The Health Care Blog – Page 352 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Open Letter to President Obama About His JAMA Paper

Aug 24, 2016• 18

KIP SULLIVAN, JD

Dear President Obama,

If I were to tell you that alligators and southern accents are correlated and that alligators cause southern accents, what would you say? You’d say, “Yes, Kip, there is a correlation, but it’s weak. But more importantly, even if the correlation were strong, there is no plausible mechanism by which alligators could influence accents. Therefore I reject your conclusion.”

I offer the same rejoinder to your argument in your August 2 JAMA article that the Affordable Care Act has reduced health care inflation. In that paper, you claimed the ACA has “contributed to a sustained period of slow growth in per-enrollee health care spending,” and you cited the low average inflation rate of the five-year period 2010 to 2014. But that period correlates only loosely with the period of very low inflation that began in 2008 and ended in 2014. The fit is even worse if we define the “sustained period of slow growth” as 2004 or 2005 to 2014 as some do. To give you the benefit of the doubt, I’ll assume you were referring to the 2008-2013 inflation lull.

Of far more importance, even if the correlation were strong, there is no plausible mechanism in the ACA that could have caused more than a tiny fraction of the 2008-2013 slowdown.

My Ideal EHR

Aug 23, 2016• 19

By NIRAN AL-AGBA

flying cadeucii Give me technology which improves my life and that of my patients, or give me death. Medical records must be informative, efficient, and flexible; like the physicians they serve. For me, a medical record does not contain just a collection of problem lists, prescribed medications, and immunizations; it is a noteworthy account of the health care provided to another human being over a lifetime.

Recently, I attended a baby shower of a patient who is now an adult. (I am a pediatrician.) I brought her medical chart wrapped with a satin bow as one of her gifts. I was her physician for many years; my father had taken care of both her and her mother as children. Her growth, development, immunizations, and illnesses were all recorded; but so were 25 years of life experiences, trials, triumphs, and tribulations. The back section contains drawings she had given me, newspaper articles of her achievements, graduation announcements, and her wedding invitation. Obviously, medical records register growth parameters, vital signs, and sick visits; but they also encompass my relationship with my patients.

Self-Driving Health

Aug 22, 2016• 1

By JACOB REIDER, MD

Screen Shot 2016-08-22 at 10.39.39 AM

Lots of news about this recently. Five years ago, you would shake your head and say “no way – not in my lifetime.” Now you know that this is our future. It will be safer, will save billions of dollars, and will be have positive consequences we can barely imagine. The kids need to go to soccer practice? Send them. Get the dog to the vet for his check-up? Plop him in the car and off he goes. It’s real. It will happen. Soon.

So why is it so hard for us to imagine self-driving health? Do we have a crisis of under-supply of primary care? Yes. Today we do . But I wonder if that’s because we’re asking the wrong question.

Aetna’s Obamacare Surprise

Aug 21, 2016• 14

By STEVEN FINDLAY

Screen Shot 2016-08-21 at 10.41.37 AM Did Aetna just pull a nasty, Trump-like move and up the ante on the Obamacare debate in advance of the election and exchange open enrollment for 2017?

The allegation is that the company withdrew from 11 state insurance exchange marketplaces for 2017 after the Justice Department failed to heed Aetna’s warning that it would do so if Justice didn’t approve its $37 billion purchase of Humana. The Justice Department announced last month that it was challenging that deal and Anthem’s proposed merger with Cigna, saying both deals threaten to sharply reduce competition in the health insurance marketplace.

A July 2016 letter from Aetna to Justice, unearthed by Huffington Post, contains the threat. But in announcing its exchange pullback this past week, Aetna made no mention of the letter and insisted its action was prompted by existing and expected future financial losses in the exchanges.

More Than a Lollipop: Helping Kids Get Through the Hospital Experience

Aug 21, 2016

By CARE LOGISTICS

Screen Shot 2016-08-02 at 7.03.56 AM In the latest installment of the Who Cares: Hospital Talk podcast we chat with Kristin Colby, a specialist with Children’s Hospital of Atlanta about the challenges of preparing kids for the uncertainty and trauma of hospital care. Could working with kids just maybe teach something to the rest of us? Maybe. Just maybe ..

The Exchanges Part II

Aug 21, 2016• 3

By JIM PURCELL

flying cadeucii I wrote earlier here about the exchanges, how they are failing, and why. It is unsurprising that what I wrote is coming true, not because I am some clairvoyant, but because I’ve lived in the insurance world and understand it. The causes are very, very obvious.

The most recent whipping boy is Aetna, which announced that it is exiting most of its exchange markets, citing losses of $200 Million in the second quarter. From correspondence, it is clear that Aetna was willing to be a good citizen and accept such losses if its proposed acquisition of Humana were not opposed by the feds. Well, the feds are opposing. And predictably, Aetna is sending back a message that it’s willing to be a good citizen, but only up to a point.

