Author Archives

Matthew Holt

Losing Patients With Insurers

Oct 29, 2010• 70

By ROB LAMBERTS, MD

We are losing patients. Certain insurance companies are trying to “play hardball” with doctors, unwilling to negotiate with us over their outlandishly low rates. We have lost patience.

So the signs went up in the exam rooms today:

As of the start of the year, we will only accept X, Y, and Z Medicare advantage plans, and we are presently negotiating with A and B insurance companies. Please consider this when enrolling in plans.

It is highly likely we will drop one of the insurance plans altogether, and we are one of the last practices in our town to accept them.

Patients are distraught. Some of them who have seen us for years are now going to have to go elsewhere, while others that just joined our practice because their previous doctors dropped out of the plan will once again have to find a new doctor. Patients aren’t mad about this, just sad. The conversations go like this:

“So you are dropping X insurance?”

“We will if they don’t change. They are paying us significantly less than other plans.”

“That’s crazy. We just left a doctor because of the same thing. Now we have to move on.”

“Yeah, I am very sorry about that. I just want to see patients; I don’t want to do this kind of thing.”

“Well, I don’t blame you. They pay $1000 for an ER visit for an ear infection, and they won’t pay you what you charge?”

Connected Healthcare: Wellness and Emerging Technology

Oct 29, 2010• 1

You are invited to attend Massachusetts Institute of Technology (MIT) Enterprise Forum’s latest Networking/Panel Event, Connected Healthcare: Wellness and Emerging Technology on Wednesday, November 17th.

Technology is changing how people connect with one another, and the interaction between doctors and patients is next. Never-before-seen opportunities are emerging to further process and analyze data to enrich healthcare outcomes. Please join us for an edifying discussion, and a networking hour to include hobnobbing with movers and shakers in the NY tech scene. Details can be found at:

http://www.mitef-nyc.org/mc/community/eventdetails.do?eventId=292906&orgId=mefny&recurringId=0

DATE: Wednesday, November 17th 2010

TIME: 5:30PM (Reception); 6PM (Panel); 7:30PM (Networking)

PLACE: Chadbourne, Parke LLP, 30 Rockefeller Plaza, New York, NY 10112

THCB Recommends …

Oct 29, 2010

So That’s How The Rates Are Set

Oct 29, 2010• 9

By PAUL LEVY

The Wall Street Journal published a very important article this week. Written by Anna Wilde Mathews and Tom McGinty, it is entitled, “Secrets of the System: Physician Panel Prescribes the Fees Paid by Medicare.

Here’s the lede:

Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars.

The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement.

Yet the influence of the secretive panel, known as the Relative Value Scale Update Committee, is enormous. The Centers for Medicare and Medicaid Services, which oversee Medicare, typically follow at least 90% of its recommendations in figuring out how much to pay doctors for their work. Medicare spends over $60 billion a year on doctors and other practitioners. Many private insurers and Medicaid programs also use the federal system in creating their own fee schedules.

Engage with Grace

Oct 29, 2010• 4

By Alexandra Drane

This is the full text of Alexandra Drane's talk about Engage with Grace at TEDMED. I'm so proud of Alex for what she's done and her talk was outstanding–Matthew Holt

So when I heard that I was going to be speaking with all of you about end of life, I was a little sad at first…even though end of life is an obsession of mine….because TedMed is such a sexy event, and speaking here is such an honor. I wanted to talk with you about something like vitality – feeling alive, being empowered, taking life into your own hands…but then it hit me… that’s what end of life actually is – that’s what it can be when it’s done well.

But … It’s not usually. 70% of people want to die at home, only 30% do.

Here’s another stat you might not have thought about recently – You only die once. Think about that for one second – You only die once. Not my words – Atul Gawande’s in his incredible essay on end of life – ‘Letting Go’– which I am now declaring as mandatory reading for each and every person attending TedMed.

End of life in the US has somehow failed to become personal. It’s like this thing we put on a shelf and ignore. And getting what you want at end of life has become synonymous with filling out forms and getting waivers and going to some lawyers office where you pay a lot of money and get excited when you get to keep the pen.

But that’s not what it’s about. Not at all. Let me tell you a story.

Once upon a time there was this extraordinary woman named Za – short for Rosaria. Za was first generation Italian, breathtaking to look at, driven to become a pharmacist – the first in her family to go to college – and of course she was also human…She loved to enjoy…spending money she didn’t always have, generous to a fault. She was madly in love with her husband John and her two year old daughter Alessia, the apple of her eye. Deep within Za welled this enormous sense of joy – a deep gratitude for the life she had. As it turned out, deep within her also lived cancer – and not just any cancer – but the terrible and unforgiving brain cancer Glioblastoma – described by one of her surgeons as whip cream in a sponge – virtually impossible to eradicate. The seven month battle Za waged against her illness was a mighty one – she endured two massive brain surgeries, radiation, chemotherapy, all the related humiliations – but the cancer didn’t really care.

Health Insurance and Life Expectancy

Oct 28, 2010• 22

By JOHN GOODMAN, PhD

Did you know that Hispanic Americans live longer than non-Hispanic whites? If that doesn’t knock your socks off, consider this: American Hispanics are three times as likely to be uninsured as non-Hispanic whites.

If you’re still not blown away, maybe you haven’t been following the twists and turns of the health policy debate. As I wrote at my blog the other day, the Centers for Disease Control (CDC) discovery that Hispanics (one-third of whom are uninsured) have a life expectancy that is 2 1/2 years longer than whites (90% of whom have health insurance) makes mincemeat out of the oft-repeated idea that the uninsured get less health care and die earlier than everyone else.

