California's Obamacare Marketplace Aims To Kick Out Poor-Performing Hospitals
Supreme Court Strikes At States' Efforts On Health Care Transparency
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FM","link":"/"}},"stateofhealth_161534":{"type":"posts","id":"stateofhealth_161534","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"161534","score":null,"sort":[1458321747000]},"guestAuthors":[],"slug":"californias-obamacare-marketplace-aims-to-kick-out-poor-performing-hospitals","title":"California's Obamacare Marketplace Aims To Kick Out Poor-Performing Hospitals","publishDate":1458321747,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>California's insurance exchange is threatening to cut hospitals from its networks for poor performance or high costs, a \u003ca href=\"http://hbex.coveredca.com/stakeholders/plan-management/PDFs/2017_QHP_Issuer_Contract_Attachment_7_3_4_2016_Redline.pdf\">novel proposal\u003c/a> that is drawing heavy fire from medical providers and insurers.\u003c/p>\n\u003cp>The goal is to boost the overall quality of patient care and make coverage more affordable, said Peter Lee, executive director of the Covered California exchange.\u003c/p>\n\u003cp>\"The first few years were about getting people in the door for coverage,\" said Lee, a key figure in the rollout of the federal health law. \"We are now shifting our attention to changing the underlying delivery system to make it more cost effective and higher quality. We don't want to throw anyone out, but we don't want to pay for bad quality care either.\"\u003c/p>\n\u003cp>It appears to be the first proposal of its kind in the country. The exchange's five-member board is slated to vote on it next month. If approved, insurers would need to identify hospital \"outliers\" on cost and quality starting in 2018. Medical groups and doctors would be rated after that.\u003c/p>\n\u003cp>Providers who don't measure up stand to lose insured patients and suffer a black eye that could sully their reputations with employers and other big customers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>By 2019, health plans would be expected to expel poor performers from their exchange networks.\u003c/p>\n\u003cp>The idea has already sparked fierce opposition. Doctors and hospitals accuse the exchange of overstepping its authority and failing to spell out the specific measures they would be judged on.\u003c/p>\n\u003cp>Health insurers, normally at odds with providers, have joined them in the fight. The insurers are balking at the prospect of disclosing their negotiated rates with providers. Health plans have long resisted efforts that would let competitors or the public see the deals they make with doctors and hospitals.\u003c/p>\n\u003cp>But scrutinizing the negotiated rates would help the exchange identify high-cost providers and allow policyholders with high deductibles to see the differences in price before undergoing a surgery or imaging test.\u003c/p>\n\u003cp>Lee said it's time for the exchange to move beyond enrollment and flex its market power on behalf of its 1.5 million members. He said insurers haven't been tough enough on hospitals and doctors.\u003c/p>\n\u003cp>Other public exchanges or large employers could try to replicate the idea, putting more pressure on providers and insurers. Lee has shared his proposal with other state marketplaces, government officials and employer groups to promote similar efforts.\u003c/p>\n\u003cp>Still, there are limits to this strategy. Exceptions would be granted if excluding a hospital or doctor from a network meant an area wouldn't have a sufficient number of providers. Insurers could appeal and offer other reasons for keeping a provider in the network.\u003c/p>\n\u003cp>\"California is definitely ahead of the pack when it comes to taking an active purchasing role, and exclusion is a pretty big threat,\" said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. \"There may be a dominant hospital system that's charging through the nose, but without them you don't have an adequate network. It will be interesting to see how Covered California threads that needle.\"\u003c/p>\n\u003cp>The composition of networks has typically been left up to insurers. Until now, most of the discussion has centered on the proliferation of narrow networks, with a limited range of providers, sold under the Affordable Care Act as a way to hold down rates. A \u003ca href=\"http://ldi.upenn.edu/sites/default/files/rte/state-narrow-networks.pdf\">study\u003c/a> in 2015 found that 75 percent of Covered California plans had narrow physician networks, with more restricted choices than all but three other states.\u003c/p>\n\u003cp>\"I don't know of anyone even close to trying this,\" said Dan Polsky, the study's author and executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. \"I applaud Covered California for being bold to improve quality and reduce costs, but I worry about the implementation.\"\u003c/p>\n\u003cp>Polsky said measuring quality can be complicated, and steps must be taken to ensure hospitals and doctors aren't penalized for treating sicker patients or serving lower-income areas. Most quality-boosting efforts use financial bonuses and penalties rather than exclusion.