Category: Uncategorized

The Pitfalls of PPACA #1 – The Medical Loss Ratio Rule

May 28, 2010• 13

By ROGER COLLIER

The Patient Protection and Affordable Care Act, signed into law by President Obama in March, is a significant step towards a more equitable health insurance system, potentially making coverage available to millions of the currently uninsured. Unfortunately, health care reform’s political strategy of let’s-just-apply-lots-of-bandaids-to-the-present-broken-system is likely to produce some disappointments.

Positive changes like assuring coverage for children with preexisting conditions are likely to be overshadowed by others that are equally well-intentioned but fatally flawed—like PPACA’s limits on insurers’ medical loss ratios.

Beginning in 2011, unless medical loss ratios (the percentage of premiums paid out for medical care) are at least 85 percent for large group health plans, and at least 80 percent for small group and individual plans, the plans will be required to offer rebates to enrollees.

Given that the MLRs of the ten largest for-profit health insurers dropped from 95 percent in the early 1990s to around 80 percent today (or, put another way, administrative expenses, overhead and profit jumped fourfold from 5 percent of premium to 20 percent in just over 15 years), it’s easy to see why this provision seemed so attractive to its principal backer, Senator Jay Rockefeller.

Support for Berwick to Head Medicare Grows

May 28, 2010• 9

By MAGGIE MAHAR

Even Fox News acknowledges that: “In the two months” since President Obama named Dr. Donald Berwick, president of the Institute for Healthcare Improvement (IHI), as his candidate to head the Centers for Medicare and Medicaid, (CMS) “not one industry group has voiced opposition to his nomination.”

This, despite the fact that Berwick will be charged with beginning to squeeze $400 billion worth of waste and fraud out of the Medicare system over a period of ten years. One man’s sludge is, of course, another man’s bread and butter. One might expect that drug-makers, device-makers, hospitals and others who profit from the current system would join the fear-mongers who have begun the assault on Berwick, claiming that he plans to “ration” care.

But that isn’t happening. In fact the American Hospital Association (AHA) gave Berwick a flat-out endorsement in a May 20 letter addressed to Senators Max Baucus, chairman of the Senate Finance Committee, and Tom Harkin, chair of the Health, Education, Labor and Pensions Committee:

“His work at the Institute for Healthcare Improvement (IHI) has engaged hospitals, doctors, nurses and other health care providers in the continuous quest to provide better, safer care.” wrote AHA President and CEO Rich Umbdenstock. “This includes dramatic advances in quality improvement, patient safety and end-of-life care through IHI’s collaborative, breakthrough series and other activities,” he added, referring to IHI’s success in success in cutting hospital infection rates and implementing better asthma care and coronary surgery improvements with little additional costs.Continue reading…

Something Wizard This Way Comes

May 28, 2010• 11

By JOE FLOWER

The country seems to have shifted in less than 18 months from a slogan of “Yes We Can!” to “Oh, well…” and a shrug, then back to “Cool! I think. What was that, really?” Hopes for a true rebirth of health care turned into the Year of Screaming Inanely, then took that long slide from what we might hope for to what we might settle for. Yet suddenly it seems like things are popping up all over the place, like mushrooms on a forest floor in springtime. New projects and initiatives are emerging from little companies, big companies, garage startups, info-giants and mega-industrial combines.

It looks just as if, frustrated by a glacial and refractory legislative process, Americans and American companies have taken matters into their own hands, not with torches and pitchforks, but devices and codes and business models, all trying to figure out some way they can help make health care better, faster and cheaper. It is as if Rosie the Riveter of the World War II poster were once again flexing a muscle and saying, “We can do it!”

New AHRQ-Funded Report Provides Snapshot of Electronic Health Record (EHR) Vendor Usability Processes and Practices

May 28, 2010• 15

By MATT QUINN, Special Expert, Health IT, Agency for Healthcare Research and Quality

The usability of EHR systems, while recognized as a critical factor in the successful adoption, safe and effective use of these systems, has not historically received the same level of attention as software features, functions and technical requirements. In recognition of the importance of this issue, the Agency for Healthcare Research and Quality (AHRQ) initiated a series of research activities focused on assessing and improving the state of usability in Electronic Health Record (EHR) systems.

Based on a research gap identified by a multi-disciplinary expert panel formed to recommend and prioritize research and policy actions in this area, AHRQ funded a follow-on project to gain insight into the processes and practices that certified EHR vendors employ during different phases of the product development to make their products usable.

Specifically, AHRQ contracted with James Bell Associates and the Altarum Institute to conduct a series of structured discussions with selected certified EHR vendors to understand their processes and practices with regard to:

One Big Little Change

May 27, 2010• 4

By ROB LAMBERTS, MD

It’s just plain stupid.

Why does the government not allow patients with Medicare part D to use pharmaceutical discount cards? What is the ethical rule broken by making the government pay less? What is the legal reason that the elderly should be prevented from saving money?

I know there are probably reasons having to do with discounts not being allowed that are not extended to all Medicare participants, but isn’t that a little silly? As long as the discount is available to all Medicare participants, why can’t they receive help from the pharmaceutical industry.

