Health Wonk Review, Spring Break Edition

By Jennifer J. Salopek

Purple and yellow crocuses are blooming, the trees are beginning to bud out, excitement is beginning to build in Washington for the Cherry Blossom Festival, and there is no snow in the forecast. It must be Spring Break! Although typically associated with half-naked college kids drinking too much on the beach, the Health Wonk Review Spring Break is a different kind of break. Ours is the one you take from your daily responsibilities to travel virtually, visiting these wide-ranging blog sites to uncover fresh perspectives and deep insights into the health policy issues of the day.

At Health System Ed, blogger Peggy Salvatore offers “Whose Patient Record Is It, Anyway? Speak Up Now.” HHS released the Meaningful Use regulations last week and opened public comment. Big stakeholders like large software companies will have a loud voice at the table; patients and providers must make sure they are heard, too. After all, it’s patient health and the providers who care for them who are the end users and have the greatest stake.

On Healthcare Lighthouse, author Shea McCarthy reveals illuminating answers to the “Top Five Questions about the SGR Deal.” The post assesses the key political factors driving Congress’s upcoming consideration of a permanent Medicare Sustainable Growth Rate (SGR) formula repeal bill. The SGR was put in place in 1997 and dictates rates paid to physicians in Medicare. For over a decade, Congress has acted to block cuts yielded by the formula.

A frequent topic on Health Care Renewal is how health care has been taken over by generic managers who seem to know little, and perhaps care little about the actual care of patients, yet are hailed as “brilliant” and rewarded handsomely by boards of directors who often have no more knowledge or familiarity with direct health care. Occasionally, a really telling example of the “brilliant” thinking of these managers slips into view. In this case, the $6.6 million/year CEO of UPMC not only envisioned a future in which artificial intelligence based on “big data” would replace physicians, but announced his institution’s contribution to a research program he apparently thought could reach that goal. Blogger Roy Poses believes that true health care reform would restore leadership of health care to people who actually understand health care, put patients’ and the public’s health ahead of revenue, and maybe actually show a humble understanding of their own limitations.

Jason Shafrin, proprietor of Healthcare Economist, takes a look at “The Next Generation ACO.”Medicare is adding a wrinkle to its accountable care organization (ACO) program,” Shafrin says. Read on to find out what that is.

Meanwhile, on the Health Business Blog, consultant and policy expert David Williams calls Sovaldi “a near-perfect example of price discrimination.” He explains: Gilead is taking a lot of grief for the wide disparity of prices it charges for Sovaldi in different markets. A quick review of the economic principle of “price discrimination” demonstrates that Gilead can actually maximize societal benefits in the pursuit of maximum profit for itself.

Another societal benefit, a potential Alzheimer’s breakthrough, is reported by Henry Stern on InsureBlog. The game-changing Alzheimer’s treatment, one that could actually restore memory, is a new non-invasive ultrasound technology that could break down the amyloid plaques that are believed to cause the symptoms of Alzheimer’s.

Blogger Louise, who writes at Colorado Health Insurance Insider, notes that Colorado has clarified that grandmothered plans must end by December 31. She wonders, Is exchange revenue a factor? “I think Colorado needs to take a hard look at whether the $26 million annual budget for the exchange is a good use of funds.  Because at that point, we’ll no longer be able to say that revenue generation for the exchange is a valid benefit to having 190,000 of us transition to ACA-compliant coverage,“ she says.

Writing on Health Access Blog, Anthony Wright offers “The History of Health Reform & Your New 1095A Form or, How I Learned to Live with the Individual Mandate.” As folks file their taxes and count up their ACA subsidies and penalties, it’s worth remembering the bizarre journey of the individual mandate, from conservative cover to help stop health reform to a progressive plank for universality.

In the occupational health arena, prevention is fundamental; but even after egregious failures, resources to correct those failures can be lacking. On the 10-year anniversary of the BP refinery explosion that claimed 15 lives and injured scores of others in Texas City, Julie Ferguson looks to lessons learned at Workers’ Comp Insider and finds disappointing results.

The Health Affairs blog features a Contributing Voices post by Charles Roehrig, vice president at the Altarum Institute and director of Altarum’s Center for Sustainable Health Spending, titled “What Is Behind The Post-Recession Bend In The Health Care Cost Curve?”

“I now turn to the present topic, the record low growth in NHE that began in 2009 (the year in which the recession ended) and continued through 2013 (the most recent year for which we have official data). There has been extensive discussion about whether these low rates are the result of temporary cyclical factors, such as the recession, or more permanent structural factors. As detailed below, I conclude that, to a surprisingly large extent, the answer is neither: the bulk of the decline in the health care spending growth rate resulted from lower economy-wide price inflation and some temporary factors not tied to the recession,” he writes.

“A Medicaid Block Grant By Any Other Name Would Stink” is the title of this month’s contribution from Brad Wright at Wright on Health. It is part of his continuing series of posts exploring the Burr-Hatch-Upton proposal to repeal and replace the ACA. Wright explains how the GOP would like to reintroduce categorical eligibility in Medicaid and turn the program into a block grant—which they disguise as a “transition to capped allotment to provide states with predictable funding and flexibility.” You can dress it up however you want, but the bottom line is that it’s a block grant. While the proposed changes would certainly control health care costs, they would do so by denying benefits to the most vulnerable Americans, and that stinks.

There’s a lot to digest in the CMS and ONC rules on Stage 3 of Meaningful use and the associated certification criteria. This post from HealthBlawg, “Meaningful Use Stage 3: The Buzz About APIs,” describes the general approach, and homes in on the plan to move things to a more modern approach by allowing use of APIs to count towards Meaningful Use attestation on a couple of measures regarding data liquidity – getting data into and out of EHRs and to and from patients. Of course, that’s ONC-certified APIs, so it’s not exactly a free gift.

In a guest column on, Michael Johnson, former Director of Public Policy, Blue Shield of California, says that the company has had its nonprofit tax exemption revoked and could end up paying $40 million annually. But Johnson says there’s much more at stake for Californians: $10 billion in community assets that Blue Shield holds and that he says should be given back to the community.

Health Wonk Review will be taking its own spring break, resuming publication with the April 23, 2015, edition, to be hosted by Joe Paduda at Managed Care Matters. Find a handy index of past and future hosts at

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