The Health Care Blog – Page 317 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

When the Patient is a Racist

Apr 8, 2017• 10

By JULIE KIM, MD

Something has changed.

In my first 16 years in practice, I received exactly one insensitive comment from a young child who had never seen an Asian in person. But in the last year, I have received a hateful, bigoted comment approximately every other month. (That includes the remarks by a person who tried to reassure me that the comments were not directed to me personally, but to the “other illegals.”)

My colleagues are experiencing an increase in bigoted comments too. A fellow physician, a southeast Asian man, says he has been called “Dr. Bin Laden” on several occasions recently.

Last September, one of my students was on the receiving end. A patient’s father requested another doctor when he saw the medical student assigned to his son’s case was black. My student and I went to see the patient’s family together. I acknowledged the father’s anxiety and reassured him that we could treat his son. I asked the surgeon-on-call to see the patient.

Is Healthcare a Right? A Privilege? Something Entirely Different?

Apr 8, 2017• 24

By BRIAN JOONDEPH, MD

Election Day 2016 should have been Christmas morning for Republicans. Long awaited control of the White House and both houses of Congress. A chance to deliver on an every two-year election cycle promise to repeal and replace Obamacare. In 2010 Republicans needed the House. They got it. In 2014, it was the Senate. Delivered. But we still need the White House they said. Asked and answered with President Donald Trump.

So, what happened a few weeks ago when the House bill fizzled like a North Korean missile launch? Disparate factions within the House couldn’t unify behind Speaker Paul Ryan’s plan, despite pressure from the White House. For some it wasn’t a repeal, only a rearranging of the deck chairs on the sinking Obamacare ship. Others in the GOP were happy with the status quo, preferring to rail against Obamacare in campaign speeches rather delivering on empty campaign promises. Still others, #NeverTrumpers, knowing that President Trump was behind the House bill, preferred to see the bill, and Trump, fail.

Kudos to the Democrats. When they ran the show in 2008, they herded their cats and passed Obamacare. No Statist Caucus on one side or a Tuesday (or Thursday or Friday) group on the other side, each wanting their own version of healthcare reform.

You’ve Got Facility Fees!

Apr 7, 2017• 12

By NIRAN AL-AGBA, MD

In a beautiful community on the Olympic peninsula, just north of where I live and practice, it happened again; another private clinic sold to a large medical corporation.

Peninsula Children’s Clinic was a bustling pediatric office meeting the vital complex healthcare needs of children in Port Angeles, WA for the commercially insured as well as Medicaid patients. Why were they forced to close?

A phone call with their office manager six months ago foreshadowed the outcome, “we are losing a great deal of revenue seeing Medicaid patients making it difficult to survive.

Peninsula Children’s Clinic was unable to remain financially solvent, so they were purchased, like a horse on the auction block, by the Olympic Medical Center. Their website recently posted the following:

“Peninsula Children’s Clinic is now licensed as part of Olympic Medical Center. Patients seeking care at these hospital-based clinics may receive a separate billing for a facility-fee. This fee could result in higher out-of-pocket expenses for patients.
Patients should contact their insurance company to determine their coverage for hospital-based clinic facility charges.”

Hospital-based clinics tack on “facility fee” charges, which are separate from the bill for the doctors’ services, for the use of the room in which the patient was seen. One hospital administrator told me to think of it as “room rental.”

Facility fees bring in a considerable flow of cash and have the secondary benefit of incentivizing hospitals to buy independent practices because then the hospital can charge two to five times more. Buying independent practices, like Peninsula Children’s Clinic, expands the hospitals’ market share and allows greater leverage when negotiating reimbursements.

Hobson’s Wrong Answer

Apr 6, 2017• 15

By JIM PURCELL

Thomas Hobson was his name, a licensed carrier of passengers, letters, and parcels between Cambridge and London in the years surrounding 1600. He kept horses for such purpose, and rented them when he wasn’t using them. Naturally, the students all wanted the best horses, and as a result, Mr. Hobson’s better mounts became badly overworked. To remedy this situation, he began a strict rotation system, giving each customer the choice of taking the horse nearest the stable door or none at all. This rule became known as Hobson’s Choice, and soon people were using that term to mean “no choice at all” in all kinds of situations.

