Above the Fold
POLICY: Me. A loony libertarian?
Not exactly but I am up at Cato Unbound with a piece replying to Arnold Kling’s fascinating essay "Insulation v Insurance." Read his first, then read mine. It’s called Abundance Is Insulated from a Crisis–For Now.
In his insightful book and in this interesting essay, Arnold Kling
has made several leaps forward from the pack of “America-first free
marketeers." If you want to see them in action, take a look at the comments page
of any blogger who dares to suggest that spending nearly double what
its economic competitors are spending on health care—primarily because
it is paying its providers more for more or less the same volume of
services—may mean that the U.S. is not getting too good a deal.It’s
apparent to any serious student of health care that the impact of
medical care on overall raw measures of health is not sufficiently
important that differences in spending here or there makes too much
difference to health. The somewhat pedantic arguments over life
expectancy and infant mortality, and the slightly more real ones over
the appropriate treatment of predominantly elderly people with serious
diseases, are all massively less important than the political and
medical culture in which the health care system exists. So there is
broad agreement, I believe, among most rational observers that the
activities Kling describes as "premium medicine" are far more in the
interests of providers and suppliers (including those middlemen who
mark up the price without taking on much risk) then they are in the
interest of patients&mdash, and certainly of society as a whole. Continue.
BTW before the brickbats start flying; “loony libertarian” is a term of affection. Actually most of the Cato guys are very sensible libertarians whom I agree with on almost all social & civil liberties issues.
QUALITY: All is not well in the DM world
Last year LifeMasters pulled out of one of the Medical Health Support DM pilots in rural Oklahoma because they found that adhering to the proper standards of care made the cost of care go up for those patients they enrolled, not down.
Now Healthways, the largest DM for-profit company, which has the greatest number of the Medicare Health Support pilots, appears to be seeing some big problems too.
MHS Pilots Based on the receipt of essentially complete first-year data which revealed smaller separation from the control group than reflected in previous reports, the Company’s net per share costs in the MHS pilots for the first fiscal quarter of 2007 totaled $0.10 per diluted share, $0.04 more than previously estimated. For the first 15 months of the pilots, per member per month (PMPM) beneficiary costs, including inflation, have been held flat, which the Company believes reflects meaningful impact resulting from program interventions. To date, however, the control group costs as reflected in the most recent report released by CMS’ third party actuarial firm are also unchanged, and do not reflect anticipated increases provided by CMS nor the results of historical national and regionally-specific trends identified by third-party actuarial analysis of the Standard Analytical File (better known as the Medicare 5% Sample). The Company has brought this issue to CMS’ attention and has received the Agency’s commitment to pursue understanding and resolution of this anomaly in a timely manner.
While the Company has no direct control over the timing of this review by CMS, it will communicate progress toward resolution. Based on the strength of the Company’s performance with the intervention group, particularly as compared to the Medicare 5% Sample data, as well as the questions raised by the unanticipated trend of control group costs, the Company is maintaining its fiscal 2007 guidance related to the MHS pilots until this issue can be resolved to the satisfaction of all parties.
In other words either Medicare has got the data wrong about its control group, or the control group is healthier than average, or (gulp) DM doesn’t save money for the sick Medicare recipients group. And so the DM companies, which have promised CMS that they’re going to pay them 5% savings for the sick group (and make their money on the reduction from there!), are going to be losing money.
Healthways stock is down around 15% over the last week as this news seems to have seeped out. But it’s PE ratio is in the 40s, and the stock price went up more than five fold 2003–6, suggesting that the market is expecting it to continue its quick growth. If MHS is deemed a failure, there may not be any growth. Watch this space.
(Thanks to Fred Goldstein for this tip).
TECH: JSK’s 2007 Health IT Forecast
Whoops. I almost missed this as it went out late last year. Here, at iHealthbeat, is the ever wonderful Jane Sarasohn Kahn’s 2007 Tech Forecast.
