The Health Care Blog – Page 708 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Trying Too Hard to Save Medicare

Jul 14, 2011• 29

By DAVID DRANOVE

In the latest edition of Health Affairs, Dr. Francis Crosson, chair of the Council of Accountable Physician Practices and senior fellow at Kaiser Institute of Health Policy, offers an impassioned defense of Accountable Care Organizations. Crosson’s main point is in his title: “The Concept is Too Vitally Important to Fail.” He adds:

“The accountable care organization model is intended as an option both for Medicare and for non-Medicare, commercial health care services. However, the general model and the specific shared savings model proposed for Medicare have come under criticism. Much of the criticism is valid and should be addressed. However, none should serve to prevent the evolution of this model.”

If the concept is “It sure would be nice to hold down costs and improve quality” then how can I argue? Who wants to argue against God, Mother or Country? But if the concept is “The only way to save the healthcare system is to organize everyone into ACOs,” well forgive me for disagreeing.

Why This Lawyer Won’t Sue Me

Jul 13, 2011• 2

By MICHAEL KIRSCH, MD

I spent the entire last weekend with an attorney, not a desirable circumstance for most physicians. However, I wasn’t being deposed or interrogated on cross examination. This was a rendezvous that we both sought with enthusiasm.

Lewis is my closest friend, a bond that was forged since we were eight years old. We are separated now only by geography, and we meet periodically because we both treasure the friendship. Earlier this year we rolled the dice in Vegas. Last weekend, we sweated in the sweltering heat of the Mile High City. Next stop? Back to Denver with a few youngins’!

Lewis is the managing partner in a prominent west coast law firm that specializes in tax evasion. (Or is it tax avoidance? Am I confusing my terms here, Lew?) He has been redrafted to this position because he has earned the respect of his colleagues. Clearly, both Lewis and I have ascended to the highest strata of our professions. Lewis is in charge of a large law firm that has global reach; he travels all over the world cultivating business and negotiating deals; and he navigates clients through complex and labyrinthine legal conundrums. I, an esteemed community gastroenterologist, perform daily rectal examinations and counsel patients on flatulence.

The Federal Exchange–Lost in alternate history

Jul 12, 2011

The next few days will be all about exchanges, or more accurately the “American Health Benefit Exchanges for Individuals and Small Business Health Options Program.” Tim Jost has a long and excellent article at Health Affairs blog explaining them, and–Yikes!–it’s the first of three. There’s going to be different rules for individuals versus small businesses, and of course differences as to whether Medicaid plans (which will cover more poor individuals) will be part of the exchange. For states that decide not to implement the exchange themselves, it’ll be done by the Feds–assuming that the whole thing doesn’t get repealed (and it won’t). But I remain very concerned that the complexity of 50 different exchanges, not to mention the ability of HHS to really keep an eye on all of them, is a problem–one that would be much reduced with a single Federal Exchange looking something like FEBHP. As Jost says, The Senate version of the ACA which became law (in contrast to the House version which did not) creates the exchanges at the state rather than the federal level. For that we have Scotty Brown and the voters of Massachusetts to blame. And thus the weirdness of the American political system has given us a long series of headaches for years to come.

Myths about Medical Malpractice: Part 2 Crisis or Hoax?

Jul 12, 2011• 56

By MAGGIE MAHAR

Conservatives call it the “malpractice crisis.” Public Citizen, a liberal non-profit consumer organization based in Washington D.C., calls it “The Great Medical Malpractice Hoax.”

No doubt you have read that ambulance-chasing lawyers have escalated their assault on health care providers, and that as a result, malpractice insurance premiums have been levitating, along with malpractice suits, further hiking the cost of medical care.

Various solutions have been floated, including “caps” on compensation for pain and suffering; “health courts” where expert judges replace juries; immunity for doctors who follow “best practice guidelines;” and “full disclosure” policies which urge doctors and hospitals to move quickly to disclose errors, apologize, and offer compensation.

In the end, the best solutions would make malpractice reform part of heath care reform. Our malpractice system should be redesigned to reduce medical mistakes, fully compensate patients who are injured by human error, reward doctors and hospitals that disclose errors, and penalize those that try to “cover up.” When it comes to the cost of malpractice, reform should slash the exorbitant administrative costs built into an adversarial process that moves at a snail’s pace, while subjecting both plaintiffs and defendants to what a recent report from the American Enterprise Institute rightly describes as “inhumane.”

Continue reading…

Let’s Stop Bashing Profits and Business In Healthcare

Jul 12, 2011• 167

By MERLE J. BUSHKIN

I’m tired of profit-bashing and business-bashing in healthcare. And every American should be, too!

Well-run, profitable businesses, along with our sense of decency, democratic institutions, education and free enterprise systems, and adherence to the rule of law, have made the United States the most extraordinary nation in recorded history. Together they have unleashed the talents, creativity and productivity of our people, generated enormous sums of capital, and created unheard of social, economic, scientific and political advances.

Is there anything nobler than providing the environment and opportunity for people to fulfill their potential and achieve their dreams, and for providing the goods and services that enable people to raise their standard of living? Not even the practice of medicine can do so much good for so many people. But that’s precisely what businesses do. (That also may explain why far more Americans today are interested in job creation than restructuring healthcare.)

In our system, an individual has an idea, attracts capital, and hires people to build a product or provide a service. When they meet a need, they prosper – and attract more capital and hire more people. Everybody wins. If they fail, they alone suffer the consequences. That’s what capitalism is all about and that’s what has made America great.

Frances Dare, Cisco: Global Health Leaders’ Survey

Jul 12, 2011• 6

By Matthew Holt

Cisco’s Frances Dare is an occasional but regular and welcome guest on THCB. Frances spends a lot of time looking at the environment for Cisco’s products and services in health care both in the US and internationally–think demand and readiness bandwidth and live video! Earlier this year Cisco released the results of a survey done with numerous international leaders in health care about their problems in general and their readiness for telehealth solutions in particular. The overall verdict? It’s getting pretty close, especially outside of the US. For the longer story, grab a cup of coffee and watch this interview in which I bring chat and Frances brings data!

Interview: Insurance exchanges, ACOs? ACS tells you how…

Jul 11, 2011• 2

By Matthew Holt

We’ve been digging under the hood a little of Xerox since (much to my surprise) they started sponsoring THCB recently. The reason Xerox cares about health care is related to their purchase of ACS a couple of years back. ACS was best known for government (mostly Medicaid) claims processing but they also had a whole lot of other technologies and capabilities. One of those is actually running the Health Insurance Exchanges that are going to be in every state (or imposed on the states in 2013 if they’re not ready). Another ACS capability is working with incipient ACOs, or providers that backdoor into ACOs via Medicare Advantage or direct deals with private plans.

Last month I spoke with Michael Sandwith who runs Market Management at ACS. Why should a state or a provider use ACS to put the systems together to run health information exchanges or ACO information capture and management systems? Mike’s logic is simple–because they’ve done it before. They’re operating 7 state HIEs already and aren’t just bringing Powerpoint. And can ACOs work given the failure of PHOs in the 1990s? It all depends if we can independently manage the physicians within the system–i.e. don’t let the hospital management screw it up! Here’s the full video interview of someone who’s been there in two of the bigger health care IT challenges of the day.