The Healthcare Policy Podcast ® Produced by David Introcaso

Listen Now California has been long known for health care delivery and payment reform (think, for example, Kaiser Permanente).   With efforts nation-wide to better align health care quality and patient outcomes with reimbursement or savings efficiency, related efforts in California are carefully watched and studied.      During this 23 minute conversation Dr. Jill Yegian briefly outlines the work...

Listen Now The Medicare program, now in its 51st year, still does not cover oral/dental health care such as exams, X-rays, cleanings, fillings, tooth extractions and dentures.   (Medicare will cover an oral health procedure if it is incent to a serious accident or disease, for example, for surgery to treat fractures of the jaw or face or if you have oral cancer and need dental services necessary f...

Listen Now Much of the health care industry's effort to improve health care payment and delivery centers around improving primary care. This is largely because Americans suffer more disease/disease burden throughout their life spans compared to individuals in other industrialized countries.   This therefore makes obvious sense since primary care is the foundation upon which an effective and effici...

Listen Now January 1st will mark the Affordable Care Act's (ACA) third health insurance expansion year.  Under the ACA individuals with income below 400% of poverty are eligible for insurance subsidies and individuals with incomes below 138% of the federal poverty level are eligible for state Medicaid coverage (or in the 31 states that have to date chosen to expand Medicaid coverage).  As of 2015...

Listen Now Telehealth and remote monitoring services generally enable physicians to treat patients and monitor their health status remotely.  Because of advances in wireless communication and biosensor technology these services are increasingly being used in the commercial health care market and as well in the Medicaid program and the VA because research shows these services can reduce acute care...

Listen Now   In 2011 a 78 year old blind, amputated Vermont woman, Ms. Glenda Jimmo, was denied physical therapy services under Medicare because her condition was determined to not likely improve. Because Medicare therapy services via skilled nursing, home health and outpatient care never required the patient "improve" in order to receive services and because thousands of other Medicare beneficiar...

Listen Now Beyond numerous other benefits derived by genetically modifying foods is herbicide resistance. This allows farmers the ability to control for weed growth without killing their crop, for example, corn and soybeans.  While a foreseeable unintended consequence, the increasing or intensive use of the herbicides, specifically glyphosate, the primary ingredient in the widely used product Roun...

Listen Now   Bundled or episodic health care payment for a clinically defined medical episodes of care has been used since at least the 1980s.  However, recently CMS has initiated two bundled payment demonstrations, the Bundled Payment for Care Improvement Demonstration (BPCI) that bundles care for 48 (DRG) episodes of care began in 2013 and more recently CMS proposed the Chronic Care for Joint Re...

Listen Now This past July CMS announced a proposed demonstration that would either reduce or increase a Medicare home health agency's reimbursement based on quality performance.   With a rapidly aging and growing Medicare population home health utilization and costs have risen significantly over the past decade.  Per MedPAC, between 2000 and 2012 total Medicare home health spending increased 64 pe...

Listen Now This past July 13th the White House convened its sixth Conference on Aging.   The meeting's purpose is to identify elder care needs over the next 10 years.  More specifically the meeting is, or is typically, held to discuss improvements to the Older Americans Act (OAA).  The OAA was  signed into law in 1965 by President Johnson and has historically enjoyed Congressional support having b...

Listen Now For the past eight years the federal government has been working to create a unique medical device identification (UDI) number that would identify a medical device's manufacturer, the device's make and model, its expiration date and other information for the purposes of improving or ensuring patient safety and product improvement.   While progress has been made in establishing a UDI tra...

Listen Now Health care analytics has typically referred to modeling insurer or payer risk or to predict patient utilization or to segment patient populations.  However, because of advances in personal or wearable medical devices, supporting software applications and the increasing use of electronic health records, individuals or patients now have the opportunity to gather their own health and medi...

