Month: November 2011

Massachusetts and Hawaii Offer the Most Cost-Effective Health Insurance Coverage

Nov 23, 2011• 28

By Al Lewis

What makes a state’s health insurance successful for its citizens? It should be affordable, it should cover a lot of people, and it should manage its members well, keeping people healthy as measured both by preventive care as well as actual health outcomes.

It turns out that, using those criteria, the state with the highest Health Insurance Success Score (HISS) is Massachusetts. One would expect high quality, good outcomes and of course close to 100% coverage in the Bay State, but it also — quite surprisingly — ranks 5^th in affordability, as described below.

Hawaii is a very close second. (One could also argue that Hawaii’s circumstances are unique and non-comparable because that state differentially attracts and retains healthy residents, but the analysis eschewed all subjectivity and second-guessing of the data.) Texas is last, one point behind Arkansas. In both the best and worst listings, there is a noticeable gap between the two states at the extremes and their respective runner-up pelotons.

FTC Commissioner: Accountable Care Organizations Will Likely Lead to ‘Higher Costs and Lower Quality Health Care’

Nov 23, 2011• 6

By Avik Roy

In August, I wrote about how hospital monopolies are the biggest driver of health costs that nobody talks about. These powerful hospital chains know that insurers have no choice but to accept their jacked-up rates, and the cost of health insurance goes up whenever it suits their needs. Now, according to remarks by Federal Trade Commissioner J. Thomas Rosch, it turns out that accountable care organizations—one of Obamacare’s most touted policy gizmos—could make this problem far worse. “The net result” of ACOs, says Rosch, “may therefore be higher costs and lower quality health care—precisely the opposite of its goal.”

Rosch spoke last Thursday before the American Bar Association’s Antitrust Fall Forum, where he lambasted the “unintended consequences” of Obamacare’s headlong rush into the buzzword-filled land of accountable care organizations. ACOs, you will recall, are meant to improve the degree to which various physicians treating the same patient cooperate with one another. In theory, this would lead to better, more integrated care and reduced waste. In reality, ACOs will also stimulate mergers between hospitals and physician groups, worsening the problem of provider consolidation.

ACO’s purported savings shift costs to private insurers

The Congressional Budget Office, much to the dismay of Obamacare’s advocates, didn’t put much stock in ACOs, projecting that the law’s new Medicare ACO initiative would save $5.3 billion over ten years: eight-hundredths of one percent of Medicare’s projected spending over that period. “In other words,” Rosch points out, “the savings to Medicare from the ACO program are no more than a rounding error. Yet even the CBO’s modest cost savings projections are likely overstated.”

My Minute with Andy Rooney

Nov 22, 2011• 5

By Michael L. Millenson

Pat Mastors, a patient safety advocate, has written a clever blog post called, “A Few More Minutes with Andy Rooney.” Channeling the curmudgeonly tones of a 60 Minutes commentary, it begins:

I died last week, just a month after I said goodbye to you all from this very desk. I had a long and happy life – well, as happy as a cranky old guy could ever be. 92. Not bad. And gotta say, seeing my Margie, and Walter, and all my old friends again is great.

But then I read what killed me: “serious complications following minor surgery.”

Now what the heck is that?

The blog goes on to have Rooney ask for someone to find out what actually killed him. This has offended some respondents who, blinded by their own biases, think a writer using a celebrity’s death to push for information that could be used to improve care is the same thing as accusing his physicians of negligence or hauling Rooney’s family into court to publicly disclose private details.

Don’t you hate people like that?

OK, that was a cheap Andy Rooney imitation. But as it happens, I did have a phone conversation with Rooney about patient safety. It came right after the Institute of Medicine released its landmark report, To Err is Human, in November, 1999. The appalling toll of medical errors wasn’t exactly a secret back then, but doctors and hospitals had gotten used to publicly tut-tutting about the “price we pay” for medical progress every time a new study came out and then going back to doing exactly what they’d been doing before.

The Super Committee Failure—What’s Next?

Nov 22, 2011• 16

By ROBERT LASZEWSKI

The stock market today was shocked, simply shocked, that the Super Committee didn’t come up with a debt deal.

I don’t know why. Republicans can’t vote for more taxes unless they’re willing to get “primaried” from the right and risk losing their seat. Ditto for Democrats who would face the same punishment from their base if they voted to change the sacred defined benefit entitlements without at least getting tax concessions from the Republicans.

