Psychologist Deb Serani informs me that it’s World Mental Health Day. Go to her blog to see more, and no snide remarks about which of our nation’s leaders this is aimed at!
Above the Fold
BLOGS/PHYSICIANS: Enoch Choi in New Orleans
oDr. Enoch Choi, a medblogger (and OT but BTW a liberal evangelical Christian just so you know there is one!) has packed up his black bag and spent the week in New Orleans following his medical calling. Go read his blog and scroll down to the October 1 entry — then read up. Doesn’t take too long as he’s posting via his Treo and he’s mighty mighty busy. It’s an amazing read.
It’s very clear that the return to New Orleans is fraught with similar perils to the evacuation. Plaudits to Enoch to heading out and putting his God-given talents to work in a crisis. They still need doctors desperately down there.
UPDATE: Enoch writes direct (promoted from the comments). Please consider donating once more to the organizations that are sending committed volunteers like him onto the very front lines.
thanks for the props, Matthew. i’ve come to new orleans with City Team ministries and serving under the local authority of Pastors Resource Council PRC Compassion, invited by the local churches in St. Bernard. Menlo Park Presbyterian Church MPPC paid all of our flights, expenses, medicines and supplies.
Any of those organizations would be able to immediately deploy your donations to people we’re seeing every day. Yesterday, one of our nurses gave us $1000 from their Kansas Church… Their entire disposable cash. We spent it today on natural tears, sunblock, nasal saline, sudafed, lozenges, cough syrup, hydrocortisone. We gave it away in 2 hours. There’s immesurable need here, and whatever you give to MPPC would be immediately consumed by that need by our medical team.
to give to MPPC:
to give to City Team:
to give to PRC Compassion:
This is so different than giving to Red Cross, what you give to them will be spent on the next disaster. The Red Cross doesn’t have physicians down here. I don’t see any other medical teams down here other than ours. There are plenty of individual physicians that have come down, and they’re very important, but as an organized group, we’re it.
POLICY/POLITICS: Linking Katrina, Medicare Part D and bird Flu
Here’s my FierceHealthcare editorial today:
FierceHealthcare has been following two stories all year that both had big moments this week. One is the avian flu that’s been popping up in Asia and may end up being as deadly as the 1918 epidemic. The other is the new Medicare Part D roll-out. For Medicare Part D, the complex mix of plans being offered to seniors will test their ability to understand the options on hand — anyone who’s bought insurance in the individual market knows that’s not easy — and will also challenge the Federal government’s ability to run and police a complex program with many different private and public agencies taking part. Given the nation’s recent experience with a similar challenge on the Gulf Coast, we can be forgiven for looking at the Medicare roll-out as the next great test of government, and hope that it shows improvement. Especially if we have a real crisis in the near future if avian flu becomes the pandemic we all fear.
POLICY: Afternoon update by John Pluenneke
Stewart Simonson, the Bush administration official currently in charge of pandemic preparedness could be another Michael Brown, say critics. Perhaps they’re just being mean.
QUALITY: DM has been counting it wrong but Al Lewis sets it straight
Over the last year or so the DM listserv has been buzzing with the concept put about from Al Lewis, Ariel Linden, and Ian Duncan that to this point ROI for disease management programs has been calculated wrongly. But in an interview with Managed Care magazine Al explains how to get it right, and also predicts that this will help DM finally take off.
My cynicism has been detailed — and refuted — before in THCB, but at some point getting DM right will make sense. My fears of course revolve around problem that the the incentive for a insurer to get rid of a sick member is much greater than the incentive for them to manage that member well, and it’s a damn site easier to do the former.
PHYSICIANS/POLICY: Malpractice explained
Susan Sheridan, whom I wrote about last month, is even more famous. She and her son Cal who has kernicterus syndrome are the hook for a piece in The New Republic by Robert Berenson. (You may only be able to get to the first page…) It largely tells the truth about malpractice, but just to reiterate, my reading of the data is that:
1) The tort system only picks up about half of malpractice2) The medical system barely ever apologizes (Susan never got an apology), but when it does law suits are much less likely3) Too much of the money goes to lawyers and expert witnesses, and lawyers and Democrats don’t want to change that, but as they don’t hold power–so what.4) Doctors, whose Republican allies now do hold power, are only interested in reducing caps on damages, which may reduce their rates a bit but does nothing to help severely injured victims of malpractice and more importantly nothing much to reduce medical costs for the rest of us. (I live in California where we have the MICRA caps and my insurance premiums ain’t going down — sufficient proof to me that the Republican talking points about this are bunk).5) Defensive medicine makes the system and the doctors more money and until they stop getting paid for it, the whole "8-10% savings" concept is a myth6) Special courts, non-binding arbitration, apologies, openness, and a near-miss reporting system are all good ideas and are the eventual solution, but the AMA won’t back them, and their Republican allies won’t either. Why not? For them tort reform has nothing to do with patients, and not much to do with doctors, but much, much more to do with stopping what are mostly legitimate lawsuits against malfeasant corporations — and it’s much better if that all gets mixed up with an evil lawyer suing Marcus Welby MD in their PR campaign.
So unless there is some real concession from organized medicine, we’ll keep what we’ve got and it doesn’t work. The "good" news is that it’s only a minor issue compared to the complete morass of the rest of the health care system.
