THCB

Categories

Above the Fold

Health Care Reform: A Better Idea

By BARRY L. FISHER, MD

President Obama asked anyone with a better health care reform proposal to bring it to his attention. As a physician who has practiced for the past 37 years, I have been in the system long enough appreciate a better way to approach this problem than is being debated.

Heath care system incentives are wrong, and are primarily responsible for its spiraling growth. Increased utilization engenders increased expense. The proposed health care reform will not reduce the growth of health care expenditure. It does nothing to change incentives driving its growth. Utilization and costs must increase if all Americans are covered as proposed, unless incentives are altered. Patients initiate the process of health care, and physicians, and suppliers benefit from increased utilization. Utilization will not decrease until patients are made financially responsible for their health care decisions.  Substantial Increases in annual deductibles and co-pays will change this incentive. People may overspend and waste time, but nobody wants to use expendable income wastefully on health care. Making people think about the cost is the ONLY way to stop wasteful spending that has led to spiraling growth of health care costs, and the only way to do this is to have more come out of their own pockets!

Patients need to take greater financial responsibility for poor lifestyle decisions. Diseases caused by poor lifestyle decisions (smoking, alcohol and drug abuse and overeating) do not deserve the same level of coverage as unavoidable conditions such as appendicitis and Type I diabetes. Lifestyle related illnesses such as type II diabetes in the obese, alcoholic hepatitis and cirrhosis, and lung cancer and COPD treatment in smokers, rate punitive deductibles or co-pays. Also conditions doctors have never been able to cure like the common cold should be excluded from coverage. Grandma needs to resume the role of diagnosing a viral cold, putting the afflicted to bed, and making the chicken soup that will provide the cure!

Educate people about the probability of effectiveness and cost of heroic end of life treatments. It has been said that the majority of Medicare benefits are paid out in the last few days of life. When faced with a terminally ill family member, families react emotionally and irrationally requesting providers to “Do Everything”. They need to be informed of the cost and probable futility of further measures, of the existence and content of the living will, and if they still request the treatment they need to be financially responsible for the cost! To reduce waste, people who cause waste have to pay for that waste.Continue reading…

Johns Hopkins Medicine and the Health Care Debate

• 8

Photo courtesy of the Johns Hopkins Gazette

While concepts for health care reform volley back and forth in Washington, D.C., and around the nation,  Johns Hopkins has quietly but meaningfully injected itself into the debate.

Johns Hopkins Medicine has been working with a group of 12 academic medical centers to explain the key role of these institutions in the delivery of health care to millions of Americans.

The group —which includes Emory University, Mount Sinai Medical Center, UCSF Medical Center, the University of Pennsylvania and others—is focusing on a number of issues, including a proposal to create “Health Care Innovation Zones” that would offer support for providers working with stakeholders in their regions to redesign a more patient-centered delivery of health care.

Continue reading…

Pioneer Speaks about MA Health Reform

• 2

By PAUL LEVY

Picture 66 The Pioneer Institute is a public policy research center in Massachusetts. On the political spectrum, most people would call it conservative, or a least free-market oriented. In my opinion, regardless of your particular position along that spectrum, the institute’s work is worth reading.

Last month, it issued a paper about the Massachusetts health care reform experiment that serves as a report card on a number of factors, with particular focus on the question of the equity and sustainability of the financing of the health care insurance access system put in place by Chapter 58 of the Acts of 2006.

For those interested in the possible applicability of the Massachusetts model to the national scene, authors Amy M. Lischko and Kristin Manzolillo say:

It is undeniably premature to enact a reasoned national-level solution based on Massachusetts’ or other state experiments. . . .Continue reading…

A little HIMSS housekeeping

• 1

By MATTHEW HOLT

Today till Weds I’ll be at HIMSS in Atlanta. You can see me at the Bloggers panel at 3pm Monday, or more importantly at the talk Jane Sarasohn-Kahn & I are giving on Health 2.0 & Participatory Medicine at 1pm on Tuesday in Georgia Ballroom 1.

I’ll also be wondering around with the trusty flipcam, so expect to see a few schedules and not so scheduled interviews up on THCB too. And you can always follow my twitter feed http://twitter.com/boltyboy If you want to meet me, best bet is to DM or follow my social schedule here although with Jetlag waking me up at 4am not sure how long I’ll last tonight!

Interspersed in all of that tech stuff, THCB will roll on as usual. I’ll let you know in 3 days time if the tech sector in health care has made more progress since last year than their political cousins!

23 skiddoo

I think the Chelsea fans with whom I went to the game today think I’m a bad omen. First loss in 39 games at home dating back to 2008

It’s Up To Us …

• 4

By PAUL LEVY

Levy A conversation with a reporter yesterday helped me clarify my thoughts about federal health care legislation. In my view, the most effective role of the federal government would be to provide national standards by which the health insurance companies operate (e.g., with regard to pre-existing conditions, rescission, and lifetime limits), require the existence of insurance exchanges, and establish the conditions under which universal access to insurance is made possible. Other items I would suggest for federal legislation are summarized below.