Might we wonder what the Obama Administration is thinking regarding the exchanges? All of this is so predictable. The exchanges were designed to fail economically. Fundamentally, insurance is a financial matter. Money in, money out. If the exchanges were designed to be something else (a socially-conscious program to afford (so to speak) coverage to everyone that would require tax subsidies), it might be time to admit to that.

The Iora Health Fellowship: A Call For Applicants

Aug 21, 2016

BY JAY MATHUR, D.O. and SUMAIR AKHTAR, MD

With STEPHEN GORDON, MD

flying cadeucii As physicians, we pride ourselves on our clinical wins – nailing the diagnosis of a rare disorder or helping a patient achieve control of their long-standing diabetes. However, we commonly face intense frustration and high rates of burnout due to socioeconomic, political, and bureaucratic forces that prevent us from delivering impactful patient care. This frustration is compounded by the constant proliferation of changes in healthcare policy and care delivery to address alarming increases in healthcare cost and waste. Between the deluge of paperwork, regulations, and resource constraints, we often ask ourselves: Why does the system often hinder rather than enhance the physician-patient relationship?

The truth is that physicians can no longer sit on the sidelines. The questionable value of so many clinical procedures and the immense cost baked into the system are clearly unsustainable. Given that physicians – with their patients – ultimately make decisions regarding care plans, they are uniquely positioned to move the healthcare system to one that rewards doing only what is best for the patient. Yet, current physician training rarely incorporates curriculum designed to create systems thinkers capable of leading multi-discplinary care teams.

Enter Iora Health and its unique fellowship in primary care innovation and leadership. Iora is an innovative primary care delivery startup that is committed to restoring humanity to healthcare. It advances a high-impact, relationship based primary care model that is backed by talented health coaches, robust technology, and payment that is focused on patient outcomes.

Value-Based Government (GACRA)

Aug 20, 2016• 5

By MICHAEL BANKS, MD

We decided that if MACRA is good for physicians, then the same thinking is probably a pretty good idea for the US government. We need Value-Based Government. It’s clear that past methods of paying for US Government services have been terribly inefficient. Costs keep going up. Quality keeps going down. We thought about doing this nationwide, with all US government personnel, but we will just do CMS leaders for now. Let’s call it a demonstration, we’re calling it GACRA, Government Access and CMS Revaluation Act.

Eventually we want all US government employees to be value- based, no more salaries. This is an obvious improvement on how we will pay you, The way you are paid now does not seem to work. Everyone agrees our government is too expensive to run and nothing gets done.

Here’s how value-based government works:

Every CMS leader will send in a code for every 10 or so minutes of work and exactly what they did. Yes, Andy Slavitt and Sylvia Burwell, you will not be paid as you were previously.

You will now be paid for value.

The American Medical Association Takes a Step In the Right Direction

Aug 20, 2016• 1

BY LAURIE LEONARD

flying cadeucii I am very glad the AMA is studying the issue of aid in dying. Opponents to the legalization of aid in dying put quotes around the term, apparently to indicate that it is a euphemism for what they believe is physician-assisted suicide. But aid in dying is not suicide.

On 9/11 witnesses saw a number of people trapped in the World Trade Center intentionally jump to their deaths. None of those deaths were ruled suicides by the medical examiner. The death certificates for the jumpers list the cause of death as homicide.

Similarly, in the states in which aid in dying is legal, the death certificates do not list “suicide” as the cause of death; instead, they list the underlying terminal disease as the cause. Just as the 9/11 jumpers chose death by falling over death by burning, those terminally ill people fortunate enough to live in an aid in dying state can choose a peaceful, quick death at the time and place of their choosing over a drawn-out, miserable death that may end alone, intubated in an ICU rather than at home with loved ones present.

Capping Co-Pays Doesn’t Lower Drug Costs

Aug 18, 2016• 2

By DEVON HERRICK

flying cadeucii Politicians are concerned about your drug costs. Unfortunately, their proposals could actually raise drug prices and force you to pay more, albeit indirectly. For instance, presidential candidate Hillary Clinton proposes to cap your prescription drug co-pays at no more than $250 per month. Rising drug costs are now a political issue because the number of diseases and conditions that can be treated using drug therapy has grown tremendously over the past 25 years. Arguably, one of the main reasons patients visit their doctors is to obtain or renew prescriptions. When they visit their doctors’ offices, Americans leave with a prescription in hand about three-fourths of the time. This is hardly a travesty; and few patients are drowning under the cost of prescriptions drugs. Most prescription costs are paid for by prescription drug plans sponsored by insurers and health plans.

Insurers and health plans use multiple techniques to make drugs affordable. One of the ways employers, insurers and pharmacy benefit managers (PBMs) hold down costs is through drug formularies with multiple tiers. The purpose of tiered formularies is to steer enrollees to lower-cost alternatives when appropriate, using differing levels of cost-sharing and co-pays. Drug plans typically encourage generic use by requiring little if any cost-sharing when a generic drug is dispensed. Prescriptions are dispensed in generic form about 88 percent of the time. Generic drugs are cheap compared to brand drugs — accounting for less than three percent of national health care expenditures.