The Health Care Blog – Page 693 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Why Not a Nurse?

Oct 18, 2011• 21

By John Goodman

After Hurricane Katrina hit New Orleans, several hundred thousand refugees descended on Dallas, Houston and other Texas cities. Many of them needed medical care. Unfortunately, Texas wasn’t prepared.

If a natural disaster hit Oregon, the victims would have fared much better. The state’s 8,500 nurse practitioners (NPs) are free to come to the aid of people in need of care, with no legal obstruction. In Oregon, nurses with the proper credentials and licensure may open their practices anywhere they choose and operate in the same capacity as a primary care physician without oversight from any other medical professionals. They can draw blood, prescribe medications, and even admit patients to the hospital.

In Texas, which has some of the most stringent regulations in the country, however, a nurse practitioner can’t do much of anything without being supervised by a doctor who must:

Not oversee more than four nurses at one time.
Not oversee nurses located outside of a 75 mile radius.
Conduct a random review of 10 percent of the nurses’ patient charts every 10 days.
Be on the premises 20 percent of the time.

Note that under the rubric of “nurse,” there are a host of subcategories. In general, nurse practitioners have the skills to prescribe, treat and do most things a primary care physician can do. They generally must have completed a Registered Nurse and a Nurse Practitioner Program and have a Masters or PhD degree. In addition, there are physician assistants, registered nurses, licensed vocational nurses, emergency medical technicians, paramedics and army medics. In most states, each of these categories has its own set of restrictions and regulations, delineating what the practitioners can and can’t do.

The Big Lie

Oct 18, 2011• 3

By Paul Levy

There is a wonderful expression in politics, “If you say something often enough, it becomes the truth.” Of course, it doesn’t really become the truth. A lie retold is still a lie. But, you can succeed in diverting political attention, especially in today’s news environment, when reporters are not given enough time and bandwidth to really explore issues.

Take today’s New York Times story about Massachusetts health care costs by Abby Goodnough and Kevin Sack. The thesis is that the introduction of capitated, or global payments, will offset cost increases resulting from universal health care access. The reporters give credence to the premise, even though there is not empirical support for the conclusion. Indeed, such support as exists in Massachusetts suggests that the manner in which global payments were introduced resulted in higher, rather than lower, costs. The story also fails to discuss consumer concerns about such plans, which would limit choice.

But then, the reporters retell the big lie, the one that suggest that concerns about the cost trends of the dominant provider group have been alleviated by a recently signed contract. Ready? Here you go:

Under market and political pressure, Partners also agreed to renegotiate its contract with Blue Cross Blue Shield and accept lower reimbursements, which is expected to save $240 million over three years. … Blue Cross Blue Shield of Massachusetts said payments to Partners would increase at about 2 percent a year rather than the previously anticipated 5 percent to 6 percent.

Let’s deconstruct this.

Join Us For Tomorrow’s Health 2.0 Show

Oct 18, 2011

Join us, tomorrow, October 19th at 10:00 AM PST as Matthew and Indu recap highlights from the 5th annual Health 2.0 Conference in San Francisco. They’ll be joined by two special guests: first, Alexandra Drane of Eliza will discuss and take another look at the popular Unmentionables panel. Then, Marco Smit, President of Health 2.0 Advisors will take a deeper dive into the special VC Advisory Session as well as the newest addition to Health 2.0, Matchpoint.

Also, our very own Jean-Luc Neptune will announce three upcoming Code-a-thons as part of the Health 2.0 Developer Challenge, and review the newest online challenges.

If you’d like to see past episodes of The Health 2.0 Show, check out our archives.

The Health Care Reform Law: What’s the Big Deal?

Oct 17, 2011• 62

By William D. Leach

I’m not an attorney, so I cannot help the federal judges struggling to figure out whether the individual insurance mandate in President Obama’s healthcare law violates the interstate commerce clause of the U.S. Constitution. But as a taxpayer (and formerly a professor of public policy), it’s hard for me to understand what all the fuss is about.

