Month: January 2012

New Year’s Predictions: More Mandates (Maybe), House Rules at CMS

Jan 5, 2012• 3

By DAVID DRANOVE

As the New Year begins, I look forward to reading and commenting on the latest developments in health economics. I thought I would start by making a few predictions:

1) With the economy on a slow but steady road to recovery, Republicans will resurrect health reform as a key issue in the fall election. They run a controversial ad showing a patient named Debbie getting diagnosed by her iPhone’s Siri. In response, Democrats show Debbie filing for bankruptcy because her insurance refused to pay for Siri’s consultation fee.

2) The Supreme Court will uphold the purchase mandate in the Affordable Care Act. Lobbyists for every major industry flood Congress with requests for more purchase mandates.

3) Healthcare continues to be a bright spot in a sluggish labor market. As a way to simultaneously address persistent unemployment and the growing needs of the elderly, Nancy Pelosi proposes a new law mandating that all baby boomers purchase a caregiver for their parents.

4) CMS will release new revised rules for ACOs. The new rules discourage ACOs from only covering patients in good health by reducing reimbursements for patients who are able to lift the new 1200 page ACO rulebook.

The Decline of the Public Good

Jan 5, 2012• 69

By Robert Reich

Meryl Streep’s eery reincarnation of Margaret Thatcher in “The Iron Lady” brings to mind Thatcher’s most famous quip, “there is no such thing as ‘society.’” None of the dwindling herd of Republican candidates has quoted her yet but they might as well considering their unremitting bashing of everything public.

What defines a society is a set of mutual benefits and duties embodied most visibly in public institutions — public schools, public libraries, public transportation, public hospitals, public parks, public museums, public recreation, public universities, and so on.

Public institutions are supported by all taxpayers, and are available to all. If the tax system is progressive, those who better off (and who, presumably, have benefitted from many of these same public institutions) help pay for everyone else.

“Privatize” means pay-for-it-yourself. The practical consequence of this in an economy whose wealth and income are now more concentrated than any time in 90 years is to make high-quality public goods available to fewer and fewer.

Much of what’s called “public” is increasingly a private good paid for by users — ever-higher tolls on public highways and public bridges, higher tuitions at so-called public universities, higher admission fees at public parks and public museums.

The slow integration of community into health care

Jan 3, 2012• 1

For a long time now patients have been meeting in online (and offline) communities, sharing experience, advice and more recently data and measurements. And the health care system–which knows that communities improve health–has done virtually nothing–other than some doctors having doctors answer questions on MedHelp. That is just starting to change. Last year Geisinger did a small trial with dLife that showed improvement in diabetics outcomes. More recently Aetna inked partnerships with MindBloom and OneRecovery, two communities focused on spirituality and addiction, and today Diabetic Connect (part of Alliance Health) announced a deeper integration with the Joslin Diabetes Center. It’s been a while, but the heart of Health 2.0 (communities) are starting to move towards the mainstream.

Teaching Residents about Costs: The Price is Right

Jan 3, 2012• 8

By Shilpa Iyer

It all started while out to dinner with a couple of my fellow Brigham/Massachusetts General Hospital OB/Gyn residents. We were discussing our favorite old TV shows and one fellow resident’s love of The Price Is Right with Bob Barker. After talking about the game show, a light bulb went off in my head and I thought, “Why can’t we play The Price is Right with hospital charges to our patients?”

With further discussion we realized that none of us knew the hospital charge, or the cost to our patients for routine workups we routinely order in our gynecology clinic. We really had no idea.

After asking around, I realized that I was not alone in my lack of knowledge, or the idea to play The Price is Right with hospital charges. A couple of years prior the Massachusetts General Hospital Internal Medicine residents had played a similar game with the goal to create awareness of the costs associated with routine workups.

