This Week in Health Reform: February 14, 2014

By Emily Warner

Greetings, Palliative in Practice readers, and happy Valentine’s day!  This week Obama is celebrating V-day by cuddling up to the fact that 3.3 million people have enrolled in private health insurance through the exchanges, a considerably better figure than the 12 or so who managed to sign up in the first week.  Though, this hasn’t detracted from the sniggers Obama is getting for once again delaying a provision of the health law, this time the health insurance mandate for medium-sized employers.  News: it has it’s ups and downs.

  1. The February issue of Health Affairs came out last week.  I failed to notice the email in my inbox, and also the fact that the month had changed, so I’m bringing you my top pick a week late. This issue is all about “connected health,” the phrase I guess we’re using now to describe healthcare delivered through and facilitated by information technologies. My top pick: Use of Telemedicine Can Reduce Hospitalizations of Nursing Home Residents and Generate Savings for Medicare.  The piece starts out with the daring hypothesis that the lack of a physician presence at many nursing homes during off hours might contribute to inappropriate hospitalizations.  The tested intervention: telemedicine (real-time medical consultation via two-way video conferencing).  The results were a bit tepid, but indicated that those facilities that utilized the telemedicine service the most saw a reduction in hospitalizations.  Unnecessary hospitalizations of nursing home residents is a very important issue, so hopefully this study will be the first of many that test telemedicine for this population.
  2. And if you’re a doc, this probably is no surprise, ditto if you speak to docs, or are a patient who goes to a doc and happens to mention that you work in health policy, but it looks like uncertainty in the healthcare business is driving more docs to seek salaried employment with larger organizations like hospitals.  In the short run, the article reports, this may lead to an increase in healthcare costs as docs employed by hospitals may have tests performed in-house, which will add a “facility fee.” And though it might make sense that the salary factor would reduce perverse FFS incentives, many contracts include bonuses for higher billing. Sigh.
  3. And finally, congratulations to Senator Ron Wyden, who on Thursday became the chair of the Senate Finance Committee.  We mentioned Senator Wyden’s Medicare reform bill in the January 17 edition of This Week in Health Refom.  Wyden is known for his big ideas and progressive policies, and his support for palliative care has been longstanding.  We look forward to seeing how his leadership unfolds on this important Committee.

And honorable mention this Valentine’s day goes to Twitter, for being a breeding ground for HPV.  That is, for #HealthPolicyValentines.  Your dutiful Wonkblogger, Sarah Kliff, pulled together a roundup of some of her favorites.  Not noted: mine.  Must have been an oversight…

This Week in Health Reform: February 7, 2014

By Emily Warner

Greetings, Palliative in Practice readers, and happy first day of the Olympics, proudly brought to us by physiatry, orthopedics, and probably DARPA, like everything else.  This week had some big stories in heath policy, and the exciting news that CVS’s will no longer sell cigarettes in its stores, so while you are Googling “what channel is the Olympics on,” let’s zip through the top 3.

