The Rundown by inforMD | Week of 1.27.2020

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Study: More Americans Insured, Fewer Can Afford Care

Although more Americans are insured, a growing number cannot afford care. According to a recent study in JAMA Internal Medicine, the number of Americans who were unable “to see a physician because of cost increased 2.7 percentage points owing to worsening access to care among the insured.” Researchers analyzed 20 years’ worth of data among both insured and uninsured Americans between the ages of 18 and 65. The study concluded that “the proportion of chronically ill adults receiving checkups did not change.” However, “results for receiving guideline-recommended preventive services were mixed.” Overall, “most measures of unmet need for physician services have shown no improvement, and financial access to physician services has decreased.”
>> Read More: Trends in Unmet Need for Physician and Preventive Services in the United States, 1998-2017

Strategic Mergers to Grow in 2020

Experts predict that, in 2020, strategic mergers will overtake financial mergers. Analysts from Kaufman Hall noted that “mega mergers” — defined as “transactions in which the smaller partner by revenue had more than $1 billion in annual revenue” — will have a more “strategic focus.” These strategic deals “are driven by complementary capabilities.” Researchers used the merger of Beaumont Health and Summa Health in July 2019 as an example: “Beaumont has strong specialty clinical programs, while Summa owns health insurer SummaCare.” This trend is reflected in the data, which shows a steep decrease in the average seller size by revenue from 2018, a record high, to 2019.
>> Read More: 2019 Healthcare M&A in Review: In Pursuit of the New Bases of Competition

Patient Advocates, Secretary Azar Defends Interoperability

The Society of Participatory Medicine, a patient advocacy group, issued a letter urging federal legislators to consider patients “the ultimate stakeholders in healthcare” when finalizing rules around interoperability. The letter cited the Health and Human Services (HHS) Office of the National Coordinator (ONC) Proposed Rule to Improve the Interoperability of Health Information and the Centers for Medicare and Medicaid Services’ (CMS) “proposed rule to advance interoperability and patient access to health data” as relevant policies. HHS Secretary Azar echoed these sentiments at the 2020 ONC Annual Meeting: “The details of the rule may be complex, but the goal is very simple: It’s about access and choice. Patients should be able to access their electronic medical record at no cost, period. … Unfortunately, some are defending the balkanized, outdated status quo and fighting our proposals fiercely.”
>> Read More: Patient/Caregiver Letter Supporting Proposed HHS Rules on Improving Flow of Our Data

Study: Medicare Spent $2.6B on Undelivered Services

A recent study published in the New England Journal of Medicine found that “the bulk of expected postoperative visits aren’t taking place.” Since Medicare and other insurers often reimburse many surgical procedures with a “single bundled payment that covers both the procedure itself and related postoperative care,” the findings suggest that payers are overpaying. Researchers estimate that, in 2018 alone, Medicare overpaid by $2.6 billion. “The researchers suggested that federal officials should include new methods, like billing claims and EHRs, to objectively measure the amount of postoperative care surgeons deliver instead of relying on physician surveys,” Morgan Haefner reported for Becker’s Hospital Review.
>> Read More: Payment for Services Rendered — Updating Medicare’s Valuation of Procedures

Dining Out May Lead to Insufficient Nutrition

Researchers found that both full-service and fast-food restaurants may contribute to insufficient nutrition. In a study published in The Journal of Nutrition, scientists analyzed meals from both types of restaurants to assess “trends in consumption, healthfulness, and related sociodemographic disparities” and nutritional quality as measured by the American Heart Association’s diet scores. Researchers found that, between 2003 and 2016, American adults consumed about 20 percent of their calories from restaurants. However, the “the average quality for both [full-service and fast-food restaurants] remained low with persistent or widening disparities.” Researchers concluded: “These findings highlight the need for strategies to improve the nutritional quality of US restaurant meals.”
>> Read More: Quality of Meals Consumed by US Adults at Full-Service and Fast-Food Restaurants, 2003–2016: Persistent Low Quality and Widening Disparities

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