The Patient Protection and Affordable Care Act created a monetary incentive for all taxpayers to obtain health insurance. Beginning in 2014, people without insurance will pay more to the IRS than people with insurance. Like the tax code as a whole, the rules for calculating the size of the penalty are incredibly complex. But once the penalty is fully activated in 2016, a single individual with no dependents will pay an extra $695, or 2.5% of his or her applicable income, whichever is higher. An uninsured family of four with annual income of less than $110,000 will typically pay $2,085 more than it would if insured.

This tax penalty is known as “the individual mandate.” It’s an important part of the new law because starting in 2014, insurers are prohibited from denying coverage or charging higher rates based on preexisting conditions. Without the mandate, people might wait to buy insurance until they needed medical care. To keep insurance affordable for patients and profitable for insurers, healthy people need to pay for coverage before they get sick.

Various courts have viewed the tax penalty in different ways. But some have concluded that it is a huge encroachment on individual rights. As a ruling from the U.S. 11th Circuit Court of Appeals put it, “This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy.”

Medicare’s Wild Ride

Oct 14, 2011• 38

By LINDA BERGTHOLD

Most of us breathe a sigh of relief when we reach Medicare age because we think we will have coverage until we die. And we will. But we may not get all the options we want. Medicare Open Enrollment period officially opens Saturday October 15th, but the insurance companies that administer the Medicare program announced their 2012 plans and rates this past weekend. There was good news and bad news.

Whether you are 16 or 66, getting dumped is a humiliating and frustrating experience. Last week, some residents of my county received a letter from their insurance company saying that their Medicare managed care plan will no longer be offered here next year. Yep. Dumped by Anthem Blue Cross.

In some places around the country, there will be no real choice of managed care options in 2012. In my county only one managed care plan will be offered and it will cost $192 a month. Other counties that Anthem dumped will be left without any managed care plans at all. It’s not just California, though. Medicare beneficiaries in Virginia saw Optima drop out of the market for 2012, citing $20 million losses for that managed care business, and 500,000 enrollees in states offering Coventry or WellCare will also see their managed care options reduced.

Will more insurance companies drop their managed care business when they realize they cannot continue to make the same profits they have been making? Perhaps. Even though the number of plans dropping out of the market is small this year, is it a national trend? Actually, so far it is nothing like a national trend.

In fact, earlier this month, federal officials said they expected a 10 percent increase in enrollment in Medicare Advantage plans, and they said premiums will be 4 percent lower on average in 2012 with benefits remaining consistent with 2011 plans. Which is all well and good if you live in a place where there is still a lot of competition for you as a Medicare beneficiary. But if you do not?

Why Are There Disparities In Health Care? Because It’s Free

Oct 14, 2011• 11

By John Goodman

The latest issue of Health Affairs is devoted to racial and ethnic disparities in the consumption of health care. Naturally, they found some. Why are they there?

Let’s consider another necessity: food. Suppose you get a Double Quarter Pounder with cheese and a large order of fries, my favorite fast food indulgence when I put all considerations about healthy eating aside. Do you think your burger would have less cheese if you were a black customer? Would your fries be less crispy if you were Hispanic? Would the meat would be less juicy if you earned a poverty level wage?

The answer to these questions is obvious. Just about anybody in America can have the same fast food dinner anyone else in America is having — usually with very little inconvenience. If there is any disparity in this market, it is due solely to individual preference and choice.

So what makes health care different? I am happy to report that increasingly, it isn’t different. MinuteClinics, RediClinics and other walk-in establishments around the country offer standardized services that are comparable to the market for cheeseburgers and fries. In fact, almost one of every five people who got a flu shot last year got it at a supermarket or a drugstore. At a walk-in clinic, your flu shot costs the same as my flu shot. Your allergy prescription is just as inexpensive and just as accessible as mine. If there is any difference between us it is solely due to differences in needs and preferences. Nothing more.Continue reading…

ER-nomics

Oct 13, 2011• 6

By Trudy Lieberman

This summer, Phil Galewitz of Kaiser Health News wrote an intriguing piece published in The Washington Post about hospitals that market their emergency room services to potential customers. The story narrative seemed out-of-whack with the conventional wisdom about hospital ERs. How many times during the run-up to health reform and during the Great Debate itself did politicos and advocates tell us that reform was necessary to keep people out of the ER, where the cost of care is sky high? Reform, we were told, was going to channel people to cheaper places for medical services. It seemed so logical. Last year, though, there were signs that logic had not won. ER use had not declined in Massachusetts, on whose reform law federal efforts are modeled.

