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The collaboration aims to help health plans more easily scale both fee-for-service and value-based models.

Long-term care, out-of-pocket spending, and even dental care are among the challenges that America faces in the next few years but Bernie Sanders, Donald Trump and Hillary Clinton are not saying nearly enough about their intentions in those areas. 

Veterans are still waiting to see a doctor. Two years ago, vets were waiting a long time for care at Veterans Affairs clinics. At one facility in Phoenix, for example, veterans waited on average 115 days for an appointment. Adding insult to injury, some VA schedulers were told to falsify data to make it looks like the waits weren’t that bad. The whole scandal ended up forcing the resignation of the VA secretary at the time, Eric Shinseki. Congress and the VA came up with a fix: Veterans Choice, a $10 billion program. Veterans received a card that was supposed to allow them to see a non-VA doctor if they were either more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them. The problem was, Congress gave them only 90 days to set up the system. Facing that deadline, the VA turned to two private companies to administer the program — helping veterans get an appointment with a doctor and then working with the VA to pay that doctor. It sounds like a simple idea but it’s not working. Wait times have gotten worse. There are 70,000 more vets waiting at least a month for an appointment than there were at this time last year. The VA claims there has been a massive increase in demand for care, but the problem has more to do with the way Veterans Choice was set up. It is confusing and complicated. Vets don’t understand it, doctors don’t understand it and even VA administrators admit they can’t always figure it out. Veterans face delays and worry This is playing out in a big way in Montana. That state has more veterans per capita than any state besides Alaska. This winter Montana Sen. Jon Tester sent his staff to meet with veterans across the state. Bobby Wilson showed up to a meeting in Superior. He’s a Navy vet who served in Vietnam and is trying to get his hearing aids fixed. Wilson is mired in bureaucracy. “The VA can’t do it in seven months, eight months? Something’s wrong,” he said. “Three hours on the phone,” trying to make an appointment. “Not waiting,” he said, “talking for three hours trying to get this thing set up for my new hearing aids.” [See also: GAO: Veterans finding VA care hard to access.] Tony Lapinski, a former aircraft mechanic, has also spent his time on the phone, with Health Net, one of the two contractors the VA selected to help Veterans Choice patients. “You guys all know the Health Net piano?” he said. “They haven’t changed the damn elevator music in over a year!” That elicits knowing chuckles from the audience. Later during an interview, he said when he gets through to a person, “They are the nicest boiler room telemarketers you have ever spoken to. But that doesn’t get your medical procedure taken care of.” Lapinski has an undiagnosed spinal growth and he’s worried. “Some days I wake up and go, ‘Am I wasting time, when I could be on chemotherapy or getting a surgery?’ ” he said. “Or six months from now when I still haven’t gotten it looked at and I start having weird symptoms and they say, ‘Boy, that’s cancer! If you had come in here six months ago, we probably could have done something for ya, but it’s too late now!’ ” Lapinski finally got to a neurosurgeon, but he didn’t exactly feel like his Choice card was carte blanche. Doctors, it turns out, are waiting, too — for payment, he said. “You get your procedure done, and you find out that two months later the people haven’t been paid. They have got $10 billion that they have to spend, and they are stiffing doctors for 90 days, 180 days, maybe a year!” said Lapinski. “No wonder I can’t get anyone to take me seriously on this program.” He said he gets it. He used to do part-time work fixing cars, and he would still take jobs from people who had taken more than 90 days to pay him or bounced a check. But he did so reluctantly. “I had a list of slow-pay customers,” he said. “I might work for them again, but everybody else came before them. So why would it be any different with these health care professionals?” Hospitals, clinics and doctors across the country have complained about not getting paid, or only paid very slowly. Some have just stopped taking Veterans Choice patients altogether, and Montana’s largest health care network, Billings Clinic, doesn’t accept any VA Choice patients. Not cool, said Montana Sen. Jon Tester, of Health Net and other contractors. “The payment to the providers is just laziness,” Tester said. “I’m telling you, it’s just flat laziness. These folks turn in their bills, and if they’re not paid in a timely manner, that’s a business model that’ll cause you to go broke pretty quick.” The VA now admits the rushed timeframe led to decisions that resulted in a nightmare for some patients. Health Net declined to be interviewed for this story. But in a statement, the company said that VA has recently made some beneficial changes that are helping streamline Veterans Choice. For example, the VA no longer demands a patient’s medical records be returned to VA before they pay. Meanwhile, though, veterans continue to wait. “If I knew half of what I knew now back then when I was just a kid, I would’ve never went in the military,” said Bobby Wilson. “I see how they treat their veterans when they come home.” Scheduling lags also irk the doctors’ offices and the VA And there’s another whole side to the coin. Doctors are frustrated in dealing with another government health care bureaucracy. In Gastonia, North Carolina, Kelly Coward dials yet another veteran with bad news. “I’m just calling to let you know that I still have not received your authorization for Health Net federal. As soon as I get it, I will give you a call and let you know that we have it and we can go over some surgery dates,” she told a veteran. Coward works at Carolina Orthopaedic & Sports Medicine Center, a practice that sees about 200 veterans. Dealing with Health Net has become a consuming part of her job. “I have to fax and re-fax, and call and re-call. And they tell us that they don’t receive the notes. And that’s just every day. And I’m not the only one here that deals with it,” she said. Carolina Orthopaedic’s business operations manager, Toscha Willis, is used to administrative headaches — that’s part of the deal with health care — but she’s never seen something like this. She said it takes, “multiple phone calls, multiple re-faxing of documentation, being on hold one to two hours at a time to be told we don’t have anything on file. But the last time we called about it they had it, but it was in review. You know, that’s the frustration.” It can take three to four months just to line up an office visit. The delays have become a frustration within the VA, too. Tymalyn James is a nurse care manager at the VA clinic in Wilmington, North Carolina. She said Choice has made the original problem worse. When she and her colleagues are swamped and refer someone outside the VA, it’s supposed to help the veteran get care more quickly. But James said the opposite is happening. “The fact is that people are waiting months and months, and it’s like a, we call it the black hole,” she said. “As long as the Choice program has gone on, we’ve had progressively longer and longer wait times for Choice to provide the service, and we’ve had progressively less and less follow through on the Choice end with what was supposed to be their managing of the steps.” The follow-through is lacking in two ways. The first is the lengthy delay in approving care. And after that’s finally resolved, there’s a long delay in getting paid for the care. At least 30 doctors’ offices across North Carolina are dealing with payment problems, some that have lasted more than a year. Carolina Orthopaedic’s CEO Chad Ghorley said his practice is getting paid after it provides the care. It’s the lengthy delay on the front end that burdens his staff and, he worries, puts veterans at risk. He’s a veteran himself. “The federal government has put the Band-Aid on it when there’s such a public outcry to how the veterans are taking care of, all right?” he said. “Well, they’ve got the Band-Aid on it to get the national media off their backs. But the wound is still open, the wound is still there.” Those experiences for both veterans and providers are typical. Congress is now working on a solution to the original solution, a bill is expected to clear Congress by the end of the month. This story is part of a partnership that includes Montana Public Radio, WFAE, NPR’s Back at Base project and Kaiser Health News. The article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The Nondiscrimination in Health Programs and Activities states that women must be treated equally to men and bans discrimination based on race, color, national origin, age or disability and, for the first time, gender.