(Hat-tip to Brian Klepper for the article)
HOSPITALS: Sutter and Kaiser getting pissy, and fiddling while Rome burns
Just to follow up on the recent "SEIU hates Sutter but loves Kaiser" piece, this morning I was up at CPMC as a patient, having a doctor looking at my bum knee in the medical office building next door. (And no, I didn’t cross a picket line as the doctor I was seeing was in a medical group that’s not owned by Sutter, at least I think it’s not and it wasn’t being picketed). The pickets were out in force with a SEIU RV parked outside.
Meanwhile, on the issue of giving free care to the uninsured (or not, as the case seems to be) Sutter is now pointing out that it thinks it gives lots of charity care because it "writes off" some $40m a year in discounts that it gives Medicaid and Medicare off its charges. After you pick yourself up from rolling on the floor laughing about that one, there is the slightly more serious issue that they raise which is that everyone else does it (or actually, doesn’t do it). "Everyone else", in this case, of course means Kaiser.
This is an old and perhaps even valid meme, in that Len Schaeffer brought it up years ago when he noted that Kaiser gives very little charity care at its hospitals, which he too converted into the concept that Blue Cross was paying for the "extra" charity care delivered at non-Kaiser hospitals, because of some mystic cross-subsidy from the care that Kaiser wasn’t giving.
So what’s the solution? Well of course it’s to form a committee, provided that Blue Shield’s Foundation comes up with $75,000 to pay the committee. Yup that’ll solve the uninsurance problem overnight.
However, if I was in Sutter’s position, I might just be trying to get my head a little lower out of the firing range and not just using the "Officer, everyone else was speeding too" excuse.
THCB: Email problems
Some a-hole spammer is spoofing ATmatthewholtDOTnet as their outbound address, luckily so far without the correct first name. The result is that I’m getting hundreds of bounce-backs with "undeliverable" email (you know, the MAILER DAEMON ones), as all emails to matthewholtDOTnet by default go into my main account. Not that it’s their fault in the first place but my email and web-hosting service has been unable to figure out how to block them all and just let the correct email go through (i.e. the ones sent to my correct email address).
Worse, this morning some bright spark at my hosting company switched off my incoming email all together, including the proper address. It’s back on now, but if you sent me an email between 1 am and 9.30 am PST, please send it again.
And any advice about dealing with this would be appreciated!
TECH/BLOGS: HISTalk nails it again
Mr HISTalk and I have a mutual love affair with each others blogs, and his news sections are always gems. Today he has a story that I’ve missed about a payroll system in Ireland (no jokes from you Brits), and a great remark about RHIOs — both total classics. Go over there and read them.
POLICY: Employer health insurance and stuttering efforts to delude the public
In The New York Times Milt Freudenheim reports a little too gushingly about the attempt by a number of big companies to let the part-time employees that they don’t cover buy into their health insurance programs.
The companies are taking a small first step toward slowing the spiraling growth of the uninsured, who now number more than 45 million. They acknowledge that the program is far from an overall solution, but they are addressing a challenge that government officials have largely ignored, said Steven M. Coppock, a senior actuary at the Hewitt Associates benefits consulting firm, which is helping the association with the program.
Surprise, surprise there’s a benefits consulting firm selling yet another new idea here. I’ve started describing CDHPs as the bastard child resulting from a one night stand between benefits consultants with nothing new to sell and a libertarian think-tank that can’t do basic math. This pretty much comes into the same category.
There are some good things about this program, in that it allows the uninsured to buy into the benefits of a big group program, at the same rates that the company is paying for its "real" employees, and not having to worry about pre-existing conditions. Of course, this won’t do a whole lot to solve the uninsurance problem for two reasons. One, the vast majority of the uninsured don’t work for these big companies (or if they do they work for companies that pretend that they’re not big, like the franchised outlets of the fast food restaurants). Two, the problem of the majority of the uninsured is not just that they don’t have access to insurance, but that they can’t afford it. There are some people who are priced out of the individual market by medical underwriting who can buy a much better product in the group market, and for them this is a good option — but that’s a low number. In general you might get a better rate (in terms of premium per benefit rather than straight premium cost) from a group plan, but if you can’t afford an individual plan of any kind you probably couldn’t afford this either.
Unless I’m really missing something there are three blindingly obvious statements to be made about this effort.
1) Part of the way employers have got out of offering benefits is by asking employees to contribute for their dependents’ costs. The numbers of employees who are offered benefits (especially for dependents) but don’t take them up is high and increasing, (although that only accounts for about 1/4 of the uninsured–the rest just don’t get offered insurance by their employers). This program is really just an extension of that, and regular employees must be feeling that they are not so far away from being told that like the part-timers, they too must start paying for their care. That’s the trend that the NY Times should be writing about. While it’s not what they are writing about, plenty of others have noticed. (Note that employees remain highly opposed to losing health benefits because they understand the grimness of the alternative).
2) As the Progressive Policy Institute and many others have suggested, if we are to allow people to buy into group programs, the logical way to do it is to open the FEBHP to everyone. Of course all buying groups like this will attract poorer risks who can’t get a better deal from the cream-skimmers in the individual market — but the FEBHP might just be big enough to let them all in and deal with it, and of course it has the heavy hand of the Feds behind it to spank any health plan that starts playing games. Of course letting everyone into Medicare is a further logical extension….but let’s not get too far ahead of ourselves.
3) Given how ineffectual this is going to be, why is the NY Times covering it?
Coda: By the way I’m pretty unimpressed with the HR people at big companies. I talked to a group of VP plus level HR people last year, and I gave them a hard time about how they were allowing the health care system to run them around. A number of them said, "but we do so much more than we did five years ago". I asked them which of their other suppliers had they allowed to hit them up with 15% annual increases for the past five years running, and not one of them had a word to say.
