The Health Care Blog – Page 991 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Mega Life parent “hurt a lot of people”

Jul 22, 2008• 13

By Matthew Holt

Is this what Blackstone, Credit Suisse & Goldman Sachs want said about their investment?

"The severity of their actions certainly warranted that level of penalty. They hurt a lot of people," says Washington Insurance Commissioner Mike Kreidler, whose state and Alaska led the investigation.

Today a group of insurance commissioners handed down a $20-million fine to parent company HealthMarkets for the behavior of Mega Life & Health, and also its corporate siblings Chesapeake Life and Great West

$20 million isn’t exactly a huge fine, and it doesn’t put HealthMarkets out of business. It’ll be interesting to see whether Mega changes the quasi-fraudulent structure of its benefit plans. After all, they’ve been ruled legal in California, and my sources tell me that the medical-loss ratio is around 30 percent.

My guess is that they know that eventually they can’t stay in business this way. So they face the choice of either changing the business completely to become more worthy and less profitable, or instead to try to bleed every last dollar out of their subscriber base and semi-trained sales team. I wonder which they’ll try.

Health Systems’ Ferocious Challenges

Jul 22, 2008• 3

By Brian Klepper

Lately, I’ve had interesting discussions with a thoughtful exec. at a
major Western health system about the ferocious challenges facing
hospitals and health systems. Her organization’s internal conversations
at the moment are centered, in part, on what they should do to become
"reform ready," not only for policy changes that could be in the wings,
but more importantly, for emerging market dynamics that will change the
ways hospitals work. She asked me to catalog some of the trends I think
health system managers will have to deal with, along with five
recommendations for action. Here’s some of what I told her.

Hospitals face dramatic financial stresses on a range of fronts.
Over the last 25 years, health systems’ average total margins have
remained reasonably stable at around 5 percent. As you’d expect, some
organizations have performed better, and others worse. About
one-quarter of all US hospitals, many of them safety nets, have
reported negative margins, and continually teeter toward failure.

Now the pressures are ramping up considerably. Perhaps most
profoundly, the balance has eroded between more profitable
privately-covered patients, and patients with public coverage –-
Medicare, Medicaid and other governmental sources –- that may not cover
cost.

Using professional societies to advance participatory medicine

Jul 22, 2008• 6

By Daniel Hoch Epatients

Dan Hoch is a neurologist based at Massachusetts General Hospital
and an assistant professor at Harvard Medical School. An early
developer of online resources for patients, Dan helped found Braintalk.

Professional medical societies are not quite like the secret society Skull and Bones at
Yale University, but they may well look that way to many patients.

In most cases, their sole reason for being is to serve their members in a pretty narrowly defined way. These services generally include continuing medical education programs, an annual meeting, promoting research, advocating for public and political awareness of the value of the specialty, providing resources to support clinical practice, and more mundane perks like access to group insurance (malpractice and otherwise).

If you define the mission of the society a little less narrowly, and it’s not hard to see how that mission can be aligned with that of participatory medicine. We often argue on the e-patients blog that full participation of all parties in health care will yield better, more efficient care. Such care will benefit the members of a professional society. Further, patients are taking part in research not just as guinea pigs, but as organizers and directors. This benefits the societies’ research missions. But, are medical societies poised to understand this, and if so, how do we guide them?

Good and bad health consequences of high gas prices

Jul 22, 2008• 2

By Jane Sarasohn-Kahn

The price of gas is a headache for every consumer. But the health impacts of high Gasprices
fuel prices go beyond that metaphorical symptom.

Consider medical supplies and home health. But it’s not all bad news: on the positive side, higher fuel prices could positive impact the obesity epidemic and the rate of motor vehicle fatalities. Read on.

Latex gloves and med-surg supplies. Think about one of the most ubiquitous medical supplies: gloves. Walgreens recently said a box of 120 private-label latex gloves has nearly doubled in price. In 2007, a consumer could purchase two boxes for $9.99; today, the store has a sale price of $7.99 for a single box. There’s a lot of oil in those protective goods.

Hospitals use petrol-intensive supplies ranging from gloves to bed pans and tubing, according to a column in the Youngstown Vindicator. A 200-bed hospital can use 16,000 gloves per day (6 million a year).

Primary care crisis is HERE

Jul 21, 2008• 24

By Bob Wachter Robert_wachter

I recently heard from a UCSF physician who was flabbergasted when he sought an
appointment in our general medicine practice and was told it was “closed.” Turns out we’re not alone: there are also no new PCP slots available at Mass General. The primary care crisis has truly arrived.

I’ve written about the roots of the problem previously, and won’t restate the sad tale of woe. But I hope you’ll take the time to listen to two very powerful NPR reports on the topic – the first, a WBUR special by healthcare journalist Rachel Gotbaum called “The Doctor Can’t See You Now,” is the best reporting on this looming disaster I’ve heard (here is the MP3 and the show’s website). The piece is long (50 minutes), so I’ll summarize a few of its moments that really hit home.