Early returns from the Health Care Innovation Awards, a CMS initiative that tests new payment and service delivery models, already "show a wide range of experiences that have resulted in tangible benefits for patients" and have helped the agency develop better policies, said CMS Chief Medical Officer Patrick Conway, MD.

Heritage Group announced this month the closing of its latest Healthcare Innovation Fund, backed by 15 leading healthcare organizations, at $220 million.

IBM plans to launch a cloud-based version of Watson's cognitive computing technology, designed solely to zero in on cybersecurity language, as a part of a year-long research project, the company announced Tuesday. The Watson for Cyber Security platform is touted as the first technology to offer cognition of security data. Watson will pull the majority of its cognitive data from the X-Force research library: a threat intelligence platform with 20 years of security research, details on 8 million spam and phishing attacks and more than 100,000 documented vulnerabilities. "Even if the industry was able to fill the estimated 1.5 million open cybersecurity jobs by 2020, we'd still have a skills crisis in security," Marc van Zadelhoff, general manager of IBM Security said in a statement. "The volume and velocity of data in security is one of our greatest challenges in dealing with cybercrime." [Also: IBM Watson offers free storage to Apple ResearchKit developers] Beginning in the fall, IBM will also collaborate with eight universities to expand the amount of security data the company has already inputted into the platform. California State Polytechnic University, Pomona; Pennsylvania State University; Massachusetts Institute of Technology; and New York University are among the institutions who will work with IBM to contribute to Watson's training. The students will also train Watson on cybersecurity language, while working close with IBM's security experts to learn how to read security intelligence to gain first-hand experience in cognitive security. IBM plans to process up to 15,000 security documents – threat intelligence reports, cybercrime strategies, threat databases – each month over the next training stages in collaboration will all stakeholders. Watson for Cybersecurity will not only provide insights on any emerging threats, it will also make recommendations on how to stop them. Additionally, the system will use data mining techniques to find outliers. IBM will begin beta production deployments later this year. "By leveraging Watson’s ability to bring context to staggering amounts of unstructured data, impossible for people alone to process, we will bring new insights, recommendations and knowledge to security professionals," said van Zadelhoff, "bringing greater speed and precision to the most advanced cybersecurity analysts, and providing novice analysts with on-the-job training."

