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The New York Times reported that a number of states expect substantial increases in next year's premiums for health insurance plans sold on the state exchanges. Some states expect increases of over 50%. While the insurance subsidies will help many, NPR points out that there are some who will experience the cost of these increases: those who are not covered by insurance through their employers but also earn too much to qualify for subsidies. The New York Times raises the persistent question of whether or not these rate hikes are part of the so-called death spiral.

The New York Times reported that a number of states expect substantial increases in next year's premiums for health insurance plans sold on the state exchanges. Some states expect increases of over 50%. While the insurance subsidies will help many, NPR points out that there are some who will experience the cost of these increases: those who are not covered by insurance through their employers but also earn too much to qualify for subsidies. The New York Times raises the persistent question of whether or not these rate hikes are part of the so-called death spiral.

This news of increased premiums comes against the positive news of nationwide availability of insurance plans sold off of the insurance exchanges: Vox reported that every county is expected to offer at least one plan.

As Americans continue to face higher health insurance premiums, insurers are looking for alternate payment models that can help contain the growth in costs. The New York Times published an article of health systems' experiences with such an alternate payment model. The piece discusses the danger of the traditional payment model -- known as fee-for-service -- where providers are paid more when they do more, regardless of the actual outcomes:

As Americans continue to face higher health insurance premiums, insurers are looking for alternate payment models that can help contain the growth in costs. The New York Times published an article of health systems' experiences with such an alternate payment model. The piece discusses the danger of the traditional payment model -- known as fee-for-service -- where providers are paid more when they do more, regardless of the actual outcomes:

"In our current system, being inefficient means higher revenue," Dr. Blumenthal said. "It's hard to do the right thing in fee-for-service. But value-based payment reverses the incentives so they're aligned with patient and societal goals. When you get the incentives right, when you reward high value instead of high volume , you see a burst of creativity among providers finding ways to do better."

The pieces examines what some health systems do differently, given the different payment model that rewards efficiency (but employs some standards to help ensure quality of treatment). For example, health system providers can find it financially worthwhile to employ additional staff to help reduce costly hospitalizations. Under the fee-for-service model, providers had very little financial incentive to do so and generally would have been financially worse off for doing so.

There have been pockets of early successes, where the providers retain more money, payers pay less, and patients are less sick. It remains to be seen how widely these new models will be adopted.

The current big news in the health policy landscape is the Republicans' most recent attempt at repealing the Affordable Care Act, known as the Graham-Cassidy bill. Knowing that the Republicans lack the 60 votes needed for a filibuster-proof vote in the Senate, Republicans have been trying to use a procedure known as budget reconciliation to essentially defund the Affordable Care Act. Budget reconciliation only requires a simple majority, and is not able to overturn all aspects of the Affordable Care Act.

The current big news in the health policy landscape is the Republicans' most recent attempt at repealing the Affordable Care Act, known as the Graham-Cassidy bill. Knowing that the Republicans lack the 60 votes needed for a filibuster-proof vote in the Senate, Republicans have been trying to use a procedure known as budget reconciliation to essentially defund the Affordable Care Act. Budget reconciliation only requires a simple majority, and is not able to overturn all aspects of the Affordable Care Act. It is unclear whether the Republicans can gather the required 50 votes; notably, Senator John McCain has already spoken out against the bill. The New York Times offered its take on what effects the bill would have.

It appears that budget reconciliation can be used until October 1. Therefore, if the Republicans are unable to pass the bill before then, the Affordable Care Act is likely to stay around for much longer than the Republicans had hoped.

Kaiser Health News published a piece on how physician practices have become increasingly hospital-owned, while the reimbursement rates for large practices tend to cost insurance companies more. According to some claims data, the publication's analysis found that insurance companies reimbursed physicians employed by a hospital system two to four times more than what they reimbursed independent physicians for a vaginal delivery (the piece followed the story of an obstetrician). I have anecdotally heard that large medical systems have approached independent physicians, offering to buy their practice in exchange for better pay and less administrative overhead. While many physicians may bemoan the loss of independence, that offer will entice many. The reason that the large medical practices can afford to make those offers is that they employ enough of the local market's physicians that they can command much higher rates -- high enough to compensate for the higher salaries and overhead. If these acquisitions were done on a national scale, the Federal Trade Commission might be sufficiently interested to stop the concentration of power; however, given the local nature of health care, these acquisitions tend not to attract regulatory oversight.

Kaiser Health News published a piece on how physician practices have become increasingly hospital-owned, while the reimbursement rates for large practices tend to cost insurance companies more. According to some claims data, the publication's analysis found that insurance companies reimbursed physicians employed by a hospital system two to four times more than what they reimbursed independent physicians for a vaginal delivery (the piece followed the story of an obstetrician). I have anecdotally heard that large medical systems have approached independent physicians, offering to buy their practice in exchange for better pay and less administrative overhead. While many physicians may bemoan the loss of independence, that offer will entice many. The reason that the large medical practices can afford to make those offers is that they employ enough of the local market's physicians that they can command much higher rates -- high enough to compensate for the higher salaries and overhead. If these acquisitions were done on a national scale, the Federal Trade Commission might be sufficiently interested to stop the concentration of power; however, given the local nature of health care, these acquisitions tend not to attract regulatory oversight.

The insurance companies clearly understand the power dynamics, knowing that any particular independent physician doesn't meaningfully affect its business. However, the insurance companies seem to take a short-sighted view on the matter: by refusing to pay independent physicians anywhere near what they pay large practices, they allow the large practices to make very attractive acquisition offers. As practices consolidate, insurance companies become increasingly beholden to these large practices, which can in turn command higher prices and make even more attractive offers.

The Wall Street Journal reported on the Joint Commission, the non-profit organization that accredits almost 80% of the hospitals in the US. Accreditation from the Joint Commission is often looked to for assurance that a certain hospital is operating properly and safely. The article points out, however, that the organization "typically takes no action to revoke or modify accreditation when state inspectors find serious safety violations" and that the "Joint Commission revoked the accreditation of less than 1% of the hospitals that were out of Medicare compliance in 2014." Those findings raise the obvious question of what accreditation actually means if it does not change with the hospitals' safety records.

The Wall Street Journal reported on the Joint Commission, the non-profit organization that accredits almost 80% of the hospitals in the US. Accreditation from the Joint Commission is often looked to for assurance that a certain hospital is operating properly and safely. The article points out, however, that the organization "typically takes no action to revoke or modify accreditation when state inspectors find serious safety violations" and that the "Joint Commission revoked the accreditation of less than 1% of the hospitals that were out of Medicare compliance in 2014." Those findings raise the obvious question of what accreditation actually means if it does not change with the hospitals' safety records.

Apparently, the Joint Commission's response is that hospitals are given some time to rectify any safety lapses, and only in rare cases are the accreditation designations allowed to lapse. This policy raises a question of whether patients should at least be able to find out about recent safety lapses, even if the hospital is in the midst of correcting its practices. Patients could benefit from such transparency and decide whether they want to continue visiting such a hospital, but the Joint Commission has kept its inspection reports confidential. That the primary revenue for the Joint Commission comes from the hospitals that it accredits seems to parallel the situation where financial ratings agencies were beholden to the banks that paid them... a situation that did not go well for the general public in 2008.