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Category: Health Policy

Bad Backs & Deductibles

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It’s time again for me to use my bad back as a case study in why American health care has such crazy incentives. 

About a month ago at the HLTH conference in Vegas, over the course of a few hours I developed debilitating leg pain. To quote from my earlier twitter  thread on my time in Vegas,  “After 3 days of excruciating pain, my wife insisted I went to the ER. The public policy person in me was horrified but we had already spent our deductible, so the cost was actually lower than paying cash for an MRI”

What actually happened was that after 3 days of dreadful pain & inability to walk (including getting myself home from Vegas using multiple wheelchairs, and being that guy who crawls off the plane onto a wheelchair), I got in to see my chiropractor. He said, you need an MRI to figure out what’s wrong with you. The alternatives were 

Looking good on the gurney!

1) Get insurance to pre approve the MRI. His guess was that that would take a few days or more. I actually called One Medical‘s urgent care video line and the PA I spoke to told me that usually insurance would only approve an MRI after I had done 6 weeks of physical therapy.

2) Pay $500 cash for a free standing MRI that could probably get me in during the next few days 

3) Go to the ER

Now the “incentives” part of this starts to really matter.

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‘Breaking Down Interstate Barriers to Telehealth Delivery’ Tops ATA’s Priorities for 2023

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by JESSICA DAMASSA, WTF HEALTH

Just one week before the ATA EDGE Policy Conference (12/7-12/9 Washington DC) we get a SNEAK PEEK at what’s topping the agenda – and the American Telemedicine Association (ATA)’s list of priorities for 2023 – to ensure that digital health and virtual care providers avoid the ‘telehealth cliff’ that could send us back to pre-pandemic scaling issues of both practice and reimbursement.

Kyle Zebley, SVP of Public Policy at the ATA and Executive Director of ATA Action (the ATA’s affiliate advocacy organization) gives us the skinny on where policies currently stand at the federal and state level and, more importantly, what’s in jeopardy of changing soon. The list is long – everything from interstate practice to originating site stipulations, in-person visit requirements (especially for tele-mental health visits), and a number of favorable reimbursement policies that made telehealth a covered benefit at federally qualified health centers, rural health clinics, and under some high-deductible health plans. And, these are just to name a few…

Right now, the pandemic’s public health emergency is still in effect until mid-January, and, though it is expected to be renewed, the renewal will only get us into the second quarter of 2023. Kyle gives us the in-depth details on what ATA is advocating for and how they’re doing it. Of particular interest is the work being done to preserve clinicians’ ability to deliver cross-state care. The details here are fascinating. Kyle explains the nuances of tactics like licensure compacts and common sense exceptions that are being explored to permanently extend cross-state telehealth care, as well as the role the federal government can play in helping these policies along by incentivizing states to adopt these them through a “carrot-and-stick approach.”

The time to get involved is now, Health Tech! Get your start by watching this in-depth chat with Kyle to get caught up on where things stand, then check out ATA’s site for information on what you can do to support these on-going efforts to keep virtual care a growing vehicle for healthcare delivery.

* Special thanks to Wheel, sponsor of this special monthly WTF Health series on the policies that are changing telehealth and virtual care. Wheel is the health tech company powering the virtual care industry, provides companies with everything they need to launch and scale virtual care services — including the regulatory infrastructure to deliver high quality and compliant care. Learn more at www.wheel.com.

The “Comstockery” of Justice Clarence Thomas

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BY MIKE MAGEE

“When we think about the past, we think about history. When we think about the future, we think about science. Science builds upon the past, but also simultaneously denies it.” These are the words of Jim Secord, a Professor of History and Philosophy of Science at the University of Cambridge. His research and teaching are on the history of science from the late eighteenth century to the present, with a special focus on Darwinian evolution. 

His perspective is especially relevant when it comes to the recent Dobbs decision. The history of this contemporary struggle is as clear as is the science disputed by modern day left and right. It began on March 7, 1844, with the birth of this man, Anthony Comstock, in New Canaan, Connecticut. Raised in a strict Christian home, his religiosity intensified during a two-year stint in the Union Army during the Civil War.