Not to be confused with Sophie’s Choice, the title of a 1979 novel by William Styron, about a Polish woman in a Nazi concentration camp who was forced to decide which of her two children would live and which would die. That phrase has become shorthand for a terrible choice between two difficult options.

Both Choices come to mind when reading this week’s Boston Globe article titled Hope for Devastating Child Disease Comes at a Cost: $750,000 a Year. The headline, as is too often the case, is inaccurate. It’s $750,000 for the first year, and $375,000 annually after that. But let us not quibble. That equals a lot of resource.

Pulse Check: Value-based Care Models and the New Administration

Apr 5, 2017• 1

By GREG FULTON

From within the new leadership at Health & Human Services (HHS), some anticipated and current payment models tied to MACRA are advancing, while others not-yet-tied to MACRA are being delayed.

MSSP Track 1+ was officially unveiled post-election through a CMS webinar March 22, and CPC+ has moved to round two. Also, but prior to the presidential election, CMS put forth several new bundled payment models whose start dates have been delayed.

Track 1+

The CMS ACO Track 1+ is being designated as an advanced-alternative payment model (A-APM) for MACRA, meaning qualified participants would be eligible for the up-front five percent MACRA bonus, and would be exempt from MIPS scoring.

Track 1 will remain with its MIPS APM designation.

The difference is Track 1+ comes with downside risk, though less than that of Track 2 or Track 3 models, themselves also A-APMs.

Do Asians Have Harder Heads? On Sports Concussions and the Need For a Fairer, Medical Research Funding Policy

Apr 4, 2017• 4

By CHUNG, ZINK, BARR

At a January event on “The Future of Baseball” organized by the Sports and Society Program at NYU’s School of Professional Studies, Yankees executive Jean Afterman spoke to the superiority of baseball over football by noting that “at least our athletes don’t have to worry about their heads after they’re done.” It was an innocuous statement but one that points to a growing assumption that sports concussion is both (a) prevalent and (b) a debilitating disease to be feared.

But is it true that sports concussions are the public health scourge of our time? Media coverage would make it seem so, with countless stories dedicated to professional athletes suffering through pain and dementia, youthful athletes retiring for fear of brain injury, and billion dollar lawsuits against the NFL.

Key Mechanisms That Define Health City Cayman Islands’ Value Innovation

Apr 4, 2017• 17

By VIDAR JORGENSEN and BRIAN KLEPPER

Health City Cayman Islands (HCCI), less than three years old and located in the Caribbean just an hour’s flight south from Miami, is a 104-bed hospital outpost of Bangalore, India-headquartered Narayana Health (NH). HCCI has caught the attention of US health care professionals not just as a nearshore health care destination, but for having extremely high quality despite pricing that is a fraction of that in the US, as well as careful attention to the patient’s experience. HCCI is not only a competitor to traditional US health systems, it is potentially a radical disruptor. It’s model is so different that it could significantly change the standards by which health systems are judged.

HCCI’s performance is the culmination of a deep commitment to access, efficiency and excellence. NH’s Founder, Dr. Devi Shetty, began with a mission-driven awareness that health care is an essential need and must be affordable to be accessible. He then spearheaded an enterprise-wide focus on process optimization to deliver the best care possible at the lowest possible price. The results have been remarkable. Fifteen years ago, NH’s bundled costs for open heart surgery in India averaged about $2,000. Now they are about $1,400, or about 1% of average US cost. Interestingly, Dr. Shetty believes that better results are within reach and has set a five year target of $800 for those services.

