Health Wonk Review: The Turkey Edition

Welcome to Health Wonk Review, the bi-weekly blog carnival featuring the latest and greatest blogging by a staggeringly wonkish agglomeration of health care policy nerds. The last edition of Health Wonk Review was hosted at Wing of Zock. The story behind the name of that blog seems (to this health wonk, at least) oddly relevant to this edition’s theme, given the recent news that the construction costs of the new presidential palace in Turkey seem to have doubled … again.

Well, our frame this week is the other turkey, the turkey that will lull many of us into a stupor late next week, and the health care policy decisions (and decisionmakers) that sometimes make us wish we were in more of a stupor … so as to lessen the pain. Top of mind in that department this week is #GruberGate:

I heard Zeke Emanuel give a speech this week at a conference in NYC, and when asked about Gruber (the reported “architect of Obamacare”), here’s what he had to say, in classic Zeke-speak (per my live-tweeting):

Zeke: ‘This is really simple. #Gruber is a talented economist. But politics is entirely different. Also, he was wrong on the facts.’ #DHC14

— David Harlow (@healthblawg) November 18, 2014

Zeke: ‘ #Gruber wasn’t part of the inner circle. He had a good model for use in analyzing the #ACA for #HHS’ #DHC14

— David Harlow (@healthblawg) November 18, 2014

Which Side of the (Pumpkin) Bread is Buttered?

At InsureBlog, Patrick Paule presents the case that another sort of obfuscation has been perpetrated on the American people — one regarding the true nature of ultimate payment for Obamacare.

Setting the Table for the Future

Louise Norris lays out her top five desired ACA fixes at Colorado Health Insurance Insider, though she readily acknowledges that the likelihood of the repeal-minded and the ACA-supporting congresspeople getting together and acting on them are slim.

John Graham, blogging at the National Center for Policy Analysis Health Policy Blog, thinks that PWC, RWJF and KFF reports, among other positive news on premiums in the exchanges for year 2 of Obamacare, are all pie-in-the-sky. He thinks low average premiums in year 2 will be achieved not by Obamacare saving money but by insurers getting better at attracting healthy applicants.

Whose Neck is on the Chopping Block?

The accountability thing has gotten to a couple of wonks this week. Roy Poses, writing at Health Care Renewal is concerned about the “Too Big to Jail” attitude taken by the powers that be in meting out mere wrist-slaps (fines) to Big Pharma in connnection with allegedly deceptive promotion of potentially dangerous drugs, with no personal consequences to executives, while putting an executive of a much smaller company through the wringer (personal felony conviction) for wastewater violations.

On another front, the former CEO of a large mining concern was indicted for “conspiring to cause willful violations of ventilation requirements and coal-dust control rules — meant to prevent deadly mine blasts –during a 15-month period prior to the worst coal-mining disaster in a generation.” Read all about it at Worker’s Comp Insider.

Back to FDA-world for a moment: The benefits of generic drug legislation were extended to manufacturers of biosimilars in 2009 (see my post on the legislation and the legislative process before we got to the end of that story). Now that the first application has been filed using this new pathway for biosimilars, a competitor has filed suit alleging violations of state and federal law. See all the gory details in Jordan Paradise’s post at the Health Affairs Blog.

Here at HealthBlawg, I wrote about the latest court ruling finding that HIPAA establishes a standard of care that may be used in a negligent disclosure of medical records case — and the implications of that ruling.

Too Many Cooks?

Many interested parties continue to kibbitz about implementation of Meaningful Use. Personally, I am more focu

sed now on the opportunities for real improvement once we get past Stage 3, and I am not alone. The eHealth Initiative, a coalition of interested parties (payors, providers, employers), launched its 2020 Roadmap to “enable coordinated efforts by public and private sector organizations to transform care delivery through data exchange and health information technology.” See Peggy Salvatore’s post at Health System Ed on the post-meaningful use possibilities painted in the roadmap and the likelihood that ONC is looking past Stage 3 already, too. Neil Versel observes at Forbes.com that the AMA just wants the federales to drop the Meaningful Use penalties that are due to kick in January 1. (They seem to get their way on things like ICD-10 implementation delays. Check out the “Struck by orca, initial encounter” illustration.)

Talking Turkey

No, there’s no such thing as a talking turkey, but two wonks posted podcast interviews worth chewing on. Check out the Larry Levitt interview at healthinsurance.org wherein the KFF SVP waxes wonkish on ACA implementation post-midterm-elections, and at the Health Business Blog, David Williams’ interview with Aron Boros, the Executive Director of the Massachusetts Center for Health Information and Analysis (CHIA) about the health data needed to power health reform (I know, it makes me think of Chia Pets, too).

Leftovers

Joe Paduda brings us a post-election wrap-up at Managed Care Matters with a focus on ACA implementation, including an important point about the pain points for hospitals that used to get “disproportionate share” payments. Those are gone under the ACA becuase they were supposed to be effectively replaced by payments under the Mediciaid expansion. Since the Supremes let states opt out of Medicaid expansion, and since many did, the former dispropotionate share hospitals in those states are hurting.

Jason Shafrin looks at both sides of the debate regarding boarding psych patients in hospital ERs over at the Healthcare Economist.

Anthony Wright breaks down the effect of the elections on health reform in California and other states at Health Access Blog.

Bradley Flansbaum channels Rodney Dangerfield in his post on being a hospitalist in The Hospital Leader.

Jordan Shlain channels Inigo Montoya in his rant at The Health Care Blog against using the word “reimbursement.” — “I do not think it means what you think it means.”

The next edition will be hosted by Hank Stern at InsureBlog. For more information and links to the archives, see the Health Wonk Review home page.

Too much to keep straight? Well: “Don’t fret about that, pilgrim.” And don’t forget: if you mess up, some turkeys are the beneficiaries of Presidential pardons.

There may be hope for us yet.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting