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Privacy Paradigms: From Consent to Reciprocal Transparency

Nov 1, 2010• 2

By FRANK PASQUALE, JD

Computational innovation may improve health care by creating stores of data vastly superior to those used by traditional medical research. But before patients and providers “buy in,” they need to know that medical privacy will be respected. We’re a long way from assuring that, but new ideas about the proper distribution and control of data might help build confidence in the system.

William Pewen’s post “Breach Notice: The Struggle for Medical Records Security Continues” is an excellent rundown of recent controversies in the field of electronic medical records (EMR) and health information technology (HIT). As he notes,

Many in Washington have the view that the Health Insurance Portability and Accountability Act (HIPAA) functions as a protective regulatory mechanism in medicine, yet its implementation actually opened the door to compromising the principle of research consent, and in fact codified the use of personal medical data in a wide range of business practices under the guise of permitted “health care operations.” Many patients are not presented with a HIPAA notice but instead are asked to sign a combined notice and waiver that adds consents for a variety of business activities designed to benefit the provider, not the patient. In this climate, patients have been outraged to receive solicitations for purchases ranging from drugs to burial plots, while at the same time receiving care which is too often uncoordinated and unsafe. It is no wonder that many Americans take a circumspect view of health IT.

Privacy law’s consent paradigm means that, generally speaking, data dissemination is not deemed an invasion of privacy if it is consented to. The consent paradigm requires individuals to decide whether or not, at any given time, they wish to protect their privacy. Some of the brightest minds in cyberlaw have focused on innovation designed to enable such self-protection. For instance, interdisciplinary research groups have proposed “personal data vaults” to manage the emanations of sensor networks. Jonathan Zittrain’s article on “privication” proposed that the same technologies used by copyright holders to monitor or stop dissemination of works could be adopted by patients concerned about the unauthorized spread of health information.Continue reading…

Companies Clearly Won’t Stop Hiking Health Care Coverage Premiums

Nov 1, 2010• 6

By STEPHEN KRUPA

As employees participate in open enrollment for their company’s health insurance enrollment next year, it’s clear they should make a point of participating in their employer’s enrollment information meetings, not merely pick last year’s coverage. Partly because of the implementation of President Obama’s health care overhaul plan, U.S. workers are expected to pay average premiums of $2,200 in 2011 – an increase of 12.5 percent, the biggest in four years, according to human resources consulting firm Hewitt Associates.

Increases in health care premiums are certain to continue increasing in coming years at double-digit rates, with inflation further exacerbated by the entry of 32 million uninsured Americans into the healthcare system. This will speed the transformation of insurers from underwriters of medical risk to managers of medical risk, a process inevitably accompanied by higher prices.

Annual healthcare inflation — and hence baseline premiums — have been rising 8-12 percent annually for two decades, and there is no reason to expect this to change anytime soon. It could actually increase as provisions of healthcare reform – such as the mandated removal of pre-existing conditions – become law. Some of these provisions, such as the elimination of a dollar amount of health benefits in a given year and the fact that children can now stay on a parent’s health plan until age 26, help explain the likely spike in health insurance premiums next year.

Job Post: Home and Community Based Services (HCBS) Policy Director

Nov 1, 2010• 1

Organization: The Service Employees International Union (SEIU)

Location: Washington, D.C.

The Service Employees International Union (SEIU) is seeking a talented and forward-thinking individual for the position of HCBS Policy Manager. This is a senior-level position within SEIU Healthcare, one of the union’s three operating divisions, and will report to the Home Care Director. The HCBS Policy Manager will have lead-level responsibility for the following:

Providing overall leadership to SEIU’s policy work in the area of home and community based services (HCBS)
Cultivating and maintaining relationships with allied organizations, academic policy experts, government policy-makers and other stakeholders in order to achieve program goals and to drive joint work
Conducting research and policy analysis and developing legislative and regulatory proposals
Developing policy white papers & other written documents for both internal and external audiences
Collaborating with our government affairs staff on lobbying and federal legislative priority-setting
Serving as a resource on long-term care issues for other SEIU staff in DC and in our local union affiliates

The focus of the work is on influencing policy-making at the federal level, though intermittent support of state-level efforts is also part of the job.

PPACA Premium Subsidies: The Government Is Here to Help You!

Nov 1, 2010• 2

By ROGER COLLIER

If anyone ever doubted the extent to which Congressional committees could turn good intentions into a bureaucratic nightmare, they need only to look at PPACA’s premium subsidy provisions and their potential impact on insurance exchanges.

PPACA offers premium and enrollee cost-sharing subsidies for lower-income people not eligible for Medicaid or SCHIP as one of the three key components—along with liberalizing Medicaid income restrictions and requiring everyone to have coverage—of reform’s attempt to solve the affordability problem that’s led to fifty million Americans being uninsured.

How will the subsidy process work? It takes up 25 pages of the final reform legislation, so the following is a vastly simplified description. It’s also one that assumes that the final regulations will not deviate significantly from the law itself.

First, anyone wishing to be eligible for a subsidy must submit an application to an exchange. The application must include all information necessary to determine if the applicant is eligible for Medicaid or SCHIP, as well as for the PPACA subsidies. (Massachusetts’ Connector—the prototype exchange—requires a 12-page page form to convey this information.)

