The Health Care Blog – Page 701 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Healthcare Spend at Historic Low

Aug 11, 2011• 67

By MERRILL GOOZNER

In a rare bit of good news for the Obama administration and budget policymakers, health care costs increased last year at their slowest pace since the advent of Medicare and Medicaid in the mid 1960s.

The new analysis, released on July 25 by officials at the Centers for Medicare and Medicaid Services, the agency that administers the two programs, showed health care spending grew last year at a “historic” low 3.9 percent rate, which is slightly below 2009’s record-setting low of 4.0 percent. Health care spending as a share of the economy remained stuck at 17.6 percent, a welcome change from most years when it increases its share of total economic activity.

At a time when the White House and congressional leaders are worried about rampant long term growth of the government’s major health care insurance programs for seniors and the poor, the new data will allow government actuaries to project growth in Medicare and Medicaid over the next decade will be less than previously feared. This could potentially ease the task of the Obama administration and congressional leaders somewhat when they finally negotiate an agreement for slowing the growth of entitlement programs to help reduce the deficit.

Moreover, CMS actuaries are now saying the cost of insuring 30 million previously uninsured Americans under the president’s signature health care reform bill will add only a sliver to overall spending, and that increase is about half the projected growth rate of a year ago.Continue reading…

Rich hospital buys poor Medicaid Health plan. Hmm

Aug 10, 2011• 4

Partners, the Boston behemoth that rivals California’s Sutter Health for its ability to impose its pricing will on the local Blues plans, has bought a struggling Medicaid plan, Neighborhood Health Plan (NHP). Actually “bought” is a strong word, as it’s like one of those deals when you “buy” someone’s car by taking over the payments they can’t meet. The fascinating part is that Partners has agreed to fund 50 community clinics that provide most of the care for the Medicaid crowd that NHP insures. So is Partners’ goal to ramp those clinics up to its standard level of pricing and charge Medicaid–i.e. the state & Feds-more for the privilege? Or is the goal (as Jeff Goldsmith suggested more generally yesterday) to import the knowledge those clinics have and get the rest of the system to run at their low cost? You be the judge…

AHIP Video Series: Brainshark

Aug 10, 2011

By DEB LINTON

Health 2.0 and THCB had the chance to catch up with Thomas Raleigh, VP of Brainshark‘s Healthcare Business Unit. In addition to having one of the coolest names in the industry, Brainshark is helping healthcare professionals improve their communications, reach mobile employees and save millions of dollars. Through Brainshark’s technology, users can rapidly create video presentations with simple tools they’re already familiar with like PowerPoint and their own phone. In this AHIP video, Raleigh shares Brainshark success stories with groups like BCBSF, Nova Biomedical, AHIP, CIGNA, Gorman Health Group etc. and discusses the platform’s role in capturing healthcare trends. You’ll also hear how Brainshark is improving the visibility of wellness programs, why it’s going “unplatformed” and much more.

The Fallen Souffle Economy

Aug 10, 2011• 4

By JEFF GOLDSMITH

It is increasingly clear that the United States’ economic troubles are far from over.

The stock market plunge that began in earnest last week reflects the market’s belief that we’re not going to recover fully from the recession that began in 2007. As a Wall Street Journal commentator said mid-Monday’s plunge: “The market is pricing in a double dip recession”. In reality, the 2007 recession (caused initially by $150 a barrel oil) never really ended.

Past remedies for recession basically involved nearly free money and Keynesian pump priming to stimulate demand with either borrowed or freshly printed money. The most recent (bipartisan) stimulus effort, nearly a trillion worth of extended Bush tax cuts, unemployment extensions, payroll tax cuts, etc. which Congress and the Obama Administration negotiated in December, seems to have disappeared into thin air, producing a whopping 0.8% economic growth in the first half of 2011 and a July unemployment rate of 9.2%. This Economist analysis argues that the political system has exhausted its remedies for our economic problems.

AHIP Video Series: Portico Systems

Aug 9, 2011

By DEB LINTON

Continuing with our AHIP video series, THCB and Health 2.0 had the chance to catch Sam Muppalla, CSO of Portico Systems. Portico is a supplier of Integrated Provider Management (IPM) solutions for payers. In this video, we get a chance to hear about Portico 9.0 which aims to optimize payer-provider relations and enable robust design, management and reimbursement of provider networks. Muppalla also discusses, Portico’s goal of significantly reducing medical, administrative and IT costs while delivering quality care to patients.

A Legal Challenge To CMS’ Reliance On The RUC

Aug 9, 2011

By BRIAN KLEPPER & DAVID KIBBE, MD

This week in a Maryland federal court, six physicians based at the Center for Primary Care in Augusta, GA filed suit against HHS Secretary Kathleen Sebelius and CMS Administrator Donald Berwick. The complaint, spearheaded by Paul Fischer MD with DC-based lead counsel Kathleen Behan, alleges that the doctors have been harmed by the Medicare payment structure developed through the agencies’ reliance on the American Medical Association’s Relative Value Scale Update Committee (RUC).

The suit also claims that the agencies have functionally treated the RUC as a federal advisory committee. But they have not required the RUC to adhere to the Federal Advisory Committee Act’s (FACA) stringent management and reporting rules – e.g., balanced representation, transparent proceedings, and scientifically valid analytical methodologies – that keep the proceedings in the public interest. The plaintiffs request injunctive relief, which would freeze the relationship between CMS and the RUC until the advisory group complies with FACA’s requirements. Of course, compliance would drastically change the way the RUC conducts its affairs, something it is almost certainly loathe to do.

