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The Chairman’s Mark – Good Ideas, Potentially Fatal Flaws

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By Roger Collier

Roger Collier

So, at long last, Senator Max Baucus has released his Chairman’s Mark draft health care reform bill for discussion by the full Senate Finance Committee. The 223-page draft bill is generally consistent with the “Framework for a Plan” document that Senator Baucus issued last week. So, no big surprises. But can it make coverage more accessible and affordable? Can it put the brakes on skyrocketing health care costs? Is it likely to help or hurt the economic recovery?

Accessibility and affordability are the main thrusts of the draft. As with the other Senate and House bills, an individual mandate would be imposed and the insurance market would be reformed to assure coverage on a guaranteed issue basis. Also as with the other bills, Medicaid would be expanded to cover anyone below 133 percent of FPL (but with the federal government picking up more of the tab), while subsidies would be available to other lower-income individuals who buy coverage through an insurance exchange. Additionally, benefit standards would be set for the individual and small group markets, with limits on cost-sharing.

Continue reading…

Nuts + Bolts – Advance Directives 101 – Do Not Call 911

By RICK PETERS

This is the first in a series of posts on the nuts + bolts problems we face in health care. As I stated
in my post initiating this effort, my goal is to sidestep the current health care reform maelstrom and discuss specific issues that in themselves
pose a discrete problem to us relative to health care quality, cost,
or outcomes.  Although policy reform is needed to solve any number
of the nuts + bolts problems we face in health care, many of these problems
require only changes in our behavior. From my perspective, if we are
going to even start to move this mountain we are going to have to foster
change from within the system. That change is going to have to come
from all of us as a society and as patients, families, health care providers,
health care organizations, and influential health care managers and
executives.  It’s not just about policy. It’s not about the
government ‘against’ the private sector. It’s about each of us
taking our own personal and social responsibility to do the right thing.

The problem in the current political climate with the health care policy debate is that the real issues all
too often get subverted. The travesty that momentarily turned end of
life issues, quality of life, and palliative care, into ‘death panels’
is Exhibit A. It has been well characterized on The Health Care Blog by
Bob Wachter with references to excellent articles in The New York Times and Joe Klein’s piece in Time.

Like so many issues in health care reform the hysteria that ‘government’ was posed to step in
and dictate our options as to how we would die and what final options
we might have is sadly misplaced.  Reality holds its own sadness
because too few of us get to die the death we would choose and when
we do choose our death it’s the current health care system and our
trusted friends and family who inadvertently subvert our best intentions.

Continue reading…

Medical Students Want You to Know

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By MICHELLE SNYDER

Snyder_michelleHow many of us can remember a world without cell phones? Today’s medical students would undoubtedly be among that group. So it is no wonder these future physicians rely heavily on technology as they embark on their career path. We surveyed more than 1,000 medical students who are Epocrates subscribers about technology (software, hardware and EMRs) and other pressing industry topics.

The survey found 45% of respondents currently use an iPhone or iPod-touch, followed by Palm and BlackBerry devices. Even prior to the launch of the iPhone, Apple has connected with this younger generation and continues to play to its strengths. Our survey did not address carrier preference, but it appears students may be more device focused; nearly 60% of non-smartphone users planning to purchase an iPhone within the next year. It is also worth noting that students may be looking at what device residents or attending physicians are using as well. In the first year of availability, over 100,000 physicians are actively using Epocrates software on an iPhone/iPod touch. We still see a significant number of physicians using BlackBerry and Palm devices, so we expect those respective populations to grow as well.

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THCB UPDATE

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If you haven’t had a chance to sign up for THCB UPDATE yet, you really should. You’ll get a helpful reminder email from us when important posts go up on the site.

In the two and a half six months year since the service launched more than 700 1,000 1,200 1,300, 2,000 more than 3,000 people have signed up, thoroughly surprising me. I’ve pledged not to divulge any details about the people who sign up, but I can tell you that list reads a bit like a health care who’s who. Go on: It’s free. It’s useful. And people seem to like it. Go visit the sign up page.

Is an IOM v. CBO Smackdown Looming on Health-Reform Costs?

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By TIM MULLANEY

The U.S. can cut health-care spending by $250 billion a year within a decade, a
congressionally chartered panel will say this month in a bid to
show costs can be contained even if all Americans are insured.

