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Tag: Policy

Essential Reading: Laszewski on Rove and Medicare D – Brian Klepper

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All of us who have worked in policy during our careers know the old joke that there are two things you never want to see made: sausage and laws. Never was this more true than with Medicare D.

Earlier this week, Robert Laszewski at Health Care Policy and Marketplace Review wrote an eloquent and succinct piece called "Good Riddance to Karl Rove: How Part D Left An $8 Trillion Debt And Got Them Nothing," a genuinely damning indictment of the cynical use of power. Read Mr. Laszewski’s posts and you quickly get the fact that he is a keen, unbiased, open-minded, analytical observer of the Washington health care scene. His obvious knowledge about the circumstances and his stature lend terrific weight to his words. I’d urge every person who reads this blog to read Mr. Laszewski’s column, and to pass it around to your colleagues.

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A Broker Afterthought: An Acknowledgment, An Apology and A Criticism – Brian Klepper

In the comment section of my post on broker compensation, KWeller properly points out that 1) some states regulate broker commissions more stringently than Florida does and 2) I do a disservice to brokers who practice without financial conflict. He is right, and I apologize to anyone whose practice is at odds with my description.

On the other hand, as several other commenters noted, the practices I described are well-known and widespread, and they occur because the brokerage profession does not self-regulate very effectively. (If it makes anybody feel better – it shouldn’t – neither do many other groups of health care professionals.)

So if you’re not one of the broker’s I was referring to, please excuse me then for pointing to the poor behavior of your colleagues. I wouldn’t have tarred you with the same brush if you had held your fellow brokers to a higher standard of practice.

Consultants to Hospitals: Prepare for Transparency – Brian Klepper

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We must view and treat the community as the "owner" to whom we are fully accountable. Aggregate financial performance data, aggregate productivity performance and aggregate quality and patient satisfaction data belong in the public realm. How else can consumers make a decision to…support us?

— Rich Umbdenstock, President and CEOAmerican Hospital AssociationInterview in Hospitals and Health Networks, 10/18/04

Most health care professionals sincerely believe in performance transparency, especially if it applies to someone else. Three years after the encouragement of Mr. Umbdenstock and similar pronouncements by colleagues throughout the industry, many physicians, health plan executives and hospitals executives remain extremely resistant to public reporting of pricing and performance.

Norton Healthcare in Louisville KY has developed one of the most progressive and forthright quality reporting efforts in the country. On their site, they provide their performance figures on a range of indices, indicating where they fall above or below national benchmarks. (You can just imagine how thrilled their staffs were with this decision to "bare all." ) The home page for their quality section lists six principals that drive their reporting.

   1. We do not decide what to make public based on how it makes us look.

   2. We give equal prominence to good and bad results.

   3. We do not choose which indicators to display.

   4. We are not the indicator owner.

   5. We display results even when we disagree with the indicator definition.

   6. We believe unused data never become valid. 

Norton sets a fine example for hospitals. But now, as demands for transparency become more compelling, the mega-consulting firms, always quick to lead the way and claim credit once a trend has been firmly established, are throwing their hats into the ring as well, hoping to provide guidance for tidy if exorbitant sums.

And so it is not surprising that the consulting firm Grant Thornton, in its spring newsletter Health Care Rx, has a thoughtful, pragmatic article urging hospitals to review and potentially change their pricing, document justifications when necessary, and generally take steps to ensure that they’re prepared as transparency efforts become irresistible. Its a good piece and, for hospital execs, well worth a few minutes time.

The Presidential Candidates On Health Care

Over at the Huffington Post, Dr. Susan Blumenthal and her team at the DC-based Center for the Study of the Presidency, have released their third in a series of articles comparing the Presidential candidates positions on various aspects of health care. This piece focuses on their views on the scientific and medical research that underlie progress in public health.

This has undoubtedly been yeoman’s work for this group of researchers, and as the election draws closer we’re indebted to them for making these positions so clear.

My guess is also that this article’s topic is particularly dear to Dr. Blumenthal, who is a former Assistant Surgeon General and recent recipient of the
US Public Health Service’s Distinguished Service Medal.

Managed Care Redux – by Brian Klepper

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Like democracy, managed care is a great idea. It’s just that its rarely been tried.

Even so, my guess is that its about to re-emerge in a new, improved form, and possibly with some other name. If the signs around us now have any meaning, it will be different than our experience of a couple decades ago, and much truer to the original principles and possibilities that first caught our attention.

Last week the New York Times’ David Leonhardt ran another pop health economics piece, exploring several presidential candidates’ notion that the savings captured by providing better care could fund the uninsured. He explains better care as really being prevention – making sure that patients get services that stave off illness – and better management of the care process once they do get sick. And then, quoting a variety of health care experts, he takes issue with the notion that these approaches actually produce returns-on-investment. The problem, you see, is that while you may save money on the diabetic who avoids hospitalization to get his foot removed, you’re spending money taking care of all those diabetics who wouldn’t ever have had a costly problem.

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POLITICS/POLICY: Hillary kicks idiot butt

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I’m not exactly a huge Hillary Clinton fan, but this brief video of her responding to an idiot questioner calling universal medicine “socialized” is pretty funny! Almost more amusing is that there was a Republican in the audience of African-American journalists!

POLICY: Consumer Reports looks at uninsurance

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Consumer reports has a new report confirming what most of us suspected about uninsurance. About 30% of those with insurance don’t think that it’ll cover them and have delayed care as a result. Which in my view is why user fees at point of service are a bad idea.

Of course a bad idea that never dies is a Zombie.

POLICY/PHYSICIANS: In which I criticize Uwe Reinhardt, really!

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Uwe Reinhardt has written to the NY Times about What Doctors Make, and Why. It’s great that they print his letter–they should be featuring a whole lot more of his stuff in comparison to their penchant for printing out of touch loonies who don’t we think we spend enough on health care. But, here’s the fact that may take some of you a moment to digest–I  don’t actually think Uwe’s entirely correct here. Here’s what he says:

In “Sending Back the Doctor’s Bill” (Week in Review, July 29), you compare the incomes of American physicians with those earned by doctors in other countries and suggest that American doctors seem overpaid. A more relevant benchmark, however, would seem to be the earnings of the American talent pool from which American doctors must be recruited.Any college graduate bright enough to get into medical school surely would be able to get a high-paying job on Wall Street. The obverse is not necessarily true. Against that benchmark, every American doctor can be said to be sorely underpaid.Besides, cutting doctors’ take-home pay would not really solve the American cost crisis. The total amount Americans pay their physicians collectively represents only about 20 percent of total national health spending. Of this total, close to half is absorbed by the physicians’ practice expenses, including malpractice premiums, but excluding the amortization of college and medical-school debt.This makes the physicians’ collective take-home pay only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy.Physicians are the central decision makers in health care. A superior strategy might be to pay them very well for helping us reduce unwarranted health spending elsewhere.

Uwe’s right in saying that doctors pay per se isn’t a big enough share of medical spending (around 10%) that a cut in it would make much difference to overall health care costs. And he’s also right that we should change their incentives so that–at the least–they don’t make more by running up health care costs elsewhere in the system. And I’m including in that fixing malpractice, college debt and the other issues that make physicians feel under so much stress to increase their incomes.

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