Axios Vitals

A briefcase with a red cross on the front.

November 09, 2018

Good morning ... One of the most isolated places on the planet is an island in the South Atlantic called, fittingly, Inaccessible Island. You can only get there via a very long boat ride, only on a couple of days per year, and there’s only one tiny stretch of walkable ground among the steep cliffs once you get there. Seems much more fun to read about this trek than to make it.

1 big thing: FDA readies its vaping crackdown

Sings in a window advertise for Juul
Photo: Scott Olson/Getty Images

Food and Drug Administration Commissioner Scott Gottlieb is almost ready to roll out his crackdown on e-cigarettes.

  • According to the Washington Post, the FDA may roll out a plan next week that includes banning the sale of flavored products in convenience stores and gas stations, as well as age verification for online sales.

Why it matters: Gottlieb has been signaling for a while now that this is coming, reiterating that while he believes e-cigarettes can be a less risky option for people who would otherwise smoke cigarettes, their popularity with teens is a bigger concern.

  • Teen vaping is on the rise, and that has brought particular scrutiny to Juul, whose products, some of them in candy flavors, are by far the market leader.

2. Mandatory demos are back, baby

Arnold Schwarzenegger Smoking GIF by hoppip - Find & Share on GIPHY

Under the leadership of then-Secretary Tom Price, the Department of Health and Human Services substantially rolled back mandatory pilot programs.

  • But Price isn’t the boss any more, and mandatory demonstration programs are back.

How it works: HHS is on a perpetual quest to change the way Medicare pays for care. One leading part of that effort involves bundling together the many individual payments Medicare would normally make for a one procedure.

  • Because that model hasn’t been perfected yet, and because the whole idea here is to save Medicare money — which means paying out less in reimbursements — it’s not always easy to get doctors on board voluntarily.

“Real experimentation ... requires a willingness to try mandatory models. We know they are the most effective way to know whether these bundles can successfully save money and improve quality,” HHS Secretary Alex Azar said yesterday.

  • “We need results, American patients need change, and when we need mandatory models to deliver it, mandatory models are going to see a comeback,” he said.

The bottom line: Providers won’t be happy. But people who want to reform the delivery system will be.

3. Google taps Geisinger's CEO

David Feinberg, CEO of Geisinger Health System, is moving over to lead health care programs at Google, the Wall Street Journal reports.

  • Feinberg will be taking on a newly created role, in which he’ll “provide strategic direction for the initiatives already under way at the company targeting health care, from web services to machine learning to devices,” per WSJ.

Between the lines: Geisinger is a large system whose national profile stems largely from its integrated approach to care. It was also, WSJ notes, an early adopter of electronic medical records.

The business world, including the tech industry, is making several big-name hires as it looks for new approaches to health care. Amazon, JPMorgan Chase and Berkshire Hathaway recently tapped surgeon and writer Atul Gawande to lead their as-yet-unnamed health initiative.

4. How Medicaid’s networks could change

Health insurers that run state Medicaid programs must have adequate networks of doctors so people don’t have to travel far. But that may change under a new federal proposal, Axios’ Bob Herman reports.

How it works: An Obama-era rule required states to come up with “time and distance” standards for Medicaid networks.

  • But now, the Centers for Medicare & Medicaid Services proposes eliminating that “time and distance” requirement and replacing it with broader “quantitative standards,” like maximum wait times or whether doctors are accepting new Medicaid patients.

What they’re saying: “We aren’t rolling back [network] requirements,” CMS Administrator Seema Verma said in a response on Twitter.

  • Insurers have said time and distance standards, especially for rare medical specialties, are hard to create for rural areas.

The bottom line: This rule could allow states to create new rules under which the nearest doctors are hundreds of miles away, resulting in “much less adequate provider networks than under the current rule,” said Edwin Park, a Medicaid researcher at Georgetown University.

5. ACA didn't hurt employer coverage

Critics of the Affordable Care Act have argued that it would force insurers to drop coverage or cut workers’ hours — but that hasn’t happened, according to a new analysis from the Urban Institute.

Details, via my colleague Caitlin Owens:

  • Employer-based health coverage held steady since 2010, as the overall number of insured people rose.
  • Researchers found no relationship between the number of people in a given field who had insurance and the overall changes in employment levels, hours worked or earnings.

Yes, but: Everything isn’t worry-free in the world of employer-sponsored insurance. Deductibles and other out-of-pocket costs have been steadily rising, as health care costs go up and employers shift more of those increases onto their workers.