A report from the Institute of Medicine, which advises the
federal government on health care, will counter “stingy”
estimates from the Congressional Budget Office, said Arnold
Milstein, planning chairman of the institute’s working group on
health costs. The panel’s annual figure is five times the amount
the budget office says the U.S. will save under a bill in the
House of Representatives, according to the budget office’s July
17 letter to House Ways and Means Committee chairman Charles
Rangel.

The preliminary findings from the institute, part of the
National Academies in Washington, will be issued amid a growing
debate over the health-care overhaul proposals that President
Barack Obama is urging Congress to pass. The report will help
bolster the argument that covering the nation’s 46 million
uninsured won’t bust the budget, advocates of the bill say.

Continue reading…

Commentology: Improving Cost-Containment

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Stephen J. Motew writes:

Surgical specialists practice under a slightly more regimented reimbursement model predominantly due to the global period payment for surgical procedures. The total care of the surgical patient for any procedure, including pre-op evaluation, the procedure itself, and all related care post-operatively including most complications is covered under a 90 day global pay period. This system has worked relatively well by containing costs to a specific 'disease' (or procedure) state. In addition, many surgical sub-specialties such as vascular surgery and oncologic surgery for example invest a large amount of time in overall disease-state management that may not even include a procedure. I believe this has allowed many surgeons to understand the concept of cost-containment and efficiency, disease management as well as outcomes-based practices.

A recent experience with a referral patient however, highlights the incredible gaps in cost-containment and disease management that can occur prior to surgical intervention. I have annotated each step in the process to demonstrate points where potential intervention may have occurred. I will leave it to the comments to discuss the reasons and realities of such a case!

Continue reading…

Washington DC conference and party!

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By MATTHEW HOLT

Wednesday morning I’ll be at the AHRQ annual conference in Rockville, Maryland. I’m moderating a panel looking at “Experiences in Patient-Centered Care: Improving Coordination and Communication among Patients and Providers”. Given this is an AHRQ meeting there’ll be actual research presented from:

    • Gail Brottman, Director of Pediatric Pulmonary Medicine at Hennepin County Medical Center in Minneapolis;
    • Jennifer Uhrig, Senior Health Communication Scientist at RTI;
    • Jim Tufano, Assistant Professor, University of Washington’s program in Biomedical & Health Informatics

Of course I’ll be dragging them down to my non-academic level pretty soon!

If you can’t join the academics in the morning, you may want to come by a drinks party hosted by my friend Maggi Cary in the evening. For that one you’ll have to email me to find out a few more details!

Obama’s Medicare Half-Truth

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By AUSTIN FRAKT

Picture 12

Obama was called a liar during his recent address to a joint session of Congress. Actually, he was not fully truthful
about the implications of cuts to Medicare. Obama repeated that his
health reform plan includes payment cuts for private Medicare Advantage
(MA) health plans:

The only thing this plan would eliminate is the
hundreds of billions of dollars in waste and fraud, as well as
unwarranted subsidies in Medicare that go to insurance companies —
subsidies that do everything to pad their profits and nothing to
improve your care. … So don’t pay attention to those scary stories
about how your benefits will be cut… That will never happen on my
watch. I will protect Medicare.

Obama’s claim that the cuts will trim insurer profits but not Medicare benefits was meant to calm nervous seniors. As I and others
have pointed out the proposed cuts will in fact reduce benefits to some
degree, contrary to the President’s assertion. But seniors, in
general, should not be concerned. First, only about 23% of Medicare beneficiaries are enrolled in an MA plan.

Continue reading…

Taxing Health Insurance Companies to Pay for Health Care

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By ROBERT LASZEWSKI

The Congress has investigated about every conceivable way to tax people to pay for the health care proposals—a millionaire’s tax, bigger taxes on home mortgages and charitable contributions, and a couple of dozen more ideas.

Now Congress looks to be the most interested in taxing insurance companies to pay for a big chunk of their health care proposals. The new taxes would come in two parts––a 35% excise tax on any health benefit cost above an $8,000 single and $21,000 family annual premium as well as a flat $6 billion annual tax on the industry to be allocated among the companies proportionate to their premium.

There is certain logic to this. Taxing high priced benefits could help deflate the health care economy. Taxing all of the health insurance companies that stand to get more than a $1 trillion in new business—most of it in the from new private insurance and Medicaid subsidies and the rest from the consumer’s share of those new private plan premiums—seems fair at one level.

Calling for a tax on that big rich insurance company also sounds a lot better to the politicians than looking voters straight in the eye and raising their taxes directly.Continue reading…

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