Galewitz’s story was so offbeat and yet so timely that it inspired us to create a new series, “CJR’s Assignment Desk,” where we will feature reporting that can be replicated across the country by local reporters who are trying to tackle health care—sometimes a daunting task in this era of limited journalistic resources. The emergency room disconnect seemed like an ideal candidate for our series debut. This story can be done by good, old-fashioned observation and connecting the dots with what you see. Observation is an important reporting tool that of late has taken a back seat to data mining as the reporter’s technique of choice. Almost every community has a hospital, and most hospitals have emergency rooms. What’s happening with them makes an interesting read, and highlights one reason why health care costs are so difficult, if not impossible, to control.

Galewitz reported that hospitals are using “aggressive marketing of ERs to increase admissions and profits.” What a surprise! That’s the name of the game in the new world of hospital conglomerates: reel in the patients wherever you can find them. Medicaid recipients have been a juicy target, although states have been trying to trim ER visits as a way to cut their Medicaid costs. Anthony Keck, South Carolina’s Medicaid director, told Galewitz: “Many hospitals are actively recruiting people to come to the ER for non-emergency reasons. When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims.” Are hospitals trying to lure Medicaid patients and others to the ERs to treat them for minor illnesses?

The Failure of Health Care Reform: An Insider’s View

Oct 13, 2011• 20

By Merrill Matthews

Employer health insurance premiums went up on average about 9 percent in 2011, and you can expect a lot more where that came from. Only a fool didn’t see this coming, which is to say the White House, every member of Congress who voted for the health care legislation, and all of their liberal enablers who have dreamed so long for the day when the government would take control of the health care system.

I was in the middle of the fight against ObamaCare. Trying to explain to Democrats and their staffs why the legislation would make health insurance premiums explode was like banging your head against the Berlin Wall.

They would mindlessly—almost zombie-like—regurgitate the liberal talking points, asserting that if we could just get everyone in the health insurance pool, premiums would go down, not up. Didn’t President Obama repeatedly promise that premiums would fall $2,500 for a family by the end of his first term?

So the government:

• Provides coverage to an additional 45 million to 50 million uninsured Americans—note that the uninsured spend less than half of what the insured spend on health care, so their spending will rise significantly;

• Requires insurance to cover lots of additional treatments and services, in many cases free of charge to the patient; and

• Guarantees that people will spend very little out of pocket, which insulates them from the cost of their decisions;

What Doctors Think

Oct 13, 2011• 18

By David M Sack, MD

A number of years ago, Dr. Jerome Groopman published a wonderful book for the benefit of patients and their physicians, entitled How Doctors Think. It is an excellent description, illustrated by anecdotes, of the cognitive processes by which doctors arrive at diagnoses, and the pitfalls that are inherent in such calculations owing to the inherent strengths and weaknesses of human thought processes. For example, our tendency to consider conditions that we have seen recently, or those for which can easily imagine examples, is one habit discussed in some depth. It is a fascinating read (or in my case, listen, as I heard it on a CD in my car over the course of a couple of weeks.)

So Dr. Groopman has exposed well how doctors think. But how often do we reveal just what we are thinking? No more often, in my opinion, than we reveal our inner thoughts to friends and relatives in our personal lives – and in fact, considerably less often if we value our professional success. We occasionally let slip our attitudes in a moment of carelessness, a gesture, or the infrequent loss of temper. But for the most part, we try to embody the ideal of “equanimitas” that was advocated by one of our icons of modern medicine, the great doctor William Osler. There have been many learned treatises on this quality as to its benefits to a physician and his patients, and I have little of great insight to add on that topic.

But wouldn’t it be nice to occasionally allow ourselves to express what we really think? I always enjoy arriving home – usually somewhat later than I promised – to relate some of the triumphs and tragedies of the battles of the day. And this, of course, is when I get to say what I really think. It has occurred to me that I might even collect enough material to publish my own book, What Doctors Think.

My wife suggested an alternative or a sequel entitled Do Doctors Think?

I am choosing to ignore the suggestion for the purposes of this post.