I am hoping the US government will not attempt to control the costs of health care by making legislative decisions with regard to clinical matters. Not because we should abandon cost control; but because federal efforts in this sphere are likely to be crude and not clinically appropriate. You just have to look at the process by which the USDA food pyramid is influenced by food product lobbyists to imagine how the government would attempt to regulate the design and provision of care among medical specialties, equipment and supply manufacturers, and pharmaceutical companies.

As should be evident to readers, I think it is possible for the participants in the health care system to accomplish major changes in the rate of medical cost inflation. Two articles have this theme. One is by Business Week’s Catherine Arnst. The other is by Lucien Leape, Don Berwick, and others in Quality and Safety in Health Care. Both are worth reading, and they overlap in recommending several areas — reducing infections and other preventable harm; empowering patients and families to participate in their care; and disclosing and apologizing for mistakes.

Beyond these articles, there is a remarkable consensus on these items, and yet hospitals and doctors often fail to implement them. Even hospitals that house some of the most accomplished authors in these fields often do not follow the advice of those colleagues when it comes to making improvements in the delivery of patient care.

It is not unusual for industries facing structural change to be slow to move. Why? Because the leaders of those industries were promoted based on their success in the past financial, political, and social environment. They were hired for their ability to maintain the status quo, rather than for their ability to make change. Eventually, though, societal forces make themselves felt. If an industry does not adapt, the government will step in. The medical profession has to decide whether it wants to take charge of this process or abdicate to Congress the right to act in its stead.

The White House Healthcare Summit – Democrats 0 Republicans 0

• 86

Laszewski

There is politics and there is policy.

On the policy front what we saw today was the same exchange of the old talking points we have watched for a longtime. No progress was made toward any kind of health care bill. That is no surprise–this was never going to be the place to
fashion any kind of compromise.

At the end the President asked the Republicans if it was worth it to spend another month or six weeks trying to come to some agreement. I am glad he did that. I am not optimistic but a “yes” from the Republicans would be the right answer for the country.

On the political front this was a win for Republicans because it was a draw. Granted, they have a very thin health care agenda but all they had to do was hold their own over the course of the day. Politically, if not on policy, they did that. No minds were changed in the room and likely none out in the country. The left will still say get on with passing this, those on right will say kill it, and the majority of critical swing voters will still be concerned that the Democratic bills are going too far too fast in the face of the Great Recession. This is the biggest reason I don’t hold out a lot of hope there will be a lot of Republican willingness to come to the table–at least before the November elections.

Ironically, this “bipartisan summit” may have just increased the political cynicism in the country because it went off so predictably.Continue reading…

Pay (Only) for Health Care that Works

• 30

By DAVID HYMAN

Health care is expensive partly because governmental payers and insurers foot the bill for large quantities of medical services that are ineffective, unnecessary, or unproven. According to a RAND report, studies of clinical efficiency “indicate that one-third or more of all procedures performed in the United States are of questionable benefit.”

When state and federal governments set the minimum terms for insurance coverage, this problem is likely to worsen. Governmental decisions reflect the political power of providers (who want to sell more services), the sympathy felt for patients (who want to consume more services and have other people pay for them), and the desires of bureaucrats (who generally want to maximize their budgets and their importance). These interests coalesce, causing governments to aggressively mandate coverage of services that may or may not be necessary.Continue reading…

Not exactly what athenahealth was looking for

• 6

By MATTHEW HOLT

This is not a fun day for athenahealth, and frankly with HIMSS coming up, not a fun time to have such a day. None of this has anything to do with their products or their client services, but late last night the company announced that it’s going to be restating its earnings. You can see a longer discussion on The Street.com but essentially it appears that athenahealth has been amortizing its installation costs over one year whereas they ought to have been doing it over more years. The net result is that they’ll have to restate some earnings and are going to miss the next earnings reporting deadline. The stock is off roughly 12% today.

Athn

What’s been happening is that the new CFO (Timothy Adams) has come in and cleaned house, and not liked what some of the old CFO (Carl Byers who moved to Chile!) had been doing. Long term this clean up is probably good news. The company is still operationally profitable (we assume!), and its business of running the back office and increasingly front offices of doctors using a combination of technology and forklifts/sweat remains a great way of both routinizing their businesses and aggregating data for overall process improvement.

So better to get any financial “irregularities” cleared out now and be more conservative. But while other than the shareholders (and the coming lawsuits) it probably doesn’t matter much, this may per chance slow down Jonathan Bush a touch next week. Or maybe not. We’ll see….

assetto corsa mods