Obviously, neither side has a lot of statesmen in their ranks who would actually be willing to compromise.

A Few More Minutes with Andy Rooney

Nov 21, 2011• 38

By Pat Mastors

“I died last week, just a month after I said goodbye to you all from this very desk. I had a long and happy life – well, as happy as a cranky old guy could ever be. 92. Not bad. And gotta say, seeing my Margie, and Walter, and all my old friends again is great.

But then I read what killed me: ‘serious complications following minor surgery.’

Now what the heck is that?

Nobody gets run over by a ‘serious complication.’ You don’t hear about a guy getting shot in the chest with a ‘serious complication.’ Sure, I didn’t expect to live forever (well, maybe only a little bit), but I was sorta going for passing out some Saturday night into my strip steak at that great restaurant on Broadway. Maybe nodding off in my favorite chair, dreaming of reeling in a 40-pound striper. You know, not waking up. This whole ‘death by complication’ thing is just so, I don’t know … vague and annoying.

Here’s something else that bothers me. This note I got a few days ago from a lady who says she’s a fan. She talked to a reporter at a national newspaper the other day. Asked the reporter, basically, what kind of complication ‘’did me in’? The reporter said ‘No idea what killed him. Unless someone dies unusually young, we don’t deal with the cause of death.’

Now I know reporters have lots to do. I was one myself before they started paying me to just say what I think. But I guess what this reporter means is, if I was 29 instead of 92, they mighta thought it was worth asking why I went in for minor surgery and died of ‘serious complications.’

Florida Sanctions Top Medicaid Prescribers, After a Shove

Nov 18, 2011• 10

By Tracy Weber and Charles Ornstein

At Dr. Huberto Merayo’s bustling psychiatry practice in Coral Gables, Fla., hundreds of poor patients on Medicaid walked away each year with prescriptions for powerful antipsychotic drugs.

Merayo’s prescriptions for the drugs totaled nearly $2 million in 2009 alone, state records show.

The 59-year-old psychiatrist is also in demand by the makers of these drugs. He’s earned more than $111,000 since 2009 delivering promotional talks for AstraZeneca, Eli Lilly & Co. and Pfizer, according to ProPublica’s database of drug-company payments to doctors.

This year, Florida regulators finally challenged Merayo’s enthusiasm for the pricey drugs, which are used to treat schizophrenia and bipolar disorder. A state review found he hadn’t documented why patients were prescribed the pills and had given them to patients with heart ailments or diabetes despite label warnings.

In May, Florida summarily ended his contract with Medicaid. But the action, though decisive, followed years of high prescribing by Merayo, according Florida’s own statistics. And he was booted only after public questioning by U.S. Sen. Charles Grassley, R-Iowa, who had asked states to investigate such cases.

Merayo’s situation is one of at least three in which Florida allowed physicians to keep treating and prescribing drugs to the poor amid clear signs of possible misconduct.

The state’s responses were marked by head-scratching errors, including the misspelling of Merayo’s name on official documents, and lengthy delays.

In another example, Florida allowed Dr. Joseph M. Hernandez of Lake City to continue prescribing narcotic pain pills to Medicaid patients for more than a year after he was arrested and charged in 2010 for trafficking in them.

Mr. Bush Goes to Washington

Nov 18, 2011• 15

By Jonathan Bush

You can’t believe the play that little athenahealth gets in Washington, DC… and thank goodness for it because no one has a clue about HIT.

How could they really?

I mean, there are 535 people in our federal legislature (give or take) and there are like a million different market spaces in the nation. This is why I have such a hard time with federal control of things. It’s impossible for them to know what’s going on…there are just not enough hours in the year.

As I’ve been thinking about care coordination and the complete lack of sustainable models or entrepreneurship in that space, it occurred to me that it’s currently not clear that it is legal for RECEIVERS of electronic health information to pay senders for the value of that health information. This means that the sender has no real motivation to send useful, relevant data in a timely manner (I know I’d pay the doc who sent me exactly what I needed about a patient more than I’d pay the doc who sends over a 30-page PDF) and that our industry will take a long time to understand the true health information exchange needs of providers.

I wanted to bring the concept with me to the Hill that Meaningful Use, in my opinion, is use that is meaningful to a medical care provider in the actual doing of business. In a space with such clear demand, we’ve got to let innovators develop a way to supply information that the market (providers of care) needs, if we want to improve outcomes and reduce costs.

