In what is being hailed — or scorned, depending upon the source — as a major victory for the health care industry, the Bush administration has issued proposed revisions to privacy regulations.

As the New York Times reports, the revisions, issued March 21, do away with a rule that says health plans, physicians, and hospitals must obtain written consent from patients before "using or disclosing medical information or treatment, the payment of claims or any of a long list of 'health care operations,' like setting insurance premiums and measuring the competence of doctors."

Tommy G. Thompson, secretary of the U.S. Department of Health and Human Services, calls the revisions "common-sense" adjustments to help ensure that high quality care is not delayed.

Consumer advocates, however, charge that the revisions eviscerate the first comprehensive federal standards for medical privacy.

Promulgated during the Clinton administration, the rules affect almost every health plan, physician, hospital, and pharmacy in the country.

Some parts of the original rules would survive. For example, patients would have the right to inspect and copy their records and could propose corrections.

A 30-day public comment period, expected to be concluded around the end of this month, will precede the issuance of the final regulations. "Under the rule," says the Times, "doctors and other health care providers would still have to notify patients of their rights and the providers' disclosure policies. Patients would be asked to acknowledge in writing that they had received such notice, but could receive care without the acknowledgement."

The revisions mean that two physicians who are overheard discussing a patient's medical condition would not violate regulations. Also, as Thompson puts it, "Sick patients will not be forced to visit the pharmacy themselves to pick up prescriptions — and could send a family member or friend instead."

Health plans and pharmacies would have to obtain "an individual's specific authorization" before sending that person any marketing materials.

What about disease management? HHS says, "At the same time, the proposal would continue to permit doctors and other covered entities to communicate freely with patients about treatment options and other health-related information, including disease management programs."

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There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

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Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
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Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

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