A member of the 17th Connecticut Infantry, he took great offense to the profanity and debauchery he witnessed in and among his fellow soldiers. With the strong support of church-based groups of the day, and as the self-proclaimed “weeder in God’s garden”, he sought out a purpose and found a political vehicle in New York City’s Young Men’s Christian Association, and parlayed that to a post as the United States Postal Inspector.

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Promises Made – Promises Kept:  President Biden’s Support for “Obamacare.”

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BY MIKE MAGEE

As the saying goes, “History repeats!” This is especially true where politics are involved. 

Consider for example the past three decades in health care. It is striking how many of the players in our nation’s health policy drama remain front and center. And that includes President Biden who recently commented on the 12th anniversary of the passage of the Affordable Care Act (Obamacare): 

“The ACA delivered quality, affordable health coverage to more than 30 million Americans — giving families the freedom and confidence to pursue their dreams without the fear that one accident or illness would bankrupt them. This law is the reason we have protections for pre-existing conditions in America. It is why women can no longer be charged more simply because they are women. It reduced prescription drug costs for nearly 12 million seniors. It allows millions of Americans to get free preventive screenings, so they can catch cancer or heart disease early — saving countless lives. And it is the reason why parents can keep children on their insurance plans until they turn 26.”

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The Secret Surveillance Capitalism That Suffuses Medicare

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By MICHAEL MILLENSON

Imagine a government program where private contractors boost their bottom line by secretly mining participants’ personal information, such as credit reports, shopping habits and even website logins.

It’s called Medicare.

This is open enrollment season, when 64 million elderly and disabled Americans choose between traditional fee-for-service Medicare and private Medicare Advantage (MA) health plans. MA membership is soaring; within a few years it’s expected to encompass the majority of beneficiaries. That popularity is due in no small part to the extra benefits plans can provide to promote good health, ranging from gym membership and eyeglasses to meal delivery and transportation assistance.

There is, however, an unspoken price for these enhancements that’s being paid not in dollars but in privacy. To better target outreach, some plans are routinely accessing sophisticated analytics that draw upon what’s euphemistically labeled “consumer data.” One vendor boasts of having up to 5,000 “certified variables for every adult in America,” including “clinical, social, economic, behavioral and environmental data.” 

Yet while companies like Facebook and Google have faced intense scrutiny, health care firms have remained largely under the radar. The ethical issue is obvious. Since none of this sensitive personal information is covered by the privacy and disclosure rules protecting actual medical data, it is being deliberately used without disclosure to, or explicit consent by, consumers. That’s simply wrong.

But a more fundamental concern involves the analyses themselves.

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Explorations in French Health Care! (Or what I did on my vacation!)

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By MATTHEW HOLT

This is a personal story about this blog’s publisher (me!) but it has just enough health care stuff to keep it relevant!

This year I finally got invited on the annual week-long mountain bike ride run by my friend JB and his ex Taiwan/Hong Kong buddies. I’ve actually been practicing and training most of the summer and arrived pretty confident even though I knew it would be tough. This edition is in Provence in France.

Before it all went wrong

And then…..2 hours in on the first day it turns out I was too confident…

Back in 2002 I smashed my knee snowboarding into a tree. When I told him my dad said ” You silly twit”

I actually was a silly twit this time too. I was on a new bike (a rental) that was actually much more advanced than my usual one and had a feature I had barely practiced with (a drop seat) that requires a new technique. It had rained heavily the day before so it was wet (& living in California I have very limited experience mountain biking in the rain), and I was behind the pack as my chain had come off. (There was a guide sweeping the rear who fixed it for me). So when I got to the first challenging down hill slope I didn’t do the sensible thing of stopping & walking to the bottom to check it or do what 75% of the group did and walked their bike down it, I just thought, “I can do that’ and plunged down it. Not quite sure exactly why I fell but I went over the bars slightly to the right (luckily missed a tree) & hit the ground on the downslope hard on my right side. In any sport any one of new equipment, new environment, new technique means you should err on the side of caution and I had all 3, yet just went for it! Very bad decision!

