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Pitfalls of VIP Syndrome

Oct 30, 2008• 2

By Sarah Arnquist

Slate has an article today by two doctors discussing VIP syndrome in health care and how it can lead to worse care for the rich and powerful, such as Sen. Ted Kennedy, who following a diagnosis of cancer convened his own tumor board.

The authors lay out the pitfalls of VIP syndrome here:

VIP syndrome affects not only treatment but also testing decisions. If
Joe the Plumber requests a CT scan he doesn’t need, doctors simply say,
"No, Mr. Plumber." But Joe Biden can get any CT he wants. Some health
care programs
for corporate executives even involve routine full-body CT scans as
screening tests as part of the "chairman’s physical." The problem is
that these expensive and detailed tests may actually increase the risk
of cancer from radiation exposure
and have never really been shown to improve anyone’s health. And if
there is an incidental finding, as there often is, more tests might be
ordered, which may lead to unnecessary biopsies. And doctors perform
heroic procedures on VIPs not just when there is clear benefit but when there is any question of benefit.

Bob Wachter wrote a few months ago about VIP Syndrome, noting there is a sizable medical literature documenting this shift in practice for the rich and powerful.

Wachter writes, "Every hospital I know keeps some sort of a VIP list, a tripwire to
alert the organization of the arrival of a dignitary or billionaire.
Even when there isn’t a formal list, you can be sure that a single call
to the CEO’s office is more than enough to lift the velvet rope. That’s
a simple fact of life, and to me, not worthy of a big fuss. Unless,
of course, they’re getting better care than Joe and Jane Average. But
are they? Believe it or not, I really doubt it."

Something interesting that both articles point out is that the top researcher or surgeon often directs the care or operates on the VIPs. Often, these top doctors haven’t been in the OR for a long time.

McCain’s health plan likely going down with him

Oct 29, 2008• 7

By Robert Laszewski

John McCain would reform the American health care system by providing big tax incentives for it to transition from being employer-based to one built on a system of individual responsibility. He would do this by eliminating the longtime personal tax exemption on employer-provided health insurance and replacing it with a $2,500 individual, and $5,000 family, tax credit for those who have health insurance.

It’s too bad this idea will likely recede from the national health policy debate whether John McCain wins or loses the presidency. Even if he wins, the Democratic majorities in Congress will be so large there is little chance we will be able to move away from the traditional employer health insurance base in the next few years. All you have to do is look at the way Obama and all of the Democratic candidates for the Senate and House have railed against McCain’s plans to "tax your health benefits" to see how Democrats have willingly painted themselves into a political corner that makes this idea a non-starter in the new Congress.

As I have said before on this blog, I have been largely disappointed in the McCain health plan. He started out with a bold new approach but never closed the loop on so many key elements in his plan. For example, he leaves those with pre-existing conditions to the fate of state-based risk pools–a place no one would ever vote themselves into.

Safeway uses incentives and transparency to improve employee health

Oct 29, 2008• 13

By Scott Shreeve Scott_shreeve

In this interview on “The Business Case for Health 2.0,” Ken Shachmut,
Senior VP Strategic Initiatives, Health Initiatives, and Health
Re-engineering at Safeway, shares is thoughts on some of the highly
impressive results that the company has obtained by introducing market-based
health plans.

SS: Ken, thanks for making time today. Tell me a little about your background?

KS: I have been active as an executive and
management consultant for over 30 years. I graduated from Princeton in
Engineering and later obtained my MBA from Stanford. In consulting, I
worked first with McKinsey & Company,
later at Booz Allen Hamilton, and for awhile independently. I had done
some consulting for Safeway. I later joined Safeway and have been there
the last 15 years in various capacities.

Due to my consulting background and analytical focus, I am
frequently asked to look at new challenges and opportunities for the
organization. As health care costs continued to rise, we started
looking at ways that we could engage our employees or work with the
unions to control costs. The process has been highly successful, and we
now have broad participation in “market-based health care” (MBHC) plans
– starting with our non-union population and evolving into our union
plans currently. In consequence, our employees are now much more
actively involved in their health care and are making better choices
that improve their health. As a result of our learning and success, we
have helped to create the Coalition to Advance Health Care Reform
(CAHR) which is led by our CEO Steve Burd. CAHR now has over 60
companies as members.

The inconvenient truth

Oct 29, 2008• 12

By Sarah Arnquist

The Los Angeles Times ran a great series last week called "Shedding Risk" in which it detailed through compelling human stories the erosion of the health insurance market. It’s definitely worth finding the time to read.

Matthew has talked about this eroding model for a while, including in a speech about three inconvenient truths that he gave to health plan executives in March.

Here are four key paragraphs from the first article in The Times‘ series to give you a sense of the articles:

At the heart of the problem is the clash between the cost of medical care and insurers’ need to turn a profit.Today, four publicly traded corporations — WellPoint Inc., UnitedHealth Group, Aetna Inc. and Cigna Corp. — dominate the market, covering more than 85 million people, or almost half of all Americans with private insurance.On Wall Street, they showcase their efforts to hold down expenses and maximize shareholder returns by excluding customers likely to need expensive care, including those with chronic diseases such as asthma and diabetes. The companies lobby governments to take over responsibility for their sickest customers so they can reserve the healthiest (and most profitable) for themselves.Meanwhile, insurance premiums are becoming a heavier burden on employers, many of which say that rising healthcare costs cut into their ability to compete and, in some cases, to survive.

