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Do the Wrong Thing

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By ROBERT LASZEWSKI

Laszewski As the Democrats make their final push to pass their health care bill many of them, and most notably the President, are arguing that it should be passed because it is the “right thing to do whatever the polls say.”

Their argument is powerful: We will never get the perfect bill. If this fails who knows how long it will be before we have another big proposal up for a vote. There are millions of uninsured unable to get coverage because of preexisting conditions or the inability to pay the big premiums and this bill would help them.

Any big health care bill will be full of compromises—political or otherwise. But this bill doesn’t even come close to deserving to be called “health care reform.”Continue reading…

The Paradox of Technology in Healthcare

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By THOMAS GOETZGoetz

One of the great humdingers in the current debate over healthcare reform is the duplicitous role of technology in increasing costs. Sophisticated medical technologies save thousands of lives every year, giving us scans that spot tumors early and devices that keep our hearts beating and our blood flowing.

But these miracle technologies come with a paradox. In nearly every sector of the economy, technology drives costs down – just as your digital camera gets cheaper and better every year, so technology drives down the cost of manufacturing, the cost of retailing, the cost of research. But for some reason, in healthcare, technology has the opposite effect; it doesn’t cut costs, it raises them. In fact, medical technologies – from CT scans to stents to biologics – are a significant factor in the 10% annual growth rate of healthcare spending, a rate that’s nearly triple the pace of inflation. (Overall, the US is now estimated to spend a stunning $2.7 trillion on healthcare in 2010.)

This was made clear once again last week, when a Massachusetts state audit found that healthcare costs rose 20% from 2006 to 2008, largely because of new imaging technologies. The single largest increase was for digital mammography, a new – and expensive – way to screen for breast cancer.

What’s going on here? Why can’t technology work its magic in healthcare, the way it does in the rest of the economy?

Continue reading…

Dear Mr President, Medicare Stinks

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By ROB LAMBERTS

Dear Mr. President:

The physicians and management in our office had a discussion this morning about the upcoming audits physicians are facing from CMS. I had to wait for my blood pressure to get out of dangerous range to write this letter. The frustration, fear, and powerlessness I felt made me really question whether it is worth continuing to see my Medicare patients.

I am a primary care physician and about 20% of my patients are covered by Medicare. As a whole, they are wonderful people, but difficult patients. The elderly are truly a delight to talk to, learn from, and care for; I consider it an honor to be their doctor. But the complexity of a person’s medical problems goes up exponentially as they near the end of their life. This means that I spend more time per patient for my Medicare population – which is OK if I can be paid for my extra time and effort.

But here is the message we physicians are being given:

Medicare auditors will be knocking at our doors, and if there are “problems” with our charting we will be told to send money back to CMS for our whole Medicare population. We are obligated to prove that we did not defraud Medicare to reclaim the money for the work we did. This is, obviously, consistent with the cornerstone of the American legal system, “A person is presumed guilty unless they can prove that they are innocent.”

The “problems” they are looking for are inconsistencies in the charting and the billing we do. These “inconsistencies” are not just egregious attempts at stealing money from Medicare, they are little things like this:

Continue reading…

The Top Ten Immediate Benefits Americans Will Receive When Health Care Reform Passes

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By MAGGIE MAHAR

Yesterday, the Democratic Caucus of the House listed the provisions of the health reform bill that will take effect “as soon as health care passes,”

The legislation would:

  1. Prohibit pre-existing condition exclusions for children in all new plans
  2. Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool;
  3. Prohibit dropping people from coverage when they get sick in all individual plans
  4. Lower seniors prescription drug prices by beginning to close the donut hole
  5. Offer tax credits to small businesses to purchase coverage
  6. Eliminate lifetime limits and restrictive annual limits on benefits in all plans
  7. Require plans to cover an enrollee’s dependent children until age
  8. Require new plans to cover preventive services and immunization without cost-sharing
  9. Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions
  10. Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs.“By enacting these provisions right away, and others over time” the Caucus declares, “we will be able to lower costs for everyone and give all Americans and small businesses more control over their health care choice.”