After I got up I thought I had just badly winded myself. The guide helped me back on the bike & I rode on. For the next 5 miles or so he helped push me up the steeper bits of a climb (he had an eBike). I actually did a slightly less challenging but still tough downslope section & a friend gave me a big dose of Tylenol at the next stop point. I actually crashed again after that (slipped on a wet rock) but landed ok on my elbow which was padded (as were my knees but not my torso) and only had some slight scratches but I made it to lunch feeling sore but OK.

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Start the Revolution without Us

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BY KIM BELLARD

Well, as usual, there’s a lot going on in healthcare.  There’s the (potential) Amazon – One Medical acquisition, the CVS – Signify Health deal, and the Walmart – United Healthcare Medicare Advantage collaboration.  Alphabet’s just raised $1b.  Digital health funding may be in somewhat of a slump, but that’s only compared to 2021’s crazy numbers. Yep, if you’re a believer that a revolution in healthcare is right around the corner, there’s a lot of encouraging signs.  

But I was in a Walmart the other day, and my thought was, these people don’t look like they care much about a revolution in healthcare. In fact, they don’t look like they much care about health generally.  That’s not a knock on Walmart or Walmart shoppers, that’s an assessment about Americans’ appetite for changes in our health care.  

That’s not to say we like our healthcare system.  A new AP-NORC survey found that 56% felt that the US did not handle healthcare well (curiously, 12% thought we handled it extremely/very well – huh?).  Prescription drugs, nursing homes, and mental health rated especially low.  We’d like the government to do more, but not, it would seem, if it means we pay higher taxes.

Much of what is wrong is our own fault. We know that we eat too many processed foods, that the food industry scientifically preys on us to target our weaknesses for fat, sugar, and salt, that we’d rather sit than drive and drive than walk, and that we are poisoning our environment, and, in turn, ourselves.  Given a choice between short term benefits versus long term consequences, though, we’ll eat that Oreo every time, literally and metaphorically.

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Tick Tock (or TikTok) for US Health Care

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BY KIM BELLARD

Yes, I know Congress just passed the Inflation Reduction Act, a big step forward in combating climate change that also has some important healthcare provisions (Medicare negotiating drug prices, anyone?), but, come on, TikTok is buying hospitals!  I can’t pass that up.

To be more accurate, TikTok’s parent company ByteDance is actually buying hospitals, through two of its health subsidiaries.  As first reported by South China Morning Post, and subsequently confirmed as a $1.5b deal by Bloomberg, ByteDance bought Beijing-based Amcare Healthcare, which runs eight women’s and children’s hospitals in four Chinese cities.  As a private system, it targets expats and high income locals.  

This is not ByteDance’s first foray into healthcare; in 2020 it bought Xiaohe Medical, an internet hospital, as well as a medical information site and a telehealth service.  It is using its AI expertise to aid in drug discovery.  Its health business are under the umbrellas of Xiaohe Health and Xiaohe Health Technologies. 

And you were excited about Amazon buying One Medical.   

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Caring Does Not Pay

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BY KIM BELLARD

Things are tough all over the job market.  With a jobless rate at 3.5%, and with millions of people who left the job market in 2020 opting to not return to work, employers are having a hard time finding workers.  Your favorite restaurant or retail store probably has a “Help Wanted” sign out.  Checking your bag for a flight has never been more problematic, in large part  due to staffing issues.  Even tech companies are having trouble hiring.

But I want to focus on a crisis in hiring for three industries that take care of some of our most vulnerable populations – teaching, child care, and nursing.  It seems that what we say we want for our kids and the sick isn’t at all what we actually do to ensure that.  

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Lou Lasagna and the MIC “Integrated Career Ladder” – More Than Just A “Revolving Door.”

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BY MIKE MAGEE

The New York Times recently shined a light on the FDA’s top science regulator of the tobacco industry, Matt Holman, who announced his retirement after 20 years to join Phillip Morris. As they noted, “To critics, Dr. Holman’s move is a particularly concerning example of the ‘revolving door’ between federal officials and the industries they regulate…”

As a Medical Historian, I’ve never been a fan of the casual “revolving door” metaphor because it doesn’t quite capture the highly structured and deliberate attempts of a variety of academic medical scientists over a number of decades in the 2nd half of the 20th century to establish and reward an “integrated career ladder” that connected academic medicine, industry and the government. 

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