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Do membership practices offer privileges or just reserved for the privileged?

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By Scott Shreeve

Scott_shreeveI have watched the meteoric rise of popular term “Medical Home.” While I personally dislike this phrase, it has caught on in the popular vernacular and looks like it is here to stay. In conjunction with the rise of the term is the growing popularity of a practice model that includes a higher level of service on a membership basis. It is essentially, next-generation concierge medicine, but now being promoted under the more politically correct banner of “direct practice.” Multiple variations of the model exist, from an all-inclusive single fee to a membership structure that retains a fee for service financial arrangement.

So discerning patients evaluating these practices are forced to determine the relative value of this new direct practice concept, and having passed that test, determine which type of practice model actually makes sense to them (All inclusive or Fee-for-Service). Lets look at these questions using a traditional four-person family with an annual all-in health care spending of $15,000 (consistent with Milliman’s 2008 numbers).

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Around the Web in 60 Seconds (Or Less)

By Sarah Arnquist

Chrome

Google launches its own Web browser, Chrome. The latest competitive move with Microsoft is available for download today.

About 800 people in New Hampshire are about to lose their health insurance because the plans don’t meet the minimum requirements set by the state. Can you say unintended consequences of consumer protection laws?

The Joint Commission will now grade hospitals on their level of "cultural competency." The Commonwealth Fund will fund a panel to "explore how diversity, culture, language and health literacy issues can
be better incorporated into current Joint Commission standards or
drafted into new requirements."

The National Quality Forum has endorsed nine new national standards for health information technology in the areas of electronic prescribing, electronic health record, interoperability, care management, quality registries, and the medical home.

California steps into uncharted territory without a state operating budget. The Legislature’s failure to agree has led to the longest overdue budget in state history.

Medicare hospital quality reporting steps up in sophistication

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By Bob Wachter

Robert_wachter
Medicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important because NPR’s "Talk of the Nation" spent 30 minutes interviewing Don Berwick and me about it — on the day of Hillary’s speech nonetheless!

To listen to the show, click here. Also, here’s an article from USA Today that got the ball rolling, as well as Avery Comarow’s thoughtful blog on these new reports.

Here are a few observations about the new Centers for Medicare & Medicaid Services initiative, some of which I made on the NPR broadcast:

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Keep tabs on your digital footprint

By Susannah Fox

Is it "disordered" behavior to Google your doctor? An article in JAMA suggests that doctors should be on their guard.

The Journal of the American Medical Association recently published an article about how doctors should be aware of how they are portrayed online and consider taking steps to manage their digital identities.

It is an article that, for the most part, could have been written about any profession with its warnings about “slanderous information published about someone with the same name” or “by a vengeful…colleague or ex-lover.” And the advice given is also familiar: create your own Web page to be sure correct information is available about you and use appropriate privacy settings on social network sites.

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Voila! Uninsured problem solved by not counting them

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John McCain’s health adviser John Goodman in the Dallas Morning News on solving the problem of the uninsured:Jcgoodman

"So I have a
solution. And it will cost not one thin dime," Mr. Goodman said.
"The
next president of the United States should sign an executive order
requiring the Census Bureau to cease and desist from describing any
American – even illegal aliens – as uninsured. Instead, the bureau
should categorize people according to the likely source of payment
should they need care.

"So, there you have it. Voila! Problem solved."

Read Matthew’s comments and a great discussion on Goodman’s quote here.

Obama and Krugman — almost mirror each other

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By Matthew HoltObama

I thought Obama was fabulous last night at the convention. He’s a great speaker, but
also able to gently laugh with his audience. His introduction showed what a tough road he had. If the Republicans manage to convince the American people that a black kid with a single white parent living in middle America is an elitist son of privilege then Karl Rove is better than I thought.

He was happy to rip McCain not on personality but on the issues. I’d like to have seen a lot more from the Democrats at this convention ripping Bush and Cheney on personality, personal corruption and the issues, and I wish Kerry had done even more in 2004, but that’s water under the bridge.

