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Month: July 2006

TECH/POLICY/RANDOM: Monday update

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Apologies for the quiet start today. A few things to keep you going with while I work on some other stuff off-line

MyMedwork is a MySpace/Linked in for physicians which has funding from a business accelerator started by bunch of big name mid-west medical orgs (including the Cleveland Clinic). Hey I (re-)met my fiancee on Linked-In so there must be something to this social networking stuff?

The first rumblings in the real business of health care—how much Medicare pays for what—are starting up. CMS is rattling the saber, and somehow managing to divert the attention onto 3M which is attempting to redesign DRGs and getting it in the neck for its troubles, apparently. Of course this is the beginning, not the end of a very long and ongoing process. The same thing is going on on the physician side around changes in the RVS system. The health plans have been muddying this water for some time, as I noted in my article about the punking of Milt Freudenheim back in June.

I’ve been having some fun backchat with Michael Cannon at Cato (the thinking man’s libertarian think-tank) over his riposte to my piece about Medicare HSAs. Well worth reading his response. More on that when I get my act together to edit our emails…Meanwhile over at Cato’s blog you should read anything Radley Balko’s written. He’s doing the best job in America about tracking the western liberal Democracies’ almost imperceptibly slow movement towards becoming authoritarian states. Did you know that “swearing” in public in the UK can now warrant a $130 on the spot fine at the sole discretion of the police?

Finally, working on some stuff on the new San Francisco health plan, which will emerge at Spot-on soon—now that I’m banned from writing about soccer for quite some time!

 

 

TECH: Comparing chronic disease management systems with EMRs

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My favorite EMR consultant, Laura Jantos (from ECG in Seattle)—who retains that title despite owing me lunch since 1995—has a report out from the California Health Care Foundation about tools for managing disease management systems. The very short  summary is that souped up DM registries are pretty good value for money compared to EMRs. This is deep in the weeds stuff, but if you care about chronic care programs, you should read it.

TECH: Uh-oh, dissent in the orthodoxy that EMR will save money

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In his Health Affairs piece It Ain’t Necessarily So (which steals its title from my one Health Affairs article on which I was 4th banana author back in 1994) Jaan Sidorov claims that merely introducing “The Electronic Health Record” is unlikely to reduce overall system health care costs.

Stone him I say! Stone him!

Oh, hang on, I mostly agree. Although I do think that EMRs, eventually, will improve patient care quality, which he kinda doubts. But to actually reduce health care costs? Nice try RAND, CITL et al, but to do that requires limiting the amount of money put into the system. And that leads to unpleasant consequences for the main actors in the system. And as the Industry Veteran often reminds us, the whole IT thing is a side show helping us avoid that (eventual) conversation.

HOSPITALS: Apparently they’re shooting them down in Texas.

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Additional light shed on Houston Healthcare firings.

I can’t claim to know anything about this, other than isn’t it a little rare for this type of mass firing in the rather clubby hospital industry? Usually grand larceny and Medicare fraud is required, and sexual harassment is insufficient! And even then it takes all kinds of tooing and froing.

If you know more please comment. 

DISEASE MANAGEMENT BOSTON JULY 30 – AUG 2At a three day conference in Boston MA, scheduled between July 31 and Aug 2, industry leaders from managed care companies, employer groups purchasing healthcare services, providers, third party administrators, physicians, healthcare technology players, nursing and pharmacy practitioners, disease management experts will meet at the 4th Annual Disease Management Conference. The event is posted online at www.srinstitute.com/ch142

BLOGS: Nurses–lots of them

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Did you know that there were 4 million nurses in America? OK I made that up, but there are about 3 million RNs, not that all of them are working as nurses. I tell you this because virtually all of them have their own blog and most of those are in the nurses carnival called Change of Shift. This may be why there’s such a nursing shortage, as they’re all writing blogs instead!

POLICY/POLITICS/HEALTH PLANS: HSAs for Medicare? Crazy but apparently true

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So the HSA ideology has wormed its way into CMS, and now Medicare is seeking proposals for its Consumer-Directed Health Plan demonstration. Those taxpayers who can do basic math might wonder why you’d want to to give healthy Medicare beneficiaries cash for health services that they’re not going to use, while taking that cash away from the pot that pays for the sick beneficiaries that do use said services. But we’ve asked that question so many times before and no-one on the free market side dare answer it. And I guess you might say, why not give the taxpayers money straight to the “healthys” instead of laundering it through Medicare Advantage plans as we’re doing it now so that they can hand out free gym memberships to seniors and boost their executives’ stock holdings.

But given that risk adjustment is coming to Medicare Advantage, it may be that that gravy train is ending. Perhaps we’ll get to see if the private plans really can stand on their care management merits—and there’s so much fat in Medicare that they ought to be able to, easily.  Although they failed to do so in the late 1990s.

However, it’s just bizarre to increase the costs of a tax payer funded universal risk pool by allowing people who are not paying into it to withdraw cash from it. So the only real explanation is that CMS and its political masters in the White House are eventually intending to put the entire system into a high-deductible plan and not fund the amount below the deductible.  Just the same as most employers are doing (as I explained in this Spot-on piece about Intel).  That of course makes perfect sense for the government and the taxpayer. Until, that is, the seniors find out! I wouldn’t want to be in charge of Medicare when that happens, remember what those seniors did to Rostenkowski!