  1. First, SGR. Lawmakers barely had time to pump the post-handshake Purell yesterday before my inbox was filled with reports on an SGR deal.   The plan was crafted by Senate Finance, House Ways and Means, and House Energy and Commerce, so it is bipartisan and bicameral, but it still needs to pass both houses. The plan would repeal the SGR and provide an annual physician fee schedule update of .5% from 2014 through 2018. Then there would be a 5 year freeze while a quality incentive system kicks in. The quality program (called MIPS) would be an amalgam of the current PQRS, VBPM, and Meaningful Use systems.  The plan would also provide a 5% bonus to providers who receive at least 25% of their revenue from payment models that use quality measurement and risk-sharing components.  In general, it’s an exciting move toward payment for value over volume, but these models are all still experimental, so one wonders if 15 years from now, we won’t be talking about repealing the MIPS.  Ah, well, one must try.  As that indomitable optimist Samuel Beckett once wrote: Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.
  2. 2.5 Million.  That’s a figure you’re going to hear a lot this election season. The CBO released a report this week finding that the health law will cause a reduction in the overall number of worker hours over the next decade—the equivalent of 2.5 million workers.  NB: that’s 2.5 million workers, not jobs, a distinction that will no doubt be lost in campaign ads. The CBO projects that because of the health law, workers will withdraw their labor from the market because of several possible reasons: a) low income workers may not qualify for subsidies if they work above a certain number of hours, b) lower wages caused by the health law could disincentivize people to work, or c) people may choose to reduce their hours because they do not need employer-provided insurance.    What this all means is open to interpretation.  SeeWhite house embraces CBO reportcontraThe first attacks based on the CBO report on Obamacare and workers.”
  3. And last but not least complicated, risk corridors. This is a complicated topic, so forgive (a) the additional words and (b) my oversimplification. The ACA contains provisions that prohibit insurance companies from charging sick people more than healthy people for plans on the exchanges. However, this is a new market for insurers—they don’t know how many will sign up, or most relevantly, how healthy those who sign up will be.  Because of this uncertainty, the ACA has several provisions which help insurers guard against this risk, and one of them is the risk corridors.  The risk corridor is plus or minus 3%–if a health plan’s costs (calculated in a complicated fashion) are within 3% of what premiums support (also calculated in a complicated fashion), the health plan keeps all gains or losses.  But, if the costs are, for example 105% of what premiums would have supported, the government helps foot the cost, and if they are 95%, the government shares in the savings.  This program only lasts though a transitional period—through 2016—but it is nonetheless under attack by some Republicans, who are calling the program a “bailout.”  The House had a hearing on this issue this week, and I expect we’ll be hearing more about it through the midterms.  So, now that we’re >200 words in, you may be wondering why we are paying attention to this issue.  Well, it’s because we don’t want health plans to skimp on care for people with serious illness because of unforeseeable risk.  If an exchange plan can’t charge sick people more than it charges healthy people, it can mitigate risk a different way: by trying to reduce the number of sick people who sign up for the plan. It could do this by offering less generous benefits for the treatment of serious or advanced illness—by excluding certain specialty hospitals, for example, or excluding extra benefits around palliative care.  As a field dedicated to achieving the best quality of life possible for those with serious illness, we want to make sure that health plans that finance excellent care are not inadvertently penalized, so we will keep an eye on how this complicated new market unfolds.

Whew. That was a mouthful.  Let’s shift to talking animal videos, shall we? Honorable mention this week goes to this lovable PSA, advertising the imperative to enroll in health insurance. It’s a strong concept, as anthropomorphized animals almost always is, but I have to say from the policy perspective it’s all wrong.  The objective with the exchanges is to get as many healthy, low-risk individuals to sign up as possible.  Featuring the brachycephalic  pug—well known for its chronic dyspnea —really sends the wrong message, I think.  Would have been better to feature a good ol’ American mutt. Also to add: more puppies.

That’s it for this week folks. Enjoy the opening ceremonies, on even as I type, and have a great weekend!

This Week in Health Reform: January 31, 2014

By Emily Warner

Greetings, Palliative in Practice readers, from the tail end of an extremely fast month.

Ah, disappointment.  As you all know, the State of the Union was this week, and despite the better hipsters of my nature, I was excited about it. People like me, see, we form social events around the SOTU.  I’ve heard about a football game on Sunday, but I’ll be working at my food co-op taking inventory of foot fungus tinctures that evening, so haven’t paid it much mind.  The real action in my social diary converges on political speeches. Make of this what you will.

So you can imagine my disappointment when, 40 or so minutes into the speech, Obama inhaled, exhaled small accolades about his eponymous law, and inhaled on a different subject.  And I was so hoping that this year he would test the limits of executive authority by unilaterally establishing a single-payer system.  Ah, well, to the top 3 we nevertheless go.  …That’s right folks, so that we can dwell on each item for a few more words, we’ll be moving to a top 3 format.  To the top 3!

