Tampa Bay Times: Florida Senate Shows Leadership On Medicaid Expansion Money The New England Journal of Medicine: Medicare’s Step Back From Global Payments — Unbundling Postoperative Care Like many fields, public health is in the midst of a data revolution: randomized control trials, pay-for-performance and value calculations, all based on data, are changing our ideas about what works and how to finance it. The impact of these new methods to gather and evaluate data pales, however, next to the Global Burden of Disease Report, an attempt to understand what sickens us and kills us in every country in the world. The Global Burden of Disease study is a single scientific project on a scale with the moon landing or mapping the human genome. It has been going for a quarter century and involves hundreds, perhaps thousands, of scientists. In 2012, its most recent report, based on 2010 data, became the subject of the first issue that the medical journal The Lancet devoted to a single study. (Tina Rosenberg, 4/9) In February, some parents’ decisions not to vaccinate their children caused great hubbub in the United States, fueled by measles outbreaks and a few politicians’ expressions of respect for this choice by “anti-vaxxers.” A natural concern is that lack of vaccination by some degrades herd immunity and makes spread of disease more likely. Because choosing not to vaccinate harms others—something we economists call a “negative externality”—it justifies government action to encourage vaccination. But in other cases in which a negative externality arises, government action is much less widely accepted as justified. Why the difference? (Austin Frakt, 4/9) Viewpoints: Kansas And Abortion; Stop Missouri’s Move To Medicaid Managed Care A selection of opinions on health care from around the country. Expanding hospital bundled payments to include physicians has been on the policy horizon for three decades. Previous efforts were derailed by concerns about physician autonomy and other implementation barriers, but it is time to reconsider. Such a payment change could remove unnecessary administrative and regulatory barriers, improve quality, and potentially provide greater freedom for individual hospitals and physicians to decide on the optimal way of delivering care. (Ateev Mehrotra and Peter Hussey, 4/9) [email protected]: On The Public Harms Of Personal Health Care Choices Kansas City Star: Reject A Mismanaged Medicaid Proposal In Missouri If you could help 800,000 low-income working Floridians gain health care coverage at no cost to state taxpayers, would you? The Florida Senate would — but they have no dance partner. The Florida House, or at least the leadership of the House, adamantly refuses to do so and Gov. Rick Scott has reversed course once again on the issue. … Taking the federal funds is a no-brainer. While polls show the vast majority of Floridians support taking the federal money to extend health care coverage to the working poor, some of Florida’s elected officials in positions of power are dug in against doing so. And this year the federal Low-Income Pool funding, which has been going to hospitals to reimburse them for treating this same group of people, is being phased out. Shouldn’t that factor into their decisionmaking and budget writing? (Paula Dockery, 4/9) During the past four years, the state of Kansas has become ground zero in the war to criminalize all abortions, and in the process to remove a woman’s ability to control what happens in her own body. … On Tuesday the state went still further, becoming the first to ban the safest and by far the most common method of ending a second-trimester pregnancy, dilation and evacuation, which involves dilating the cervix and removing the fetus, often in parts. (4/9) A hasty and ill-timed attempt to make a major policy change regarding how to oversee health care services for about 200,000 Medicaid recipients in Missouri requires a quick burial. In the early hours of Wednesday morning, Republican Sen. Kurt Schaefer succeeded in pushing through a plan to extend the use of for-profit companies to manage Medicaid in much of the state’s rural areas. The full Senate narrowly sent the managed care idea on to the House as part of a $26 billion annual state budget. That’s where it should die. (4/9) JAMA: Including Physicians In Bundled Hospital Care Payments Medicare’s recent decision to unbundle most postoperative visits from global packages of surgical services is striking. … Medicare’s experience with global surgical payments offers a cautionary tale for other bundled-payment programs. The discrepancy between the number of postoperative visits paid for and the number that actually occur highlights the importance of being able to monitor utilization so that payments can be adjusted as care delivery changes. Bundling of payments also creates a perverse incentive to “unbundle” services — that is, to change the time or location of care or the clinician providing it so that the care qualifies for separate payment. The global surgical packages as previously structured lacked mechanisms for updating bundles over time and for monitoring unbundling. (Andrew W. Mulcahy, Barbara Wynn, Lane Burgette and Ateev Mehrotra, 4/9) The New York Times’ Opinionator: Turning To Big, Big Data To See What Ails The World The New York Times: Kansas Tries To Stamp Out Abortion This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.