\u003c/p>\n\u003cp>Under the Covered California plan, hospitals would be judged on a wide range of performance and safety measures, from rates of readmission and hospital-acquired infections to adverse drug events. The exchange said it will draw on existing measures already tracked by Medicare and other groups, and it will work with hospitals, consumer advocates and other experts over the next 18 months to finalize the details.\u003c/p>\n\u003cp>The California Hospital Association said the exchange is moving too fast and acting too much like a regulator.\u003c/p>\n\u003cp>\"The devil is in the details, and the rapidity of this concerns us,\" said Dr. David Perrott, chief medical officer at the state hospital trade group. \"We understand value-based purchasing is here in some form and we do not oppose that. But Covered California is charging ahead with this assessment and trying to figure out the answers when it hasn't been worked out.\"\u003c/p>\n\u003cp>California physicians warn that the exchange's proposal could further reduce networks that are already too thin for patients.\u003c/p>\n\u003cp>\"Right now, one of the biggest problems in healthcare is limited access to specialty care. This allows more narrowing of the networks under spurious guidelines,\" said Dr. Ted Mazer, a board member of the California Medical Association and a head and neck surgeon in San Diego.\u003c/p>\n\u003cp>Charles Bacchi, chief executive of the California Association of Health Plans, predicted that Covered California's idea will backfire, discouraging hospitals and doctors from participating in the exchange and driving up premiums as a result.\u003c/p>\n\u003cp>\"It's the right goal but the wrong approach,\" Bacchi said. \"Covered California is proposing a top-down, arbitrary measurement system that carries a big stick. This can make it difficult for health plans and providers to work together constructively.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes \u003ca href=\"http://californiahealthline.org/news/california-insurance-marketplace-wants-to-kick-out-poor-performing-hospitals/\" target=\"_blank\">California Healthline\u003c/a>, a service of the California HealthCare Foundation. Follow Chad Terhune on Twitter: \u003ca href=\"https://twitter.com/chadterhune\">@chadterhune\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News.\u003c/div>\n\n","blocks":[],"excerpt":"The Covered California proposal appears to be the first of its kind in the country. Trade groups for California hospitals and insurers are wary of the plan.","status":"publish","parent":0,"modified":1458321824,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":1006},"headData":{"title":"California's Obamacare Marketplace Aims To Kick Out Poor-Performing Hospitals | KQED","description":"The Covered California proposal appears to be the first of its kind in the country. Trade groups for California hospitals and insurers are wary of the plan.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California's Obamacare Marketplace Aims To Kick Out Poor-Performing Hospitals","datePublished":"2016-03-18T17:22:27.000Z","dateModified":"2016-03-18T17:23:44.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"161534 http://ww2.kqed.org/stateofhealth/?p=161534","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/03/18/californias-obamacare-marketplace-aims-to-kick-out-poor-performing-hospitals/","disqusTitle":"California's Obamacare Marketplace Aims To Kick Out Poor-Performing Hospitals","nprImageCredit":"Anne Cusack","nprByline":"Chad Terhune\u003cbr />\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>","nprImageAgency":"LA Times via Getty Images","nprStoryId":"470851581","nprApiLink":"http://api.npr.org/query?id=470851581&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/03/18/470851581/california-insurance-marketplace-aims-to-kick-out-poor-performing-hospitals?ft=nprml&f=470851581","nprRetrievedStory":"1","nprPubDate":"Fri, 18 Mar 2016 05:00:00 -0400","nprStoryDate":"Fri, 18 Mar 2016 05:00:15 -0400","nprLastModifiedDate":"Fri, 18 Mar 2016 05:00:15 -0400","path":"/stateofhealth/161534/californias-obamacare-marketplace-aims-to-kick-out-poor-performing-hospitals","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>California's insurance exchange is threatening to cut hospitals from its networks for poor performance or high costs, a \u003ca href=\"http://hbex.coveredca.com/stakeholders/plan-management/PDFs/2017_QHP_Issuer_Contract_Attachment_7_3_4_2016_Redline.pdf\">novel proposal\u003c/a> that is drawing heavy fire from medical providers and insurers.\u003c/p>\n\u003cp>The goal is to boost the overall quality of patient care and make coverage more affordable, said Peter Lee, executive director of the Covered California exchange.\u003c/p>\n\u003cp>\"The first few years were about getting people in the door for coverage,\" said Lee, a key figure in the rollout of the federal health law. \"We are now shifting our attention to changing the underlying delivery system to make it more cost effective and higher quality. We don't want to throw anyone out, but we don't want to pay for bad quality care either.