The Health Care Blog – Page 951 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Small Business Coverage: A Report from the Trenches

Nov 25, 2008• 4

Brianklepper By Brian Klepper

John Sinibaldi, a well-respected health insurance agent in St. Petersburg, Fla., has become prominent in Florida’s broker community because he counsels and services a large book of small business clients and studiously tracks the macro trends that impact coverage for this population. And he’s active in the state’s regulatory and legislative activities.

The other day I dropped him Jane Sarasohn-Kahn’s post that reported on International Foundation of Employee Benefit Plans’ survey showing that most employers still want to be involved with health care. John responded with a long description of what the small employers he works with are up against. It’s an illuminating, damning piece. I asked him whether I could post it, and he graciously agreed.

John notes that only 36 percent of Florida’s small businesses — employers with two to 50
employees – now offer coverage. This is significant because 95 percent of
Florida businesses are small. Nationally, about one-third of all employees work for firms with fewer than 100 employees.

The increasing pressure on small business may explain why, as I
pointed out the other day, even the arch-conservative National
Federation of Independent Business (NFIB) recently co-sponsored a
reprise of the Harry & Louise health care reform ads. This time
it advocated for, rather than against, universal health care. Previously,
they were part of the coalition that killed the Clinton reform effort.

Finally, Mr. Sinibaldi’s message should drive home a key point, echoed by Shannon Brownlee and Zeke Emanuel in the Washington Post over the weekend and Bob Laszewski’s post yesterday.
To be successful, the expansive health care reform discussions that
typically dominate in Washington MUST go beyond the Massachusetts and
California reform efforts. Approaches
that can address waste and cost are just as important as those relating
to universal coverage. Otherwise the resulting solutions will continue
to be out of reach to a sizable portion of the American people,
and the underlying driver of the crisis, out-of-control cost, will
remain untouched.

Often the discussions on sites like this are dominated by people who understand health care’s problems deeply but abstractly. For John and his employers, buying health care is a stark, concrete problem that boils down to cutting care arrangements that are affordable for the employers and employees. As he describes it, it’s an increasingly impossible task.

Health care costs are crippling small businesses

Nov 25, 2008• 4

By John Sinibaldi

I’ve got news for the folks doing the International Foundation of Employee Benefit Plans’ survey: Smaller businesses, especially those defined as true small businesses with two to 50 full-time employees, are strapped beyond belief when it comes to paying ever-higher premiums for health care.

The survey’s results are NOT indicative of what is happening in the small group market (much like the Kaiser Family Foundation’s (KFF) annual survey on total premium and the portions shared by employees, which always makes me laugh. The employees at my businesses would kill to have the low percentage of total premium passed on to them that is reported in the KFF survey).

Across the board, the 100+ businesses I represent, all of them two to 50 full-time employees, have received increases between 13 percent and 75 percent this year. The average has been around 20 to 24 percent. That’s on top of more than 15 percent average increases last year, the year before, and the year before.

Up in smoke

Nov 25, 2008• 1

By Sarah Arnquist

Taxing cigarettes is the single-most effective way to lower smoking rates, particularly among youth. And if we could lower smoking rates, we’d save hundreds of thousands of lives and billions of dollars each year.

Good Magazine demonstrates this strong correlation on a state-by-state basis in a fantastic interactive graphic. Go check it out.

In a related matter, I heard Matt Myers, president of Tobacco Free Kids, recently predict a federal cigarette tax increase to fund SCHIP. He said there’s strong bipartisan support, particularly to fund an expansion of children’s health coverage.

The demands for robotic surgery

Nov 24, 2008• 13

By Paul Levy

Many months ago,
I wrote about the da Vinci Robot Surgical System and expressed doubts
about whether there was evidence to support the clinical efficacy of
this equipment, as opposed to the marketing efficacy of the company
selling it. Well, the time has come to graciously say, “Uncle!”

Without
making any representations about the relative clinical value of this
robotic system versus manual laparoscopic surgery, I am writing to let
you know we have decided to buy one for our hospital.

Why? Well, in
simple terms, because virtually all the academic medical centers and
many community hospitals in the Boston area have bought one. Patients
who are otherwise loyal to our hospital and our doctors are
transferring their surgical treatments to other places.

Prospective
residents who are trying to decide where to have their surgical
training look upon our lack of the robot as a deficit in our education
program. Prospective physician recruits feel likewise. And, these
factors are now spreading beyond urology into the field of
gynecological surgery. So as a matter of good business planning,
concern for the quality of our training program, and to continue to
attract and retain the best possible doctors, the decision was made for
us.