  1. So what did he say about healthcare?  A few sentences. He opened the topic by framing it as one of financial security—that increased access to health insurance will prevent bankruptcy because of medical bills.  He mentioned a few popular provisions of the law (i.e., no more denial of coverage because of pre-existing conditions). He called on Republicans to stop voting to repeal the law.  And finally, he instructed us all to consult the Governor of Kentucky, who expanded Medicaid coverage through executive order last year (attaboy, Gov), to learn what effect the law is having.   This concludes the President’s remarks on that fifth of the economy we call healthcare.
  2. New ACO numbers are out.  CMS released data Thursday on Medicare ACO savings.  For an analysis of the release, you can check out this capsule from KHN.  The main takeaway probably can be summed up thusly: “It’s not insignificant, but it’s not what you’d consider a huge success.”
  3. And last but very far from least, Maryland.  Maryland has often been on my mind in the last year: it passed a palliative care bill, it has a unique all-payer rate setting system for hospital services, and CMS just approved its Medicare waiver program to permit a state-wide quasi-ACO arrangement that includes not just Medicare, but all payers. This new plan is a radical departure from fee-for-service. “Under the plan,” the article reads, “each Maryland hospital will be given a budget, based on its historic revenue levels, to care for a defined number of people in its community, regardless of the number of actual admissions or the severity of the cases.”  This gives hospitals a strong financial incentive to reduce overall admissions, and invest in care in the community.  That means helping people with serious illness stay safe and comfortable at home, and that means investing in community-based palliative care.

And honorable mention this week goes to Sarah Kliff’s WonkBlog post which, yes, provides us substantive content on Medicaid expansion, including 4 states to watch (Arkansas because it might be the first to quit Medicaid expansion; Virginia because one of the priorities of the newly-elected governor is to expand Medicaid; Utah because Republican Governor Gary Herbert says he wants to do something on Medicaid; and Pennsylvania, your humble author’s home state, because Republican Governor Tom Corbett wants to expand Medicaid with the condition that some Medicaid beneficiaries work 20 hours per week [Emily shakes head]), but more importantly because it links us to this gif of our war-weary Sebelius. Stay strong, Sec.

That’s it for this week, folks.  Enjoy your Super Bowl parties, if applicable.  I’ll fill you in on how much colloidal silver we need to order next week.

This Week in Health Reform: January 24, 2014

By Emily Warner

Greetings, Palliative in Practice readers, and happy Friday from the frozen tundra of New York.  The State of the Union address is still five days away, but already my newsfeed is filled with articles about GOP messaging, Obama staying on-message, and hypotheses about shifting the messaging from Buzzword A to Buzzword B. I have to say folks, “messaging” has got to be the most cynical word since the modern conception of “politics” itself.  Completely apropos and entirely accurate, but a sad encapsulation of political discourse nonetheless.  Thankfully, there were some really exciting palliative care stories this week to buoy the mood, so let’s get to the top 5.