Usual, customary and made up

Jan 2, 2012

By Matthew Holt

It’s been a while since THCB discussed usual customary and reasonable charges, and it’s been longer since health plans did much about them–other than cover them at a low rate and let providers charge what they like. That’s mostly because Ingenix (now Optum Insight) got itself and United beaten up about the topic a while back. But I noticed today (via a company selling expensive webinars about the topic) that Aetna is starting to go after providers that are gilding the Lilly on out of network charges again. In this case a couple of surgeons who were self-referring to a surgery center they owned, not charging the patients their official share, and meanwhile somehow managed to charge nearly $100K for ear wax removal. Aetna, don’t forget, was the “nice” insurer that started the trend of settling with doctors and being nice to them over pricing back in Jack Rowe’s time as CEO. If Aetna’s now starting to get aggressive about out of network charges to its members, then perhaps we really are entering a new era of health insurer activity.

The Crash of Air France 447: Lessons for Patient Safety

Jan 2, 2012• 7

By Bob Wachter, MD

From the start of the patient safety movement, the field of commercial aviation has been our true north, and rightly so. God willing, 2011 will go down tomorrow as yet another year in which none of the 10 million trips flown by US commercial airlines ended in a fatal crash. In the galaxy of so-called “high reliability organizations,” none shines as brightly as aviation.

How do the airlines achieve this miraculous record? The answer: a mix of dazzling technology, highly trained personnel, widespread standardization, rigorous use of checklists, strict work-hours regulations, and well functioning systems designed to help the cockpit crew and the industry learn from errors and near misses.

In healthcare, we’ve made some progress in replicating these practices. Thousands of caregivers have been schooled in aviation-style crew resource management, learning to communicate more clearly in crises and tamp down overly steep hierarchies. Many have also gone through simulation training. The use of checklists is increasingly popular. Some hospitals have standardized their ORs and hospital rooms, and new technologies are beginning to catch some errors before they happen. While no one would claim that healthcare is even close to aviation in its approach to (or results in) safety, an optimist can envision a day when it might be.

The tragic story of Air France flight 447 teaches us that that even ultra-safe industries are still capable of breathtaking errors, and that the work of learning from mistakes and near misses is never done.

Matthew’s end of year letter

Jan 2, 2012

OK, the new year has started, but those of you who are interested in my personal “End of 2011” letter about charities & causes can find it on my barely-used personal blog here—Matthew Holt

Which Health Incubator Should You Apply To?

Jan 2, 2012• 4

By Thuc Huynh, MD

Health startups are emerging in high numbers this year and it’s no surprise. The health tech space is booming with new advances in HTML5, mobile health, and social media. But with the economic downturn, it’s hard to go out on your own without funding or guidance. But there’s help. Over the past year, four startup incubators have surfaced offering a mentoring program specific to health technology entrepreneurs. But, which one should you apply to? Here’s a breakdown of each accelerator and their offerings:

How Did My 2011 Predictions Turn Out?

Jan 2, 2012• 1

By Evan Falchuk

Pretty well, actually.

As predicted last December, there was no big change to health care reform, doctors still didn’t have enough time with their patients, Microsoft (disclosure: Microsoft is a Best Doctors client) made moves to create a “Windows” for electronic health records, and “ACO” became the hot buzzword in health care. Some state governments started major redesigns of their benefits programs, saving money in the same ways private sector employers do. Meanwhile, more than ever, private sector employers are penalizing employees who don’t take care of themselves.

Misdiagnosis finally started to be recognized as a public health problem. At Best Doctors we got a great deal of press coverage in 2011 on this (for a few examples, go here, here, here, here and here). I will sneak in a 2012 prediction and tell you that you will hear a lot more about this this year, and not just from us.

What did I get wrong?

Well, I said no major employer would drop their health benefits – and none did, so I didn’t really get this wrong. But I was surprised to hear some very major employers quietly talking about their plans for dropping coverage in 2014. It’s a bad idea – and I would have thought its badness would have been enough to keep it off the table. For some employers, apparently not.