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INDUSTRY/TECH/POLICY/HOPSPITALS: ID Theft Infects Medical Records

In an LA Times article called ID Theft Infects Medical Records Joseph Menn tells several terrifying stories of people who have had their identities stolen by other people who have used them to get medical care. Not only does this give those people the nightmare of having to try to deal with bills and insurance hassles (as if they weren’t bad enough already) for medical care that was done to someone else, but it also means that false information arrives on their medical records. One victim went ot the hospital for a heart attack and was nearly treated for diabetes she didn’t have. That could of course be fatal, if a healthy person was given insulin, for example.

Lots to think about for health care organizations and the rest of us in this article so read it all!

PHYSICIANS/PHARMA: The oncologists’ chemo junket flies above the radar

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You may have heard just a few things on THCB from Greg Pawelski, Matt Quinn, me and others about the oncologist prescribing franchise, and how it might just change physicians’ behavior a tad. Well Greg informs me that last Thursday the whole issue made it onto the NBC Nightly News.

Greg also notes that the community oncologists (well, he calls them something rather ruder, but he’s insulting the world’s oldest profession so I won’t use his language) have their own response. They are “outraged!”

HEALTH PLANS: Blue Cross cancellation story rumbles on

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With an election in less than 2 months, the state is finally wading into the Wellpoint BC cancellation mess. Blue Cross now faces a fine:

In the first sanction of its kind, California’s top HMO regulator fined Blue Cross on Thursday for illegally canceling a woman’s medical policy because she did not disclose corrective surgery she had 23 years earlier. The $200,000 fine might not be the last resulting from the state’s investigation of allegations that insurers dump sick policyholders to avoid paying claims, said Cindy Ehnes, director of the Department of Managed Health Care.

And Arnie has broken his silence:

“Californians — who make the right decision to have health insurance as security for themselves and their families — should not be afraid that if they use it, they will lose it because of confusing applications,” he said in a statement. “oh and please vote for me in 6 weeks” (OK he didnt say that last part)

Meanwhile, the east coast establishment has noticed—or at least Paul Krugman has—it’s the lead in his column today calling for single payer Medicare for all

TECH: Patient physician email only growing slowly

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So says HSC:

Only about one in four physicians (24%) reported that e-mail was used in their practice to communicate clinical issues with patients in 2004-05, up from one in five physicians in 2000-01, according to a national study released today by the Center for Studying Health System Change (HSC).

Much more here

PHYSICIANS: Dr. Mom sounds off

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Angela Heider is no longer practicing as an OBGYN, and has written a book about why not, called The Rise and Fall of Dr. Mom: Women, the Health Care Crisis, and the Future. What went wrong? Well she starts to explain in this piece:

Wanted.  Part-time.  Private practice seeks obstetrician and gynecologist.  Forty hours a week, some nights and weekends.  Pretax income $70k/yr and falling.  Life-altering medical malpractice claims average only 1/3 years.  Electronic medical record – partially functioning.  Administrative skills required.  Medicare, Medicaid, self-pay, and dozens of insurance plans accepted – billing, coding and prescribing proficiency needed for above plans.  Keep up with this ever-changing medical field and all technical skills on your time.  $80k exit fee due at termination of employment.  Expect childcare expense approaching $35k/yr.     Fortunately, I vacated the above position before the required $80k in malpractice tail coverage took effect.  Unfortunately for all of us, many female obstetricians are forced to make the same choices.  In my practice alone, five of nine female partners elected to retire within the past two years.  I left the practice after only three years when my inability to balance work and family life became obvious.  I was clearing less than $20k a year – and money wasn’t even the biggest problem.  Clearly, my case is only one example; my concern is that it is not the only example, but a nationwide trend for women in private obstetrical practices.

Much has been said about physicians and the part their greed plays in the current health care crisis.  Admittedly, many examples can be found of physicians who have milked the system, over-billed, over-treated, and committed outright insurance fraud in order to make more money.  On the other hand, some physicians have been praised for their utter selflessness, physicians who devote all of their time and resources to charitable care.

Most, myself included, do not fit the description of either extreme.  Like many Americans, we want to excel professionally, enjoy our work, have others appreciate the contributions we make, and raise our families comfortably.  As a physician, I would have been happy with my salary minus the bureaucratic nightmare the practice of medicine has become, the constant threat of catastrophic legal action, the ingratitude, and the long hours away from my young children.  Some physicians long for the honor that once accompanied the profession.  Others miss the joy associated with personal doctor-patient relationships.  Still others enjoy their work, but also want to enjoy their families.  Money is not always the bottom line.

My current job – wife, mother of three small children, new author of the book, The Rise and Fall of Dr. Mom: Women, the Health Care Crisis, and the Future, and advocate for health care reform – doesn’t generate any income, but the benefits are better.  I hope to be a part of needed change in our health care system simply by telling my story.  The compensation is not important; the fact that I can enjoy and am proud of what I am doing is.  We can raise awareness by examining the effects the system has on individual doctors, patients, and communities.

We all depend on our physicians to provide quality medical care, to take our lives into their hands.  If for no other reason, should we strive towards health care reform so we can restore their job satisfaction?  Do we not want them to be happy when they are guarding our lives?  Do we not want the best and the brightest to continue to sign up for careers in medicine?  And how much should they earn anyway?

In my opinion, reform will be required in order to retain a qualified, diverse pool of primary care obstetricians and gynecologists for women across the country.  Such reform must include medical malpractice reform, as current rates make the cost of less than fulltime practice prohibitive.  Changes in the training of obstetricians and gynecologists could be made to allow for women to focus on either obstetrics or gynecology, thus improving their odds of being able to keep abreast of changes in practice patterns.  Finally, the enactment of a national health care plan with health care coverage for all would reduce the administrative costs and barriers to practice and improve physician job satisfaction.      

PODCAST/TECH: Jeff Rose, Health Alliant Interview

For those of you who don’t want to listen to the podcast, here’s the transcript of my conversation last week with Jeff Rose from Health Alliant.

Matthew Holt: So it’s Matthew Holt from the Health Care Blog and we are doing another podcast and this one is from Jeff Rose from Health Alliant. Jeff, thanks for taking the time to speak to me.

Jeff Rose: Thank you, it’s nice to be here.

Matthew: Well let me briefly introduce Health Alliant for those of you who don’t know it. I think pretty much without question Health Alliant has created a niche for itself in being a consulting company that is helping RHIOs get off the ground. As many of the folks that read The Health Care Blog know, we’re somewhat cynical about the prospects of RHIOs here, and full disclaimer, back I think about eleven, twelve years ago I wrote a report on something called CHINs, which were in some ways precursors to RHIOs, saying that they faced a pretty bleak future and that actually came to pass. But a lot of things are different now.So for most of this conversation I’m going to speak with Jeff about the evolution of RHIOs and what he thinks they’re doing. But to start off with I’m going to ask Jeff a little bit about Health Alliant and a little bit about his background. So Jeff, can you just tell me a little bit about what you did before you got to Health Alliant, and then a little, just a thumbnail sketch about the sort of service Health Alliant is providing and for whom.

Jeff: Yes Matthew. I’ve spent all of my career in healthcare, principally between healthcare services and information technology. I began my career in information technology for Coopers & Lybrand and then Foster Medical Corporation and from there started a company in healthcare services called NovaCare, which was a very large medical rehabilitation provider.

Matthew: Sure.

Jeff: Then I’ve been involved in other healthcare service and IT related businesses, coming on close to thirty years now.

Matthew: You sound young though [laughter], haven’t been beaten up to much by the experience. So give me a quick thumbnail of Health Alliant, what it does and also it has a somewhat unusual structure for a typical consulting company.

Jeff: Yes, we do have an unusual structure. We began as a non-profit on a mission to improve the US healthcare system. Our founders included Molly Coye, David Brailer, Blackford Middleton, Bill Bernstein and myself. And then when David Brailer went to Washington as the National Coordinator for Health Information Technology had to resign from the board, and Scott Wallace of the National Alliance for Health Information Technology came on the board. I say we began as a non-profit as recently we’ve heard from the IRS that they’re questioning whether RHIOs need to be non-profits and also whether firms that serve them need to be non-profits. So we’re in discussions with them. It’s not clear what the outcome from that will turn out to be.