Implementation of MACRA will impact not only physicians, but also the hospitals with whom they partner, the American Hospital Association told Andy Slavitt, acting administrator of CMS, and the U.S. House Ways and Means Subcommittee on Health on Wednesday. Health Subcommittee members met with Slavitt Wednesday on the implementation of the Medicare Access and the CHIP Reauthorization Act of 2015. MACRA's Quality Payment Program, released by CMS on April 27, consolidates a patchwork of programs into two paths for physicians receiving Medicare payments: the Merit-based Incentive Payment Systems (MIPS); and an Advanced Alternative Payment Model (APM). The AHA said it applauds MACRA's streamlining of the physician reporting burden, but still has concerns, especially for smaller practices, and is disappointed the federal government is providing no financial incentives for upfront investments in technology to meet the demands of implementation. The estimated investment is $11.6 million for a small accountable care organization and $26.1 million for a medium ACO, the AHA said. [See also: A deep dive on the 'overwhelmingly complex' MACRA proposed rule.] "Hospitals that employ physicians directly may bear the cost of implementation of an ongoing compliance with the new physician performance reporting requirements under the Merit-based Incentive Payment Systems, as well as be at risk for any payment adjustments," the AHA said in a statement. "Moreover, hospitals may be called upon to participate in alternative payment models so that the physicians with whom they partner can qualify for bonus payments and exemption from MIPS reporting requirements that accompanies the APM 'track.'" House Ways and Means Subcommittee on Health Chairman Pat Tiberi, R-Ohio, asked Slavitt about concerns he's heard about the difficulty smaller practices may have coming into compliance, saying the rural provider, and one or two-person provider group "has a bunch of angst right now." Slavitt said the data shows that smaller and solo practices can succeed as well as physicians in larger-size groups as long as they report. It's up to CMS to make the reporting burden as easy as possible, Slavitt said. "Importantly we are looking for additional steps and ideas as people review the rules, but I will say that we are focusing on technical assistance, providing access to medical home models, opportunities to report in groups and using a reporting process that automatically feeds data, reduces the number of measures and overall lowers the burden for small practices," Slavitt said. Small physicians can report in groups and other physicians may not have to report at all because they're under a minimum threshold for the number of Medicare patients they see, Slavitt said. Slavitt said he's heard from physicians that they want to focus on care, not reporting. Congress has provided funding for MACRA technical assistance to small practices, rural practices and others, he said. MACRA replaces the sustainable growth rate and changes the way physicians and providers are paid, moving the healthcare system closer to CMS's goal of tying 50 percent of Medicare payments to alternative payment models by 2018. CMS is taking comment on the MACRA proposal for 60 days. "Success will come from adopting approaches that are practice-driven," Slavitt said. "It is our intent to align the MIPS and the Advanced APM components of the Quality Payment Program, allowing maximum flexibility for clinicians to switch between MIPS and participation in Advanced APMS based on what works best for them and their patients." To spur motivation, MACRA established an 11-member independent advisory committee, the Physician-Focused Payment Model Technical Advisory Committee, PTAC, that will meet quarterly to review payment models. [See also: A deep dive on the 'overwhelmingly complex' MACRA proposed rule.] The AHA has formed its own clinical advisory group to identify  important policy and operational implications of MIPS and APMS for hospitals. The AHA recommends hospital-based physicians be able to use their hospital's quality reporting and pay-for-performance program to measure performance in MIPS; employ risk adjustment rigorously, including for sociodemographics to ensure providers do not perform poorly simply because they care for more complex patients; and align EHR Incentive Program changes for physicians with those of eligible hospitals. The AHA applauded CMS's proposal to reduce the number of measures for quality reporting from nine to six, and also for its recent work with private insurers and physician groups to reach agreement on a common set of physician quality measures that can be used in both CMS and private payer pay-for-performance programs. "Physicians and hospitals alike spend significant resources reporting on multiple versions of measures assessing the same aspect of care to meet the differing requirements of CMS and individual private payers," the AHA said. The AHA is disappointed CMS has proposed a narrow definition of financial risk in advanced APMs for purposes of MACRA bonus payments, in not recognizing the upfront investment made by providers to implement alternative payment models. The AHA also said fraud and abuse laws need to be modified for a "legal safe zone" where physicians and hospitals can share information Twitter: @SusanJMorse

A healthcare attorney spotlights big problems and offers advice on ways to navigate around the pitfalls, from cybersecurity insurance to HIPAA, social media to patient access. 

The federal regulatory environment has not kept pace with the progress of mobile health, which is driven by consumers who expect to have all sorts of information, including health data, on their phones.