The Health Care Blog – Page 843 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Pay (Only) for Health Care that Works

Feb 26, 2010• 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

Feb 26, 2010• 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….

Paris, Here We Come Are

Feb 26, 2010• 5

By MATTHEW HOLT

For those of you just getting up on Friday, here’s a little taste of the atmosphere we’re drinking in for the upcoming Health 2.0 Europe conference. And yes, we have been working hard here too!

Health 2.0 Team in Paris from Health 2.0 on Vimeo.

The Messy Business of Transparency

Feb 25, 2010• 4

By NAOMI FREUNDLICH

President Obama’s latest plan for health reform brought a flurry of commentary in the last two days; including divergent views on whether his commitment to “transparency” is helping or hurting the process. Yesterday, the Los Angeles Times blamed the current “healthcare backlash” on Obama’s insistence that the messy business of hashing out health reform be done in Congress, not behind closed doors in the Oval Office. In the L.A. Times’ view, there’s been too much transparency:

“By leaving the overhaul in the hands of Congress, [Obama] has given the public a full view of how lawmakers do business. The result is an anti-Washington mood that Republicans have tapped into.”

Meanwhile, the House GOP leader John Boehner, calls the Obama plan—introduced yesterday on the eve of the “bipartisan” health summit—a “Democrats-only backroom deal” that “doubles down on the same failed approach that will drive up premiums, destroy jobs, raise taxes, and slash Medicare benefits.” In the Republican’s view of things, there’s been too little transparency in the health reform process.

So which is it: Back-room dealing or a too-public view of the dirty business of lawmaking?

At the very beginning of the health reform process, the Obama administration made a conscious decision not to repeat the mistakes that doomed Bill and Hillary Clinton’s plan for universal coverage in 1993. The consensus was that the Clinton plan ultimately failed because the bulk of the planning went on behind closed doors—Congress and the American people felt locked out and were blindsided by the cost of the proposal. “With a task force that operated largely in secret, the first lady drew up a detailed and complicated plan that met with fierce opposition by the health care industry and Republicans before it ultimately sank of its own weight in a Democratic Congress,” writes Peter Baker in the New York Times.

More of the Same, Only More Expensive

Feb 25, 2010• 39

By SARAH PALIN

Former Alaska governor Sarah Palin, who played a major and highly controversial role in the health reform debate last year, published her response to the Obama plan on her Facebook page yesterday. In the spirit of debate, THCB is republishing the full text of her remarks.

The President has wrestled control of the health care debate away from Nancy Pelosi and Harry Reid by finally introducing his own plan. Unfortunately, the White House’s proposal includes everything we found untenable about the old Senate bill – only this one is even more expensive! This is what you might call putting “perfume on a pig.”

What’s in this “new” proposal? It has the unpopular (and arguably unconstitutional)individual mandate that forces people and employers to purchase health insurance – only this time with much harsher fines on employers who choose not to go along with another expensive government mandate. It has provisions that will make employers think twice before expanding their workforce. It has cuts to Medicare Advantage, a popular program which allows seniors to pay a little more money out of pocket for better coverage. And, of course, it still has sweetheart deals – only this time they’ve been extended even more.

We don’t know what the final long-term cost of this will be because the Congressional Budget Office hasn’t had a chance to calculate costs. We do know that the White House recognizes that its proposal will cost tens of billions more over the next ten years than the already-expensive $2.5 trillion Senate bill. The Presidentpromised last July that he won’t sign a health care bill if it “adds even one dime to our deficit over the next decade.” But he’s now proposing a health care bill withuncertain fiscal repercussions that could lead to endless deficits.

The President’s Health Care Plan

Feb 25, 2010• 33

By ROBERT LASZEWSKI

It is hard to see how the health care plan the President released this week changes anything.

There is nothing new in it save a health insurance rate regulatory board that is an awkward political proposal at best. What powers would it really have and how would it operate in conjunction with the states already
charged with insurance company oversight are just two of the first questions it does not answer.

Fundamentally, what good would insurance rate regulation do if the President’s plan has only tepid cost containment built into it in the first place?

There are not the votes in the House right now to pass this new proposal—or the Senate bill. There are not likely even the votes in the Senate under a 51-vote rule for the President’s new plan.

That could change if the President scores a game changer on Thursday at Blair House that finally moves the polls from the 40% approval rating Democrats have had on health care to something over 50%.

