How should we react to 1,718 pages of new regulation? Let’s start by stipulating the White House and HHS perspective:
“Taken together, these reforms will deliver on the promise to put patients at their center of their own health care — you are empowered with control over your own health care choices.”
Next, let’s stipulate the patient perspective via this video lovingly assembled by e-Patient Dave, Morgan Gleason, and the folks at the Society for Participatory Medicine. In less than 3 minutes, there are 15 patient stories, each with a slightly different take on success.
Live from the tradeshow floor of HIMSS, it’s Health in 2 Point 00! And no, I’m not fading away from coronavirus on this episode—but how many people could I have singlehandedly infected had the conference gone forward? On Episode 111, Jess and I have some fun with virtual backgrounds and talk about all of the things we’re missing at HIMSS right now. From what Trump would’ve said had he gotten the opportunity to speak, to what conversation would’ve gone on about the new ONC rules, to the big funding announcement we missed, here’s everything that succumbed to #HIMSSpocalypse2020. —Matthew Holt
The only way to
fully eliminate medical debt would be a comprehensive single payer plan, which
allowed no fees at the point of service.
However, such a
plan would require setting all prices for all doctors, hospitals, labs, and
drug companies. All providers would have to be satisfied – in advance — with
what the government is going to pay them on each procedure.
Countries like
Germany accomplish this through collective bargaining. Japan, France, Taiwan,
Israel and Scandinavia also have national fee schedules. However, I do not
think you could get all the providers in Toledo to agree on one schedule, much
less every provider group in America.
Single payer
would also require new income and payroll taxes of at least ten per cent more
than we pay now, if we want first-dollar coverage.
The first section of this article stated that many forms of medical debt can be reduced or cancelled by stronger enforcement of consumer protection laws. These debts are not inevitable and are not due to poverty. It would not require trillions of federal dollars to cancel them, either – just the willingness to go against lobbyists.
Therefore
I advocate the following attacks on medical debt:
Phase One
We must
cancel balance bills and surprise bills if there was no prior disclosure.
In most cases,
providers will not have the right to collect anything more than what the insurers pay them.
Phase Two
We must cancel the older, inactive “zombie debts” that are being purchased by collection agencies.
This line of
business must terminate. Providers throughout the country are selling
uncollected medical debt for pennies on the dollar to collection agencies, who aggressively attempt to force
patients to pay the full amount due. These debt collectors harass patients at
work and at home, deploying unscrupulous tactics even after the statute of limitations
on the debt has expired.
The recent
proposal by Sen. Bernie Sanders to cancel $81 billion of medical debt is a very
good start—but it is only a start.
The RIP Medical
Debt group—which buys old medical debts, and then forgives them—is absolutely
in the right spirit. Its founders Craig Antico and Jerry Ashton deserve great
credit for keeping the issue of forgiveness alive.
Unfortunately,
over $88 billion in new medical debt is created each year; most of it still
held by providers, or sold to collectors, or embedded in credit card balances.
Tragically, none of this has to happen! In France, a visit to the doctor typically costs the equivalent of $1.12. A night in a German hospital costs a patient roughly $11. German co-pays for the year in total cannot exceed 2% of income. Even in Switzerland, the average deductible is $300.
U.S. patients face cost-sharing that would never be tolerated in Germany, says Dr. Markus Frick, a senior official. “If any German politician proposed high deductibles, he or she would be run out of town.”
Healthcare today, in the broadest sense, is not a benevolent giant that wraps its powerful arms around the sick and vulnerable. It is a world of opposing forces such as Government public health ambitions and more or less unfettered market ambitions by hospitals and downright profiteering by some of the middlemen who stand between doctors and patients, such as insurers, Pharmacy Benefits Managers, EMR vendors and other technology companies.
Within healthcare there is also a growing, more or less money-focused sector of paramedicine, promoting “alternative” belief systems, some of which may be right on and showing the future direction for us all and some of which are pure quackery.
I stand by my conviction that physicians must embrace the role of guide for their patients. If we see ourselves only as instruments or tools in the service of the Government, the insurance companies or our healthcare organizations, patients are likely to mistrust our motives when we make diagnoses or recommend treatments.
What do the coronavirus
and Navy ships have in common? For that matter, what do our military
spending and our healthcare spending have in common? More than you might
think, and it boils down to this: we spend too much for too little, in large
part because we tend to always be fighting the wrong wars.
