The Health Care Blog – Page 792 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

The Health Insurance Purchase Mandate: Peeking Into Pandora’s Box?

Sep 15, 2010• 25

By DAVID DRANOVE

Governors from most twenty mostly red states are suing to block the implementation of health reform. I have no idea whether they will win on the legal merits. But when it comes to the economics of the issue, they are on the wrong side. But even as my head says that the mandate is a good thing, my heart tells me otherwise.

Mandating the purchase of a good or service should be anathema to any card-carrying economist. But healthcare is unlike other goods and services in one critical way. No one will sell you food or clothing or anything else that you cannot pay for. But if you need surgery to save your life, someone will operate on you. Healthcare providers are trained to “treat now, bill later.” And while providers pursue (and sometimes harass) the uninsured for payment, the lion’s share of their costs end up as bad debt or charity write-offs. So the uninsured get their care while the rest of us pay for it. An insurance mandate is supposed to prevent such free riding. It is as if we are saying, “We can’t stop ourselves from taking care of everyone who needs medical care, so we will force everyone to pay their fair share.”

This concern about free riding is how we got health insurance in the first place. During the Great Depression, many patients couldn’t pay their bills. So hospitals and doctors encouraged individuals to prepay for their share of the community’s medical costs in exchange for guaranteed access. Even then, many remained uninsured and some had trouble getting medical care. By the 1950s, the new Hill-Burton program subsidized nonprofit hospitals in exchange for guarantees that they would take in the uninsured. A building spree of taxpayer funded county hospitals and community health centers further bolstered the safety net.Continue reading…

The Next Big Thing for Doctors

Sep 14, 2010

By RICHARD REECE, MD

The Future Just Happened,
by Michael Lewis, 2001

As a consultant to the Physician Foundation, a not-for-profit 501 C-3 Organization representing physicians in state medical societies, as a sometime futurist, and as someone who has written extensively about innovation in Innovation-Driven Health Care (Jones and Bartlett, 2007) and in 1475 blogs in Medinnovation, I have been asked: What is the next big thing for doctors, and how should they react to it?

The next big thing for physicians will be Medicare fee cuts in the neighborhood of 50% by 2020 as mandated by the Affordable Care Act, and the next big clinical innovative response for doctors will be encouraging patients enter their own data, their own chief complaint, and their own medical histories before seeing the doctor to compensate for fee reductions.

Ceding a Traditional Physician Function to Survive Economically

Doctors will have to cede a traditional function – taking a history – to patients to become more efficient to survive. Payers – including Medicare, Medicaid, and private health plans- will demand standardization and restructuring of the medical history to achieve consistency in medical records. Patient-entered information may be disruptive. Doctors will have to change practice flow patterns to adjust to reality of lower pay. The need for greater productivity will drive this change.

The Cost of Care

Sep 13, 2010• 45

By NEEL SHAH, MD

Do you have a story about a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a medical test or treatment might cost and couldn’t find out?

Costs of Care, a nonprofit group based in Boston, is offering $1000 for anecdotes like these that illustrate the importance of cost-awareness in medicine. Judges will include former U.S. Health and Human Services Secretary Michael Leavitt, Boston surgeon and New Yorker writer Atul Gawande, and former Massachusetts Governor and Democratic Presidential Candidate Michael Dukakis. According to Dr. Neel Shah, who is directing the contest, “Using everyday examples from across the country, these stories will highlight the need to make healthcare prices more transparent.”

Submissions should be no longer than 750 words and are due by November 1st. More details are available here.

EHR Mythology 101

Sep 13, 2010• 25

By MARGALIT GUR-ARIE

Healthcare IT is bustling with activity these days. There are big changes in the air and, only time will tell, but we may be witnessing a defining moment in HIT. Naturally, everybody involved has an opinion and some folks, yours truly included, have more than one.

Below are some of the more popular opinions amongst physicians and a considerable portion of industry analysts.

The current EHRs on the market are outdated legacy systems

This is the battle cry of every new entrant to the market. First the ASP, or web based, vendors referred to the existing client/server vendors as legacy systems. This is about to change once the iPhone EHR vendors start calling the web EHRs legacy systems. One common thing that new vendors tend to gloss over is the fact that the existing vendors did not stop writing software in 1995. Most incumbents are releasing updates and major new versions on a regular basis, and by now most Visual Basic code has been replaced by .NET and the latest Java technologies. True, here and there, you can still find MUMPS platforms, but even the VA’s VistA is in the process of getting a major upgrade towards generic web based capabilities, not to mention the futuristic bombshell veteran EHR vendor e-MDs is about to toss into the mix.Continue reading…

Building a Better Mousetrap

Sep 13, 2010• 23

By JOHN C. GOODMAN, PhD

The story was front page and above the fold in The New York Times. Six teachers in Newark are leaving the traditional school system to start a public school of their own.

If the product was something other than education, this would have been no news at all. I would guess that the vast majority of businesses in this country were started by people who walked away from an employer, convinced that they could make a better product on their own. Teachers rarely have the opportunity to do the same, however. They are usually trapped in a system that does not allow innovation or experimentation and is ordinarily hostile to entrepreneurship.

