#PNN In Other News

Here are some other local, state or national stories we are reading that may impact you, your practice or your patients.

How Health Systems Are Meeting the Challenge of Climate Change | The human and health impacts of climate change are becoming increasingly hard to ignore. Extreme weather events are disrupting more and more lives and businesses while also exacerbating chronic health conditions like asthma, expanding the range of infectious diseases, and worsening mental illness. In 2018, the UN Intergovernmental Panel on Climate Change estimated that to avoid catastrophic changes to our climate, we need to cut our greenhouse gas emissions in half by 2030 and get to net zero emissions by 2050. It’s time for all of us to take the threat and opportunity of climate change seriously, but how can businesses make meaningful change? How does sustainability fit into the competing priorities so many of us face? We spoke with leaders at four major U.S. health systems — Cleveland Clinic, Kaiser Permanente, Boston Medical Center (BMC), and Partners Healthcare — that are finding solutions. Climate change strikes at the very core of health systems whose mission is to keep people healthy. They are also affected financially and structurally by the rising frequency of extreme weather events, and they are major contributors to carbon emissions. Even distant climate events can impact them. Consider what happened when Hurricane Maria hit Puerto Rico in 2017. The storm killed people and knocked out power. It also disrupted supply chains. Suddenly, across the United States, doctors and patients faced shortages of critical intravenous fluids and medications because Puerto Rico manufactures IV bags for the rest of the country, and the plants were severely damaged in the storm. For months, nurses had to resort to standing at the patient bedside slowly injecting medications by syringe instead of letting the medication drip in from an IV bag.

Which Health Policies Actually Work? We Rarely Find Out | A few years ago, Oregon found itself in a position that you’d think would be more commonplace: It was able to evaluate the impact of a substantial, expensive health policy change. In a collaboration by the state and researchers, Medicaid coverage was randomly extended to some low-income adults and not to others, and researchers have been tracking the consequences ever since. Rigorous evaluations of health policy are exceedingly rare. The United States spends a tremendous amount on health care, but very little of it learning which health policies work and which don’t. In fact, less than 0.1 percent of total spending on American health care is devoted to evaluating them. As a result, there’s a lot less solid evidence to inform decision making on programs like Medicaid or Medicare than you might think. There is a similar uncertainty over common medical treatments: Hundreds of thousands of clinical trials are conducted each year, yet half of treatments used in clinical practice lack sound evidence.

Physician viewpoint: EHRs provide more support for systems' fiscal health than patients' | EHRs should offer more extensive financial information relating to patients' cost of care to foster transparency between providers and patients, according to pulmonary and critical care physician Walter J. O'Donnell, MD, of Massachusetts General Hospital in Boston. In an op-ed for STAT, Dr. O'Donnell argued that the type of transparency patients want most is about the cost of care surrounding their physician's orders. However, this information is often unavailable in the EHR, prompting Dr. O'Donnell to question whether it's really the physician's fault when a patient is billed a costly episode of care. He attributes the variety of payers and the companies' different deals with hospitals and pharmacy benefit managers to the lack of price transparency. Dr. O'Donnell argued that the "primary purpose of today's [EHRs] is financial management, not medical." Despite one of his patient's undergoing an insurance scan before entering the exam room for her appointment, Dr. O'Donnell was still unable to view the patient's out-of-pocket cost in the EHR for a test he ordered because it required a diagnosis for her insurance company, according to the report. "These electronic systems are good at prioritizing the fiscal health of a medical practice or hospital, while remaining unconcerned about the need of patients and clinicians to avoid — or at least prepare for — big medical bills," Dr. O'Donnell wrote.

Does value-based pay have a future? | Value-based care has created a conundrum: pretty much everyone in healthcare likes the idea of paying for outcomes, but no one is sure how to fairly implement it. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) introduced a new world of value-based care to many physicians and was a major step away from fee-for-service. Gone was the Sustainable Growth Rate, replaced with a program that was supposed to drive costs down by reimbursing for quality patient outcomes. “Congress had revised the Sustainable Growth Rate many times over the past 20 years, and everyone was fatigued by it,” says Larry Kocot, JD, head of KPMG’s Center for Healthcare Regulatory Insight and a former CMS official. “Physicians were willing to take something new to not have to go through that exercise again.”

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