The five things to pay attention to in 2010

The five things to pay attention to in 2010

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There’s no doubt that despite my thoughts that Obama wouldn’t (and shouldn’t) have pushed health reform in 2009, it was a very big year for health care. Death panels, public options et al—one hundred thousand visits to THCB in August don’t lie.

So what should you look for next?

  1. The finish is the start: It looks like some version of the Senate bill will be a done deal by sometime late January. That means that there’s about two years of health care industry players figuring out what it all means. The biggest two questions are; what will the types of plan sold in the exchanges look like? (high deductible with some preventive care thrown in is most likely), and what will the cuts and changes in Medicare payment actually look like in practice? (More of the same or real re-alignment around some kind of bundling). All these changes need reactions from the incumbents to reorganize around the new revenue streams.
  2. The economy and the politics: Sometime around now, the Bush recession is becoming the Obama slump. Despite the Tea Party/Palin/Beck implosion of the Republicans these last 14 months, we’re almost certainly going to see Democratic losses in the Senate and House in 2010. Whether those losses are bad enough to cost Democrats control of Congress depends on whether the end of the recession becomes a weak recovery or Japan in the 1990s.  Given the unremitting support from Republicans for policies any logical business-minded group logically should oppose in health care, and how much the current bill leaves undone in future changes to Medicare and more, the 2010 elections really matter.
  3. Complications and opportunities in the IT rollout. I have great respect for the good folks at ONC who have done wonders in a relatively short time. I also think that the “new” focus on interoperability and patient access to data is a very important part of meaningful use. But it’s clear that we are not going to simply see mass adoption of the mainstream EMR vendors’ products. Instead physician organizations are also going to dip their toe in SaaS based Health 2.0 tools, or remain too confused to actually do anything before 2012 or 2013. Meanwhile, ONC initiatives (like Beacon and Extension Centers) are going to be very important in this transformation. And don’t forget, most private sector health care players aren’t very used to working with the government in the manner of their defense and agriculture counterparts.
  4. Patients will continue to get rowdy. 2009 was the year of patients demanding access to their data and moving from meeting online to actually starting to see (and even exchange) their data. A combination of new “unplatforms” (iSlate?), better data exchange, technologies for social organization (Facebook, Twitter, Foursquare), will continue to force its way into health care. We’ll of course be covering this in Health 2.0 over the year (including in a brand new report coming out this week). But the distance between a patient’s advocate disputing access to their records and appearances on NPR (and in legislation) is getting shorter and shorter all the time. Health care providers and organizations are just starting to wake up to this.
  5. An evolving discussion about quality of care, especially concerning dying. Ten years after To Err is Human argument about quality of care is now public. What’s coming up next is a discussion about who should be in control, and what should happen, with patients who are much closer to death. It’s unclear as to whether throwing many more medical services at very, very ill people does them any good. It’s clear that many many people think that we do too much, not too little. There’s been little discussion in the court of public opinion about this issue. But as more baby boomers see it happen to their parents expect the “automatic” setting in ICUs across the country to be challenged much more.

These are just some of the many issues we’ll be following on THCB. And soon (no promises exactly when) we’ll be doing it in a brand new format. Welcome to 2010. For you health care junkies it’ll be even more fun.

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29 Comments on "The five things to pay attention to in 2010"


Guest
Jun 21, 2010

It was only a few weeks ago that this was a big talking point on the left. If insurance didn’t make a difference, no one would care if they didn’t have it. No one would bother trying to insure everyone.

Guest
Jan 12, 2010

Hi, great post there! I like it very much.
This is my fav part:
Patients will continue to get rowdy. 2009 was the year of patients demanding access to their data and moving from meeting online to actually starting to see (and even exchange) their data. A combination of new “unplatforms” (iSlate?), better data exchange, technologies for social organization (Facebook, Twitter, Foursquare), will continue to force its way into health care. We’ll of course be covering this in Health 2.0 over the year (including in a brand new report coming out this week). But the distance between a patient’s advocate disputing access to their records and appearances on NPR (and in legislation) is getting shorter and shorter all the time. Health care providers and organizations are just starting to wake up to this.
Thanks for posting it!
Cheers!
Effie