Photo by STR/AFT via Getty Images
I started thinking about this a couple weeks ago due to a WSJ article about the U.S. Navy’s “aging and fragmented technology.” An internal Navy strategy memo warned that the Navy is “under cyber siege” by foreign adversaries, leaking information “like a sieve.” It grimly pointed out:
Our
adversaries gain an advantage in cyberspace through guerrilla tactics within
our defensive perimeters. Once inside, malign actors steal, destroy
and/or modify critical data and information.
This is the Navy, after all, that proudly tried to modernize by installing touch screen technology on some of its ships, only to have the disaster that hit the USS McClain. Its vaunted Integrated Bridge and Navigation System was, ProPublica found, “was a welter of buttons, gauges and software that, poorly understood and not surprisingly misused, helped guide 10 sailors to their deaths.” And that wasn’t the only technology-enabled naval disaster in recent years.
Today, primary care is considered the bee’s knees of value-based care delivery. Instead of being viewed as the punter of the football team, the primary care physician (PCP) has become the quarterback of the patient’s care team, calling plays for both clinical and social services. The entire concept of the accountable care organization (ACO) or patient-centered medical home (PCMH) crumbles without financially- and clinically-aligned PCPs. This sea change has resulted in rapid employment or alignment to health systems, as well as a surge in venture capital being invested into the primary care space.
Before we get too far in the weeds, let’s first begin with the definition of primary care. The American Academy of Family Physicians (AAFP) defines a primary care physician as a specialist typically trained in Family Medicine, Internal Medicine, or Pediatrics. Some women do use their OB/GYN as their PCP, but these specialists are not traditionally considered PCPs. Now if you’ve gone to your local PCP and noticed that your care provider is not wearing a white coat with the “MD” or “DO” credentials, you are either receiving treatment from a hipster physician, nurse practitioner (NP), or physician assistant (PA). Two of the three professionals are trained in family medicine and can provide primary care services under the responsibility of an associated PCP. At least one of the three has a beard.
The crazy thing is, despite the industries heightened focus on the importance of PCPs, we’re still expecting a shortage of primary care providers. In April 2019, the Association of American Medical Colleges (AAMC) released a report estimating a shortage of between 21,100 and 55,200 PCPs by 2032. Given we just passed 2020, this not that far off. The primary reason for the shortage is the growing and aging population. Thanks mom and dad. Digging into the numbers will really knock your socks off, with the U.S. Census estimating that individuals over the age of 65 will increase 48% over that same time period. Like a double-edged sword, the issue is not just on the patient demand side though. One-third of all currently active doctors will be older than 65 in the next decade and could begin to retire. Many of these individuals are independent PCPs who have resisted employment by large health systems.
Sara Holoubek, Founder & CEO of Luminary Labs, a strategy and innovation consultancy — and the recognized “Queen” of identifying the undercurrents and sub-text of conversations at healthcare conferences — dishes about those undercurrents running just-below-the-surface at JP Morgan Healthcare 2020. Where’s the digital health market headed? Says Sara, “When you see too much bottle service at the parties…that’s when you should watch your back!”
Filmed at J.P. Morgan Healthcare Conference in San Francisco, January 2020.
By THOMAS WILSON PhD, DrPH and VINCE KURAITIS JD, MBA
A recent study in the New England Journal of Medicine reported on the results of a “hotspotting” program created by the Camden Coalition of Healthcare Providers (Camden Coalition). Hotspotting targets interventions at all or a subset of healthcare superutilizers – the 5% of patients that account for 50% of annual healthcare spending.
The results
of the study were disappointing. While utilization (hospital readmissions)
declined for the hotspotting group, the declines were almost identical in the
control group. At least three headlines
implied that the conclusion of the study was that hotspotting care management
approaches have been proven not to work:
“’Hot spotting’ doesn’t work. So what does?” Politico Pulse
“Reduce Health Costs By Nurturing The Sickest? A Much-Touted Idea Disappoints.” NPR
As we’ll
explain, we believe that much of what’s going on here can be explained by one
or both of what we call “RTM Traps” (regression to the mean traps).
In this
essay, we will:
Define RTM (regression to the mean)
Explain the RTM Traps and how many
have fallen into the traps
Suggest how to avoid the RTM Traps
We believe
our POV is relevant to clinical, technical, and executive staff in the many
organizations focusing on the superutilizer population – hospitals, physicians,
ACOs, health plans, community groups, etc.