I do my best to prescribe the cheapest medications possible. I love the $4 list at Wal-Mart et. al., and I try to never use a brand when a generic would do the trick. But there are times where I have no choice. These newer drugs are sometimes the only choice we have to help control their blood pressure, diabetes, or pain. Without these drugs, we end up with worse blood pressure, worse diabetes, and more pain. What do you think is the consequence of that? More people:

Develop complications of chronic disease poorly controlled.
Are hospitalized for these complications.
Visit the doctor for management and/or treatment.
Have pain.Continue reading…

We’re getting so excited (and Todd Park always is)…about DC

May 27, 2010• 4

By Matthew Holt

The next ten days are going to be very very exciting. It all culminates in Health 2.0 Goes to Washington on June 7 (Monday). But there’s lots leading up to that which is very important for the whole Health 2.0 community and anyone interested in innovation in health care.

Yesterday at Gov 2.0, Sunlight Labs’ Clay Johnson announced the winners of the Design for America challenge. The Visualizing Community Health Data prize (in conjunction with the Community Health Data Initiative) was won by County Sin Rankings and it’s great—even thought THCB/Health 2.0 favorite Regina Holiday’s painting will be the winner in our hearts (and gets a special mention in the announcement blog)

Apples

Today at Gov 2.0 Todd Park is talking at 3pm EST, 12pm PST, and it’s being livestreamed here (have to sign up). Watch for a very interesting pre-announcement about the next iteration of developers. And if you tune in 10 minutes earlier you’ll see Jay Parkinson too. Comparing Todd & Jay’s visible enthusiasm levels will be fun!

Shining a Light on Conflict of Interest in Biomedical Research

May 27, 2010• 2

By NAOMI FREUNDLICH

Last week Francis Collins, the director of the National Institutes of Health proposed important new rule changes for federally-funded investigators that are designed to increase transparency and remove many of the conflicts of interest that abound in biomedical research.

The proposed NIH rules, which are open for comment and expected to go into effect before the end of the year, represent the first time financial reporting requirements have been overhauled since 1995. The rules require investigators to disclose to their institutions all payments they receive from industry above $5,000, as well as any equity position they hold in a company. Research funding, speaking fees, paid authorship and travel expenses all must be part of this accounting. The previous limit was $10,000. The new regulations, which are aimed at reducing or removing industry bias from academic research, also require the academic medical centers to come up with a plan to manage investigator’s conflicts of interest—for example, university officials might insist that an investigator sell stock he owns in a company that helps pay for his research. Institutions will also be required to post all relevant payments (along with names of individual investigators) on a public website.

10 Rules for Good Medicine

May 27, 2010• 38

By ROB LAMBERTS, MD

The recent discussion of the appropriateness of bringing patients back to the office has really gotten me thinking about my overall philosophy of practice. What are the rules that govern my time in the office with patients? What determines when I see people, what I order, and what I prescribe? What constitutes “good care” in my practice?

So I decided to make some rules that guide what I think a doctor should be doing in the exam room with the patient. They are as much for my patients as they are for me, but I think thinking this out will give clarity in the process.

Rule 1: It’s the Patient’s Visit

The visit is for the patient’s health, not the doctor’s income or ego. This means three things:

All medical decisions should be made for what is in their interest, including: when they should come in, what medications they are given, what tests are ordered, and what consults are made.
Patients who request things that are harmful to themselves should be denied. People who ask for addictive drugs or unnecessary tests should not get them. Patients who are doing harmful things to themselves should be warned, but only in a way that is helpful, not judgmental.
All tests done on the patient should be reported to them in a way that they can understand.

An Open Letter to Senator Scott Brown

May 27, 2010• 4

By PAUL LEVY

Dear Scott,

I understand the Senate confirmation process in Washington, DC, and how the appointment of individuals
gets hung up for a variety of political reasons. I don’t particularly like it, but I understand it.

But I don’t understand how with regard to the appointment of Don Berwick as head of CMS, the Medicare agency, this can be the case, as reported recently in the Boston Globe:

Senator Scott Brown, a Massachusetts Republican, has not decided how he will vote, a spokesman said.

That Don Berwick is an internationally renowned expert in health care delivery is not in doubt. That he is an honest, hard-working, and thoughtful person is also clear to the thousands of people in the health care professions with whom he has worked. That his primary focus has always been on reducing harm and medical errors is likewise the case. He is also interested in reducing costs in the health care delivery system when such costs represent waste and inefficiency.

Scott, the issue here is not whether the recently passed health care bill was right or wrong for the country. I respect your opinion on that matter. But that vote has been taken.

In Defense of Paul Levy

May 26, 2010• 20

By ROBERT WACHTER

Paul Levy, the blogging CEO of Boston’s Beth Israel Deaconess Medical Center, found himself in hot water last

month over an inappropriate relationship with a female subordinate. While some of the details of the transgression remain sketchy, I think I now know enough to opine on it. To my mind, Paul has been an extraordinary healthcare leader, and – while the episode represents a lapse in judgment that deserves censure – he should not lose his job.

Let’s start with some background. Paul took the helm of BIDMC 8 years ago. At the time, the hospital – which operates in the shadow of its more storied Harvard cousins, Brigham and Mass General – was in crisis: its staff was dispirited, it was losing a million dollar a week, and it was still reeling from the challenges of blending the cultures of its two recently merged progenitor hospitals, Beth Israel and Deaconess. (Hint: the religious mismatch was only the start of the tsuris.)

Paul was an unusual choice for the position of CEO. BIDMC CEOs have historically been physician-leaders, whereas Paul’s major prior roles had been to teach Environmental Policy at MIT and to lead the Massachusetts Water Resources Board, where he spearheaded the cleanup of Boston Harbor. Some folks wondered whether he was up to the task of being CEO.