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HEALTH PLANS/HOSPITALS: United–not in enough trouble, goes looking for more

• 9

I don’t know what’s going on at UnitedHealth Group, but I am missing the strategic subtlety of this latest move. If I were trying to manage PR for the biggest and most profitable health plan in the country, and I found that my CEO had made hundreds of millions of dollars by (definitely unethically and presumably illegally) back-dating option grants, I wouldn’t want to see a major regional subsidiary written up in the New York Times about how it’s aggressively targeting one of New York City’s poorest safety-net hospitals. Apparently the hospital thought it had agreed a contract, but eventually they noticed that they were being paid at the old rate. When they enquired as to why, Oxford (which United bought in 2004) brought up other issues and the whole thing has since escalated to the close to nuclear option.

This spring, Oxford told hundreds of doctors and thousands of its subscribers that it would no longer pay for medical care at Jamaica Hospital Medical Center, and gave them a month to make new arrangements. It told some doctors that they, too, would no longer be allowed to participate in the Oxford plans, and it told many patients that they needed to find new doctors.

Now we tough Californians are used to this stuff—and usually used to the insurer losing. But the concept is new in New York apparently, and it’s just dreadful PR to use it on Jamaica hospital, which is that hospital in the run down part of Brooklyn that most wealthy Manhattanites only stare at out of the cab window when they’re heading to JFK

Kenneth E. Raske, president of the Greater New York Hospital Association, a trade group, said: "I field complaints from hospitals about insurers every day. But I have never seen anything like this." Jamaica Hospital, on the Van Wyck Expressway near Jamaica Avenue, serves a largely poor population with many immigrants and a large number of uninsured patients. It is generally considered well managed, but has had serious losses in recent years. Officials say it merely broke even in 2005.

There may be good business reasons for United to be doing this. Lord knows health plans have spent precious little time or effort in recent years trying to contain the excesses of the system on their clients’ behalf. But surely going after a hospital that relies on its better paying customers to keep the lights on for the poor is not going to generate the kind of PR that the company needs.

Is Mr Spitzer watching? I suspect so…

PHYSICIANS/PHARMA/POLICY: More Friday fun

• 5

I was checking out potential book titles when I cam across this site, Health Care for Dummies. Given that I’ve spent some of the week beating up on the AMA, and spent some of yesterday touching on why the health care system looks like it does today—mostly based on Paul Starr’s book. But the real conspiracy theory is much more fun (even if I can’t exactly vouch for the truth). Read on for an amusing Friday diversion.

I’ll see ya back here on Tuesday

 

OFF-TOPIC: The most important world news

Iraq? Terrorism? Middle East? Health Care? IT?

None of that is in the least importance compared to what the English nation is fixated on. Will Wayne Rooney’s right foot be better in time for the world cup? The answer appears to be that a Scan rules Rooney out for six weeks. So he should be fit for the latter stages, provided we sneak past Trinidad, Sweden and Paraguay.

TECH/POLICY/BLOGS: from PARC–GUI, Ethernet, the Laser Printer, and now….moi–Talking

• 10

Xerox PARC — Silicon Valley’s most famous research center. The place where the HomeBrew Computer club used to meet. The place from which good ideas were “appropriated” and become the core of minor companies like Apple, 3Com and later Microsoft.  The place of the legendary Thursday afternoon lectures, and yup, now it’s risen to its all time height (or hype) and it’s hosting me!

So if you want to hear me talk, it’s happening at 4pm on Thursday 25 May, free and open to the public. I’ll be talking about health care, IT, Doctors, bribery and corruption….the stuff you know and love

Directions here

HEALTHCARE UNBOUND! A Visionary Conference & Exhibition on Remote Monitoring, Home Telehealth and Pervasive Computing. July 17-18, 2006, Cambridge, MA. For full details, please visit: http://www.tcbi.org/hu2006/index.html

TECH/HEALTH PLANS/PHYSICIANS: Let’s hire this PR firm!

• 7

To those of you who’ve been paying attention, this may not exactly be news.

Apparently, health insurers don’t pay claims immediately and deny some of them. But it is news because practice management/billing company AthenaHealth has quantified the numbers across its practices and published a list by plan of who’s paying when. They’ve even sent me the spreadsheet with every plan’s numbers. And they, or rather their apparently amazing PR company (which called me at 6 am—don’t worry I’ll be making them pay my divorce lawyer’s fees) have done amazingly well to get this into Milt Freudenheim’s story in the NY Times called The Check Is Not in the Mail.