The Secret Sauce of Successful Pilots

Apr 4, 2017

By CHELSEA POLANIECKI PARTNER CONTENT

Ever wish you could tell the future? Well, you can’t- but a pilot study can certainly help. Pilots are instrumental in helping organizations learn how a technology application might work in practice, or, more specifically, in their practice. By conducting a pilot, you get a chance to test out your technology, predict what might occur when you expand your reach, and most importantly, learn how to tweak your business model to support a large system. Eric Conner, Co-founder & Chief Revenue Officer of Healthify learned that, “Piloting de-risks trying out new technology… and forces both the host and the innovator to be more innovative.” Conner also adds that after piloting, “… you’re ready to implement your technology in a large health system [since] you have the kinks all worked out” and your company is prepared with the tools they need for large-scale growth.

National Coordinator 6.0: A Blueprint For Success

Apr 3, 2017• 48

By JACOB REIDER, MD

Now that it’s public, I’ll offer my thoughts on the next steps for Don and ONC. Don Rucker is a good pick for the nation, and will be a great National Coordinator. I’ve gone on record as saying that some others are not qualified, and as many of you know – I don’t mince words. Don is smart, focused, thoughtful, intentional, and will make good decisions for ONC and HHS. I have known Don for 20 years. He’s got a long track record of integrity, he’s a nice person, he deeply understands the challenges, limitations, and opportunities of Health IT. I have no doubt that he’ll do a good job. He’s got a lot on his plate.

Where should he focus?

Stay the course with health IT certification. I disagree with the growing meme that ONC has broadened its certification scope too far. Certification has one purpose: to provide consumers with a way to be confident that the product they are purchasing will do what the seller says it does. Some people seem to have forgotten (or don’t know) that some of the companies that sell health IT solutions have claimed that the products do things they do not do. There needs to be a process by which these claims are tested, verified and, yes, certified. If this program is scaled back, health IT systems will be less safe, less interoperable, less usable, and less reliable. #KeepCertification.
2.Keep the Enhanced Oversight Rule in place. My former colleagues (and Don’s former colleagues) in the vendor community will disagree, as do some of the house Republicans. As Don will learn first hand in his initial few weeks as NC, some of the companies that have been selling certified health IT products have been misbehaving. In some cases, products have been de-certified. In other cases, there have been investigations and resolution of problems without de-certification. ONC is protecting the public by doing what Congress asked it to do initially. The certification program is more than testing of products in a petri dish, it’s about what happens with the products in the real world. Surveillance is therefore a necessary part of making sure that the products do what they were certified to do. #KeepOversight.Continue reading…

Who Won When the AHCA Failed?

Apr 3, 2017• 19

By ANISH KOKA, MD

You may have heard that repealing and replacing Obamacare recently failed. The analysis of what went wrong comes from many corners. Andy Slavitt, former insurance executive and most recent director of CMS, writes that the ‘failure of Trumpcare can be seen as a rejection of policies that Americans judged would move the country backward.’ Apparently, the theory goes, moderate republicans, especially in states that expanded heavily and rely on Obamacare Medicaid expansion, were skittish of a repeal and replace plan that endangered the healthcare of millions of constituents. The conservative David Frum writes in the Atlantic that most Democrats and Republicans have accepted the concept of universal health care coverage – and that the idea of a repeal of the right to healthcare is sheer anathema. And if the Republicans were wavering, town halls filled with angry constituents were sure to provide an extra dollop of pressure.

The effort to get the messaging right is clearly important to many, but I find most of it functions as a smoke screen seeking to obscure the real battles being fought over your healthcare.

It is certainly true that Obamacare insures millions of Americans. But it is also true that having health insurance and having health care are two very different things. To be clear, the folks attempting to preserve the status quo want to preserve the ability to force all Americans to buy health insurance that costs hundreds of dollars per month. Put another way, the folks attempting to preserve the status quo want to force Americans to give a monthly fee to health insurance companies. Remember, these plans have deductibles so high that most of the cost of care delivered during the year in the form of labs, copays, and imaging studies falls on the hapless patient. The insurer, for the average healthy person, doesn’t pay a dime.