Guest

Healthcare IT will definitely experience a growth in 2010, visit our Healthcare event page for job opportunities in healthcare IT.
Miami, FL

Guest
Nate
Jan 11, 2010

jd, wouldn’t a bill addressing cost which would lower insurance premium which would increase percentage of those insured have been the way to go? Instead they passed a bill that will explode cost and make it even more unaffordable. Nothing in the current bill is about fixing access or cost and 100% about taking control. Why do you beleive anything positive can be built on this?
Last year Medicare increased at almost twice the rate of private insurance, this will continue until Medicare passes more cost onto private insurance at which time the left will again crow about how efficient Medicare is. Our government can’t run Medicare and Medicaid but you still beleive they will somehow get it right with private insurance, there is a difference between desiring a result and based on factual data believeing it possible. You seem far to inteligent to really believe this bill will improve anything.

Guest
Jan 8, 2010

Give unto Caesar what is Caesar’s. Give unto God, that which belongs to God.
It’s a simple fix. All we have to do is re-instate birthrights. There are a lot more dead people than live. If they set up foundations before they die, they will create a propagating, everlasting, taxable income stream that will pay for socialized health care, create jobs and rebuild social security. Not to mention the heirs will receive Legacy checks until they die. Go figure, God is always the answer.
http://godslegacytrust.blogspot.com

Guest
Peter
Jan 7, 2010

jh, I gave up on health insurance when Blue Cross/Blue Shield of NC fought me for 6 mths on a $1500 claim (my first in 6 years of being covered by them) that they eventually paid after I contacted the State dept. of insurance. They did not appreciate that I was one of their few premium payers who did not overuse the system and didn’t go to the doc for every little sniffle and also looked after my health with exercise and good eating habits – I was a money maker for them. After that experience and their 6% to 10% premium increases per year plus an age boost every so often I decided I wasn’t going to play their(and the system’s) game any longer. I now self insure to a point by putting my premiums into my own bank account for future use. I would recommend that you determine what you can afford and bank that amount as you will eventually need it when you get older or at least when the new healthcare bill mandates coverage. I will also use healthcare in India/Canada/Thailand at about 20% to 25% of the cost of U.S. based care and get a vacation thrown in. It’s too bad more Amereicans like yourself don’t see the need for total system overhaul and understand as you seem to the wise use of resources. But what would you be willing to give up for more affordable insurance? Most Amereicans don’t want to give up anything, or at least they want the other guy to be the one give up something.

Guest
Song
Jan 6, 2010

Good point on the Health IT opportunities and challenges brought to the forefront by the EHR Meaningful Use incentives. I also wrote about this same topic. I think SaaS will indeed become the name of the game, especially for smaller medical practices which are still still on the sidelines as far as EHR/EMR is concerned.