What does all this have to do with health care? A lot. Doctors are just as trapped as teachers. And that is the most important defect in the health care system.

This, of course, is not the conventional view. The received wisdom in the health policy community is that doctors have too much freedom, not too little. Witness the wide variation in medical practice patterns — from city to city and region to region — all seemingly unrelated to medical outcomes. How can anyone defend that? Certainly not me. Where I part company with so many of my colleagues is that they blame the doctors for this problem — I blame the third-party payers.

Were we to look into the matter, I’m sure we would find wide variations in the practice of teaching from school to school, district to district and state to state. Yet I still maintain the teachers are essentially trapped. This may appear to be an oxymoron, but it’s really not. Both in education and in health care, the practitioners have a great deal of freedom to waste resources. But they have virtually no freedom to profit by discovering innovative ways of lowering costs and raising quality.

Interview: Highmark introduces private label ADAM iphone app

Sep 12, 2010• 3

By Matthew Holt

A few weeks back Highmark, the big Pennsylvania Blues plan, became one of the first major US insurers to introduce a local navigational iPhone app—a white labeled version of the ADAM tool formerly known as Medzio. I caught up with Steffan Johnson, the Consumer Lead at Highmark responsible for the app to talk about why they did this and where insurers like Highmark might be heading. (And in a technical note, I’ve gone back to transcribing interviews rather than putting up the audio. Let me know what you think. Do you like the transcript or the audio or both? Please answer in the comments)

Matthew Holt: I am talking with Steffan Johnson. Steffan’s formal title is the Senior Consumerism Lead at Highmark. Highmark of course is the big Blues Plan, that was Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield, but is now a Delaware regional insurer in Pennsylvania, and one of the biggest Blues plans overall. Steffan, good morning! Actually, good afternoon for you!

Steffan Johnson: Good morning Matthew!

Matthew: The reason I have got you on here is that you guys have just done a deal with a company that we know well at Health 2.0 called A.D.A.M. This is actually the continuation of something that A.D.A.M. introduced back in early 2009, so a little while ago. And A.D.A.M. has been through some changes, not the least of which is they got purchased by another company this morning, which I just found out about

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Sep 12, 2010

Front-Line Managers are Key to Wellness Program Participation

Sep 11, 2010• 8

By TOM UNDERWOOD

What’s the difference between a company with a high participation rate in wellness programs and a low one? As it turns out, front-line managers—the people who run the daily operations and work the most closely with their colleagues—are actually the ones who can have the most influence, and can best help improve their company’s wellness participation rates.

Finding the answer to increasing wellness participation has vexed employers for years. We’ve done a good job at getting younger, healthier employees to participate in wellness. And employers recognize and appreciate the benefits of comprehensive and integrated wellness programs.

But we haven’t quite found out how to motivate people who have tried and failed or those who have multiple conditions and don’t think anything can help; who think they are too busy; or who simply would rather go home and have a pizza, six pack and watch TV.

Unfortunately it’s individuals with poor lifestyle habits who are costing employers the most. On average, for every $1 of medical and pharmacy costs there is about $2.3 of health-related productivity costs that employers must pay—and that figure is much greater for some conditions. We must find ways to get these non-participants in wellness programs motivated and involved –- for our good—and theirs.

Back to the role of managers; we work with large employers and health plans nationwide. Several times a year we meet with employers at a Summit to share best practices as well as research and analysis we’ve conducted on outcomes from specific health and wellness programs. There’s a good cross section of employers at the Summit who struggle every day to find ways to hold down costs and help their workers become healthier and more productive.

Consumers to Pay More Under Reform

Sep 10, 2010• 32

By MERRILL GOOZNER

The latest analysis of health care reform – out this week from bean counters at Medicare – shows reform will raise health care spending slightly over the next 10 years, not reduce it as promised by President Obama. That won’t make selling it on the stump any easier. Yet there’s a glimmer of hope in the out years of the 10-year projection that the plan will begin to “bend the cost curve.”

Here’s the real bad news for reform supporters. The private insurance market will absorb most of the increase, and most of that will fall on individuals. Employer contributions for their workers’ private insurance will actually fall $120 billion in 2019 from previous projections because of reform.

Individuals will get hit two ways. First, the actuaries at CMS are projecting a huge 9 percent increase in out-of-pocket expenses in 2018 and 2019, after the so-called “Cadillac tax” goes into effect. This is a steep excise tax on high-cost insurance plans. To avoid tax penalties, experts expect employers with such plans – which may only be high-cost because they are filled with sicker and older beneficiaries – will reduce coverage by increasing co-pays and deductibles.

A second factor driving out-of-pocket expenses higher for individuals under reform will be the insurance mandate, which will drive many people to seek coverage through the new state exchanges. CMS predicts over 30 million people will be getting insurance through the exchanges in 2019, substantially more than the 24 million projected by the Congressional Budget Office last March, when reform passed.