Physicians

Today’s news today, doctors, Peel, and individual insurance

I just noticed that THCB today is all about last week and Sunday’s news—including Merrill Goozner and me jumping separately on the same magic quote in the NY Times CT piece. So how about three little pieces of news about stuff reported today.

First off, in a desperate attempt to keep the Republicans from losing all 33 Senate seats in November, CMS is freezing the cuts in Medicare fees which were due to go automatically into effect this week. Bob Laszewski has a just excellent explanation of how the Dems finally seem to have figured out how to play hardball with the Republicans and AHIP. Perhaps they’ve taken on Tom Delay as an advisor, now he’s not so busy. Meanwhile Bob thinks that the 7 missing Republican votes will return from July 4 and the Medicare Advantage and PFFS plans will get their comeuppance. Wall Street isn’t so sure, and those health plan stocks are trading higher today.

Second, in the category of things I couldn’t resist, self-appointed patient privacy advocate Deborah Peel has a letter in the NY Times
telling us all that the reason that doctors don’t use EMRs is because
they’re concerned about their patients’ privacy. She claims that:

Doctors are loath to add sensitive records to a system that uses
personal health information against patients. Americans’ personal
health information is used to deny jobs, promotions, insurance and
credit…<SNIP>…The data-mining industry makes millions selling our
health information, claims data, prescriptions and genetic information
to insurers, employers, researchers, drug companies and data
aggregators.

Let’s assume that she’s right (which she’s not) and
that identified data is being sold rampantly. What data is it that gets
sold? It’s almost all claims data — as she points out. If doctors are so
adamant that none of their patients data should leave their office
because of privacy, presumably none of them would submit claims. Oh,
hang on — they all submit claims. So perhaps it’s not privacy concerns
that are the problem. Hint to Dr Peel and the rest—doctors submit
claims because they get paid by doing so.

Of course, Dr. Peel could join those of us who believe that
it’s not the sharing of information that should be stopped, but instead
we should ban the discriminatory practices of those who use it against
patients after directly requesting it from them. Which is how they
actually get that identified information, rather than buying it from
mysterious middlemen. (Or perhaps Dr Peel has never filled in a health
or life insurance application).

Third, talking of discrimination in the the individual
insurance market, Hawaii has done something sensible. It’s calling sole
proprietors a “group” and telling the insurers to give them the group deal and stop underwriting them.
Massachusetts did something similar with it’s new plans. Now all they
need is to mandate them to buy insurance (to stop adverse selection)
and come up with a sensible way to pay for it. OK, I know that’s what
we need the whole country to do. Maggie Mahar points to the Fuchs/Emmanuel plan as one way of doing that (although I get a little lost in the VAT versus income tax debate….)

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jdMartin JensenDavid C. Kibbe, MD MBAScott Recent comment authors
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jd
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jd

Matt has it exactly right on privacy. Matt, the Hawaii measure is better than nothing, but as you point out these are merely half-steps. Back in February on this blog, I had argued that there is an enormous missed opportunity here for advocates of universal health care. The best way to remove the fear of medical information being misused to deny insurance is to institute universal healthcare, so that discrimination on coverage no longer makes sense. (see here) It seems with Martin’s comment on this thread, this is becoming an increasingly common idea, but is still ignored by many privacy… Read more »

Martin Jensen
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I made this point to some policy folk at the CSS conference in May. To wit: If we want to reduce the aggregate risk of disclosure, we could do it by reducing the harm of such a disclosure rather than simply trying to reduce its likelihood. The solution to the Privacy Problem is, then, Universal Healthcare. I got an equal number of pats on the back and puzzled looks. Ms. Peel wants to through the baby of improved access to critical information out with the bathwater of discrimanatory underwriting. (And, as you point out, she misses it with EMRs anyway.)… Read more »

David C. Kibbe, MD MBA
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Bravo, Matt! There’s no place other than THCB where these developments are treated like the high theater that they truly are. I have the sense that we’re watching some Greek tragedy unfold, with soothsayers and witches, riddles and revelations of incest right around the corner. Or perhaps I have the wrong century, and we’re on to the Shakespearean stage: “the lady doth protest too much!” and “A plague on both your houses!” come easily to mind. DCK

Scott
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Dr. Peel couldn’t be more wrong. There has been no evidence showing that switching to EMR is cost effective or saves time, especially for a small practice.