First, it is true – MGH is not accepting any new primary care patients. Like UCSF, therefore, getting “a regular doctor” at MGH now takes the combination of cajoling, pleading, and knowing somebody generally referred to as “working the system.” In other words, the process of finding a primary care doc is now like getting a great table in a trendy restaurant. Obviously, this is horrible for patients, but it is also no fun for doctors. For example, in the NPR special, MGH’s director of Emergency Medicine laments:

“If you really want to give me heartburn, you can say, excuse me but I know you work at Mass General and I would like a primary care physician please.”

Determination of need rule only goes partway

Jul 21, 2008• 1

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care, Inc., a nonprofit health plan that covers more than 1 million New
Englanders. Baker blogs regularly at Let’s Talk Health Care.

I usually spend some time throughout the year visiting with accounts, physicians, hospitals, and brokers (among others), just to hear what’s up and what’s going on. Earlier this week, I was out visiting the leadership at a community hospital in Massachusetts, and asked them if they appreciated the MA Department of Public Health’s (DPH) decision to require academic medical centers to prove they weren’t duplicating existing clinical services in the community when they opened new operations in the suburbs around Boston.

For the uninitiated, this issue has been percolating in Massachusetts for the past couple of years, as a number of well known teaching hospitals have broken ground on some pretty big outpatient facilities in the suburbs around Boston. The service suite in these places varies, but it’s basically day surgery, cancer treatment, cardiac care, high-end radiology, and assorted other high-margin outpatient services that many community hospitals in Massachusetts argue they were already doing, and may now lose to these new facilities.

Around the Web in 60 Seconds (Or Less)

Jul 21, 2008• 1

By THCB Staff

USA Today: Examines individual health policies and concludes they leave many behind.

USA Today: A record number of babies were born in the USA in 2007. Is this the next baby boom?

CNN: Teen pregnancies up for first time in 15 years.

NY TIMES: Paul Krugman predicts the doldrum economy to last many years and targets lack of universal health care as a reason.NY TIMES: David Brooks says we’re entering an era of "epic legislation" and health care is one of the areas where policy makers will redefine the landscape for future generations.

REUTERS: Family planning groups object to a Bush administration memo that
proposes to redefine abortion to include several types of
contraception, including birth control pills and intrauterine devices.

CNN: FDA lifts the safety ban on tomatoes.

WSJ Health Blog: California rulings against insurance rescissions could spread across the country.

HEALTHNEWSREVIEW: Journalistic hype of health news never stops, says Gary Schwitzer critiques as he critiques ABC’s claims about a "miracle drug" for Alzheimer’s. disease.

Marketplace: New magazine for “Amateuer Economists”

Jul 21, 2008

The online magazine Amateur Economists launched this month to explain the factors that influence how people and organizations make choices for non-economists.

The expert writers will explore current economic issues their respective fields, such as health care, law, politics, literature and art
and science and technology.

In "The Dismal Side of Health care" section, a physician and nurse discuss the latest issues affecting health care economics. In "Fictionomics," an English professor explores the subject of economics in fiction, and in "Economically Correct," a lawyer and law student look at the economics of laws.

Should a surgeon be punished for wrong-site surgery?

Jul 20, 2008• 6

By Paul Levy Surgeon

During these couple of weeks following our wrong-side surgery, a number of people
have asked me if we intend to punish the surgeon in charge of the case, as well as other people in the operating room, who did not carry out the expected time-out procedure.

My initial and immediate reaction has always been, "No, these people have been punished enough by the searing experience of the event. They were devastated by their error and distraught to think that they could have participated in an event that unnecessarily hurt a patient. The surgeon immediately reported the error to his Chief and to me and took all appropriate actions to disclose and apologize to the patient, as well as participate openly and honestly in the case review."

This reaction was supported by one of our trustees, who likewise responded, "God has already taken care of the punishment." But another trustee said that it just didn’t feel right that this highly trained physician, "who should have known better," would not be punished. "Wouldn’t someone in another field be disciplined for an equivalent error?" this trustee asked.

Birthing turf wars

Jul 18, 2008• 7

By Vijay Goel

This spring, the American Medical Association decided to support a legislation "that
helps ensure safe deliveries and healthy babies by acknowledging that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital" or accredited birth center.

So the AMA is against ANY women choosing to give birth at home. This appears to be based more on turf management than evidence.

(The issue erupted following the release of the documentary, "The Business of Being Born," by former talk show host Ricki Lake in which she haves her baby at home. The American College of Obstetricians and Gynecologists and AMA publicly criticized Lake, who wrote about the ordeal last month for the Huffington Post.)