5 Things Colorado:  “Don Quixote,” Hospital value report, 1332 waiver update

We are nearing the end of summer, with fall elections (recall campaign?) and Democratic debates on the horizon. The Broncos and Nuggets are getting ready to play, which is a good autumnal distraction.  But, before you know it, you’ll be watching returns from Iowa and New Hampshire on cable TV.

Between now and then, thanks as always for reading our stuff. Now, here are 5 Things We’re Watching in Colorado health care and health policy for August, 2019.

 


With help from Emily Viles

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2. CIVHC data shows facility fees vary widely

Data released Friday from CIVHC shows wide variation in facility fees from Colorado hospitals and freestanding emergency rooms. The CIVHC data underscores that there is often no clear reason for the high fees, and that there is also variation by condition.

The data shows that while there is variation by severity, this variation is not standard. Highly severe conditions, for example, had facility fees that varied anywhere from $1,990 to $4,700 per visit, but could range up to a “maximum allowed amount” of nearly $47,779.

3. “Don Quixote” goes to Washington DC

Before Gov. Hickenlooper was a one-time candidate for the Democratic nomination for president, he was trying to elevate his status as a health reform leader by holding prominent events with then-Ohio Gov. John Kasich. Now, another former governor, John Kitzhaber of Oregon, is talking health reform in Washington DC, though with a much more low key approach.

I spent a few days with Gov. Kitzhaber on a recent trip to DC as he was trying to focus the opinion of DC insiders. “Medicare for All is really a financing mechanism. And, if we don’t reform the underlying delivery system, the way we finance it won’t get at the root problems of quality in health care.”

4. Nuances in the Hospital Value Report

The Colorado Hospital Value Report looks at the costs of various medical procedures from around the state to compare the price of a given procedure per hospital. Data in the report shows that overall scores do not necessarily mean a higher quality of care.

The report found that 80% of Colorado hospitals rank in the top quartile for at least one service, and that 55% offer at least one service in the top 10 percent of the nation. At the same time, 80% of hospitals also offer at least one service in the bottom quartile of care. The report is part of an ongoing conversation on healthcare costs in the state, one that will likely build into the next legislative session.

5. CMS approves state 1332 innovation waiver

The Centers for Medicare and Medicaid Services (CMS) approved Colorado’s request to develop state-based reinsurance programs under Section 1332 of the Affordable Care Act (ACA). Implementation of the program can begin for two years starting January 1, 2020.

The state’s $249 million reinsurance program is expected to reduce 2020 premiums by 16 percent compared to what they would be without approval of the waiver. The federal government is expected to contribute $162 million while state funds are expected to account for $87 million. The insurance commissioner can assess insurers if Congress suspends the health insurance tax.