\"\u003c/p>\n\u003cp>It appears to be the first proposal of its kind in the country. The exchange's five-member board is slated to vote on it next month. If approved, insurers would need to identify hospital \"outliers\" on cost and quality starting in 2018. Medical groups and doctors would be rated after that.\u003c/p>\n\u003cp>Providers who don't measure up stand to lose insured patients and suffer a black eye that could sully their reputations with employers and other big customers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>By 2019, health plans would be expected to expel poor performers from their exchange networks.\u003c/p>\n\u003cp>The idea has already sparked fierce opposition. Doctors and hospitals accuse the exchange of overstepping its authority and failing to spell out the specific measures they would be judged on.\u003c/p>\n\u003cp>Health insurers, normally at odds with providers, have joined them in the fight. The insurers are balking at the prospect of disclosing their negotiated rates with providers. Health plans have long resisted efforts that would let competitors or the public see the deals they make with doctors and hospitals.\u003c/p>\n\u003cp>But scrutinizing the negotiated rates would help the exchange identify high-cost providers and allow policyholders with high deductibles to see the differences in price before undergoing a surgery or imaging test.\u003c/p>\n\u003cp>Lee said it's time for the exchange to move beyond enrollment and flex its market power on behalf of its 1.5 million members. He said insurers haven't been tough enough on hospitals and doctors.\u003c/p>\n\u003cp>Other public exchanges or large employers could try to replicate the idea, putting more pressure on providers and insurers. Lee has shared his proposal with other state marketplaces, government officials and employer groups to promote similar efforts.\u003c/p>\n\u003cp>Still, there are limits to this strategy. Exceptions would be granted if excluding a hospital or doctor from a network meant an area wouldn't have a sufficient number of providers. Insurers could appeal and offer other reasons for keeping a provider in the network.\u003c/p>\n\u003cp>\"California is definitely ahead of the pack when it comes to taking an active purchasing role, and exclusion is a pretty big threat,\" said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. \"There may be a dominant hospital system that's charging through the nose, but without them you don't have an adequate network. It will be interesting to see how Covered California threads that needle.\"\u003c/p>\n\u003cp>The composition of networks has typically been left up to insurers. Until now, most of the discussion has centered on the proliferation of narrow networks, with a limited range of providers, sold under the Affordable Care Act as a way to hold down rates. A \u003ca href=\"http://ldi.upenn.edu/sites/default/files/rte/state-narrow-networks.pdf\">study\u003c/a> in 2015 found that 75 percent of Covered California plans had narrow physician networks, with more restricted choices than all but three other states.\u003c/p>\n\u003cp>\"I don't know of anyone even close to trying this,\" said Dan Polsky, the study's author and executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. \"I applaud Covered California for being bold to improve quality and reduce costs, but I worry about the implementation.\"\u003c/p>\n\u003cp>Polsky said measuring quality can be complicated, and steps must be taken to ensure hospitals and doctors aren't penalized for treating sicker patients or serving lower-income areas. Most quality-boosting efforts use financial bonuses and penalties rather than exclusion.\u003c/p>\n\u003cp>Under the Covered California plan, hospitals would be judged on a wide range of performance and safety measures, from rates of readmission and hospital-acquired infections to adverse drug events. The exchange said it will draw on existing measures already tracked by Medicare and other groups, and it will work with hospitals, consumer advocates and other experts over the next 18 months to finalize the details.\u003c/p>\n\u003cp>The California Hospital Association said the exchange is moving too fast and acting too much like a regulator.\u003c/p>\n\u003cp>\"The devil is in the details, and the rapidity of this concerns us,\" said Dr. David Perrott, chief medical officer at the state hospital trade group. \"We understand value-based purchasing is here in some form and we do not oppose that. But Covered California is charging ahead with this assessment and trying to figure out the answers when it hasn't been worked out.\"\u003c/p>\n\u003cp>California physicians warn that the exchange's proposal could further reduce networks that are already too thin for patients.\u003c/p>\n\u003cp>\"Right now, one of the biggest problems in healthcare is limited access to specialty care. This allows more narrowing of the networks under spurious guidelines,\" said Dr. Ted Mazer, a board member of the California Medical Association and a head and neck surgeon in San Diego.\u003c/p>\n\u003cp>Charles Bacchi, chief executive of the California Association of Health Plans, predicted that Covered California's idea will backfire, discouraging hospitals and doctors from participating in the exchange and driving up premiums as a result.