The Health Care Blog – Page 319 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Evidence-Based Health Reform

Mar 26, 2017• 13

By MARGALIT GUR-ARIE

President Trump campaigned on making health care better, cheaper and available to all Americans, regardless of ability to pay. Once Mr. Trump was safely in the White House, the Republican thought leaders in Congress were quick to supply him with plans to repeal and replace Obamacare. Most were written in protest to President Obama’s policies and were never meant to be implemented.

When scrutinized by the rank and file of the Republican Party, it turned out that the Ryan/Price American Health Care Act was neither repealing enough for some, nor replacing enough for others.

Now What, Mr. President? Here’s What.

Mar 26, 2017• 7

By STEVEN FINDLAY

In the wake of the AHCA’s demise, most lawmakers and policy experts agree that Congress will put repeal and replace aside for the rest of 2017.

As House Speaker Paul Ryan acknowledged on Friday that means the ACA/Obamacare remains the law for the “foreseeable future.”

Thus, as was widely reported over the weekend, that begs the question: how will the Trump administration administer the law and when might be the right time to return to the issue of fixing and improving it (however you want to label that.)

This is unknowable at the moment. The President, although inconsistent in his remarks, threatened to let the ACA “explode” this year and in 2018, thus forcing Democrats, in his mind, to beg him to fix it. At the same time, he said maybe the legislation’s demise was the “best thing” that could have happened since it would allow him to work with Democrats to craft an ACA replace or fix bill that would win their votes, bypassing the hard-right Freedom Caucus block in the House.

They’re Taking Selfies in the Streets …

Mar 26, 2017• 1

BY JOHN IRVINE

Filed under: Worth 10,000 words.

Taken as word of the Trump administration’s decision to pull the AHCA broke Friday afternoon, a selfie by Sean Patrick Maloney (D-Cold Spring) @RepSeanMaloney quickly went viral on Twitter.

How Not to Innovate (And the Stuff You Really Should Be Doing)

Mar 24, 2017

JOHN HALAMKA, MD

I’ve written several posts over the past two years about the need for innovation in healthcare IT – deploying self-developed apps, leveraging third party cloud hosted functions, and embracing the internet of things.

I’ve previously discussed establishing a center for innovation. In preparation, I’ve worked on innovative projects in industry accelerators, academic collaborations, and government sponsored hack-a-thons.

What has worked?

1. I’ve learned that it is very important to make innovation a part of the day to day work inside an organization. Creating change externally and then trying to graft it internally results in a disconnect between research and operations. At BIDMC, we’ve created a meritocracy in which those have competitively illustrated out of the box thinking are given reserved time each week to focus on highly speculative areas of innovation. The project started as ExploreIT and is now being formalized as the Center for Information Technology Exploration in Health Care.

Dr. Noseworthy and the AHCA

Mar 24, 2017• 128

NIRAN AL-AGBA, MD

The CEO of the Mayo Clinic, Dr. Noseworthy, was last heard recommending patients fire their physicians suffering from burnout. While he does not have truckloads of compassion or empathy for colleagues; he is, at least, honest. Dr. Noseworthy recently confessed “We’re asking…if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal that we prioritize the commercial insured patients enough so… We can be financially strong at the end of the year to continue to advance our mission.” The ‘ailing’ nonprofit generated a paltry $475 million last year.

During his speech, Noseworthy noted the “tipping point” was the recent 3.7% surge in Medicaid patients as a direct result of ACA Medicaid expansion. “If we don’t grow the commercially insured patients, we won’t have income at the end of the year to pay our staff, pay the pensions, and so on,” he said. These are difficult decisions to make by rationing access to healthcare for the poor. It is a moral dilemma those of us in independent practices have been facing for some time.

Mayo will continue taking all patients, regardless of pay or source, and this policy exempts those seeking emergency care.

Watch the Recorded Repeal & Replace: Impact on Health Tech Webinar

Mar 23, 2017

By JILL MERRIGAN

In case you missed the Repeal & Replace webinar this morning, click here or the image above to watch Health 2.0’s Indu Subaiya and Matthew Holt tackle questions with policy expert Josh Seidman from Avalere Health.

Jill Merrigan is the Marketing Manager at Health 2.0.