Matthew: Well that’s actually non-coincidental because as you probably know there was that report out today about the role of non-profit hospitals and that’s the main question and if you go back to the – full disclosure here, I used to work for IFTF which is the organization which incubated HealthTech where Molly Coye ended up and where David Brailer was working, although I wasn’t with IFTF at that time. So IFTF is also a non-profit and was constantly walking that line between what’s a non-profit organization doing consulting for non-profits and for-profits, and there’s always a sort of question in American business about what the role of non-profits is. I think that’s an ongoing question.

Jeff: I would just say that when we started this, now four and a half years ago, it was in response to what we perceived as a market failure – a market failure in healthcare in that the costs here are significantly higher than around the world. Health status is not as good as elsewhere around the world and there’s certainly questions about the quality and access to care and so what we saw was an industry that needed different kinds of support in order to move forward, to progress. And we characterized this as a market failure, and usually when there’s a market failure either non-profits step in to fill the breach or the government acts. And so we thought this was an appropriate role for a non-profit and we weren’t trying to do this as a for-profit venture.

Continue reading…

PHARMA/POLITICS: When Democrats attack!

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When Democrats attack, somehow it doesn’t convey the ferocity of the original series…but with Bush’s approval ratings going up as the price of gas comes down, the Democrats are issuing a Medicare drug report. Yup, they’ve noticed that there is both an election in November and that plenty of Part D participants are in the donut hole. And perhaps it’s about time to take the initiative back from the BS meme that “most people in Part D are happy so it must be a good thing/Republican votegetter, and the donut hole doesn’t really exist anyway.” The donut hole is the most obvious thing to go after, and the one that most seniors are concerned about, so here goes:

The analysis includes a breakdown by state showing how much more money residents would have to pay annually if they switched to a plan that had no doughnut hole. The nationwide average was $458. Residents of New Jersey would have to pay, on average, an additional $298. Residents of seven states would have to pay, on average, an additional $721. Those states are Iowa, Minnesota, Montana, North Dakota, Nebraska, South Dakota and Wyoming.”As this report shows, the opportunity to purchase plans that fill the hole is a mirage,” said Rep. Pete Stark, D-Calif. “Beneficiaries are no more able to afford expensive, full-coverage plans than minimum wage Americans are able to afford a Mercedes.”

On the other hand, they don’t seem to mention getting effective drug re-importation, even though that is banned by the legislation and over 80% of adults are in favor of it. And somehow they’ve managed to get the AP guys confused by the White House spin:

Democrats contend that one solution to filling the doughnut hole would be to let the government negotiate drug prices on behalf of beneficiaries, instead of having fragmented insurance companies doing that. Then, the government could use the savings achieved to do away with the gap. But Nelligan replied that all of the Democratic proposals that have been scored by the Congressional Budget Office had cost projections at least twice as high as the cost of the current drug benefit.

Hmm… it’s hard to imagine something costing more per benefit delivered than the current version of the Medicare Modernization Act, especially when the payoffs to employers, insurers and hospitals are counted in. And wasn’t there something about a certain government agency that already negotiates rather better on drug pricing that the Part D private plans, and yet somehow that information didn’t make it into this article? Oh yeah, there was.

HEALTH PLANS: Wellpoint backs down?

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Given that Blue Cross of California Unveils Major Initiative to Revise Rescission Policies and Procedures: in order to stop its retroactive cancellations, and that in its very own press release it quotes :

William Shernoff, an attorney representing some customers who have filed suit claiming rescission of their policies was not warranted, said the actions that Blue Cross has undertaken are appropriate and positive. "I’m impressed with the Blue Cross response to rescission concerns," Mr. Shernoff said. "Blue Cross is stepping up and acting very proactively to streamline the process and ensure fairness."

The new policies and procedures will be submitted to the Department of Managed Health Care and Department of Insurance for review and comment.

Methinks that a big out of court settlement is about to happen. Or else why would Shernoff be sounding quite so cordial. Blue Cross must be hoping that the usually tame DMHC and their not quite so tame “buddy” insurance commish John Garamendi are not going to follow up too much or too expensively.

For a view of what obfuscation may lie behind their shiny new guidelines, see over at Insureblog (yup the one blog that was supporting Blue Cross!).

I personally really hope that this is a case of a big bad insurer mending its ways. Let’s see.

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