Guest
jd
Jan 6, 2010

Peter,
Thanks for the vote of confidence, and I’ve always looked forward to your posts as well. It’s certainly true that insurance is only valued as a means to an end, or ends. These ends have been primarily financial (protection from catastrophic costs, smoothing of costs to make them more budgetable, etc.), but the effect of the financial benefits is to improve access to care, compared to the uninsured.
I agree this round of health care reform focused too much on insurance. Some of it was to demagogue private insurance as a convenient whipping boy to try to rally the base behind the need for universal coverage (which backfired when the public option wasn’t included). But most of the focus on insurance coverage had at its root the goal of improved access to affordable care through catastrophic coverage and premium subsidies. Yes, they aren’t really controlling total costs yet (though measures in the bill might be far more effective than at first appears), but the focus on insurance was not a barrier to effective cost control. The barrier to effective cost control was and is the power of the provider and supplier lobbies, who were able to cut deals with the administration up front. And as wretched as those deals are, I think at least some of them were necessary in this round of reform because if hospitals, doctors or pharma were to have turned on this reform in a major way, it probably would have killed it altogether. Maybe they could have defeated pharma, so I’m least happy about that deal.
But as I’ve been saying for years here: Providers have the public eating out of their hands when it comes to big public fights. We need years’ worth of prominent news stories showing the fraud and waste in healthcare and how it leads to high premiums (or Medicare funding woes), similar to the waves of stories that came out in the late 90s about the evil HMOs. It was always less than half-true that insurers based their business model on denying needed care, but that is what most Americans have come to believe. In contrast, it is literally and flatly true that the business model of a hospital depends on people becoming very unwell. It is antithetical to the interest of a hospital that you stay healthy. It is antithetical to the financial interest of a specialist physician that you not contract a disease, or if you have one that you control it with behavior changes that don’t require medical supervision, high-tech scans, injections, surgery, etc.
For the large majority of providers paid on a fee for service basis, these statements are not half-truths, they are close to the full truth. And yet, when physicians with average incomes over $200,000 complain that a 5% cut in fees will force them to stop taking Medicare, or stop accepting some private insurance, the public reflexively believes it.
I really, really want this health care bill to pass and be done with, so that we can focus on the next decade’s worth of fighting on cost control. The Obama administration and the Democrats need to be on top of this or it will overwhelm them. Starting with the very act of signing this bill, Obama has to resist the urge to downplay the limitations and needs to say clearly that the fight over controlling the cost of health care has only begun. And then, starting in 2010, they need to start chipping away by maximizing what measures are permitted in the bill, and in 2011 by introducing new, small-scale legislation that gores one industry lobby’s goat at a time in the public interest.
Or something like that.

Guest
jh
Jan 6, 2010

Today we had a benefits meeting at work. My cost for a family plan would set me back a little over $600.00/month…and I don’t smoke! (Smokers have higher rates) And, allegedly, my company is picking up 50% of the total premium. Needless to say, it is completely unaffordable. People like myself who just want to raise their children, enjoy the fruits of our labors, and play by the rules get costed out of what should be available to everyone who works and contribute to their communities. What I don’t understand is why so expensive? Something that should really be a noble enterprise, seems almost elitist. Now that may sound like an exaggeration, but from my perspective, it’s not.
Maybe it’s a failure of capitalism run amok? Always the more, more, more attitude? I don’t know. But, what I found what works for me and my family is to promote exercise and eating nutritious food. It seems to be serving me and mine for the time being, but I always worry about the things I can’t control which could bankrupt what little I have.

Guest
Peter
Jan 6, 2010

jd, first you are one of my most respected posters and I do not forget that you support more government control of healhcare. But people don’t really want access to insurance, they want access to healthcare. In other industrialized countries they get access to healthcare and the private insurance portion (if any) is secondary to needed care. We could “easily” give people the access without the private insurance. By concentrating on insurance we miss the point entirely.
Access to care with insurance is certainly better than without it, but insurance is a business that will only allow access if you meet their rules and premium requirements – their game is not about healthcare, but about the difference between premiums and reimbursements. If private insurance has had a bigger impact on quality than Medicare it is because providers look at their return more than their patients and I don’t pull many punches for providers as well. The biggest reason I dislike insurers (the Blues the most) is that to continue to keep them in control of the dollars prevents true reform. I will also agree that people are unrealistic in their expectations that costs should come down while “managed care” by any definition is not also part of needed cost control. But people don’t want insurance execs or government bureaucrats managing their care, they want doctors doing it.

