THCB

Categories

Above the Fold

One Clue to Why Health Care Costs are So High?

• 18

By DAVID WILLIAMS

I often hear from hospitals that they’re being squeezed greatly on cost and not getting paid enough by government and private payers. I have some sympathy for this argument, but on the other hand somehow this country outspends every other country by at least two to one, and hospitals are a big part of the reason.

So what gives?

An article in yesterday’s Wall Street Journal (One Way for Hospitals to Cut Costs of Tests), reporting on an Archives of Surgery study, provides part of the answer.

Making physicians aware of the costs of blood tests can lower a hospital’s daily bill for those tests by as much 27%, a new study suggests.

Researchers simply told the doctors what things cost.

“There was no telling anyone when, or when not, to order a particular test,” says Elizabeth Stuebing, a study co-author…

But she says it shows what can happen merely by giving physicians information they don’t usually have. “We never see the dollar amount of anything,” Dr. Stuebing says. “The first week I stood up and said that in the previous week we’d charged $30,000 on routine blood work and I could hear gasps from the audience.”

The situation doctors are in today is sort of like being sent to a store and told to get what they need, but not paying for the goods and not  knowing the prices of the items or even which items are expensive and which are cheap. That’s certainly a formula to run up the bill, even if inadvertently –which is what the “gasps from the audience” indicate.

The experiment was analogous to putting prices on the items in the store, but still letting the shopper buy whatever they thought they needed. That’s a step in the right direction but not exactly draconian from a cost control standpoint! (Of course there are some cost control measures hospitals impose centrally, which is different from my shopping analogy.)

I have mixed views on whether physicians should be exposed to what things cost. Pricing in hospitals is not like pricing in stores, because “charges” are often a small fraction of what’s ultimately reimbursed. I don’t know that I want doctors making tradeoffs based on faulty data or an incomplete understanding of patient preferences.Continue reading…

Much More Reform Needed for Medicare?

• 13

By ROGER COLLIER

This week’s startlingly gloomy annual report from the Trustees of the Medicare Trust Funds lent new urgency to the need for further Medicare expenditure reforms. Whether Washington DC politicians will respond with more than sound bites is less likely.

The Trustees’ report shows a dramatic deterioration—even based on the most optimistic assumptions— in the financial position of the Part A Trust Fund, along with expectations of continued faster-than-GDP growth for Parts B and D.

Compared with the prior year’s Trustees’ report, which forecast that the Part A Fund would run out of money in 2029, the latest report estimates that the fund will dry up in 2024—five years sooner. The reasons for the sudden acceleration of financial disaster include a significant drop in revenues from taxes on workers’ earnings due to the ongoing recession, and new forecasts of longer life spans for beneficiaries.

The report also includes new forecasts for Medicare Part B and Part D, which operate on a pay-as-you-go basis using mixes of beneficiary premiums and general federal monies. While Parts B and D will not exhaust their respective trust funds, they will have increasing impacts on the deficit as their federal subsidies are forced to increase. Medicare B costs are projected to grow at a 4.7 percent annual rate (based on current law), and Medicare D at a 9.7 percent rate through 2020, compared with forecasts of 5.2 percent annual GDP growth.Continue reading…

The System Firsthand

• 1

By BRAD FLANSBAUM, DO

Grandma and me

Grandma is 93.  The matriarch of my family is in worsening health, and her decline is difficult to observe.  We all experience the travails of the US health care system at some point, and in my family’s case, ours is no exception.  The stress on my mom and aunt is considerable, and my grandmother is increasingly alarmed at her frailty and poor memory.

Through July of 2010, she was independent.  She walked daily, traveled, drove (that is another story), and enjoyed her brainteaser and crossword puzzles.  By all accounts, she was happy, albeit with the usual pangs of age.  She took no medication.

Last summer that changed when she fell and underwent a 3-day hospital stay.  Her memory was not the same and her gait was unsteady thereafter.  It was a minor stroke.

After discharge, her functional status worsened, and the vicious cycle we all witness as docs—setback beget setback—reared its head.