Steve Krein talks OrganizedWisdom

Nov 1, 2010• 2

By Matthew Holt

And in the “stuff I should have posted a few weeks back” file, here’s my interview with Steven Krein, CEO of OrganizedWisdom. Steve (with Unity Stoakes) runs one of the more interesting companies in the online health search and content space. OrganizedWisdom uses actual humans to direct people looking for very specific information to the best content–via their core offering the WisdomCard. As you might imagine that’s harder said than done, so following me teasing Steve a little about him not being at the most recent Health 2.0 Conference (the first and hopefully last they’ve missed), I got him to talk about and show the new WisdomCards and the Expert Health Graph. It’s well worth watching and Steve also gets to hint about some forthcoming news about expanding the presence of WisdomCards much deeper into the health care experience.

Losing Patients With Insurers

Oct 29, 2010• 70

By ROB LAMBERTS, MD

We are losing patients. Certain insurance companies are trying to “play hardball” with doctors, unwilling to negotiate with us over their outlandishly low rates. We have lost patience.

So the signs went up in the exam rooms today:

As of the start of the year, we will only accept X, Y, and Z Medicare advantage plans, and we are presently negotiating with A and B insurance companies. Please consider this when enrolling in plans.

It is highly likely we will drop one of the insurance plans altogether, and we are one of the last practices in our town to accept them.

Patients are distraught. Some of them who have seen us for years are now going to have to go elsewhere, while others that just joined our practice because their previous doctors dropped out of the plan will once again have to find a new doctor. Patients aren’t mad about this, just sad. The conversations go like this:

“So you are dropping X insurance?”

“We will if they don’t change. They are paying us significantly less than other plans.”

“That’s crazy. We just left a doctor because of the same thing. Now we have to move on.”

“Yeah, I am very sorry about that. I just want to see patients; I don’t want to do this kind of thing.”

“Well, I don’t blame you. They pay $1000 for an ER visit for an ear infection, and they won’t pay you what you charge?”

Connected Healthcare: Wellness and Emerging Technology

Oct 29, 2010• 1

You are invited to attend Massachusetts Institute of Technology (MIT) Enterprise Forum’s latest Networking/Panel Event, Connected Healthcare: Wellness and Emerging Technology on Wednesday, November 17th.

Technology is changing how people connect with one another, and the interaction between doctors and patients is next. Never-before-seen opportunities are emerging to further process and analyze data to enrich healthcare outcomes. Please join us for an edifying discussion, and a networking hour to include hobnobbing with movers and shakers in the NY tech scene. Details can be found at:

http://www.mitef-nyc.org/mc/community/eventdetails.do?eventId=292906&orgId=mefny&recurringId=0

DATE: Wednesday, November 17th 2010

TIME: 5:30PM (Reception); 6PM (Panel); 7:30PM (Networking)

PLACE: Chadbourne, Parke LLP, 30 Rockefeller Plaza, New York, NY 10112

THCB Recommends …

Oct 29, 2010

So That’s How The Rates Are Set

Oct 29, 2010• 9

By PAUL LEVY

The Wall Street Journal published a very important article this week. Written by Anna Wilde Mathews and Tom McGinty, it is entitled, “Secrets of the System: Physician Panel Prescribes the Fees Paid by Medicare.

Here’s the lede:

Three times a year, 29 doctors gather around a table in a hotel meeting room. Their job is an unusual one: divvying up billions of Medicare dollars.

The group, convened by the American Medical Association, has no official government standing. Members are mostly selected by medical-specialty trade groups. Anyone who attends its meetings must sign a confidentiality agreement.

Yet the influence of the secretive panel, known as the Relative Value Scale Update Committee, is enormous. The Centers for Medicare and Medicaid Services, which oversee Medicare, typically follow at least 90% of its recommendations in figuring out how much to pay doctors for their work. Medicare spends over $60 billion a year on doctors and other practitioners. Many private insurers and Medicaid programs also use the federal system in creating their own fee schedules.

Engage with Grace

Oct 29, 2010• 4

By Alexandra Drane

This is the full text of Alexandra Drane's talk about Engage with Grace at TEDMED. I'm so proud of Alex for what she's done and her talk was outstanding–Matthew Holt

So when I heard that I was going to be speaking with all of you about end of life, I was a little sad at first…even though end of life is an obsession of mine….because TedMed is such a sexy event, and speaking here is such an honor. I wanted to talk with you about something like vitality – feeling alive, being empowered, taking life into your own hands…but then it hit me… that’s what end of life actually is – that’s what it can be when it’s done well.

But … It’s not usually. 70% of people want to die at home, only 30% do.

Here’s another stat you might not have thought about recently – You only die once. Think about that for one second – You only die once. Not my words – Atul Gawande’s in his incredible essay on end of life – ‘Letting Go’– which I am now declaring as mandatory reading for each and every person attending TedMed.

End of life in the US has somehow failed to become personal. It’s like this thing we put on a shelf and ignore. And getting what you want at end of life has become synonymous with filling out forms and getting waivers and going to some lawyers office where you pay a lot of money and get excited when you get to keep the pen.

But that’s not what it’s about. Not at all. Let me tell you a story.

Once upon a time there was this extraordinary woman named Za – short for Rosaria. Za was first generation Italian, breathtaking to look at, driven to become a pharmacist – the first in her family to go to college – and of course she was also human…She loved to enjoy…spending money she didn’t always have, generous to a fault. She was madly in love with her husband John and her two year old daughter Alessia, the apple of her eye. Deep within Za welled this enormous sense of joy – a deep gratitude for the life she had. As it turned out, deep within her also lived cancer – and not just any cancer – but the terrible and unforgiving brain cancer Glioblastoma – described by one of her surgeons as whip cream in a sponge – virtually impossible to eradicate. The seven month battle Za waged against her illness was a mighty one – she endured two massive brain surgeries, radiation, chemotherapy, all the related humiliations – but the cancer didn’t really care.