  1. Wonderful development out of the World Health Organization (WHO) yesterday: The WHO Executive Board adopted a resolution urging member countries to integrate palliative care into healthcare systems, to improve palliative care training for healthcare workers, and to ensure that relevant medicines, including strong pain medicines, are available to patients. A nice article about the resolution is available over at ehospice. This is a powerful statement about the importance of palliative care, and a powerful tool to help advocates gain stronger support for palliative care throughout the world.
  2. Health Affairs blog published its third post pulled from Meeting the Needs of Older Adults with Serious IllnessThe post, authored by Laura Hanson, Anna Schenck, and Helen Burstin, discusses how quality measurement can improve care for adults with serious illness. Significant next steps in this project include better identifying those with serious illness, measuring what matters most to these patients, rewarding high-level communication skills, helping hospices with EHRs and quality measurement, and improving measurement of care coordination.
  3. CMS updated portions of the Medicare Benefits Policy Manual last week to clarify that coverage of skilled nursing and skilled therapy services “does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.” This clarification was issued pursuant to the settlement agreement in Jimmo v. Sebelius, a case in which plaintiffs alleged that Medicare contractors were denying claims for skilled care because the patient’s condition was not expected to improve (the so-called “Improvement Standard.”) This clarification should prevent future denials of coverage for patients whose conditions are not expected to improve, but nevertheless need skilled care to prevent or slow further deterioration.
  4. More palliative care-specific news: the Colorado Board of Health approved a definition and basic standards for palliative care that will be applied to all licensed facilities in CO.  From now on, facilities in CO that claim to offer palliative care must have written policies and procedures that detail how the different elements of palliative care will be provided and documented.  These elements include pain and symptom management, goals of care planning, provision of services that meet spiritual and psychosocial needs,  family support, and, if indicated, bereavement support. This is an excellent first step in promulgating baseline quality standards for palliative care.
  5. And finishing up the top 5 is a quick fact: exchange enrollments reached 3 million this week. If sign-ups keep their January pace, that number could be up to 6.5 million by the end of March.

And honorable mention this week goes to Kaiser Health News, one of the most respected names in health reporting, for finally adopting the Buzzfeed standard of cat-photo supported journalism.  The feature, 8 Things to Know About Obamacare in 2014, hopefully signals a new era over at KHN. Soon we should see headlines that read, “Exchange plans can cover all pre-existing conditions, if they just follow this one simple network modification…”

And that’s it for this week folks.  Enjoy the SOTU on Tuesday.  My prediction: he will *not* say “is in crippling decay.”

Health AGEnda Puts Spotlight on CAPC

CAPC is honored to have been featured in Health AGEnda’s 500th blog post. Health AGEnda, published by the John A. Hartford Foundation, advocates for health improvements for older adults in the United States. Now in its fifth year, the blog features frequent guest articles by clinicians and advocates.

Christopher A. Langston, PhD, Program Director of the John A. Hartford Foundation, penned the blog’s 500th post which highlights the role CAPC plays in raising awareness for palliative care.

“The work of the CAPC team and its leader, Diane E. Meier, MD, has taught us a great deal about how to think about being person-centered in the care of people with serious illness,” says Langston.

Click here to read the full post.

This Week in Health Reform: January 17, 2014

By Emily Warner

Greetings, Palliative in Practice readers, and happy Friday! Congress is back, ladies and gentleman, and it is apparent.  What an active week for the so-called do-nothing Congress.  In particular, it passed a 1,500 page omnibus spending bill, a bill that was no doubt carefully reviewed by each member in full.  Though, if you were thinking that this swift action is a sign of productivity to come in 2014, allow the media to divest you of that idea. Obama’s “year of action” will be taking place in just one branch of government, and it’s not the one that starts with “L.” Let’s move on, shall we?