My mom sold the house, and grandma moved into an assisted living facility, a lovely place, but it was not home.  Her refrains, “the food and company are lousy, and I am depressed and lonely,” along with an assortment of other issues —all upsetting, given the vitality of this woman until recently—presented and intensified.  Relocation trauma is a known condition, but one you would differentiate only if you witnessed it firsthand.  I am now familiar with a (new) geriatric term.Continue reading…

It’s All Going According to Plan

• 75

By JONATHAN HALVORSON

Most people regard health care reform in America as thoroughly bungled. The proverbial train left the station weak and wheezing, was pushed off the rails by hooligans and is about to crumple in an inglorious heap in the ditch. Only about 20% say the reform hits the sweet spot, with the rest convinced it went too far or didn’t go far enough.

To review the most recent pilings-on: in a time of huge Federal deficits, we get depressing predictions that the PPACA will do little or nothing to slow the growth of health care costs. Only a year after passage of what was supposed to be comprehensive reform, Democrats acknowledge that Medicare and Medicaid spending remain out of control and propose new cuts in the hundreds of billions. In the span of four months, Republicans switched from posing as aggrieved defenders of Medicare spending, to proposing to slash it and leave seniors to absorb the spillover. Medicaid funding is probably even more precarious, since fewer Medicaid recipients vote.

To add injury to injury, the Supreme court may rule to invalidate the entire law, or perhaps just the mandate to purchase insurance, thereby removing the most hated part of the law, but eliminating the “universal” part of universal coverage and inviting an actuarial death spiral. Oh, and the few reforms that look like they might bring costs down, like the IPAB board in Medicare and the minimum medical expense ratio for insurers, are under threat of being watered down. A year after legislation has been passed that will transform nearly a fifth of the American economy, to the casual observer it looks like nothing much has happened and nothing in the future is secure, especially anything that the big industry players don’t like.

In light of this and more, pessimism is understandable, but what we are witnessing in these turns of events is not mere politically-driven chaos. There is good reason to think that events are unfolding more or less in line with a staged strategy for deep reform that emerged out of the experience in Massachusetts. The strategy is essentially this: enact universal coverage first to precipitate a sense of crisis. This will lead to deep reform on the problem that exacerbates all other problems: the cost of health care. Readers of this blog need little reminding that these costs are twice as high as in any other nation.Continue reading…

Talking Uninsurance with Phil Lebherz

• 2

By MATTHEW HOLT

Phil Lebherz is the Executive Director of the Foundation for Health Coverage Education, which has as its mission the goals of educating uninsured people about their options to get insurance. Phil is also the Founder and Chairman of LISI, a company that provides sales support services for employee benefits insurance brokers. With colleagues at the Foundation (including Alain Enthoven, Len Schaeffer and David Helwig) Phil just released a report that was featured in Health Affairs that basically said that most uninsured people showing up in Emergency Rooms in San Diego should have been covered by Medicaid, and that the set-up of Medicaid in California makes it impossible for them to enroll themselves. This is preciously close to the conservative argument that there are no uninsured because they all “could be” covered by Medicaid. But given that under the ACA Medicaid is going to massively expand, you may surmise that I’m not altogether won over by this argument.

So a fun conversation with Phil ensued. You can listen to it here (and look at for the bit where he claims that Len Schaeffer–the man who built Wellpoint into the force it is today–is really a supporter of universal health care because he ran HCFA under Carter for a few minutes in the 1970s!). And no, it wasn’t all violent disagreement–but enough was to make it interesting.

When It Comes to Patient Safety, Caution Isn’t a Four-letter Word

By JORGO CHATZIMARKAKIS

Around the world and now in the United States, there is a broadening discussion of how best to proceed down the path of approving and getting to market medicines called biosimilars.  Biosimilars are non-identical copies of next generation medicines known as biologics.  As the U.S. begins establishing new guidance for biosimilars, regulators and legislators should look to the European Union model on guidance policy and approve these important, often life-saving, drugs when they are proven to be safe for the patients they are intended to heal.

There is justified debate and concern both here in the EU and other nations on how best to introduce biosimilars into the marketplace.  We know from the science, that it’s immensely more difficult to  produce a biosimilar than a generic version of a traditional drug.  And with this increased difficulty, comes increased risks to patients in the form of efficacy and drug-to-drug interactions.  However, by adding biosimilars to the treatment regimen, we can hope to see long-term therapy at the lower costs that biosimilars may be able to provide.  This is important to every country struggling to meet the demands of an aging population and rising health care costs.