So there you have it. This is an illustrative story of the health care system in which we operate

Paul Levy is the President and CEO of Beth Israel Deconess Medical
Center in Boston. He blogs about his
experiences at, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

Fostering an adult conversation about health reform

Nov 24, 2008• 8

By Robert Laszewski

Zeke Emanuel and Shannon Brownlee have an op-ed in Sunday’s Washington Post that should be required reading for anyone interested in health care reform.

The title is, “5 Myths About Our Ailing Health Care System.”

They suggest the “5 Myths” are:

America has the best health care in the world.
Somebody else is paying for your health insurance.
We would save a lot if we could cut the administrative waste of private insurance.
Health-care reform is going to cost a bundle.
Americans aren’t ready for a major overhaul of the health–care system.

At one level I can disagree with many of their points and at another I can agree with all of them — but they are right on all counts.

Hospitals hit by economic downturn

Nov 24, 2008• 2

By Jane Sarasohn-Kahn

Forty percent of American hospitals have seen drops in inpatient admissions, according to the American Hospital Association.

In the AHA’s survey, Report on the Economic Crisis: Initial Impact on Hospitals, it’s clear that hospitals are already experiencing the effects of the economic downturn.

CEOs are considering several cost-cutting tactics in dealing with this financial crisis:

56% of CEOs are postponing renovations or plans to increase capacity
45% are delaying purchase of clinical technology or equipment
39% are postponing investments in new information technology.

Electronic health records provide the foundation for clinical excellence

Nov 24, 2008• 5

By Scott Shreeve Scottshreeve

I have mentioned this many times but it bears repeating with three
recent news articles – the electronic health record itself is not a
game changer but it is a powerful information gathering tool.

However,
by gathering information in a single collaborative place, EHR
technology allows all clinical providers to measure, monitor, and begin
to improve the way they provide care. It is this later part, which is part of the overall organizational transformation enabled by the technology (not solely because of it), that allows an organization to achieve the promised high performance results of an often painful EHR implementation.

America’s CEOs set priorities for Obama Administration

Nov 21, 2008• 11

By Brian Klepper

This past Monday and Tuesday, The Wall Street Journal convened an extraordinary conference of about 100 CEOs to develop and recommend issue priorities for the new Administration. (See the participant list here.)

This meeting brought together the nation’s industry power players. Several Senators and Congressional representatives participated, as well as Rahm Emanuel, the President-elect’s new Chief of Staff, and others who advise Mr. Obama.

Based on their business’ core focus, the attendees were assigned into four major areas: 1) Finance and the US Economy, 2) Energy and the Environment, 3) American and the Global Economy, and 4) Health Care.

Then in the General Session that followed, the focus groups’ recommendations were incorporated into a final list and reranked by all the participants. Here’s the graph showing the relative ranking of all issues.

Consumer-Generated Clinical Trials? Research Minus Science = Gossip

Nov 21, 2008• 7

By Val Jones MD

Valjones My readers know how passionate I am about
protecting the public from misleading health information. I
have
witnessed first-hand
many well-meaning attempts to “empower consumers” with Web 2.0 tools.
Unfortunately, they were designed without a clear understanding of the
scientific method, basic statistics, or in some cases, common sense.

Let me first say that I desperately want my patients to be
knowledgeable about their disease or condition. The quality of their
self-care depends on that, and I regularly point each of my patients to
trusted sources of health information so that they can be fully
informed about all aspects of their health. Informed decisions are
founded upon good information. But when the foundation is corrupt –
consumer empowerment collapses like a house of cards.

In a recent lecture on Health 2.0, it was suggested that websites
that enable patients to “conduct their own clinical trials” are the
bold new frontier of research. This assertion betrays a lack of
understanding of basic scientific principles. In healthcare we often
say, “the plural of anecdote is not data” and I would translate that to
“research minus science equals gossip.” Let me give you some examples
of Health 2.0 gone wild:

Fighting Alzheimer’s one ribbon at a time

Nov 21, 2008• 2

Ribbon By THCB Staff

Caring.com and the Alzheimer’s Association have teamed up to spread awareness about the disease through an online
Purple
Ribbon campaign.

The official campaign ended earlier this year with 1,000 blogs and websites displaying the purple ribbon, but ribbons are still available for creating. For each ribbon created, Caring.com donates $10 to the Alzheimer’s Association for education programs.

Anyone who wants to help
raise awareness for Alzheimer’s disease can create a free web ribbon with just a few clicks. You can personalize the ribbon with a
loved one’s name and it comes in different shades and sizes to
match your website or blog.

Also, if you’re an adult child or caregiver caring for a parent or loved
one with Alzheimer’s, visit the Alzheimer’s and Other Dementias section
of Caring.com for helpful information and resources.