  1. MedPAC voted on some significant recommendations this week. In its March report to Congress, it will recommend that the rules are changed to require Medicare Advantage plans to cover hospice services.  Currently, when beneficiaries elect hospice, they must enroll in traditional Medicare. Yours truly doesn’t have an opinion on this change at this time.  There is some discussion that this may allow patients to receive concurrent hospice and curative care, which would be a good thing, but I have yet to get a clear handle on all the interests at stake. MedPAC also is recommending that home health agencies with high readmission rates face penalties much the same way hospitals do, which could have broad implication for home-based palliative care.
  2. Senator Ron Wyden, longtime palliative care supporter (and sponsor of the Palliative Care and Hospice Education and Training Act), introduced a Medicare reform bill this week along with Senator Johnny Isakson, that would create “Better Care Programs” for Medicare beneficiaries with multiple chronic conditions. These BCPs would be paid a fixed fee per beneficently, and would encourage team-based, personalized care.  This is a very exciting, innovative bill and CAPC will be watching it closely. [Full text of the bill here.]  As this Washington Post article notes, Wyden’s work “often wins fervent praise from reformers—but rarely much political support.” However, Wyden is positioned to take the Chair of the Senate Finance Committee, one of the most powerful chairs in Congress, so we may see increased political viability of his ideas in the future.
  3. No news article on this, but this week the Patient Quality of Life Coalition (PQOL) met in Washington D.C. to outline goals for the coming year.  PQOL was formed to advance the interests of patients and families facing serious illness. It includes more than 20 nongovernmental organizations, among them the American Cancer Society Cancer Action Network, the Catholic Health Association, and, of course, the Center to Advance Palliative Care.  The Coalition’s efforts are aimed at promoting public policy that will improve and expand access to high-quality palliative care across the country.  At this year’s meeting, particular emphasis was placed on the two palliative care bills in Congress, the Palliative Care and Hospice Education and Training Act, and the Patient-Centered Quality Care for Life Act.
  4. Also no news article (why is that?), but the MAP Pre-Rulemaking Draft Report has been published and is awaiting public comment. A few weeks ago I noted that it was MAP season– time for the Measures Application Partnership to review the quality measures CMS is considering for inclusion into various quality programs. Well, all the MAP workgroups have met and the report has been drafted. Now it is just up to us to read the 394 pages and make our comments, which are due Monday, January 27. CAPC will be commenting on this important report, but if this is a topic that interests you, we encourage you to dive in and comment as well! Pshhh, free time…
  5. And finally, HealthLeadersMedia has an article out about the extremely promising data on patient-centered medical homes (PCMHs).  The article highlights the findings of an analysis released this week from the Patient-Centered Primary Care Collaborative that shows that the PCMH model is reducing costs of care, unnecessary emergency department and hospital visits, and improving population health. In the course of my work, I often hear the moniker “palliative care medical home.” This can refer to several concepts, one of which is embedding outpatient palliative care into PCMHs.  If you are interested in this topic, make sure to check out CAPC’s upcoming web conference, “Outpatient Palliative Care in the Patient-Centered Medical Home: A Report from a Two Year Pilot.”

And honorable mention this week goes to the comprehensive republican healthcare reform bill, a figure that John Boehner prophesized is, even now, slouching toward Washington to be introduced. I await this bill with rapt attention.  2009 was a great year. I can’t wait to live it again.

This Week in Health Reform: January 10, 2014

By Emily Warner

Greetings, Palliative in Practice readers, and welcome to a new year!  It’s 2014 and everything is different:  new ACA provisions are in effect, Senator Cruz has taken a vow to redouble efforts at undoing all that has been done, and I have a new Zen Page-a-Day calendar that will no doubt have me writing like Yoda in no time. So sit idly we must not; to the top 5 we must hasten.

  1. The January issue of Health Affairs came out this week. This month’s edition focuses mainly on alternatives to malpractice litigation, but my top pick resides in the Web First section: Developing a Viable Alternative to Medicare’s Physician Payment Strategy. In this quick 7-page read, the good Dr. Gail Wilensky will tell you all you need to know about this SGR business.
  2. To kick off the year in quality, HealthLeaders Media has compiled a list, broken into two parts, of the top quality items to watch this year. The list is 14 items long, for reasons I don’t entirely understand, but this is 2014 and within the peculiar numerology of marketing, this is likely reason enough. Some highlights from the list: the readmissions penalty, now at 2%, will go up to 3% in FY15 and add 2 more conditions (hip and knee arthroplasty and COPD); the new Hospital Acquired Conditions Reduction Program is set to start with a 1% penalty for hospitals with the top quartile of HACs in FY15; the Choosing Wisely campaign is picking up steam; and disproportionate share reductions will continue to be an issue, though for whom and by how much is yet to be seen.
  3. And to kick off the year in flashcards, HLM has compiled a list of the top healthcare buzzwords for 2014.  The list, also 14 items long, and also in two parts, includes words like “high outliers,” “MSPB” (Medicare Spending per Beneficiary), “Flipping Healthcare,” “Billing Optimization,” “The Hospitalization Toxic,” and “PROs” (Patient Reported Outcomes).  These are indeed important words that I’m sure to repeat a lot this year, so though I don’t have children, if I did, we would definitely be drilling these flashcards sometime between kindergarten and Brazilian jui-jitsu.
  4. Not really the most heartening of news, but all data helps, I suppose: Massachusetts’ s Health Policy Commission released a report indicating that up to $27 Billion of healthcare dollars in MA may be wasted each year. A large portion of that spending may be going toward preventable readmissions. This highlights the importance of palliative care across the continuum to ensure patients are able to stay safely and comfortably at home.
  5. And last but not least, pop the champagne, ratchet your noisemakers and drop the balloons; publications are ringing in the New Year with exultant headlines like “Another Modest Rise for Health Costs” and “Health Care Costs Grew More Slowly Than The Economy in 2012.”   Last year healthcare spending increased by just 3.7%, and as a percent of the economy, shrunk by .1%  from 17.3% to 17.2%.  Small victories, yes?