Insure.graph

But is this news? Insurance companies make money off the float—always have. So it’s in their interest to be at the bottom of the list until either they get fined by the state (as happened to United in Arizona lately) or they get sued by medical associations (as happened to all the big guys in the late 1990s) and settle as Aetna and a bunch of others did three years ago. The numbers AthenaHealth put out seem to be a little better than they were in the 1990s, but maybe not as good as the doctors would like. If I was Humana CEO I’d call my CFO in and ask why we’re on the top of the list when the bigger more profitable plans are down the bottom!

Maybe I just love conspiracy theories too much, but given the NY Times penchant for printing up any rubbish that gets pushed to it by the current administration, perhaps Freudenheim is craving some of Judy Miller’s publicity! After all the CEO of AthenaHealth is not only named Bush but he’s a blood relative.

I’m also amused by the comments from the doc quoted:

Dr. Molly Katz, a Cincinnati gynecologist and former president of the Ohio Medical Association, said she hoped the publicity would encourage insurers to improve their payment practices. "I would much rather have my staff talking to patients than talking to insurance companies," Dr. Katz said.

Be careful what you wish for, Dr. Katz. Given that the organized medicine is getting its wish and we’re seeing more high-deductible plans, she’ll find that her staff—while they may not spend less time on the phone with insurers—will be spending much more time on the phone with their patients. Trying to get them to pay their bills!

POLICY/PHYSICIANS: More on the AMA

• 11

So why did I get so grumpy with the secretary of the AMA and his talk at TEPR. I actually stood up and asked a long question which he interrupted to tell a bunch of lies about Canada, ignoring that there are lots of other countries with universal health care that do it differently and better. When I finally got to ask about why when ePrescribing was originally mandated for Part B in the house version of the 2003 MMA eRx legislation and ask as to why it mysteriously was left out of the final bill, and what was the AMA’s role in that — well as Neil Versel said to me afterwards “no one dodges the question like the AMA.”

Things he featured prominently………………The uninsurance crisis and how tough that is for doctorsThings he didn’t mention……………………The AMA’s long, long history of opposing universal health insurance including 1994

Things he featured prominently………………The AMA’s proposal for tax credits for the uninsuredThings he didn’t mention……………………That those proposals do almost nothing to reduce uninsurance

Things he featured prominently……………….How Pay for Performance was unfair on doctorsThings he didn’t mention……………………The AMA’s long, long history of opposing quality improvement

Things he featured prominently……………….How Medicare pay rates have fallen by half over timeThings he didn’t mention……………………The vast real increase in physician incomes since 1965

Things he featured prominently……………….How physicians will drop Medicare patients if fees go downThings he didn’t mention……………………The research that shows that this is untrue and an empty threat

Things he featured prominently……………….How other countries government’s paid for doctors’ ITThings he didn’t mention……………………How other countries doctors earn much less than him and his colleagues

Things he featured prominently……………….How the government should pay for physician IT but not mandate its useThings he didn’t mention……………………Every other business has been force to get IT to better serve its customers

Things he featured prominently……………….How Canada has rationing and is going to allow some private medicineThings he didn’t mention……………………That low–middle income Canadians don’t go bankrupt from the cost of health care

Yup, apparently it is just everyone else’s fault and physicians have no need to change anything.

I am on record as wanting doctors to run our health care system. I want physician organizations to get the money and decide its rational allocation . But apparently organized medicine’s response is to bury its head in the sand and demand that the rest of us hand them a blank check, and let’s all pretend it’s 1972 again.

Please please someone tell me that this guy is an anachronism and that he really doesn’t represent physician opinion….or else I will get even more depressed…

TECH: Iinteroperability, Schminteroperability

• 1

I’m up at Health-IT World talking about interoperability. I interviewed the Sun guys and TeraMedica for this brief article, and will have something else on the topic out later this week. I hope that I made it understandable….it’s the kind of buzzword-full topic that makes your head spin. Please let come back and let me know what you think after you’ve read it.

 

TECH: Phil Sissions on the NHS–Less there than meets the eye

Also at the TEPR Conference, Phil Sissions, who recently left working for the UK’s NHS’ National Program for Information Technology (NPfIT), gave a pretty critical account of the progress to date for the single largest program in health care IT. The only real successes were getting broadband into the various hospitals and practices, and getting some PACS systems up. Getting doctors their own email address was somewhat mocking called the biggest achievement. Sessions said that many of the other programs, including the Choose and Book appointment system are barely being used, and that GPs have revolted when being told that they had to change out their practice management systems. So far the project has spent hardly any of the money allocated to it (approx. 650m GBP each year) because most of the contracted software hasn’t been delivered. Meanwhile, local hospitals and physician authorities have little money for process change, and have stopped much IT development progress waiting for the central program to provide for them. Sissions didn’t give the attendees much cause for optimism, and indicated that there was a heightening level of hostility between the vendors and NPfIT head Richard Granger.

More later….

 

 

 

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