PHYSICIANS: Remember, it’s a FFS world
Remember kids, almost all physicians work in a FFS world. HSC reminds us:
While the proportion of physicians in group practice whose compensation is based in part on quality measures increased from 17.6 percent in 2000-01 to 20.2 percent in 2004-05, far more physicians face financial incentives tied to individual productivity, according to a national study released today by the Center for Studying Health System Change (HSC).
Despite the small but statistically significant increase in quality-related physician compensation, financial incentives tied to physicians’ individual productivity continued to be much more common, consistently affecting about 70 percent of physicians in non-solo practice since 1996-97, the study found. Nevertheless, nearly all physicians with quality incentives also face productivity incentives.
So don’t be surprised about what’s happening.
POLICY/POLITICS: I love the guy’s moxie
Say what you like about Arnold, but you got to give him credit for being a proper flip-flopper with real moxie. While Bush drowns in his stay-the-course quagmire, Arnold has repudiated basically everything he claimed to care about when he first came into office, and is now running like the unaligned centrist everyone thought they were voting for back in 2003.
Today he called for universal coverage based on a comprehensive pay or play, surrounded by an individual mandate. He even brought back the notion of provider taxes, a beast last seen in the wild in the pre-HillaryCare years, but thought to be extinct having been shot by the AMA and AHA back then.
But my favorite of all is the fact that the pay-or-play employer mandate he’s calling for includes all employers with more than 10 employees. In November 2004, just 26 months ago, he told people to veto Prop 72, which had a pay-or-play system for employers with more than 20 employees. Boy, times and people change, don’t they!
POLICY/POLITICS: It’s all the illegal Austrian socialist’s fault
It’s all quite amusing. You wouldn’t know it, but there are no problems with health care in California, and what Arnie did yesterday was a display of showing his true feelings—a combination of handouts to illegal aliens and an introduction of European socialism.
At least that’s what you’d think if your only source was reading the Los Angeles Times reader comments about the proposal. Methinks that the FreeRepublic or Michelle Malkin crowd was sent over there….
(BTW I’ll be writing more about the Arnie plan at Spot-on tomorrow, but I wrote most of what I think the result will be there last week)
TECH: Healthcare Blogger and Reader Meet-up at HIMSS in New Orleans
Shahid Shah is the official HIMSS blogger, and he’s running a meet-up. When will it be? Depends on when you want it. Go to his site and have your say….Healthcare Blogger and Reader Meet-up at HIMSS in New Orleans
HEALTH PLANS/POLICY: And it’s a right, and a left, and another right–I’m not sure he can take any more…
You’d think the LA Times’s Lisa Girion would have had the human decency to stop beating up the health insurance industry. It’s getting close to the time when the referee should step in to save the insurers from further punishment. But oh no, it’s haymakers landing on the chin time after time.
This time she uncovers another little nuance about why the individual insurance market is such a disaster—entire classifications of occupations are automatically disqualified. Good article, go read it.
I’m reminded of two things. One, back in 1991 Mary Ann O’Sullivan then (I think) of Health Access gave a speech in which she described exactly the same thing. She quoted one insurer denying used car salesmen insurance because “you just can’t trust those people!”
Two, I paraglide, and on the paragliding list in a discussion about how to make sure that your health insurance covered paragliding we got a beautifully naive question from a recent immigrant from (I think) Hungary where the national paragliding association groups together and buys health insurance for its members. He suggested that the US national association did the same thing as the Hungarians! Some of us on the list suggested that this might not be the best way to go about finding affordable insurance.
TECH: Nerd med student builds “the GMR, An EMR That Doesn’t Suck”
Graham Walker, Stanford med student and blogger, is such a nerd that he’s built what he thinks is a better interface for an EMR–trying to make it a true desktop work-tool using Web2.0 type tools.
I’m not an expert on EMR interfaces, other than knowing most docs don’t like them, so go to his web site, and take a look at the movie demo. This may be how progress gets made.
Anyway, go take a look if the EMR in actual use is your bag.
