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TECH/HEALTH PLANS: A Permanente Group Executive speaks

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There continues to be much flack in about the “email heard around the health care IT world” about Kaiser Permanente’s HealthConnect program and its success or lack or it, and its contribution or lack of it to a potential massive shortfall or profit  in the organization’s finances. If you want to know what lots of insiders and outsiders think, go read these comments on KP in this HISTalk post. Suffice it to say that there’s a wide, wide divergence of views on whether Epic is scalable or not, or if anything else would or could work. Given that this is America’s largest health care EMR deployment, it’s not a trivial issue.

But in addition there are wider rumblings that something is going awry at Kaiser Permanente. Given that it’s just coming out the other side (bar the lawsuits) of a scandal where something went very badly wrong in its new kidney transplant program in Northern California, this latest brou-ha-ha is more grist for the mill for the anti-KP folks. I am not one of those, and in fact have been criticized for being too supportive of pre-paid medicine in the past. But I call things the way I see them, and I don’t get any money from Kaiser. So I’m trying to remain “neutral” in what is a highly emotional issue.

Today Andy Wiesenthal, an Executive Director with the Permanente Federation, the umbrella group for the regional PMGs emailed me offering to go on the record. I told him that I would ask about HealthConnect, the kidney transplant fiasco and how TPMG works with the health plan. This podcast is what he had to say when we spoke late Friday evening. It was via cell phone so the sound quality isn’t the greatest.

He was unable to comment on the kidney transplant story, claiming to only know what he read in the papers. But about everything else he had strong and I think relatively balanced opinions–especially as he was the physician executive in Colorado who was in charge of the CIS project that was being implemented system-wide when it was scrapped in favor of the Epic/HealthConnect software system–which he strongly defends.

Whatever your views, it’s very interesting stuff. I hope I asked him the tough questions and in general I think he gave very thoughtful answers. And it’s to his credit that he decided to get his and Permanente’s side of the story out, as they’ve been far too reticent to talk openly in the past. Here’s the interview. There’ll be a transcript as soon as it’s available.

TECH: Medsphere; what’s going on?

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Fred Trotter, advocate of open source for health care , has tried to help out Medsphere which is having a nasty dispute with its founders Scott and Steven Shreeves. This is long and complex, but if you’re interested read this one first then this less happy one — Medsphere betrays community

Fred is particularly concerned because Medsphere is seen as the leading open source health care company. Fred believes (probably rightly) that if Medsphere is seen either not to be able to hold a rational open source model together or to be betraying the open source model, then open source in health care is probably dead.

UPDATE: Dmitriy writes in to say "I know, for a fact, that a "well known HIT infrastructure firm"
decided to not pursue MedSphere for a partnership because of this mess.
As a company MedSphere is done – who in their right mind will
contribute to their project? But I have no doubts that other flavors of
VistA, under better stewardship have bright future."

BLOGS: Business Blogging for Health Professionals

Dale Hunscher of FutureHIT is a glutton for blogging punishment who wants to afflict his addiction on the rest of health care’s unwashed masses. So he’s written a book and a has a blog called Business Blogging for Health Professionals. Go check it out but don’t say you weren’t warned when you find yourself in Dale’s predicament (and mine!), and notice that in his “five reasons you should be blogging”, getting paid wads of cash is curiously absent from the list!

JOBS: Hospital Accounts specialist for software co

And on the not really existing jobs board… (it’s the board that doesnt really exist, the job is real!)

a healthcare financial services, software company seeks Hospital Accounting Specialist. Ideal candidate will have an accounting background with work experience in a hospital business office or finance department. Must have experience in the preparation of Medicare cost reports as well as Medicare and state Medicaid disproportionate share calculations. Also must have experience in the review and analysis of hospital AR days and government receivables

Email me your resume if this is you!

INTERNATIONAL/POLICY: Compare and contrast the attitudes

Crowd Protests Health Care in China (in the New York Times)

Some 2,000 people mobbed and ransacked a hospital in southwestern China on Friday in a dispute over medical fees and shoddy health care practices……essential medical care was denied the boy until his grandfather, who was taking care of him, could pay for the treatment. The boy died after the grandfather left to raise money, the group said. An official report from the New China News Agency confirmed that a dispute over medical fees erupted at the hospital, but also said doctors there had treated the boy even though the grandfather did not have $82 to pay for the service.

But no one seems to care in the US, in fact it’s fine and legal in the Sacramento Bee

And then one day my husband was in excruciating pain and the morphine we had at home, nothing I could do would relieve his pain, so I called Cedars Sinai to say I’m bringing him in, he needs — he needs something. He needs to be relieved of this pain. And they said I’m sorry Mrs. Christensen you guys are not allowed through these doors anymore, your insurance has capped out, they’re not paying us anymore and your bills are high. And we can’t allow you to come through these doors anymore. So I had to take my husband to an emergency room where he sat for about eight hours, you know, which is the worst place for a cancer patient to be.

