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Above the Fold

The McVictim Syndrome Could Kill Us

Dec 9, 2010• 57

By DAVID GRATZER, MD

Call it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America’s obesity epidemic.

In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month’s Journal of Health Economics, University of Illinois researchers join a long list of analysts who blame urban sprawl for obesity. In November, former Carter administration advisor Amitai Etzioni argued that it’s so hard for Americans to keep weight off that adults should simply give up and focus attention on the young instead.

The peak of the trend: A recently released Ohio study, using mice, suggests “fine-particulate air pollution” could be causing a rise in obesity rates.

How long before we’re told that the devil made us eat it?

The McVictim syndrome spins a convenient — and unhealthy — narrative on America’s emerging preventable disease crisis. McVictimization teaches Americans to think that obesity is someone else’s fault — and therefore, someone else’s problem to solve.

Bending the Curve, Beginning with Birth

Dec 9, 2010• 4

By AMY M. ROMANO

As I prepare for next week’s webinar on payment reform to align incentives with quality, I have been thinking a lot about how we pay for maternity care in this country, and the opportunities to rein in costs while improving the quality of care. I have concluded that we face both an unprecedented opportunity and an unprecedented responsibility to get serious about maternity care payment reform.

Pregnancy, childbirth, and newborn care are collectively the most common and expensive hospital conditions billed to both Medicaid and private insurers. The national hospital bill for maternity care totaled $98 billion in 2008 – and no other condition came close to this figure. (See more facts about costs on Childbirth Connection’s updated Facts and Figures page), With states across the country facing budget crises, strategies that responsibly reduce the Medicaid bill for births ought to be on the table, especially if we can do so while simultaneously improving quality. (More on that in a minute.)

What are the arguments for payment reform? They fall into a few categories:

We’re paying too much
Incentives and idiosyncrasies built into the current system virtually guarantee that we’ll continue to pay too much
The payment system offers no accountability whatsoever for providing high quality care. In fact, it incents poor quality care.

Although maternity care seems to have been off the radar of those debating strategies to bend the cost curve, that seems to be changing. A flurry of recent articles and reports have demonstrated the points above:

$978 American Dollars

Dec 9, 2010• 7

By JESSA HARFORD

On 4/29/10 I received a Mirena IUD. I thought about this a lot; I read forums and articles on the device and its side-effects. I decided that because I already have a beautiful son who is 2 years old with my wonderful boyfriend of 7 years and we do not need any more children at this point in our lives, that it would be a good idea. You see, we both have been unemployed for a little over a year now. And while on Unemployment we made too much to receive Medi-Cal for any members of our family. So, while on Unemployment I was paying about $300/month out-of-pocket in premiums for medical insurance for my son and myself. (My boyfriend thinks his body can heal itself.) Anyway, after paying $75 for the visit and only being in the appointment for about 30 minutes, and another $75 for a mandated follow-up appointment, I received a bill on 8/18/10 for $978. (That is 978 American dollars, just to clarify.)

As I stated, while I got this device I was paying out-of-pocket for my insurance premiums because I could not be approved for Medi-Cal. A couple months after getting the IUD both of our Unemployment checks stopped coming. We had no income. Zero dollars a month coming into our home. So I instantly went down to the DHA and applied for pretty much anything I could. I started receiving Medi-Cal for all 3 of us. (This was all before I got the bill, or knew how much it was going to be.) When I went to Kaiser’s Customer Relations Department they informed me that Medi-Cal would take care of whatever cost the IUD would be, but now that I have gotten this bill and spoken to them again, they are saying that they were mistaken when they told me that because I was not receiving Medi-Cal during the time I got the IUD.

The Next Generation of Communities Part 2: Integration Within the Delivery System

Dec 9, 2010

By BIANCA GROGAN

The notion that an online community could be embedded in a health care delivery system is still mostly foreign, but at the Health 2.0 Fall Conference in San Francisco, October 7-8 , 2010, we saw two examples. The Next Generation of Communities session introduced a collaboration between dLife and Geisinger Health System and a presentation from the UK’s iWantGreatCare.

Spent

Dec 9, 2010• 2

By ROB LAMBERTS, MD

“I need you to do me a favor,” my nurse asked me at the end of our day on Friday.

“Sure,” I answered, “what do you want?”

“Please have a better week next week,” she said with a pained expression. “I don’t think I can handle another one like this week.”

It was a bad week. There was cancer, there was anxiety, there were family fights, there were very sick children. It’s not that it’s unusual to we see tough things (I am a doctor), but the grouping of them had all of us trudging home drained of energy. Spent.

I think that this is one of the toughest thing about being a doctor (and nurse, by my nurse’s question): the spending of emotional reserves. I am not physically active at work, yet I come home tired. I don’t have to be busy to feel drained. It’s not the patients’ fault that I feel tired. They are coming to me to get the service I offer to them, and I think I do that job well. The real problem is in me. The real problem is that I care.

Analysis: Aetna Jumps into HIE Market Acquiring Medicity

Dec 9, 2010• 2

By JOHN MOORE

First it was United Health Group’s (UHG) Ingenix Division’s acquisition of leading HIE vendor (and top competitor to Medicity) Axolotl. Then this morning Aetna counters by acquiring Medicity. In just a few short months these two payers have completely changed the landscape of the HIE market by acquiring the two leading HIE vendors in the market today. Now that both of these vendors are in the hands of payers what are the implications both to the HIE market and more broadly the healthcare sector? Following is our assessment based on our continuing research of the HIE market and a number of interviews today, not only with the Aetna and Medicity, but also several other active participants in the HIE market.