And no honorable mention this week. This Governor Christie business seems to have jammed up all the political roads, leaving no thruway for healthcare reporting. Perhaps by next week the traffic will have cleared…

Have an excellent weekend everyone and I’ll see you next week!

This Week in Health Reform: December 27, 2013

By Emily Warner

Greetings, Palliative in Practice readers.  And Merry Christmas, if you are into that sort of thing.  Merry everything else if not.

First off, apologies for missing the top five last week. I was struck by a short-lived but highly impairing illness, the third in what is shaping up to be a particularly virulent season for a one E. Warner, and was unable to take note of the top five.   But we’re back, with the final installment of 2013.

As you might expect, news this week has been slow, and publications have been forced to palliate their horror vacui with thinly-conceived features like the “Top 10 Physician Complaints of 2013.” But mixed in with the drivel were these, my top picks of the week:

  1. The second installment of the Health Affairs Blog’s coverage of Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform was published this week. This week’s post is adapted from a chapter written by Brad Stuart, Andrew MacPherson and Gary Bacher about the Advanced Care clinical model.
  2. Lest you are thinking that ACOs will drift into obscurity in 2014, allow these facts to persuade you otherwise: CMS has announced that 123 new ACOs will be participating in the Medicare Shared Savings Program in 2014, and a recent survey found that half of hospital respondents plan to join or start an ACO by 2015.
  3. I am morally opposed to “slideshows” and accordingly swore I would not link to the Health Leaders feature: 20 People Who Are Making a Difference in Healthcare, but how could I not highlight #16, Brad Stuart: palliative medicine physician, CEO of Advanced Care Innovation Strategies, and coauthor of the “Meeting the Needs” chapter referenced above.  Great to see a dedicated palliative care doc receive this recognition.
  4. For your end-of-year SGR update, the 3-month “patch” forestalling the SGR-mandated Medicare cuts passed the Senate as part of the budget bill and is expected to be signed into law by President Obama.  So, mark your calendars for March.  I expect it will be filled with SGR reform debate.
  5. And finally—though this isn’t quite news—this piece from the New York Times highlights the increasing interest in voluntary “accreditation” of home health agencies. As many of you are aware, palliative care has an enormous role to play in effective home health care, so how quality is defined in home health is of tremendous importance to patients and to our field. As quality standards in this crucial setting develop, it is important for palliative care providers and accreditation agencies to stay in dialogue to ensure that patients are receiving the best in-home care possible.

And honorable mention this week goes to all of you out there who are manning the ERs, ICUs, hospices, palliative care teams, and other essential services throughout the holidays.  Unfortunately, illness and suffering stop for no date on the calendar, and we appreciate that you don’t either.

That’s it for 2013, folks.  See you next year!

My Palliative Care Moment


Sarah Friebert, MD, Director of the Palliative Care Program “A Palette of Care,” at Akron Children’s Hospital, is the winner of our #MyPalliativeCareMoment Twitter Contest! Dr. Friebert received the most retweets for her submission in which she highlighted the reasons she is proud to call palliative care her profession.