HEALTH PLANS: Legal cons abound in health insurance

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(Hat tip to Don McCanne). Apparently being a scummy insurance company and selling not-quite-fraudulent policies to dumb consumers is all fine and dandy—or at least legal. This is not the first or last we’ve head of this type of thing—a company called Mega Life and Health selling a cut rate policy via commission salesmen to unsuspecting punters. When something really bad happens the punter discovers that the policy is worth basically squat, and they owe $200K plus. The judge says this is America and you should have read the fine print. We all know that the best cons are the legal ones.

There’s a related category of insurers who pay out on small claims but dissapear completely when enough big ones come in. Jon Cohn’s soon to be published book will blow the lid of that bunch (I hope) so I won’t say much about them. But essentially these are all on a sliding scale from California Blue Cross cancelling coverage after the fact, to Golden Rule selling their underwritten products, to the con artists and outright fraudsters. And given the collapsing state of the employer insurance market, and the growth in desperation from people like the couple in this article, I guess it’s only a matter of time before these insurers become a bigger and bigger piece of the market and someone like United HealthGroup buys them.

And if Active Health Management is over on the Yin side of the health insurance world, these shysters are out there on the Yang end. There is a possible solution to the whole thing, but if the responsible heads in the insurer world won’t push for serious reform of their own industry, these kinds of stories will make a government run system much more likely. I suspect I’ll be saying “I told you so” in 2016 or thereabouts

CODA: I missed this at the time, but the (now fortunately dead) Shadegg bill would have aloowed the shysters at Mega and their ilk to do this everywhere, as PBS NOW reported. See the excellent transcript.

HEALTH PLANS/POLICY: Policy wonks explaining the bleeding obvious

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KFF has some new reports out. The first is a Comparison of Expenditures in Nongroup and Employer-Sponsored Insurance. Here’s what the press release says:

The first Snapshot examines the differences in costs associated with individual, nongroup insurance and employer-sponsored insurance. Premiums for nongroup health insurance available from online brokers or reported by insurance industry surveys are much lower than premiums observed for employer-sponsored coverage. This is surprising to some because nongroup health insurance has higher administrative costs. The paper uses data from the Medical Expenditure Panel Survey and finds that people covered by individual insurance have much lower health care spending on average than people who have employer-sponsored insurance, but pay a greater share of that spending out-of-pocket. It also shows that those with individual insurance are significantly more likely than those with employer-sponsored insurance to report that they are in excellent physical and mental health. These findings may help explain why premiums for individual coverage are actually lower than group coverage. The analysis suggests that proposals to extend coverage to lower income people through lower cost nongroup health insurance need to account for the higher out-of-pocket costs associated with these policies.

In other words when someone tells you that eHealthInsurance.com is selling a product cheaper  than employers buy it for (as the Galen folks and David Gratzer’s book have recently done), you need to understand that they’re not only selling something different (lower benefits) but that they’re refusing to sell it to people who might actually use it.

The second is a little more subtle. It’s about the ratio of sick people to healthy people in an insurance pool, and the impact on the pools overall cost (premiums). Again from the press release:

The second Snapshot examines the sensitivity of health insurance premiums to enrollment shifts by high cost enrollees – a process often referred to as adverse selection. The introduction of high-deductible, consumer directed health plans has raised concern about their potential to attract younger and healthier people away from more traditional insurance plans, which could increase the costs of those plans. The public discussions of this possibility are often phrased in rather extreme terms – for example, that consumer directed health plans attract primarily the young and healthy. The new report shows that extreme selection behavior is not needed to produce real premium differences between insurance pools, and that the shift of even a small percentage of high spenders from one risk pool to another can have a dramatic impact on average costs – and, therefore, premiums – in the pools

In other words, you only need to avoid a very few sick people to make your pool cost much less. This is something that Medicare Advantage plans (and the GAO) as well as those in the individually underwritten market have known for years. And it’s why the only rational policy outcome (note I said rational, not likely) is a single national pool.

CODA: This is too funny. The very next email into my inbox after the KFF one was the charlatans at Consumers for Health Care Choices (Greg Scandlen) promoting a dinner for Pat (loony) Rooney–the guy who founded Golden Rule and pushed HSAs, and basically is more responsible than anyone else for fracturing what was left of the nation’s insurance pool, and causing all the problems that KFF is explaining!

TECH: Big practices using IT, less so in smaller ones

Another incomplete but useful study from HSC on physician technology use. Essentially the investments made by big groups in EMRs are showing up in the data, with nearly half those in groups of 50 and above using ePrescribing—perhaps the key indicator of whether a doc is using a computer for a basic clinical function.

But for those in the 1–9 sized group the number went from 8% in 2001 to 13% in 2005. A big increase in percentage terms, but not exactly setting the world alight.

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