Here are Matthew’s three inconvenient truths to the insurance execs:

e-Patient Dave tells his story

Oct 28, 2008• 7

By Matthew Holt

In the Connected Health conference at Partners I sat in on a great session in which e-Patient Dave (Dave deBronkart) and his physician, Danny Sands described his use of listservs, the Internet, email and BIMDC’s PatientSite and other tools in his (successful!) battle with renal cancer—after being told median survival was 24 weeks. I won’t tell the whole story as they’re trying to get it published in an authoritative journal—so that physicians will pay attention and promote this use of technology by patients.

Danny Sands says most patients with his condition feel incredibly alone. but "Dave told me he didn’t think he was isolated. He felt
connected.”

Dave said, “Reading and connecting online makes me a better patient. But it doesn’t make me an oncologist.” But doing all these things via ACOR and the use of CaringBridge and PatientSite did, he believe, increase his hope & outlook, and helped make his treatment successful.

A remarkable story and one that we’ll tell more about later.

(Note: I made a minor edit as my original note got garbled between my ears and my fingers!)

The latest on technology-enabled DM

Oct 28, 2008

By Matthew Holt

I sat in on another session at Connected Health about A Progress Report on Medicare’s CMHCB (Care Management for High Cost Beneficiaries) Pilot. This is the medical group alternative to Medicare Health Support operated via providers not health plans. Some quick notes…

Suneel Rataan from Health Hero: We know that we can make DM work using the Health Buddy and supporting nurses in the VA. But could they make it work in a community setting under Medicare Fee for Service. We know how badly Medicare Health Support has gone, what about this one (CMHCB)? “We can’t talk about the results but our program has not been terminated!” (Actually they have applied for an extension & expansion of the project).

Couple of others, one from Montefiore in the Bronx another from Partners—the Partners one has a variety of practices and the problem is that they need to have the consistent program across those.

Be careful what you wish for

Oct 28, 2008• 16

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care. This post first appeared on his blog, Lets Talk Health Care.

The show is
pretty much the same – every time. Public sector entity gets in budget
trouble, cuts have to be made, and providers who do business with the
public sector get hammered – hard. It’s happened with Medicare at
the federal level for years, and it happens with Medicaid at the state
level with some frequency as well.

Well, the show is back in town, as state governments face declining
revenues. In Massachusetts, the state is not only cutting Medicaid
payments prospectively – it’s cutting Medicaid payments for some
providers retrospectively – simply choosing not to make payments to
them they had planned on and expected.

I must say, each time this happens, I can’t help but wonder if the
hospital operators and physician leaders who think a single-payer like
Medicare For All is a good idea ever stop to think about how these
agencies deal with their financial problems. When they have a problem,
they unilaterally whack their provider community hard – in ways private
sector payers would never consider.

And then those same providers who think Medicare For All is a great
idea turn to the private health plans they do business with and say,
“Hey – you need to help solve my Medicare/Medicaid deficit – which just
got worse.”

Sheesh. All I can say is, “be careful what you wish for.”

Entering the era of participatory medicine

Oct 28, 2008• 2

By Jane Sarasohn-Kahn

I’ve returned from a week of Health 2.0 immersion on the west coast. The top-line finding: we’ve entered the period we can call Participatory Medicine. For some, like the pioneering Gilles Friedman of ACOR, this is nothing new. Other people have never heard of it. It’s global. It’s local. It’s a movement and a verb, as I pointed out thirteen months ago following the inaugural Health 2.0 conference. H20logo_2

Here are some reflections…

On Tuesday, I appeared on a panel on Health 2.0 at the Commonwealth Club in San Francisco for KQED public radio, sponsored by the California HealthCare Foundation. The Club’s motto by founder Edward Adams is, "We only propose to find truth and turn it loose in the world." My fellow panelists resemble that remark! They were the inspiring Amy Tenderich, founder and blogger of Diabetes Mine; and the ebullient, motivating and insightful Dr. Ted Eytan, now with Kaiser Permanente. We riffed on the roots of H2.0, the risks and benefits of people sharing health information and opinions online, and prospects for the future. Amy and Ted were stellar and shared their special perspectives as patient and doctor, respectively. When the podcast online is available, I will point you to it.

Will a $5,000-tax credit be the silver bullet to solve health care?

Oct 28, 2008• 9

By Shuka Kalantari John_mccain

If Senator John McCain becomes U.S. president he plans to give each American family $5,000 to pay for health insurance premium costs in the individual market. Individuals would get $2,500 for the same use.

How does McCain propose to pay for this? In part, by revoking the tax deductibility of workers’ health benefits and by making cuts to Medicare and Medicaid. Even with these provisions, however, The Tax Policy Center estimates McCain’s plan will run an estimated $1.3 trillion short in funding over the next ten years.

In McCain’s “Health Care Action” television ad, he says, “The problem with health care in America is not the quality of health care, it’s the availability and the affordability. And that has to do with the dramatic increase in the cost of health care.”

Make your voice heard!

Oct 28, 2008• 3

For the next week, you have a unique opportunity to make your voice heard on health information privacy issues, their impact on the Health 2.0 movement, and how best to build public trust in these technologies.

The National Academy of Public Administration (with funding from the Office of Management & Budget) is hosting a unique "national dialogue" on the intersection of health IT and privacy, which will take place on the Web beginning yesterday, October 27, and lasting through November 3.

They are seeking to gather feedback from the public on the important privacy issues that confront all of us as we promote the movement to e-health. A report will be generated based on the responses, so it is important that a broad range of stakeholders participate. Go to www.thenationaldialogue.org to find out more and to log on!

Hat tip to: The Health 2.0 social network