In the Land of the Health Care Experts

Mar 23, 2017• 17

By ANISH KOKA, MD

Arguably, the most consequential moment of the nascent Trump administration will take place later today when Congress Votes on the first iteration of the bill known as the American Health Care Act (AHCA). If the success or failure of the bill to this point is to be judged by its reception from policy thinkers on most sides of the political spectrum, it is already an unmitigated failure.

It should be worth noting, however, that healthcare in America is a massive business accounting for 3 trillion dollars in spending with powerful stakeholders. Any real attempt at reform is bound to be opposed by those who would naturally resist attempts to dam the river of dollars that flows to them. The resistance from these parties always comes in the form of entreaties to think about patients harmed by whatever change is trying to be made.

Figuring out which stakeholder actually has the patients best interests at heart is akin to playing a shell game. All the cups look the same and its entirely possible the marble is underneath none of the cups. As a physician, I am of course, another stakeholder with inherent bias but I would submit that practicing physicians, among all the players at the table, have their interests most aligned with the patients they must directly answer to every day.Continue reading…

A Healthcare Reform Compromise That Just Might Work (Maybe)

Mar 23, 2017• 4

By BRIAN JOONDEPH, MD

Healthcare reform is stalled, so says Politifact. Fake news or the truth? Hard to know these days. President Trump and Speaker Ryan both sounded optimistic in recent public appearances. The Tweeter-in-Chief this week tweeted, “Great progress on healthcare. Improvements being made – Republicans coming together!” Maybe so, but remember that every TV news network was optimistic over Hillary Clinton’s landslide victory until about 9 PM on election night.

Is Trump’s enthusiasm part of “The Art of the Deal”? To quote from the book, “I never get too attached to one deal or one approach. For starters, I keep a lot of balls in the air, because most deals fall out, no matter how promising they seem at first.” Is the Ryan plan just but one ball floating in the Washington, DC air?

If conservative Republicans in the House and Senate revolt, Ryan’s plan ignominiously dies. What’s next? How about a compromise that just might garner support from all warring factions? There is an old saying, “Compromise is where nobody gets what they want.” But the corollary is that everyone gets something they like out of the deal.

The Incredible Self-Destructing Healthcare Marketplace

Mar 22, 2017• 1

By DAVID INTROCASO

Too frequently what gets overlooked in policy making are the regulations that implement or update legislation. As Henry Mintzberg observed over 30 years ago policy is oftentimes formed without being formulated. For example, the Congress did not define the most important provision in MACRA. The Congress simply defined financial risk under an Alternative Payment Model (APM) as monetary losses in excess of a nominal amount. It was CMS that determined via regulatory rule making specific revenue and benchmark-based standards. While the focus has largely been on Congressional Republican efforts to repeal the ACA, three weeks ago the Trump administration recommended regulatory changes, via a proposed “market stabilization” rule, that will likely, should it as anticipated go final this month or next, have a more near term negative effect on state marketplaces.

I Dub Thee “Three Pronged” Care

Mar 22, 2017• 16

By MARGALIT GUR-ARIE

There are approximately 18 million Americans who purchase health insurance on the so called individual market, on and off the Obamacare exchanges. There are another 14 million or so who could be buying insurance on the individual market, but choose not to buy anything. This puts the total individual market at about 10% of Americans. Half of those are, or are eligible to be, heavily subsided through Obamacare (including those huge deductibles). The other 5% are facing the full brunt of health insurance price increases under Obamacare. Of those, 3% are paying for Obamacare health insurance and getting garbage in return for their money, while the remaining 2% are uninsured.

This is the magnitude of the primary problem we are supposedly trying to solve. The 17% of Americans on Medicare are not upset at Obamacare. The approximately 23% of Americans on, or eligible to be on, Medicaid are not angry at Obamacare either (although the 1% eligible for the Medicaid expansion in states that chose not to expand it, might be angry with their Governors). Some of the 50% or so, who are getting health insurance through their employer, and used to get rather flimsy insurance in the past, may be somewhat disgruntled because the Obamacare imposition of “essential benefits” caused their share of premiums and deductibles to rise, and their ability to choose their doctors to plummet.

This is the secondary problem we are supposedly trying to solve. The American Health Care Act (AHCA) addresses neither problem and exacerbates both.