Category: Uncategorized

Commentology: Improving Cost-Containment

Sep 15, 2009• 4

Stephen J. Motew writes:

Surgical specialists practice under a slightly more regimented reimbursement model predominantly due to the global period payment for surgical procedures. The total care of the surgical patient for any procedure, including pre-op evaluation, the procedure itself, and all related care post-operatively including most complications is covered under a 90 day global pay period. This system has worked relatively well by containing costs to a specific 'disease' (or procedure) state. In addition, many surgical sub-specialties such as vascular surgery and oncologic surgery for example invest a large amount of time in overall disease-state management that may not even include a procedure. I believe this has allowed many surgeons to understand the concept of cost-containment and efficiency, disease management as well as outcomes-based practices.

A recent experience with a referral patient however, highlights the incredible gaps in cost-containment and disease management that can occur prior to surgical intervention. I have annotated each step in the process to demonstrate points where potential intervention may have occurred. I will leave it to the comments to discuss the reasons and realities of such a case!

Obama’s Medicare Half-Truth

Sep 14, 2009• 34

By AUSTIN FRAKT

Obama was called a liar during his recent address to a joint session of Congress. Actually, he was not fully truthful
about the implications of cuts to Medicare. Obama repeated that his
health reform plan includes payment cuts for private Medicare Advantage
(MA) health plans:

The only thing this plan would eliminate is the
hundreds of billions of dollars in waste and fraud, as well as
unwarranted subsidies in Medicare that go to insurance companies —
subsidies that do everything to pad their profits and nothing to
improve your care. … So don’t pay attention to those scary stories
about how your benefits will be cut… That will never happen on my
watch. I will protect Medicare.

Obama’s claim that the cuts will trim insurer profits but not Medicare benefits was meant to calm nervous seniors. As I and others
have pointed out the proposed cuts will in fact reduce benefits to some
degree, contrary to the President’s assertion. But seniors, in
general, should not be concerned. First, only about 23% of Medicare beneficiaries are enrolled in an MA plan.

Taxing Health Insurance Companies to Pay for Health Care

Sep 14, 2009• 9

By ROBERT LASZEWSKI

The Congress has investigated about every conceivable way to tax people to pay for the health care proposals—a millionaire’s tax, bigger taxes on home mortgages and charitable contributions, and a couple of dozen more ideas.

Now Congress looks to be the most interested in taxing insurance companies to pay for a big chunk of their health care proposals. The new taxes would come in two parts––a 35% excise tax on any health benefit cost above an $8,000 single and $21,000 family annual premium as well as a flat $6 billion annual tax on the industry to be allocated among the companies proportionate to their premium.

There is certain logic to this. Taxing high priced benefits could help deflate the health care economy. Taxing all of the health insurance companies that stand to get more than a $1 trillion in new business—most of it in the from new private insurance and Medicaid subsidies and the rest from the consumer’s share of those new private plan premiums—seems fair at one level.

Calling for a tax on that big rich insurance company also sounds a lot better to the politicians than looking voters straight in the eye and raising their taxes directly.Continue reading…

Health 2.0 Conference

Sep 14, 2009

Health 2.0 is right around the corner – be sure to register before it sells out! If
you are a practicing physician and want a special opportunity to
review Health 2.0 tools and attend the conference for free, apply here.

CBO: HELP Bill’s Public Plan Not Much Help on Costs

Sep 14, 2009• 5

By MERRILL GOOZNER

The green-eyeshade meanies in the Congressional Budget Office took another whack at the public plan today, at least the one contained in the health reform bill passed by the Senate Health Education Labor and Pensions committee last June. Responding to queries from ranking member Michael Enzi (R-WY), CBO chief Doug Elmendorf noted on his blog that “premiums for the public plan would typically be comparable to the average premiums of private plans offered in the insurance exchanges.”

The reason given was the HELP bill emasculated the public plan’s ability to piggyback on the administrative efficiencies of Medicare and required it to be “financially self-sufficient.”Continue reading…

What Voters Really Think About Evidence-Based Health Care

Sep 13, 2009• 8

By ROBERT LASZEWSKI Campaign for Effective Patient Care

I want to call your attention to an important survey done by the California-based Campaign for Effective Patient Care. They surveyed California voters on their understanding of evidence-based medicine.The bad news is that patients think their health care treatment is generally evidence-based even though that assumption is highly questionable. The good news is that patients want it to be evidence-based.At a time when we hear anecdotal evidence, particularly from town hall meetings, that people don't want any "interference" between them and their doctors they do seem to appreciate they need to get all of the facts when making a treatment decision.Here is the survey summary. You can access all of it here.

Recently on THCB

Sep 13, 2009

10,000 US Physicians have something to say, and we’re not wasting time by Dr. Daniel Palestrant What Obama Must Demand from Congress on Health Care by Robert Reich Public Still Backs the Public Plan by Merrill Goozner Not Really An Option by Gary Nissen No Alternative: An Analysis of the GOP Plan by Harris Meyer“Winners and Losers – Strategy in a Post-Reform World” by Roger Collier“Betsy McCaughey’s Infected Advocacy” by Michael Millenson“The Health care cost shifting myth” by Austin Frakt“Health care reform good for the business of healthcare” by Robert Laszewski“Can the two Democratic parties get it together on healthcare reform?” by Jeff Goldsmith“Health Panels are a NICE way of controlling costs” by Adrian Baker “Winners and Losers – Strategy in a Post Reform World” by Bill Kramer“Our President is on the Ropes” by Dr. Stephen Kardos“Will Republicans be spoilers or problem solvers on health care reform?” by Brian Klepper and Dr. David Kibbe“The Right to Live” by David Shaywitz“Tweaking Medical Education to Leverage EHRS” by Glenn Laffel

Not Really an Option

Sep 13, 2009• 16

By GARY NISSEN

To: Executives leading U.S. Hospitals

The public option appears to back in the national dialogue and I’m wondering how concerned you all are about that.

After all, many of you have been quite successful at minimizing the appearance of true profit by growing your cost structure on the backs of private insurers, right?

Thinking back over the last ten to fifteen years, many things have changed.Continue reading…