So I flew down to Washington and it was tons of fun… me and Lauren Fifield and the lobbyist and a full dance card on Capitol Hill.

First, we met with Sally Canfield, policy director for Sen. Marco Rubio, R-Fla.

She’s a true health policy veteran who likes getting—and will give you—the straight story. She’s also one of the only people on the Hill with whom I could speak at my normal (lightning) pace and know she can keep up. We talked about everything from the potential fall of hospitals (Need a hospital? Just scan the horizon for a construction crane)…to the alarming rate of physician employment…to making Meaningful Use really meaningful…to encouraging care coordination…to life in the cloud.

MedPAC’s SGR Solution: Bad Medicine For A Chronic Problem

Nov 17, 2011• 16

By JEFF GOLDSMITH

The Medicare Payment Advisory Commission (MedPAC) is the closest thing Congress has to adult supervision on important health policy questions. The Commission commands bipartisan respect both for its record of sound policy advice and for its leadership.

With its October recommendations, MedPac attempted to solve the sustainable growth rate (SGR) physician payment formula budget crisis by spreading its more than $300 billion cost beyond the physician community. More than two-thirds of the burden would fall on hospitals, pharmaceutical and device manufacturers and, significantly, on Medicare beneficiaries themselves. Clearly MedPac’s intent was to widen the circle of pain.

However, a significant portion of the burden, over $100 billion, would still be borne by the physician community through 17 percent reductions in specialists’ fees and a ten-year freeze on primary care fees. If implemented, MedPac’s policies will give rise to a festival of unintended consequences: weakening multi-specialty group practices (which rely upon specialist comp to cross-subsidize their primary care services); winding down private practice-based primary care medicine; accelerating the hospital roll-up of medical practices while widening hospitals’ losses on the practices they already own; and triggering a further wave of ill-timed cost shifting to private insurers.

Do Something Cool

Nov 17, 2011• 1

By Evan Falchuk

What does it mean to be an entrepreneur in health care?

Twice in the last two weeks I had the honor of speaking at Northeastern University’s Health Sciences Entrepreneurs Program. It’s a terrific program, dedicated to fostering the creation of health care businesses by helping the people who build them figure out how to do it. That it exists is a testament to how strong the American spirit of entrepreneurship really is – and how the 21st century economic engine is going to be health care.

But the hundreds of students and alumni who attended the events already knew this. What they wanted to know were the answers to more practical questions – how do I know if it’s a good idea to try something? What happens if I make mistakes, or fail? Do I really need to start a business to be an entrepreneur? What opportunities does the changing world of health care create?

They’re the right questions because they’re hard. Being an entrepreneur means you’re willing to look at the world as it is and want to make it as you think it should be. It means being willing to take risks, try new things, and not being afraid to fail. In fact, if you listened to the panels of highly successful entrepreneurs, you’d think failure was a big part of what entrepreneurs do. You can’t create something new without making mistakes along the way.

At the end, we were all asked to give one piece of advice to the budding entrepreneurs.

Mine was this: Do Something Cool. Always put yourself in a position where you’re doing something that is so cool you want to tell people about it. When you don’t think it’s cool anymore, leave, and find something else that you think is cool. Don’t worry about whether it means starting your own business or working with someone else who has. Put yourself someplace where you think you are changing the world.

If you can do that, you’ll be an entrepreneur.

Evan Falchuk is President and Chief Strategy Officer of Best Doctors, Inc. Prior to joining Best Doctors in 1999, he was an attorney at the Washington, DC, office of Fried, Frank, Harris, Shriver and Jacobson, where he worked on SEC enforcement cases. You can follow him at See First Blog where this post first appeared.

Categories

Everything you always wanted to know about the Health Care system. But were afraid to ask.

Month: November 2011

Massachusetts and Hawaii Offer the Most Cost-Effective Health Insurance Coverage

FTC Commissioner: Accountable Care Organizations Will Likely Lead to ‘Higher Costs and Lower Quality Health Care’

My Minute with Andy Rooney

The Super Committee Failure—What’s Next?

A Few More Minutes with Andy Rooney

Florida Sanctions Top Medicaid Prescribers, After a Shove

Mr. Bush Goes to Washington

MedPAC’s SGR Solution: Bad Medicine For A Chronic Problem

Do Something Cool

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