Category: Uncategorized

A Full-Scale Assault on Medical Debt, Part 3

Mar 10, 2020

By BOB HERTZ

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.

A Full-Scale Assault on Medical Debt, Part 2

Mar 9, 2020• 3

By BOB HERTZ

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.

A Full-Scale Assault on Medical Debt, Part 1

Mar 6, 2020• 3

By BOB HERTZ

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.”

As Physicians Today, We Must Both Represent the “System” and Disregard it

Mar 5, 2020

By HANS DUVEFELT, MD

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.

Health in 2 Point 00, Episode 110b | Maven, IntelyCare, and New Acquisitions!

Mar 4, 2020• 1

Today on Health in 2 Point 00, we resume our two-part series with part B and bring our promised special guest! Continuing from the first part of Episode 110, Jess and I discuss the women and family health startup Maven raising $45 million in its Series C round with celebrity investment. 1UpHealth, the MassChallenge HealthTech Finalist, raises $8 million; IntelyCare raises $45 million bringing the gig-economy approach to nurse staffing raises, and HealthJoy raises $30 million in Series C funding. The hospital owned ACO umbrella services company Caravan Health acquires Wellpepper, and Sharecare acquires Visualize Health; are these good acquisitions? -Matthew Holt

Health in 2 Point 00, Episode 110a | Trump at HIMSS20, K Health, and Accolade

Mar 3, 2020

Today on Health in 2 Point 00, Jess is singing as we are finally back with a two-part episode to cover the deals over the past couple weeks! On part A of Episode 110, Jess and I begin with Trump as he is set to speak at HIMSS next week. K Health raises $48 million in its Series C round to focus development on AI-powered primary care. Accolade files for a $100 million IPO and the telehealth language service platform Cloudbreak Health raises $10 million. Finally, Q Bio raises $40 million in Series B funding aiming to open additional centers and enhance the digital health platform. -Matthew Holt

Can Startups Save Primary Care?

Mar 3, 2020• 4

By ANDY MYCHKOVSKY

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.

The Undercurrents & Subtext of JP Morgan Healthcare 2020 | Luminary Labs, Sara Holoubek

Mar 2, 2020

By JESSICA DaMASSA, WTF HEALTH

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.

Hotspotting, Superutilizers, and Avoiding “RTM Traps”

Mar 2, 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

“Hotspotting” Apparently Doesn’t Reduce Superutilizers’ Readmissions” NEJM Journal Watch

NOT SO FAST!

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.

How Hospital Systems Invest in Digital Health | Brent Stackhouse, Mount Sinai Ventures

Feb 28, 2020

By JESSICA DaMASSA, WTF HEALTH

Savvy health tech startups can learn how the differing investment priorities of venture capital funds and strategic investors (those tied to large healthcare organizations like health plans, pharma companies, and health systems) can impact everything from their capital raise to their ability to gain new clients. Brent Stackhouse, Managing Director at Mount Sinai Ventures, talks about the nuances of investing as a strategic, trying to balance a health system’s inherent aversion to risk with the gusto it takes to place good bets on the future of health. Where does a hospital system find investments? Are they looking for clinical solutions or consumer solutions? Brent shares the details behind Mount Sinai’s investment thesis and talks ‘big picture’ about trends he’s seeing in healthcare investing worldwide.

Filmed at Frontiers Health Conference in Berlin, November 2019.