Guest
Jan 6, 2010

jd,
Enjoyed your comment.
I’ll be the first to tell you I don’t know anything about money or care about it either, but I do know this: The day we gave up and were acquired by a corporate outfit our rates jumped up 30%. The patient was still out the same co-pay amount, but the insurance companies paid more to our new outfit. This was not because we delivered any better care; we were the same docs we always were. It was only to pay for the machinery of two powerful entities who fought with each other. I never saw the extra margin used to carry the poor along by either side like we did when it was a community effort.
In many ways, my daily routine didn’t change when we were acquired. I was just glad to be able to be able to see sick people because that is all I know. I assure you none of the change trickled down to the foot soilers, and as I said it doesn’t help the patients at all except we are still there instead of out of business. Primary care is in deep trouble, and it mostly due to a daily grind with managed care and government chart jockies who have worn it down.
Over the years I have dealt with tens of thousands of patients and aced a string of Board tests. (94th percentile) In spite of it all I still love the doc biz. (Must be sick)
Too much time was wasted on the phone with all kinds of ‘managed care’ folks. Many of them didn’t understand the more subtle presentations things like of myocardial ischemia or spinal cord compression. While I suppose they might believe in their cause and mean well, in general they were a nuisance and bordered on dangerous. With each reviewer I made it clear that I believe we all have a right to our opinion, but with the right to offer advice comes responsibilty. Should they force a patient into a bad choice I kept a lawyer on retainer and would hold them accountable. It’s funny, but when forced to be accountable no one decided to be where the buck stopped. It might happen tommorrow, but it hasn’t happened yet.
My point is only that too much power and control is vested in folks who sit in offices and don’t work the street. I have to admit I wouldn’t trade places with you though, ’cause I am doc to all my people. I’ll serve them as long as I can until the system become completely unworkable.
All the best and thanks for listening,
Dr. B

Guest
MD as HELL
Jan 6, 2010

inchoate but ernest,
Arizona was an “in your face” action. The earlier actions were economic, as was this one. Did you have a point? They still are going to be bell weathers for not playing ball with this Obamanation.

Guest
jd
Jan 5, 2010

Peter,
I thought it was clear among the regulars here that I’m a fan of government intervention to fix the market problems in health care. The Dutch model holds the most appeal to me of existing systems, but the French model isn’t far behind and both clean the clock of our mis-organized system.
Also, I like your final paragraph, but I would change “eliminates” the bulk of private insurers to “transforms” and I think you do overestimate a bit how happy most insurers are to just skim a fraction of the rising cost off the top. After all, their customers hate these rising costs.
Now the big disagreement:
“To me the numbers say that insurance companies and their execs make a good living while doing NOTHING to solve any healthcare problem, be it access, cost or quality.”
I have no idea how you can believe this. To say that insurance doesn’t help with access to care is almost too ridiculous to refute. Do you not believe the estimates about tens of thousands who die every year due to the fact that from lack of insurance they don’t access care, or don’t access care that is as good as that had by those with insurance? It was only a few weeks ago that this was a big talking point on the left. If insurance didn’t make a difference, no one would care if they didn’t have it. No one would bother trying to insure everyone. I have a feeling you didn’t literally mean what you said, but will want to restate it in some way.
As for controlling cost, it’s more complicated and depends entirely on what you are comparing them to. Obviously, health insurers have done a miserable job controlling cost compared to payors in other nations with universal health care (be they public or private payors), though it’s a little weird to be madder at private insurers than at those entities driving up costs year after year, for whom health care expenses are only revenues. Also, the biggest brake on managed care effectiveness is public attitudes that have been captured by provider interests, attitudes which also constrain cost control in Medicare and in the decisions of companies that purchase private insurance. As you say, the pain is not strong enough yet for people to demand real reform to the utilization and cost structure of care.
For a different contrast, it should be clear that insurers in the form of managed care companies have done a better job at controlling costs than did the indemnity insurers that came before them. Look at the cost trends in the pre-managed care 60s-80s, compared to the managed care 90s, (particularly 1993 to 1998 when managed care was less constrained in negotiating power to lower rates by public attitudes and government).
So, while no one can say that private insurers have done a good job controlling costs, it’s not like they’ve been working under conducive conditions.
There are also things to say about quality (I think almost anyone would say that private insurance has had a bigger impact on quality of care than Medicare has, for example), but this comment has gone on long enough.

Guest
inchoate but earnest
Jan 5, 2010

MD as HELL – clueless again. Mayo FL hasn’t accepted Medicare for 2 years, and has been non-participating in some parts of the state for over 7 years.
If you really think their AZ decision was prompted principally by reform legislation, you’re as dimwitted as RushBeckOReilly.

Guest
Nate
Jan 5, 2010

Peter everyone in the country has the ability to buy low cost Nate TPA instead of high cost insurance company. It is against everything America stands for to tell people you can’t spend your money “stupidly” you must buy Nate. As much as I would love the additional business that is not the country I live in nor is it one I want to live in.