In support of the conventional wisdom, for example, the Physicians for a National Health Care Program (PNHCP) went so far as to claim that a whopping 45,000 people die every year because they are uninsured. That figure, repeated as though it were unquestioned fact by President Obama and most of the health care media, is almost as large as the number of American soldiers killed in the entire Vietnam War!

Families USA went so far as to make the astounding claim that 6 people die every day in Florida because they are uninsured. Eight die every day in California; and 25 die in New York. In Texas, the report implies that more people die every two months from lack of health insurance than the number killed at the battle of the Alamo (counting only losses on our side, that is). Nationwide, says the PNHCP, an uninsured person dies every 12 minutes.

Health 2.0 Developer Challenge Code-a-thon Finalist: Team Transpera Health

Oct 28, 2010

By BIANCA GROGAN

Team Transpera Health, led by Cathy Huang, introduced software that will enable consumers to make healthcare provider and procedure decisions based on costs and quality. The team utilized databases from the CMS Medicare Physician Fee Schedule and CAHPS Hospital Survey as the basis for calculations. Judges at the Code-a-thon noted the concise and consumer-friendly aspects of the application.

Alexandra Drane doing Engage With Grace at TEDMED

Oct 28, 2010• 2

By Matthew Holt

Just one photo from TEDMED, a really fascinating conference where I’ve been this week (courtsey of RWJ). This is Alex Drane telling Za’s story and presenting Engage with Grace. She was remarkable.

Privacy Paradigms: From Consent to Reciprocal Transparency

Oct 28, 2010• 1

By FRANK PASQUALE

Computational innovation may improve health care by creating stores of data vastly superior to those used by traditional medical research. But before patients and providers “buy in,” they need to know that medical privacy will be respected. We’re a long way from assuring that, but new ideas about the proper distribution and control of data might help build confidence in the system.

William Pewen’s post “Breach Notice: The Struggle for Medical Records Security Continues” is an excellent rundown of recent controversies in the field of electronic medical records (EMR) and health information technology (HIT). As he notes,

Many in Washington have the view that the Health Insurance Portability and Accountability Act (HIPAA) functions as a protective regulatory mechanism in medicine, yet its implementation actually opened the door to compromising the principle of research consent, and in fact codified the use of personal medical data in a wide range of business practices under the guise of permitted “health care operations.” Many patients are not presented with a HIPAA notice but instead are asked to sign a combined notice and waiver that adds consents for a variety of business activities designed to benefit the provider, not the patient. In this climate, patients have been outraged to receive solicitations for purchases ranging from drugs to burial plots, while at the same time receiving care which is too often uncoordinated and unsafe. It is no wonder that many Americans take a circumspect view of health IT.

Privacy law’s consent paradigm means that, generally speaking, data dissemination is not deemed an invasion of privacy if it is consented to. The consent paradigm requires individuals to decide whether or not, at any given time, they wish to protect their privacy. Some of the brightest minds in cyberlaw have focused on innovation designed to enable such self-protection. For instance, interdisciplinary research groups have proposed “personal data vaults” to manage the emanations of sensor networks. Jonathan Zittrain’s article on “privication” proposed that the same technologies used by copyright holders to monitor or stop dissemination of works could be adopted by patients concerned about the unauthorized spread of health information.Continue reading…

Confessions of a Health Literacy Expert

Oct 28, 2010• 14

By HILARY SELIGMAN, MD

I have a patient who I will call Antonia.

Antonia is in her early 70’s. She came to the United States from Guatemala many years ago, but never learned to speak much English. This doesn’t cause her much of a problem; her community is small and tightly-knit, so she doesn’t have much need to speak English in her home or her neighborhood. And she has a large family—children and grandchildren and great-grandchildren—who live close by.

Antonia is one of my favorite patients. We communicate in different languages, and taking care of her is a series of endless frustrations. But I love her contradictions.

She seems so little when she sits in the chair in my exam room, feet up on the bar supporting the chair’s legs, her body folded up around the purse clutched tightly in her lap. But when she talks, she shines; she is larger than life. We enjoy ourselves. I like her, and I like being her doctor.

Here is Antonia’s medication list:

For diabetes:
Metformin 1000 mg: 1 tablet 2 times daily
Glyburide 5 mg: 1 tablet 2 times daily

For pain associated with neuropathy (a complication of her diabetes):
Gabapentin 300 mg: 1 tablet 3 times daily

For high blood pressure:
Hydrochlorothiazide 25 mg: 1 tablet 1 time daily
Benazepril 20 mg: 1 tablet 1 time daily

To protect from heart attacks:
Aspirin 81 mg: 1 tablet 1 time daily

For a recent bout of depression:
Escitalopram 10 mg: 1 tablet 1 time daily

For heartburn:
Omeprazole 20 mg: 1 tablet daily

For osteoporosis:
Os-cal 500mg: 1 tablet 2 times daily

For cough of unclear etiology (maybe asthma?):
Albuterol Inhaler: 2 puffs four times daily as needed for cough

Despite these ten medicines on her official list, Antonia’s blood pressure is often too high when she comes in to see me. Her blood sugar is way out of control. And she has had a cough now for many months. I don’t know why she has a cough, because she has not completed most of the tests I have ordered for her. All of this troubles me.