute of Allergy and Infectious Diseases (NIAID) have been working on early human testing of a vaccine candidate co-developed with GlaxoSmithKline (GSK). More information on safety and immunogenicity from clinical trials of the NIAID/GSK Ebola vaccine also are anticipated by the end of 2014. Additionally, as reported in Congressional Quarterly, Bloomberg, WSJ, and Reuters, vaccine manufacturers are partnering with one another and with the National Institute of Allergy and Infectious Disease with the hope of producing millions of Ebola vaccines by 2015. Also: NYT ($), The Hill
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Medicaid – General

Urban: Report: Louisiana's Success with Express Lane Eligibility for Medicaid
Report details Louisiana's experience with Express Lane Eligibility, a streamlined process for enrolling beneficiaries in Medicaid based on eligibility for other programs. ACA's impact also discussed.
WSJ: Employers Work to Avoid ACA Penalties
Employers are shifting employees to Medicaid and offering skinny plans to avoid fines under the ACA. The penalties can cost $2,000 per employee and will go into effect in 2015 after a one year delay.
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Health Information Technology (HIT)

CMS: Study Finds Uneven Use of Mobile, Online Information; Linked to Out-of-Pocket Costs
While a majority preferred offline communication with providers, researchers find that more than half of respondents across Medicaid, Medicare and privately insured groups use the Internet for obtaining health information. They note that "as out-of-pocket costs of medical care increase, consumers may increasingly turn to these generally free electronic health tools."
CMS: FAQ: Meaningful Use Security Risk Analysis Requirement
CMS provides details on meeting Meaningful Use's requirement to protect electronic health information, including differentiating requirements for Stages 1 and 2. The agency specifies aspects of the required security risk analysis while noting that generally, the  "objective complements but does not impose new or expanded requirements on the HIPAA Security Rule."
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Health Insurance Exchanges

RAND: Report: Examining the Impact of Young Adult Enrollment on Exchange Premiums
With the passage of the ACA, much discussion was had about the importance of young adults within the broader enrollment pool. Study finds that reduced enrollment would create modest premium increases.
CMS: Slides: FF-SHOP Transaction, Testing Details
During a technical assistance call with Federally Facilitated SHOP plans, CMS discusses the 820 payment transaction ID, cancellation and termination reason codes, the addition of newborns to an enrollment (see slide 10), and the SHOP 834 transaction's inclusion of issuer-assigned group numbers in specified instances, among other details. Beginning on slide 13, the agency provides an update on increment (phase) 2 of FF-SHOP testing.
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Hospitals

AHRQ: AHRQ Releases New Version of Quality Indicators Toolkit
AHRQ released a new version of the AHRQ Quality Indicators Toolkit for Hospitals (QI Toolkit) to help improve the quality of inpatient care. The toolkit is intended to help hospitals improve performance on AHRQ Quality Indicators, 18 Patient-Safety Indicators (PSIs) and 28 Inpatient Quality Indicators (IQIs). It also aims to help facilities:
  • Use inpatient data to assess the quality of care, identify areas for improvement, and track performance over time;
  • Improve quality from various levels, including senior leaders, analysts, and multidisciplinary improvement teams; and
  • Take advantage of “Best Practices” for 14 PSIs, identifying potential gaps, and to provide suggestions for hospitals regarding improvement, process steps, and additional resources.
The QI Toolkit is designed to support hospitals understand the QIs from AHRQ and use them to improve the quality of care and patient outcomes. The QIs "use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time." Specifically, the toolkit guides hospitals through the QI process from self-assessment to ongoing monitoring of quality measures. The agency notes that the "tools are practical, easy to use, and designed to meet a variety of needs, including those of senior leaders, quality staff, and multi-stakeholder improvement teams." The toolkit was established by the RAND Corporation and the University HealthSystem Consortium with funding from AHRQ and available for all hospitals to use free of charge.
JAMA: Report: Hospital For-Profit Status Does Not Impact Quality
Hospital conversion from non-profit to for-profit entities was not associated with a relative change in mortality rates, quality process measures, Medicare volume or portion of patients with Medicaid.
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Quality

AHRQ: AHRQ Releases New Version of Quality Indicators Toolkit
AHRQ released a new version of the AHRQ Quality Indicators Toolkit for Hospitals (QI Toolkit) to help improve the quality of inpatient care. The toolkit is intended to help hospitals improve performance on AHRQ Quality Indicators, 18 Patient-Safety Indicators (PSIs) and 28 Inpatient Quality Indicators (IQIs). It also aims to help facilities:
  • Use inpatient data to assess the quality of care, identify areas for improvement, and track performance over time;
  • Improve quality from various levels, including senior leaders, analysts, and multidisciplinary improvement teams; and
  • Take advantage of “Best Practices” for 14 PSIs, identifying potential gaps, and to provide suggestions for hospitals regarding improvement, process steps, and additional resources.
The QI Toolkit is designed to support hospitals understand the QIs from AHRQ and use them to improve the quality of care and patient outcomes. The QIs "use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time." Specifically, the toolkit guides hospitals through the QI process from self-assessment to ongoing monitoring of quality measures. The agency notes that the "tools are practical, easy to use, and designed to meet a variety of needs, including those of senior leaders, quality staff, and multi-stakeholder improvement teams." The toolkit was established by the RAND Corporation and the University HealthSystem Consortium with funding from AHRQ and available for all hospitals to use free of charge.
AHRQ: Draft Pediatric Dental, HIV-Related Electronic Quality Measures Open for Public Comment
Newly posted draft metrics include: HIV screening, HIV screening for patients with sexually transmitted infection, oral health sealant for children ages 6-9 and oral health care continuity for children ages 2-20.
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Legal

Reuters: Judge Rules in Favor of Law Banning Abortion Pills in Oklahoma
Oklahoma judge is allowing a law banning abortion-inducing pills to take effect Nov 1. Proponents see the move as protection against off-label use; opponents argue it will increase surgical abortions.
HR GPS: HealthCare.gov Health Plan Agreement Includes Halbig-Related Provision
Insurance entities sign an ACA QHP agreement before selling their plans on HealthCare.gov. Agreement now includes a provision allowing plans to be terminated if subsidies on the FFM end. Also: IHP$
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Delivery Reform

JAMA: Report: An Overview of CMS' Pioneer Accountable Care Collaborative Model
Authors provide a detailed history of CMS' Pioneer ACO model including the process and priorities adopted in each year, the outcomes observed, and the relationship to other Medicare ACOs.
Brookings: Commentary: How to Use Health Care to Improve Population Health
Introducing Brooking's upcoming Population Health Forum, Mark McClellan explains how new payment approaches can integrate community health programs, health care, and social services to improve health.
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Prevention

FDA: Agency Tabulates Flu Vaccine Lots Released to Date
An FDA chart tracks the number of flu vaccine lots released by the agency and cleared for distribution by manufacturers so far in the 2014-15 flu season.
AHRQ: Draft Pediatric Dental, HIV-Related Electronic Quality Measures Open for Public Comment
Newly posted draft metrics include: HIV screening, HIV screening for patients with sexually transmitted infection, oral health sealant for children ages 6-9 and oral health care continuity for children ages 2-20.
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