Mid week update

The Senate continues to consider healthcare legislation. Two unsuccessful votes have been held so far. The Wall Street Journal explains that 

The Senate will continue debating health-care and voting on amendments, with a marathon all-night session of amendment votes expected to begin later this week. If Republicans can’t agree on any other plans for repealing and possibly replacing the ACA, GOP leaders are hoping they can pass a “lowest common denominator” proposal just cobbling together the elements that they all agree on, including repealing the individual and employer mandates and a tax on medical devices.

Any adopted Senate bill would have to go back to the House of Representatives, and the two Houses of Congress could form a conference committee. What we are see is politics in action.

Yesterday, the Department of Health and Human Services unveiled  an improved website for disclosing large reported breaches of unsecured protected health information. A large breach under the law affects 500 or more individuals.

Also on the HIPAA front, Healthcare IT News reports that the AHIMA trade association

has released a model Patient Request for Health Information form, which can be used as a modifiable template and given to patients when they request access to their EHR data.
The form is meant to help the process for providers, and ensure they're compliant with the right of access rules outlined by the HHS Office for Civil Rights under HIPAA. It also dovetails with a recent report from the Office of the National Coordinator for Health IT that called for a more transparent patient records request process to reduce the burden on consumers, according to AHIMA.

On the drug cost front, Modern Health reports that

Health systems can expect drug prices to increase by 7.61% next year, largely due to the surging prices of branded, specialty medications, a group purchasing organization said Tuesday. Vizient said in its drug pricing forecast that it's seen a spike in purchases for products not offered on its contract, most of which are patented, branded pharmaceuticals. Those specialty drugs also see sharper price increases, which force providers to find alternatives to optimal treatments and cause patients to avoid taking costly medication.

Of course, the hospitals hope to mark up those prices when they are charged to patients and their health plans so the impact  could be larger, which depends on the negotiations between the hospitals and the health plans. But the cost curve remains up.

Medcity News tells us that hospitals are teaming up with major pharmacy chains, like CVS and Walgreeens, to control their prescription drug dispensing costs and provide for close to patient outpatient care in the pharmacy urgent care centers.

It comes as no surprise the medical specialists make more money than primary care doctors but according to a recent Modern Healthcare study that gap is showing evidence of closing somewhat due to increased demand for primary care services.

Finally it's worth pointing out that a National Bureau of Economic Research report using insurance claims data finds that

[I]n 22% of emergency episodes, patients attended in-network hospitals, but were treated by out-of-network physicians. Out-of-network billing allows physicians to significantly increase their payment rates relative to what they would be paid for treating in-network patients. Because patients cannot avoid out-of-network physicians during an emergency, physicians have an incentive to remain out-of-network and receive higher payment rates. Hospitals incur costs when out-of-network billing occurs within their facilities. We illustrate in a model and confirm empirically via analysis of two leading physician-outsourcing firms that physicians offer transfers to hospitals to offset the costs of out-of-network billing and allow the practice to continue. We find that a New York State law that introduced binding arbitration between physicians and insurers to settle surprise bills reduced out-of-network billing rates.