Sarah Frebert FINAL

Her team will receive 20 “Ask Me About Palliative Care” buttons, and the picture she submitted (which features her with a young patient), will be CAPC’s Twitter profile photo for the next week. Dr. Friebert’s team will also be the subject of an upcoming blog post that will put the spotlight on their program.

Contest Recap

Before the contest, we launched the My Palliative Care Moment YouTube Playlist which features video testimonials from healthcare professionals. We then asked you to submit your moments which we posted to our blog. All submissions were shared on Twitter and retweeted by friends and colleagues.

Your submissions show that there is a shared belief that palliative care can make a true difference in the lives of patients, their loved ones, and the professionals who tend to them:

Catherine Kelly-Langen

Andrea L. Tackett, Moment

Christine Ritche, UCSF, Moment

Adonyah Whipple Moment

DiAnn Young, Moment

Community Palliative Care Consultants, My PC Moment

Hackensack Medical Center

Kellie Lightfoot, Physical Therapist

Denise B. Zehner

PcareTeam, Mission

Turner West Final

Linda P. Dolan Final (2)


Thank you to all who participated as well as those who retweeted their favorite moments. Check back here in the coming weeks as we will be announcing more exciting contests!

This Week in Health Reform: December 13, 2013

By Emily Warner

Greetings, Palliative in Practice readers, on this auspicious Friday the 13th.  It’s cold and blustery here in New York, but it is no doubt toasty warm in Speaker John Boehner’s heart: a bone-fide budget bill passed the House yesterday, in part thanks to Boehner’s stately show of leadership/ slightly unhinged censure of outside conservative groups. Before the cockles of our hearts are cooled by the ashen winds of war, let’s turn to the top 5.

  1. About that budget bill.  The Medicare sequestration cuts of 2% survived this unusually decisive House vote, but some groups are lobbying hard against these cuts, so let’s see what happens in the Senate.
  2. The budget bill also includes a 3-month patch to keep the SGR from, as a HuffPo headline would say, whacking Medicare docs.  An SGR fix probably won’t pass this year, but the 3-month patch means there’s a good shot we’ll see something in the first quarter of 2014, particularly because the CBO lowered the cost of the repeal once again. I expect there will be some changes as the months go by, but you can see current details on the bill, including a nice section-by-section, here.
  3. No big news article on this one (indeed, there appear to be no news articles on this at all) but you should know that it is MAP season, and this week many work-groups of the NQF MAP met in DC.  The MAP, or Measures Application Partnership, meets each year to give input to CMS on the quality measures to be included in various CMS quality programs.  Through December and January, MAP work-groups comb through the measures CMS is considering, vetting them for scientific validity and priority.  They release their recommendations to CMS in February.  Though CMS is free to ignore MAP recommendations,  it’s a large undertaking with significant consequences, and each year it’s important to advocate for the inclusion of measures that will improve palliative care for the sickest and most vulnerable patients.  </soapbox>
  4. Also no news article, but this Monday there was a hill briefing on palliative care, featuring presentations by our own Diane Meier, Sean Morrison of the National Palliative Care Research Center, and the incomparably well-spoken Amy Berman, a nurse by training and patient advocate who spoke elegantly about her experience of being diagnosed with stage IV breast cancer and her ability to live with the highest quality of life possible thanks to palliative care.  The event was meant to educate policymakers on the importance of palliative care to both patients and the health system. It was attended by about 50 Hill staffers and members of the public—not bad for an icy day in the capital.
  5. And last, and we hope, least: readmissions. It looks like the readmissions penalties may be working, because the rate of readmissions, which usually hovers around 19%, has fallen below 18%.

And honorable mention this week goes to, which as of Nov. 30 enrolled about 137,000 in health insurance, for inspiring what, based on the photo, appears to be an article about how Kathleen Sebelius is hovering outside your window, waiting to come after your children while they sleep.


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