Listen Now With the health care industry now accounting for 18.5 percent of the nation's GDP, or a far greater percentage than any comparable nation, combined with ever continuing access, coverage (now possibly moreover the issue of under-insurance) and quality (including the frequency of patient or iatrogenic harm) health care policy students are left to wonder to what extent has health care deli...

Listen Now The use of community health workers (CHW) dates back to the 1800s.  The impetus for these workers today is to provide peer support largely in poor or under-served communities since these communities typically suffer disparities in health care access, in the quality of health care delivery and consequently experience higher morbidity and mortality rates.  The ACA via the Center for Medic...

Listen Now Shortly before the Supreme Court recesses in early July the Court will rule on David King v. Sylvia Burwell, the case where the plaintiffs argue the Affordable Care Act only allows for tax credit subsidies via state-run exchanges or only those, as the ACA states, "established by the state."  If the court rules in favor of the plaintiff an estimated 5 to 8 million newly insured will lose...

Listen Now Risk adjustment is a statistical method by which payers can reasonably predict how much a patient's care needs are expected to cost in any given year.  In so called Fee-For-Service Medicare this matter is essentially moot since since providers are simply paid for the reimbursable services they provide their patients.  However, health care payment is rapidly moving towards fixed or pre-a...

Beyond hospital care's considerable expense and at times questionable quality, it can be often times unnecessary.  We spend over $900 billion, or one-third of all health care spending, on hospital care annually. Despite these costs the quality of hospital care can be poor if not harmful.  A 2013 study published in the Journal of Patient Safety concluded between 210,000 and 440,000 patients hospita...

Listen Now Alzheimer's Disease accounts for approximately 70% of all dementia diagnoses.  The disease affects over five million Americans or upwards of 35 million worldwide.  Disease burden is currently estimated to grow to 16 million patients in the US by 2050 with projected costs estimated at over $1 trillion.  Patients diagnosed with Alzheimer's survive three to nine years. The disease kills 50...

Listen Now Visiting nurse services have been delivering home-based health care since the late 19th century providing everything from maternal and child health to geriatric care.  Today their services are more frequently being sought due to an ever-increasing emphasis on keeping patients out of the hospital (and emergency department), improving care coordination, comprehensiveness and patient satis...

Listen Now Street Sense is a tabloid newspaper that has been sold biweekly by the District of Columbia's homeless residents for the past 12 years.  The publication's focus is on homelessness and related issues confronting the poor.  DC has one the highest rates of homelessness in the country with over 2,000 individuals and families sleeping on the streets on any given night, a quarter of whom are...

Listen Now Health care payment is solidly moving, or moving once again, toward pay for value or value-based contracting.  This means a health care provider's reimbursement is incented or tied to a predetermined (typically annual) financial amount and/or is based on attaining certain quality care metrics.   The Medicare Shared Savings Program and private sector "accountable care organizations" are...

Listen Now Over 20 million immigrants live in the US, approximately half of whom, or 11 million, are undocumented.  Because immigrants are frequently employed in low-wage jobs they largely lack health care coverage.  Legally residing residents are able to acquire coverage via the ACA's state marketplaces however they are typically required to wait five years to apply to qualify for Medicaid. Undoc...

Listen Now Over the past few years the lines between health care payers and health care providers have been blurring.  Some say these health care industry silos, insurance companies and acute and post-acute providers, will eventually merge.  For cost purposes, health care plans are ever-increasingly interested in improving their relationship with patients in order to provide more efficient and eff...

Listen Now Medical tourism has been defined moreover as people traveling from less developed to more developed countries to receive medical treatment.   Today, well over one million Americans travel both within the US and worldwide to receive a wide variety of medical interventions.  Medical tourism originating in the US is growing dramatically, it is today considered one of the fastest growing se...

Listen Now Beyond the problem of an estimated 600,000 Americans being homeless each night (and 1.5 million in any given year), homelessness or unstable housing is strongly correlated with high rates of chronic illness, unmet healthcare needs and mortality. Inadequate housing impedes access to health care and  an ability to stay healthy such as caring for injuries or disease and taking medications....