\u003c/p>\n\u003cp>\"It's the right goal but the wrong approach,\" Bacchi said. \"Covered California is proposing a top-down, arbitrary measurement system that carries a big stick. This can make it difficult for health plans and providers to work together constructively.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes \u003ca href=\"http://californiahealthline.org/news/california-insurance-marketplace-wants-to-kick-out-poor-performing-hospitals/\" target=\"_blank\">California Healthline\u003c/a>, a service of the California HealthCare Foundation. Follow Chad Terhune on Twitter: \u003ca href=\"https://twitter.com/chadterhune\">@chadterhune\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 Kaiser Health News.\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/161534/californias-obamacare-marketplace-aims-to-kick-out-poor-performing-hospitals","authors":["byline_stateofhealth_161534"],"categories":["stateofhealth_2442","stateofhealth_15"],"tags":["stateofhealth_368","stateofhealth_2678","stateofhealth_2519"],"featImg":"stateofhealth_161535","label":"stateofhealth"},"stateofhealth_155806":{"type":"posts","id":"stateofhealth_155806","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"155806","score":null,"sort":[1456946274000]},"guestAuthors":[],"slug":"supreme-court-strikes-at-states-efforts-on-health-care-transparency","title":"Supreme Court Strikes At States' Efforts On Health Care Transparency","publishDate":1456946274,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>The U.S. Supreme Court dealt a \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/14-181_5426.pdf\" target=\"_blank\">blow Tuesday\u003c/a> to nascent efforts to track the quality and cost of health care, ruling that a 1974 law precludes states from requiring that every health care claim involving their residents be submitted to a massive database.\u003c/p>\n\u003cp>The arguments were arcane, but the effect is clear: We're a long way off from having a true picture of the country's health care spending, especially differences in the way hospitals treat patients and doctors practice medicine.\u003c/p>\n\u003cp>It also means that, for the time being at least, we'll remain heavily reliant on data being released by Medicare, the federal health insurance program for the elderly and disabled, to study variations in health care. ProPublica has used Medicare data to study differences in \u003ca href=\"https://projects.propublica.org/checkup\" target=\"_blank\">medication prescribing\u003c/a>, \u003ca href=\"https://projects.propublica.org/surgeons/\" target=\"_blank\">surgeons' complication rates\u003c/a> and \u003ca href=\"https://projects.propublica.org/treatment/\" target=\"_blank\">use of services by doctors\u003c/a>, but it's still not clear that Medicare is representative of all health care in the country.\u003c/p>\n\u003cp>The court's decision involves a case from Vermont, one of 18 states that created so-called all-payer claims databases. Vermont's law called for health insurers, health providers, medical facilities and government agencies to report data on health care costs, prices, quality and use of services to the state. That included employers who pay the costs of their workers' treatments themselves, and not through an insurance contract. (Self-insurance is common for large companies.)\u003c/p>\n\u003cp>But Liberty Mutual Insurance Co. objected, saying the Employee Retirement Income Security Act of 1974, or ERISA, prevents states from imposing such a requirement on self-funded plans. The idea is that companies that have operations across the country shouldn't be subjected to 50 different state laws, but instead should only have to abide by rules from one agency, namely the U.S. Department of Labor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The court sided with Liberty Mutual, in a 6-2 decision, ruling it didn't have to submit the data demanded by Vermont.\u003c/p>\n\u003cp>In a friend-of-the-court \u003ca href=\"http://www.scotusblog.com/wp-content/uploads/2015/09/150904-amicus-gobeille-liberty.pdf\" target=\"_blank\">brief filed last September\u003c/a>, the American Hospital Association and the Association of American Medical Colleges said that without the data from self-funded plans, all-payer claims databases will be incomplete and not as valuable as they could be.\u003c/p>\n\u003cp>\"Hospitals only have data for the patients they treat,\" the groups wrote. \"Information from across the spectrum of an individual's health care experience is needed to inform clinical, payment, and public health policy...Complete data across all payers (including self-insurers like Respondent) is required so that both health care providers and policymakers can understand the variations in the health care system, and address those that need to change.\"\u003c/p>\n\u003cp>They also noted that self-insured plans cover a \"large majority of the working population: in 2013, nearly 60 percent of workers with health insurance were enrolled in such plans, and that figure is growing.