The Year of Going Paperless

Aug 9, 2011• 5

By DINOSAUR MD

Seven months into 2011, things look very different than they did this time last year at my office. Not only have I been using an electronic medical record for nine months now, but I’ve also been submitting claims electronically (through a free clearinghouse) using an online practice management system. I’ve also begun scanning patients’ insurance cards into the computer, as well as converting all the paper insurance Explanation of Benefits (EOBs) into digital form. I’ve even scanned all my office bills and business paperwork and tossed all the actual paper into one big box. As of the first of the year I even stopped generating “daysheets” at the end of work each day. After all, with my new system I can always call up the information I want whenever I need it.

How did such a committed papyrophile get to this point? It is the culmination of a process that actually began last summer with the purchase of an adorable refurbished little desktop scanner from Woot ($79.99, retails for $199, such a deal!) The organizational software is useless for my purposes, but it does generate OCR PDFs, which makes copying and pasting ID numbers from insurance cards into wherever else they need to be a piece of proverbial cake. The first step was to start scanning the office’s administrative paperwork (phone bills, electric, etc), since that didn’t affect the staff’s workflow. Suddenly, instead of having to sort the increasingly teetering piles of paper bills into file folders in an upstairs desk drawer, I had a single file on my computer where I could access any document I needed with a click or two.

Dropping the Price of Surgery

Aug 9, 2011• 47

By JEFFREY RICE, MD

I would like to share a story about my son’s recent surgery that, while only one simple case, reveals the foundational problem with the U.S. health care system.

I write this story as a father of a 12 year old boy who has cerebral palsy. Jack is fortunate to be healthy and active with minor medical needs. As he has grown he experienced some issues with contractures in his right lower leg which recently required a minor 2 hour outpatient surgical procedure. That is where our saga begins.

When Jack’s surgery was scheduled I started the time consuming process of getting price estimates from the surgeon, anesthesiologist and the facility since we have a high deductible insurance plan. The physician fees were straight forward and relatively easy to obtain, not so with the facility. Jack’s surgery was scheduled at the local hospital’s outpatient surgical facility. I called the hospital to request a price for the surgery and they said they couldn’t really tell me. They offered to send the procedure codes to an external reviewer who would provide a general idea of the anticipated charges. Three days later the answer came back at $37,000. I reiterated that I had high deductible insurance and needed to know the actual price they would bill me after an insurance adjustment to the network fee schedule.

SaaS tiptoes into the hospital

Aug 9, 2011

By MATTHEW HOLT

As we prepare for the Health 2.0 conference in the Fall and get stuck into demo after demo, it’s interesting to step back and look at the bigger picture. Clearly the cloud/SaaS trend is going beyond the obvious places–consumer tools, online communities and the data utility layer–to those where client-server architecture has been dominant and successful, such as practice management. Carecloud and athenahealth are examples in that environment (and athenahealth offers a lot of services to go with their on-demand software) and of course the SaaS-based EMR space is burgeoning with not only web-native applications like Practice Fusion, Clearpractice and athenaclincals, but also several of the bigger players like GE with Centricity Advance, OptumpInsight’s Caretracker (United) and even eClinicalworks adding SaaS offerings into the mix. Even the AMA is in the game, with its Amagine service offering a fully hosted SaaS version of NextGen, as well as several other tools and packages.

But then we get up to the walls of the “enterprise.” In health care “enterprises” are called hospitals. Every week it appears that HISTalk is reporting that yet another hospital is uninstalling one client-server EMR product and going with another–almost always Epic. But–with the exception of an odd announcement I don’t understand from McKesson–there doesn’t seem yet to be the healthcare equivalent of large enterprises going with a Salesforce.com approach, where core parts of their infrastructure are put in the cloud. And every installation is a separate custom installation, leaving groups of users needing to be literally banded together by consultants to humbly petition the wizards of Madison County to make particular interface changes. (I’m not kidding–there really is at least one consultant putting together such a group of Epic users). Cloud-based systems of course can roll out these changes much more easily, and receive feedback from their users much more quickly.Continue reading…

The Economic Urgency of Health Care Reform

Aug 8, 2011• 1

By GOV. PETER SHUMLIN

Watching the events of the past several weeks in Washington has been sobering. Decades of failed fiscal policy have finally come home to roost and Congress is tied in knots trying to find a compromise solution and avoid American default. Americans rightly are scared that our leaders can’t find a way out of this muddle. But the really sobering part is this: the solutions under consideration don’t fix the problem. Even if Congress enacts the most draconian spending cuts advanced by the Tea Partiers, and all of the tax increases advanced by the liberals, we will not be out of the mess. The crisis will still loom. Why? Because health care costs continue to increase at an unsustainable rate, and health care spending is the single largest category of federal spending. Without real, sustained health care cost control, we still face a crisis, no matter what package of cuts and revenues the new “gang of 12” develops.

As a Governor, I can’t ignore this problem. Health care spending more than tripled in Vermont between 1992 and 2009. Between 2000 and 2009, health care spending as a share of our gross state product rose from 12.9 percent to 18.5 percent.

We come face to face with the impact of growing health care costs every year in our state budget process. Health care squeezes out all sorts of other priorities, and we (state government) aren’t even paying our fair share of the increase. The state can’t afford to sustain a rate of growth that far exceeds growth in our economy and growth in our tax revenues. So we shift costs from state health care programs to the private sector. The private sector can’t sustain the growth, either, so they cut jobs and reduce insurance coverage for their employees. That’s why, despite aggressive efforts to expand government-sponsored insurance coverage in Vermont, nearly one in ten Vermonters is uninsured, and nearly a quarter of our population is underinsured — they have coverage, but could still go bankrupt if they had a major illness.