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

Price Controls Do Not Work

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By PAUL LEVY

Paul levy

If there is anything about economics that has been proven over and over, it is that price controls do not work. The unintended consequences are usually worse than the problem that led to the solution in the first place.

Massachusetts legislators, feeling the frustration of higher insurance premiums, are now considering a bill to limit doctor and hospital reimbursement payments to 110% of Medicare rates, or perhaps some other percentage of Medicare rates. The problem with this is that Medicare rates are not fully compensatory to doctors and hospitals and have contributed to the increase in private insurance company rates. This was one of the conclusions reached by the Attorney General in her extensive investigation of these matters.Continue reading…

George Clooney Was Onto Something

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By JESSIE GRUMAN200px-Up_in_the_Air_Poster

In the Oscar-nominated movie “Up in the Air,” Ryan Bingham (aka George Clooney), travels around the country firing employees for company bosses who don’t have the stomach to do it themselves -– the ones who prefer to “outsource the downsizing function.”

He finds his own job threatened by a hotshot business school graduate who convinces the president of their company that it would be more efficient to do the long-distance layoffs via the Internet.

Sitting in a hotel bar, our hero makes a passionate speech to his young colleague about how important it is to fire people face-to-face: that a look in the eye, a few words that personalize the institutional rejection and a handshake allow them to maintain some small shred of dignity at the very moment they lose their identity as a valued employee.

This speech resonates with me as I contemplate the waves of e-mail notices in my inbox announcing new electronic tools and personalized Web-based services and sites that can help me take care of myself.  I can take a picture of my rash with my iPhone and send it to my dermatologist.  I can check online to see when I had my last tetanus shot or schedule my next mammogram.  I like interacting with my doctors by e-mail about minor matters.  And if I lived in the empty plains of Eastern Montana, I would probably often prefer a telemedicine visit with a doctor or nurse over a 10-hour round-trip drive for a 20-minute in-person appointment.Continue reading…

Andy Wiesenthal, Kaiser Permanente

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By MATTHEW HOLT

Those of you with really long memories may remember that Kaiser had a little kerfuffle with a guy named Justen Deal. As part of that incident, I did a rather unorthodox interview with Andy Wiesenthal from The Permanente Group in 2006 which is still a hell of a read—mostly about the history of how KP got to the Epic decision and where it was in the middle of the installation process.

Fast forward the better part of 5 years. HealthConnect is done. And the pain and not inconsiderable expense is somewhat forgotten. But now it is done, what happens next? A long and somewhat philosophical interview. But a very interesting discussion.

In ONC I Trust …

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By JOHN HALAMKAPicture 2

It’s my nature to question authority.

Whether it’s religion, politics, or even my local administrative leadership, authority figures must earn my trust.

Earning that trust is not easy. As folks who work closest with me know, I believe that much of Dilbert is based on true case studies.

Over the past year, I’ve worked very closely with many people at ONC – David Blumenthal, John Glaser, Judy Sparrow, Farzad Mostashari, Chuck Friedman, Carol Bean, Doug Fridsma, Chris Brancato, Jonathan Ishee, Arien Malec (on loan to ONC for 8 months), and Jodi Daniel. I’ve worked with HHS CTO Todd Park. I’ve worked with US CTO Aneesh Chopra.Continue reading…

Jonathan Bush, quickly

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By MATTHEW HOLT

Jonathan Bush gave me a quick interview at HIMSS ten days ago. We had a chat about what the recent restatement of accounting was all about (stock off about 12%), and last night they released numbers that apparently made Wall Street a little happier (stock up 6% after hours)

More interestingly we also chatted about the uptake of the clinicals product (pretty well), and whether and when athena would open its network to other application vendors (in a while).

WebMD–Nan Forte explains Health Exchange

By MATTHEW HOLT

WebMD introduced a new series of Health 2.0 style forums last week called Health Exchange. Not everyone was thrilled–in fact John Moore gave it a right padding over at Chilmark mostly because of usability issues. I got Nan Forte, Exec VP at WebMD to explain and she talked at length about how much user testing they’ve done, WebMD’s respect and interest in the rest of Health 2.0, and how tricky it is to deal with those pesky users (my words not hers!). Take a listen to the interview.

Nan Forte, WebMD

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