\"\u003c/p>\n\u003cp>So what now? One option is for self-insured plans like Liberty Mutual to voluntarily provide their data to state-run databases. But given the lawsuit, that appears unlikely.\u003c/p>\n\u003cp>Another possibility, raised by Justice Stephen Breyer, is for the federal government to require self-insured plans to disclose their data. \"I see no reason why the Secretary of Labor could not develop reporting requirements that satisfy the states' needs, including some state-specific requirements, as appropriate,\" he wrote.\u003c/p>\n\u003cp>For now, though, we may have to do what we have done for years: Settle for an incomplete picture of health care spending and utilization.\u003c/p>\n\u003cp>Our team at ProPublica has already found fascinating patterns in Medicare data. In \u003ca href=\"https://www.propublica.org/article/billing-to-the-max-docs-charge-medicare-top-rate-for-office-visits\">one example\u003c/a>, 1,800 doctors billed Medicare for the most expensive type of office visits at least 90 percent of the time, compared to just 4 percent of office visits for all doctors.\u003c/p>\n\u003cp>Another group, the \u003ca href=\"http://www.healthcostinstitute.org/\" target=\"_blank\">Health Care Cost Institute\u003c/a>, has greenlighted research using data from three of the nation's largest private insurance companies. It has found some \u003ca href=\"http://www.healthcostinstitute.org/news-and-events/hcci-releases-new-research-assessing-national-and-state-health-policies\" target=\"_blank\">interesting trends\u003c/a> too, but hasn't released data on individual doctors and hospitals.\u003c/p>\n\u003cp>Medicare could release more data, as could the Health Care Cost Institute.\u003c/p>\n\u003cp>The Supreme Court decision means transparency has a long way to go.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.propublica.org/about/pixelping\" target=\"_blank\">Charles Ornstein\u003c/a>\u003cem> is a senior reporter at \u003c/em>\u003ca href=\"https://www.propublica.org/\" target=\"_blank\">ProPublica\u003c/a>,\u003cem> an independent investigative newsroom based in New York.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Supreme+Court+Strikes+At+States%27+Efforts+On+Health+Care+Transparency&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n","blocks":[],"excerpt":"The U.S. Supreme Court ruled that states can't require many large employers to submit health care claims to a massive database. The decision means Medicare data will remain the go-to source for now.","status":"publish","parent":0,"modified":1456946367,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":711},"headData":{"title":"Supreme Court Strikes At States' Efforts On Health Care Transparency | KQED","description":"The U.S. Supreme Court ruled that states can't require many large employers to submit health care claims to a massive database. The decision means Medicare data will remain the go-to source for now.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Supreme Court Strikes At States' Efforts On Health Care Transparency","datePublished":"2016-03-02T19:17:54.000Z","dateModified":"2016-03-02T19:19:27.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"155806 http://ww2.kqed.org/stateofhealth/?p=155806","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/03/02/supreme-court-strikes-at-states-efforts-on-health-care-transparency/","disqusTitle":"Supreme Court Strikes At States' Efforts On Health Care Transparency","nprImageCredit":"Saul Loeb","nprByline":"Charles Ornstein","nprImageAgency":"AFP/Getty Images","nprStoryId":"468756393","nprApiLink":"http://api.npr.org/query?id=468756393&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/03/02/468756393/supreme-court-strikes-at-states-efforts-on-health-care-transparency?ft=nprml&f=468756393","nprRetrievedStory":"1","nprPubDate":"Wed, 02 Mar 2016 08:49:00 -0500","nprStoryDate":"Wed, 02 Mar 2016 08:49:48 -0500","nprLastModifiedDate":"Wed, 02 Mar 2016 08:49:48 -0500","path":"/stateofhealth/155806/supreme-court-strikes-at-states-efforts-on-health-care-transparency","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The U.S. Supreme Court dealt a \u003ca href=\"http://www.supremecourt.gov/opinions/15pdf/14-181_5426.pdf\" target=\"_blank\">blow Tuesday\u003c/a> to nascent efforts to track the quality and cost of health care, ruling that a 1974 law precludes states from requiring that every health care claim involving their residents be submitted to a massive database.\u003c/p>\n\u003cp>The arguments were arcane, but the effect is clear: We're a long way off from having a true picture of the country's health care spending, especially differences in the way hospitals treat patients and doctors practice medicine.\u003c/p>\n\u003cp>It also means that, for the time being at least, we'll remain heavily reliant on data being released by Medicare, the federal health insurance program for the elderly and disabled, to study variations in health care. ProPublica has used Medicare data to study differences in \u003ca href=\"https://projects.propublica.org/checkup\" target=\"_blank\">medication prescribing\u003c/a>, \u003ca href=\"https://projects.propublica.org/surgeons/\" target=\"_blank\">surgeons' complication rates\u003c/a> and \u003ca href=\"https://projects.propublica.org/treatment/\" target=\"_blank\">use of services by doctors\u003c/a>, but it's still not clear that Medicare is representative of all health care in the country.