As policymakers this dilemma is made easier because our focus must always be on patient safety.  Citizens trust that their nation’s regulatory bodies are looking out for their best interests and doing their due diligence to ensure a safe drug supply.  So patient safety is our starting point, our ending point, and our path along the way.Continue reading…

Maybe there really is mobile health after all

• 1

OK, I’m kidding–but Ford Motor Co is excited enough about its new collaboration with WellDoc that it wanted to fly me to Detroit to take a look at it. (I declined–perhaps they should move their headquarters to San Tropez). Welldoc is a pretty interesting Web & iPhone based diabetes management tool (here’s a interview video I did with CSO Chris Bergstrom last February). Now Ford has put it in the car. Apparently they believe that it’ll interact with pollen counts and automatically turn on the AC (or at least this is what the “Wheels” blogger on the NYTimes took away from the meeting). But what is interesting is that they’ve integrated the speech to text version of Ford’s Sync–which is the internal bluetooth system that allows people to talk to their car. It’s experimental, but it wouldn’t surprise me to see this in many more cars–at least by the time I buy my next new one in 2024.

A New Cost Control Idea – Paying For Outcomes

• 3

By JOHN E. MCDONOUGH

When it comes to reducing or controlling rising health care costs, we face a problem called “the fierce urgency of NOW.”

We have learned from the Medicare and Medicaid budget proposals by Rep. Paul Ryan, R-Wis., that Republicans have no substantive ideas on how to address these costs beyond shifting the bill to consumers and states. We also know that Democrats embedded a lot of promising ideas to generate savings into the health law — concepts ranging from medical homes and accountable care organizations to payment bundling and value-based insurance design. But these ideas will take time before we know if and how well they work.

But time is something we don’t have.

The federal government, states, employers and consumers are all struggling under the pressure of rising health care costs. For them, solutions can’t come soon enough.

State governments are facing a “Medicaid desert” between the end this year of the stimulus package’s enhanced federal matching rate and the 2014 implementation of the health overhaul’s Medicaid expansions. Some worry the sorry choices to address the funding shortfall will come down to cutting benefits, shrinking provider payments, hiking cost sharing and shredding eligibility. Proposals to control spending within Medicare have put that program equally in peril.Continue reading…

Using Laws to Help Solve the Public Health Crisis of Mental Illness

• 2

By JEFFREY SWANSON & JOHN PETRILA

May is Mental Health Month, a good time to remember the ten million adult Americans who suffer from a serious mental illness such as depression, bipolar disorder, or schizophrenia.  Without proper treatment, psychiatric disorders put an enormous strain on affected individuals, family members and on society at large.

In the mid-1950s, state mental hospitals housed about a half a million people with mental illness. Many held patients against their will for decades in understaffed and deteriorating wards.

Today, most of those hospitals have been shuttered; the ones remaining hold fewer than 50,000 patients.

Taking people out of psychiatric institutions would have marked an extraordinary leap in social progress, if only it had been accompanied by a proportionate and continuing public investment in community-based mental health care. Instead, we now have a public system of mental health care that is fragmented and grossly underfunded.Continue reading…

Fact-checking Medical Claims

• 7

By BRIAN MOSSOP

In 2007/08, the work of Nicholas Christakis and James Fowler revealed that human behaviors, and even states of mind, tracked through social networks much like infectious disease.

Or put another way, both obesity and happiness worm their way into connected communities just like the latest internet meme, the best Charlie Sheen rumors, or the workplace gossip about Johnny falling down piss-drunk at the company’s holiday party.

But according to a new research study, incorrect medical facts may be no different, galloping from person to person, even within the confines of the revered peer-reviewed scientific literature. And by looking at how studies cite facts about the incubation periods of certain viruses, a new study in PLoS ONE has found that quite often, data assumed to be medical fact isn’t based on evidence at all.

How many glasses of water are we supposed to drink each day? Eight – everyone knows it’s eight. But according to researchers from the schools of Public Health and Medicine at Johns Hopkins University, this has never been proven true. In fact, they argue there’s not one single piece of data that supports this claim.

Digging a little deeper, the research team dove into scientific papers looking for places where researchers quoted the incubation period of different viruses, from influenza to measles. Every time a claim was made, they traced the network of citations back to the original data source (and provided a cool visualization of the path, to boot). For example, many studies will set the stage for their own research by saying that it’s commonly known that the incubation period for influenza is 1-4 days, and next to that statement, they’ll put a small reference in parenthesis, which signals where they obtained that information.Continue reading…

assetto corsa mods