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Prescription drug spending in Medicare has been rising fast, but it is not completely clear what policies are driving the increases. The Obama administration hopes to find ways to control costs by testing different approaches to paying for the drugs. The experiments would apply to a class of drugs covered under Medicare Part B that are administered in doctors’ offices and hospitals to treat cancer, rheumatoid arthritis and other conditions. The government and the program’s beneficiaries spent nearly $21 billion on these medicines in 2013, 29 percent more than in 2007, according to a Government Accountability Office report published in November. A big part of the reason spending has shot up is that drug prices have been going up faster than inflation or overall medical costs. (3/10)

Suppose you’re an eye doctor and you’re treating a patient with macular degeneration, a disease that can cause blindness. You have the choice of giving one of two drugs — one that costs $2,000 per treatment and another, very similar one, which costs $50 per treatment. Do you think it would influence your decision if you were paid $117 more if you chose the more expensive drug? (Margot Sanger-Katz, 3/9)

“Moving from volume to value” is health care reform’s latest mantra. Policymakers hope to replace fee-for-service systems with value-based approaches that reward improved outcomes achieved at lower cost. Ground zero in these efforts is the Medicare Physician Fee Schedule (MPFS). What payment reformers often fail to recognize is that the specific MPFS payment rates have important implications for Medicare and its beneficiaries. The relative payment levels for the thousands of service codes and the absence of payment for other activities powerfully influence how physicians spend their time — and their tendency to perform unneeded tests and procedures. The mix of services that physicians provide under a particular fee schedule can affect value at least as much as any improvements derived from rewarding physicians on the basis of quality measures — the approach Congress took in the Medicare Access and CHIP Reauthorization Act of 2015. (Robert A. Berenson and John D. Goodson, 3/9)

Last week, the Centers for Medicare & Medicare Services announced it had beat its target of tying 30% of Medicare Part A and B payments to “quality of care rather than quantity of services.” That goal was initially set for the end of 2016, but was actually achieved in January. Initially, this was a goal set only by administrative fiat, in January 2015. However, it soon picked up bipartisan legislative support in the so-called “doc fix” bill of April 2015. The Administration has a goal of tying 90% of payments to “quality” by 2018 and it now looks like this is a realistic target. (Graham, 3/10)

There are two ways to look at Obamacare. One is that it was more or less American politics working as it's supposed to ... But there's another popular narrative of Obamacare — that it was a hijacking of American politics in order to pass radical, unconstitutional legislation that forever transformed the country. (Ezra Klein, 3/9)

What good is health insurance if the medical providers in network are unavailable? This is the problem posed by the contemporary American insistence on retaining consumerism and competition in much of our healthcare system. It’s easy to communicate and regulate price. Cost sharing arrangements can be extremely complex but at least use of standardized vocabulary such as copay, deductible and coinsurance can regularize communications about the order in which insureds and insurers pay for medical expenses. (Seth Chandler, 3/10)

When the director-general of the World Health Organization (WHO) declared that the recently reported clusters of microcephaly and other neurologic disorders represent a Public Health Emergency of International Concern (PHEIC), she called for increased research into their cause, including the question of whether the Zika virus is the source of the problem.1 The declaration provides an opportunity to step up the pace of research in order to find the answer to some important questions more quickly. It could not only facilitate the accumulation of knowledge about the relationship between the Zika virus and microcephaly, but also accelerate the study of newer technologies for mosquito control, which could have far-reaching effects on global health security beyond controlling Zika infections. (David L. Heymann, Joanne Liu and Louis Lillywhite, 3/9)

Kentucky has turned into the place where Obamacare repeal rhetoric meets Obamacare repeal reality. Reality is winning. Gov. Matt Bevin (R) made his name in Bluegrass State politics as a tea party outsider, and throwing out the Affordable Care Act was one of his most common refrains. He used it first during his unsuccessful primary challenge against Sen. Mitch McConnell, now majority leader, in 2014, and then in his winning bid for the top position in the state last year. (Jeffrey Young, 3/9)

Polling consistently has shown strong public support for allowing a federal expansion of Medicaid for low-income Kansans. But if the expansion is budget-neutral, as a plan developed by the Kansas Hospital Association seeks to be, support is even greater. (Phillip Brownlee, 3/9)

Having read several articles promoting doctor-assisted suicide in Iowa, an old Polish saying comes to mind, namely: “When you are unsure about the road ahead, ask the old man who is walking back from there.” In 1997, Oregon enacted its Death with Dignity Act, which permits doctors to prescribe a lethal medication at the request of terminally ill patients. In considering what Iowans can learn from Oregon’s experience, several unanswered questions remain: How has doctor-assisted suicide affected Oregon’s culture? (The Rev. Msgr. Frank E. Boganno, 3/9)

Exploding hoverboards may have gotten all the attention lately, but electronic cigarettes also have been showing a disturbing tendency to spontaneously combust, injuring a growing number of people whose devices have blown up in their faces or pockets. (3/10)

It’s well known that the U.S. is in the midst of a prescription opioid overdose and abuse epidemic. Adverse outcomes from prescription opioid abuse have dramatically escalated over the past decade and a half, with fatal prescription opioid overdoses roughly quadrupling and emergency department visits involving prescription drugs (mostly opioids) more than doubling. Outrageous statistics—such as that opioids were involved in almost 29,000 drug overdose deaths in 2014, or that 46 people die from a prescription opioid overdose every day—have less “shock” value now than they did several years ago. Moreover, the opioid crisis has become personal: many (including presidential candidates) have experienced a close friend or family member struggle with addiction. (Rebecca Haffajee, 3/9)

Lawmakers are considering a bill in the General Assembly that only a few years ago would have been thought a dangerously radical proposal: legalizing the creation of so-called "safe injection facilities" where people addicted to heroin and other opioids can consume the drugs under the supervision of medically trained staff without subjecting themselves to criminal penalties ... This isn't something Maryland should rush into, but neither should it be dismissed out of hand. (3/9)