\u003c/p>\n\u003cp>The court's decision involves a case from Vermont, one of 18 states that created so-called all-payer claims databases. Vermont's law called for health insurers, health providers, medical facilities and government agencies to report data on health care costs, prices, quality and use of services to the state. That included employers who pay the costs of their workers' treatments themselves, and not through an insurance contract. (Self-insurance is common for large companies.)\u003c/p>\n\u003cp>But Liberty Mutual Insurance Co. objected, saying the Employee Retirement Income Security Act of 1974, or ERISA, prevents states from imposing such a requirement on self-funded plans. The idea is that companies that have operations across the country shouldn't be subjected to 50 different state laws, but instead should only have to abide by rules from one agency, namely the U.S. Department of Labor.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The court sided with Liberty Mutual, in a 6-2 decision, ruling it didn't have to submit the data demanded by Vermont.\u003c/p>\n\u003cp>In a friend-of-the-court \u003ca href=\"http://www.scotusblog.com/wp-content/uploads/2015/09/150904-amicus-gobeille-liberty.pdf\" target=\"_blank\">brief filed last September\u003c/a>, the American Hospital Association and the Association of American Medical Colleges said that without the data from self-funded plans, all-payer claims databases will be incomplete and not as valuable as they could be.\u003c/p>\n\u003cp>\"Hospitals only have data for the patients they treat,\" the groups wrote. \"Information from across the spectrum of an individual's health care experience is needed to inform clinical, payment, and public health policy...Complete data across all payers (including self-insurers like Respondent) is required so that both health care providers and policymakers can understand the variations in the health care system, and address those that need to change.\"\u003c/p>\n\u003cp>They also noted that self-insured plans cover a \"large majority of the working population: in 2013, nearly 60 percent of workers with health insurance were enrolled in such plans, and that figure is growing.\"\u003c/p>\n\u003cp>So what now? One option is for self-insured plans like Liberty Mutual to voluntarily provide their data to state-run databases. But given the lawsuit, that appears unlikely.\u003c/p>\n\u003cp>Another possibility, raised by Justice Stephen Breyer, is for the federal government to require self-insured plans to disclose their data. \"I see no reason why the Secretary of Labor could not develop reporting requirements that satisfy the states' needs, including some state-specific requirements, as appropriate,\" he wrote.\u003c/p>\n\u003cp>For now, though, we may have to do what we have done for years: Settle for an incomplete picture of health care spending and utilization.\u003c/p>\n\u003cp>Our team at ProPublica has already found fascinating patterns in Medicare data. In \u003ca href=\"https://www.propublica.org/article/billing-to-the-max-docs-charge-medicare-top-rate-for-office-visits\">one example\u003c/a>, 1,800 doctors billed Medicare for the most expensive type of office visits at least 90 percent of the time, compared to just 4 percent of office visits for all doctors.\u003c/p>\n\u003cp>Another group, the \u003ca href=\"http://www.healthcostinstitute.org/\" target=\"_blank\">Health Care Cost Institute\u003c/a>, has greenlighted research using data from three of the nation's largest private insurance companies. It has found some \u003ca href=\"http://www.healthcostinstitute.org/news-and-events/hcci-releases-new-research-assessing-national-and-state-health-policies\" target=\"_blank\">interesting trends\u003c/a> too, but hasn't released data on individual doctors and hospitals.\u003c/p>\n\u003cp>Medicare could release more data, as could the Health Care Cost Institute.\u003c/p>\n\u003cp>The Supreme Court decision means transparency has a long way to go.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.propublica.org/about/pixelping\" target=\"_blank\">Charles Ornstein\u003c/a>\u003cem> is a senior reporter at \u003c/em>\u003ca href=\"https://www.propublica.org/\" target=\"_blank\">ProPublica\u003c/a>,\u003cem> an independent investigative newsroom based in New York.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Supreme+Court+Strikes+At+States%27+Efforts+On+Health+Care+Transparency&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/155806/supreme-court-strikes-at-states-efforts-on-health-care-transparency","authors":["byline_stateofhealth_155806"],"categories":["stateofhealth_2442","stateofhealth_14"],"tags":["stateofhealth_2678","stateofhealth_799"],"featImg":"stateofhealth_155807","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You ask the questions. You decide what Bay Curious investigates. 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. 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