A Backhanded Way to Make Policy

Feb 25, 2010

By PAUL LEVY

One of the arcane steps in government regulation of health care is the Physician Payment Rule. This is the manner in which CMS, the Medicare agency, annually allocates payment dollars among the various specialty services. The PPR effectively makes policy.

The construct for all of this is a zero-sum game. When CMS wants to raise fees for some specialties (e.g., primary care doctors), it is required to reduce the fees for others.Continue reading…

The President’s Proposal

Feb 25, 2010• 60

By MAGGIE MAHAR

You might be wondering why I haven’t written about the President’s Health care bill. The reason is that I have very little to say.

This, I realize, is unusual. But the truth is that the president’s proposal is very similar to the Senate bill—which is not a surprise.

Nevertheless, I am very glad to see the proposal. I was worried that the White House had put reform on the back burner.

Will it pass? As always, I’m trying to be optimistic. But I think that everything depends on whether the White House decides to twist arms. The president will have to persuade House liberals that this is a good first step—and that we can worry about improving the plan over the next three years.

I would still like to see a public option, and I hope that, in the end, the federal government will wind up overseeing the state-based exchanges. But the legislation doesn’t goes into effect until 2014; that gives us more than enough time to improve on it.

The President also will need to keep an eye on Senate moderates. I would favor sending Joe Lieberman on a special mission to South Korea. A relative who is stationed there tells me that the demilitarized zone is particularly bleak this time of year.

There is no need to worry about the Republicans. They can be counted on to vote against any reform bill that even attempts substantive reform. Universal coverage is not their top priority, and they definitely don’t want to pay for it.

A 2.0 Interview with Berci Mesko, regional ambassador to Hungary for Health 2.0 Europe

Feb 25, 2010

By DENISE SILBER

Dr Bertalan Mesko, or Berci to his friends, is a recently-graduated Hungarian medical doctor, with whom I had the pleasure of blogging about geriatrics at IAGG 2009. Berci was then just beginning his PhD in clinical genomics. He’s also found the time to create Webicina, a web 2.0 guidance service for patients and medical professionals, continue to be an award-winning blogger, Scienceroll.com, become an educator for a Medicine and Web 2.0 university credit course and participate in a recent seminar with me. Enjoy the interview below with our Regional Ambassador extraordinaire to and from Hungary 😉 for Health 2.0 Europe coming up in Paris on April 6–7, 2010.

Denise Silber: How did you get interested in 2.0 tools for physicians?

Berci Mesko: Ves Dimov, MD from Clinical Cases and Images sent me his slideshow in 2006 and the idea of facilitating the workflow of physicians through social media amazed me. On http://Scienceroll.com I started to write about interesting applications and tools doctors and patients can use day by day either in a medical practice or in health management. Later my blog won some blog awards and had plenty of new readers so I thought I should keep on working and informing the public about the potential role of web 2.0 in the future of medicine and healthcare. Through my blog, I’ve received many invitations to speak about these issues at international conferences. All the things I’ve ever done and experienced online resulted in a Health 2.0 site called http://Webicina.com.

DS: As you do your doctorate in genetics, which 2.0 tools are the most helpful for your studies and research?

From Pain to Poverty

Feb 24, 2010• 48

By STEVE SANDERS, MD

“What am I going to do now Doc?” asked Mike, a down on his luck, 29 year–old recently unemployed truck driver, as he handed me his hospital bill.

Mike was seen at our local emergency department on a Friday evening with complaints of indigestion. Earlier that day he and his wife Susan celebrated their second anniversary by splitting a store bought pepperoni pizza. Mike had just lost his job and his wife, already working two jobs, managed to keep them afloat. When Mike later complained of indigestion, Susan became alarmed. She had just read about the symptoms of heart disease in the local paper. Mike wanted to get some antacids but Susan demanded he go to the hospital. Mike stated he initially protested, but when it came to his health he looked to his wife for advice.

He said he wanted her to drive him to the hospital and told me his wife wouldn’t hear of it. “We’re going to call 911, she told him. “You could die on the way to the hospital.” Now, Mike admitted, that made him scared and he quickly agreed. Fifteen minutes later he was on a gurney rolling through the double doors of the emergency department.

Physical assessment by the emergency resident physician came quickly followed by an EKG, chest x-ray, CT scan of the chest (“they said I might have had a blood clot”), and lab, specifically including cardiac enzymes. Mike said his only complaint was it took over five hours before he heard any news.Continue reading…