But the key point is that for most Americans things aren’t going well. Paul Krugman, who’s had his differences with Obama says it well today showing just how much key Republicans are out of touch — especially on the economy and health care.

Of course all he has to do is quote Phil Gramm, who appeared in Obama’s speech, and John Goodman who didn’t but does make it into Krugman’s column today. Goodman, of course, was pilloried in THCB yesterday. But I still think it’s a triple bluff on his part.

Two Boston Health 2.0 companies show a little more

By Matthew Holt

Two MD-run Health 2.0 companies in Boston had decent interviews recently in which they told a little more about themselves.

American Well’s Roy Schoenberg was interviewed by Health Business Blog’s David
Williams. It’s a long and thorough interview although Roy doesn’t tell Americanwell_2anything particularly new, it’s as good a summary of what he thinks their business will be as I’ve seen anywhere. And they get all those fun trips to Hawaii too!

Meanwhile, across the Charles River in Cambridge Sermo’s Daniel Palestrant is making a
little more public. It’s no longer just Pfizer, now most of the big pharma companies are dipping their toe in the Sermo pond, as he tells Xconomy. What he won’t tell anyone yet is how deep their feet are in, but Sermo which reached more than 70,000 signed up docs recently — Sermofrom less than 10,000 only 18 months ago — is clearly basing most of its business plan on getting big pharma to move from experimenting with it to using Sermo as a mainstream educational and marketing channel. As I’ve said before, this makes lots of sense for Sermo and its users. Whether it helps big pharma remains to be seen!

But the good news is that Daniel is not shy with his advice to other Health 2.0 Companies. “You Will Not Pay Your Bills with ads by Google,” he says.

Why not, Daniel? It works pretty well for Google!

(Both Roy of American Well and Daniel of Sermo will be at Health 2.0 next month, of course!)

The mirage of a “nonprofit” health system

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By Don Johnson

Not-for-profit hospital monopolies are helping make health insurance unaffordable for millions of Americans.

In its Thursday edition, The Wall Street Journal profiles the near monopoly that Carilion Health System has in Roanoke, Virg., and how it uses its monopoly power to inflate prices and enrich its executives.

The impact graph:

Carilion’s market clout is manifest in other ways. With eight hospitals, 11,000 employees and $1 billion in assets, the tax-exempt hospital system has become one of the dominant players in the Roanoke Valley’s economy. Its dozens of subsidiaries include businesses ranging from athletic clubs to a venture-capital fund.

The power of nonprofit hospital systems like Carilion over their regional communities has increased in recent years as their incomes have surged. Critics charge this is creating untaxed local health-care monopolies that drive the costs of care higher for patients and businesses.

The Journal also published a story in its Jan. 17, 2005, edition. about how the Federal Trade Commission was trying to stop monopolistic hospital mergers. I commented on it here.

On Jan. 24, 2007, I said health care reform should include breaking up not only health systems, but also medical groups and large regional insurers.

The Journal continues to call not-for-profit, tax-exempt health care providers “nonprofit.” Its stories show that tax-exempt health care providers are not “nonprofit.”

Checklists save money but adopted at glacial pace

By Charlie Baker

For the past year or so, I’ve been listening to and participating in a conversation in New England and nationally about the rising cost of health care. It’s a sticky wicket, to be sure, with no obvious, simple solutions. But I must say, I’ve been surprised that at least one pretty good idea hasn’t generated more traction. Intensive Care Unit checklists — which I’ve written about before — have already demonstrated that they can save lives, money and time, reduce variation, and improve quality, but they remain the exception instead of the rule in ICU care.

In June, the World Health Organization shared preliminary data on a demonstration it’s running using a “Safe Surgery Checklist” that showed reductions in deaths, complications and infections, along with significant improvements across many care standards for a wide range of surgeries that were done using the tool. And yet the take-up rate on this tool — which is so simple it fits on one single sheet of paper — is very slow to occur.

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