The Deal:
Aetna acquired Medicity for a King’s ransom of $500M, a handsome multiple of Medicity’s 2010 gross revenue. Medicity will operate as a separate entity under the Aetna brand maintaining its current headquarters in Utah. According to Medicity, initial conversations began in late October/early November and quickly accelerated to the deal announced today. Aetna plans to close the deal before the end of year. As part of the deal, the senior management team of Medicity has agreed to stay in place for the next few years.

The Motivation:
While some may argue that Aetna was simply looking to counter the move by UHG or Aetna’s new CEO was looking to make a mark, Chilmark sees a more thoughtful and strategic move at play here which in the end may justify the price paid.

Healthy People 2020 Participates in the Health 2.0 Developer Challenge

Dec 8, 2010• 2

Health2challenge

Health 2.0 is excited to announce the first challenge for the 2011 cycle of the Health 2.0 Developer Challenge that will be live through the New Year!

Healthy People 2020, launched on December 2, 2010, is the Nation’s leading health promotion and disease prevention agenda for the decade, including goals, 40 plus topic areas, and 100s of data-driven objectives and targets. HP2020 is primarily aimed at achieving the goal of longer, healthier lives for all Americans. Now that they have launched, they’ve submitted the myHealthyPeople Challenge to the Health 2.0 Developer Challenge.

The myHealthyPeople Challenge is asking entrepreneurs, developers, health educators, public and clinical service providers to develop an engaging and empowering customized. Features could include mash-ups, easy-to-use data visualizations, analytics, reporting, and other novel combinations of national, state and community level health data. Applications should enable users to tailor their areas of interest and enable myHealthyPeople to be accessible on desktops and/ or mobile devices.

Is My Canadian Online Pharmacy Really in Canada?

Dec 7, 2010• 8

By ED PULLEN, MD

Maybe Not.

I practice in Washington State, and have a number of patients who travel to Canada to purchase their medications. Why drugs are so much less expensive in Canada than in the US is primarily related to the single payer system in Canada, where drug companies have to negotiate prices with the Canadian health plan.

In the US with so many different insurers none have the where-with-all to negotiate steeply discounted prices because to remain competitive they have to offer all the popular drugs or risk losing patients to plans that do offer those drugs. This leads to a situation where many patients simply cannot afford some of the expensive branded drugs that they are prescribed. Admittedly we have a nice variety of inexpensive generic medications for most conditions, but in some situations there is no good alternative to expensive drugs. Don’t think the Discount Drug Coupons are going to save you in the long run.

Of my patients who get drugs from Canada, many of them see a physician there who does a brief evaluation and re-prescribes the medications prescribed for them by me or other US physicians. Others find pharmacists who will fill prescriptions written by US doctors. At the border crossing coming home rarely patients are searched and have their prescriptions confiscated, but the prices in Canada are enough less than US drug prices that it is worth the trip and risk of confiscation that patients using expensive branded meds find the trip worthwhile. I don’t have a big concern for these patients. I have no reason to believe that the drugs dispensed in Canada by pharmacists to visiting Americans are not the same medications they get in the US.

HIT Trends Summary for November 2010

Dec 7, 2010• 1

By MICHAEL LAKE

This is a summary of the HIT Trends Report for November 2010. You can get the current issue or subscribe here.

Hospitals continue to drive HIT dynamics. According to a report by SK&K, more than half the physicians in health system- or hospital-owned practices are using EMRs, a jump of more than 10% over last year. This is further validation of the importance of hospitals and systems in the current adoption dynamics. The relaxation of Stark rules, the influence of provider incentives and potential hospital participation in medical home and accountable care may be driving interest. KLAS reports that smaller hospitals are ignoring typical suppliers in favor of more traditionally large hospital vendors. They likely feel the companies serving bigger organizations will be getting the best experience in helping clients meet federal criteria to get the incentives. And according to an executive of a firm providing lab technology writing in Becker’s, all this hospital EMR activity presents new opportunities for hospital laboratories. They may be able to leverage new connections with community physicians into increased business opportunities.

McAllen and El Paso Redux: New Evidence from the Insured Under-65 Population

Dec 7, 2010• 24

By JON SKINNER, PhD

Last year, Atul Gawande wrote in the New Yorker about the remarkable differences in health care spending for two Texas cities: McAllen and El Paso. In 1992, according to the Dartmouth Atlas, the two cities were essentially identical with respect to per capita Medicare expenditures. By 2007, McAllen’s spending had surged, with overall expenditures nearly twice as high as in El Paso. Dr. Gawande visited the two communities, and brilliantly documented a culture of entrepreneurship among McAllen physicians that seemed to explain their elevated rates of hospital admissions, end-of-life care, and home health care.

But what about the under-65 population? Dr. Gawande spoke with two independent firms about their measures of under-65 utilization, and found generally higher rates in McAllen. My colleague Thomas Bubolz studies the under-65 Medicare population – primarily people on Social Security Disability Insurance — and his preliminary results also point to much higher utilization in McAllen compared to El Paso. Another study using national data by Michael Chernew and colleagues (here) found a strong positive correlation between utilization rates for Medicare and the under-65 population insured by large firms. (That they also found a negative correlation between Medicare spending and the negotiated price per procedure in the under-65 population points to another source of regional variation: market concentration.)

So when Luisa Franzini and Osama Mikhail, professors at the University of Texas School of Public Health, first offered me the opportunity to work with them using Blue Cross-Blue Shield data on under-65 spending in Hildago (McAllen) and El Paso Counties, I had strong expectations that we’d end up with pretty much the same result.

I was wrong. In a recent Health Affairs article, we found that, on average, overall spending per patient in McAllen was about 7 percent below that in El Paso. Granted, we found the familiar Medicare utilization patterns among people over age 50: McAllen admission rates were 89 percent higher than those in El Paso, and overall expenditures 23 percent higher. But outpatient visits and spending were lower across the board in McAllen, as was total spending for those under age 50. What was going on?