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Here's a wrinkle in the idea of disclosing quality metrics: what if one of the metrics is misleading? The rate of hospital readmissions is a commonly accepted quality metric: hospitals that have more risk-adjusted readmissions are typically deemed to provide worse care. Medicare even ties reimbursement to readmissions, penalizing hospitals that have readmissions that are too high. Some doctors from Cleveland Clinic have argued that not all readmissions are bad. Their angle is provocative, showing that hospitals that had a higher readmissions rate for heart failure tend to have a lower mortality rate. The authors posit that the higher readmissions rate is because hospitals operated sufficiently well to avoid patients' deaths, although those cases were complicated enough to warrant a second visit to the hospital. The argument goes that the hospitals that could not prevent death had fewer readmissions as an unintended side effect.

Here's a wrinkle in the idea of disclosing quality metrics: what if one of the metrics is misleading? The rate of hospital readmissions is a commonly accepted quality metric: hospitals that have more risk-adjusted readmissions are typically deemed to provide worse care. Medicare even ties reimbursement to readmissions, penalizing hospitals that have readmissions that are too high. Some doctors from Cleveland Clinic have argued that not all readmissions are bad. Their angle is provocative, showing that hospitals that had a higher readmissions rate for heart failure tend to have a lower mortality rate. The authors posit that the higher readmissions rate is because hospitals operated sufficiently well to avoid patients' deaths, although those cases were complicated enough to warrant a second visit to the hospital. The argument goes that the hospitals that could not prevent death had fewer readmissions as an unintended side effect.

I'm not familiar enough with the issue to understand how plausible this argument is, but I can very well see the possibility that some metrics need refinement. If this is a serious issue, then the caveat should be noted when patients are viewing such data. Nevertheless, I consider the collection and dissemination of this data to be a win for transparency, even if it comes with a counterintuitive disclaimer. Starting with this data and then understanding its limitations moves the conversation further along much more than if the data were never collected to begin with. Transparency gives people visibility; sometimes, though, the image can be hard to interpret.

In another example of how payers are pushing for better value, STAT reported that Harvard Pilgrim and two pharmaceutical companies have agreed that total payments for certain medications should depend on the efficacy of the medications. Harvard Pilgrim, an insurer, will expect discounts or rebates if medications do not outperform competitive options. In theory, both sides could be happy: Harvard Pilgrim would be paying for results, not just volume, while pharmaceutical companies might get reimbursed more if their products really perform better than alternatives.

In another example of how payers are pushing for better value, STAT reported that Harvard Pilgrim and two pharmaceutical companies have agreed that total payments for certain medications should depend on the efficacy of the medications. Harvard Pilgrim, an insurer, will expect discounts or rebates if medications do not outperform competitive options. In theory, both sides could be happy: Harvard Pilgrim would be paying for results, not just volume, while pharmaceutical companies might get reimbursed more if their products really perform better than alternatives.

Getting an accurate measure of drug effectiveness is likely going to be difficult. I would guess that Harvard Pilgrim will be primarily reviewing claims data, which has its limitations. For one, if a drug causes certain side effects, it may be difficult to recognize them. Nevertheless, this is an encouraging step towards measuring and paying for effectiveness within the realm of medicine.

The practice of pharmaceutical representatives bringing lunches or inviting doctors out to fancy retreats has long been controversial. The practice was so controversial that Congress passed a law called the Physician Payments Sunshine Act, requiring that gifts and sponsorships from pharmaceutical had to be disclosed publicly. HHS then required that such disclosures had to be reported through it, centralizing the information and making it available for download. Around the same time, CMS also made Medicare prescription information available, allowing researchers to study the correlation between payments from pharmaceutical companies and physician prescriptions. One such study was recently published in JAMA.

The practice of pharmaceutical representatives bringing lunches or inviting doctors out to fancy retreats has long been controversial. The practice was so controversial that Congress passed a law called the Physician Payments Sunshine Act, requiring that gifts and sponsorships from pharmaceutical had to be disclosed publicly. HHS then required that such disclosures had to be reported through it, centralizing the information and making it available for download. Around the same time, CMS also made Medicare prescription information available, allowing researchers to study the correlation between payments from pharmaceutical companies and physician prescriptions. One such study was recently published in JAMA.

Perhaps not surprisingly, the study found that there is indeed a correlation between receipt of industry-sponsored meals and an increased rate of prescribing the promoted medication. The paper is clear to point out that the conclusion is only a correlation, not a causation. Bloomberg published some interesting commentary exploring why that distinction is very important. The author of that editorial argues that maybe -- just maybe -- physicians are learning important information about the promoted medications that causes them to prescribe them more. More research needs to be done to figure out whether these sponsored meals are unduly affecting physician behavior, but regardless, it seems appropriate that consumers have this information available to them so they can decide whether to be wary.

Following last week's post about Geisinger Health requesting a 40% increase in premiums, the Kaiser Family Foundation released a preliminary analysis of fourteen major cities, reporting that on average, premiums for benchmark silver ACA plans are expected to rise by 10% for 2017. Only two of the fourteen cities analyzed expect a decrease in the benchmark premium.

Following last week's post about Geisinger Health requesting a 40% increase in premiums, the Kaiser Family Foundation released a preliminary analysis of fourteen major cities, reporting that on average, premiums for benchmark silver ACA plans are expected to rise by 10% for 2017. Only two of the fourteen cities analyzed expect a decrease in the benchmark premium.

The New York Times published interesting commentary on this study, with the reporters questioning whether the increases this year are one-time adjustments or part of a longer trend. It still seems early to make a call on that question. While people are enjoying better coverage, it's unclear whether there is anything in the pipeline that effectively addresses the underlying pricing concerns.

The New York Times profiled Geisinger Health, an apparently enthusiastic supporter of the Affordable Care Act. Specifically in the spotlight is Geisinger's request to increase insurance premiums by 40 percent for 2017. They are not alone, of course, as Blue Cross and Blue Shield of Texas asked for an increase of nearly 60 percent. Other states are expecting significant increases as well, although generally not quite as severe. Part of the rationale is that insurers previously lacked sufficient historical data to accurately estimate claims.

The New York Times profiled Geisinger Health, an apparently enthusiastic supporter of the Affordable Care Act. Specifically in the spotlight is Geisinger's request to increase insurance premiums by 40 percent for 2017. They are not alone, of course, as Blue Cross and Blue Shield of Texas asked for an increase of nearly 60 percent. Other states are expecting significant increases as well, although generally not quite as severe. Part of the rationale is that insurers previously lacked sufficient historical data to accurately estimate claims.

The rate of uninsured has dropped after the implementation of the Affordable Care Act, which means that more Americans are getting coverage. At the same time, it appears that health insurance premiums might be rising faster than many have expected. In essence, the Affordable Care Act seems to have helped with coverage, but not with cost. Rapidly increasing costs might at some point become an issue of access.