Category Archives: Health Wonk Review

HWR on health care cost trends, reform implementation, and motivations

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This biweekly edition of health Wonk Review covers the recent news that health care cost inflation has moderated, digs into various aspects of ACA implementation, and provides insights on a couple other timely topics.  Read on!

Health care cost trends are slowing…

First up, Health Affairs’ just-released research indicates the decline in inflation could result in a reduction of $770 billion (yup, that’s “billion” with a B) in public program health care costs over ten years.  

I can hear the cheering…

For those looking for a thoughtful and comprehensive consideration of the sustainability of this trend, consider this post from John Holahan and Stacy McMorrow of the Urban Institute; “All of these factors taken together suggest that a return to a high historic growth rates in health care spending may not materialize….we…are cautiously optimistic.”

John Roehrig is less optimistic, using research into economic cycles and related factors to come to a conclusion that “I don’t think either of these studies suggests that spending growth is likely to remain at the 4 percent levels seen over the past four years. [emphasis added] Some portion of the slowdown is permanent but some will be given back during a recovery.

I’ve reviewed these and several other reports, and my takeaway is guarded optimism.  Sure, the economy reduced demand, but there’s no question there are fundamental changes occurring that are affecting care delivery, pricing, and reimbursement.  

While drug costs are not top-of-mind these days, a group of oncologists is plenty cranky about the cost of specialty meds intended for cancer patients.  David Williams gives us his take, quoting one section of the doctors’ opinion piece: ““In the US, prices represent the extreme end of high prices, a reflection of a “free market economy”.

One cannot talk drugs without talking marketing to docs; Gary Schwitzer has highlighted an innovative marketing approach involving Hooters… If you don’t follow Gary, you should.

One area that researchers are paying close attention to is facility costs; Brad Flansbaum’s entry; Brad discusses the problems inherent in reducing costs in the hospital environment – “Most providers employed by hospitals know the drill: increase throughput, implement regulatory changes, monitor hospital measurement and report cards, and of course, reduce costs.  However, despite the growth of “hospital as laboratory” and rise of the inpatient practitioner, we must face facts.  We receive our salary from the beast we wish to slay.” [emphasis added]

Sticking with hospitals, a recent WSJ opinion piece assaulted Medicare’s new hospital re-admissions reimbursement policy; the John Hartford Foundations’ Chris Langston presents a clear-eyed, point-by-point rebuttal that shows why the program is a necessary and important step to improving health care for older adults. The net? The reduction in reimbursement for re-admitted patients appears to be good policy and will likely drive improvements in patient care and quality. 

Implementing reform

A big part of reform’s implementation involves exchanges; Louise Norris ofColorado health Insurance provides a brief overview of the progress his state has made: “Less than a year after the ACA was signed into law, Colorado began the – often contentious – process of creating the state’s exchange.  They’ve been working on it pretty much constantly ever since.  And the result is Colorado’s health insurance exchange is on track to open on time and provide all of the promised services:  small business and individual sales platforms, with an option for employees to select from multiple plan options in the small business exchange.  Jay hasn’t seen data from DC and the other 16 states that opted to run their own exchanges, but guesses they’re also faring relatively well,

Interestingly, the move to electronic health records (EHR) may well lead to higher costs, as providers get better at coding, payers end up paying for more stuff.  That’s one  takeaway from Jonena Relth’s submission on EHR and a recent teleconference on same.

The changes in delivery models may well lead to long-term cost reductions, however patient involvement will be key.  Jason Shafrin’s contribution contemplates the issues inherent in informing Medicare patients they’ve been assigned to an ACO; many may not know…

Neil Versel has also contributed a piece on consumer awareness – or more accurately the lack thereof.  His piece refers specifically to ignorance about telemedicine, and what the industry must do to reduce that ignorance

For those seeking more info on Medicare and the often-mind-numbingly-confusing array of programs, acronyms, and payment schemes, Joanne Conroy MD’s post offers a simple overview of the program.

Writing at healthinsurance.org, Wendell Potter doesn’t see the possible decision of some large insurers to avoid the exchanges as much of an issue; “The number of insurers that participate in the exchanges will vary from state to state, but there should be no shortage of affordable options available, especially when the subsidies – which will be available only for coverage purchased through the exchanges – are factored in.”  Wendell cites Vermont as an example; there are only two likely participants but both have submitted rates that are quite competitive with current products.

Motivations and motivators

Then there’s the motivation of big health plans and their leaders – can you spell M-O-N-E-Y?  I thought you could…The always-engaged Roy Poses MD has two posts; one discussing UnitedHealth’s CEO, his compensation, and UHG’s rather checkered recent past and issues of quality, physician oversight, and patient safety.  Ouch.  Similar concerns exist regarding Amgen’s executive compensation and their recent legal troubles.  

An interesting perspective on the same issue comes from Jaan Sidorov MD MHSA; Jaan wonders if the policy of “no pay for readmissions” could translate into shoddy care for patients who, despite the best of care, still have to be readmitted; If you had to be readmitted through no fault of anyone, wouldn’t YOU want your doctors to be compensated for taking care of you?

Thanks to Maggie Mahar for her post on breast cancer awareness – an effort that I (and others) think has had some significant negative consequences.  Maggie says: “Could it be that breast cancer arareness has become over-awareness? This isn’t happening in other countries. Then again, we are better at marketing fear than any other country in the world. And the pink ribbon campaign is all about marketing.”[emphasis added]

Side-bar note – I’ve long been a critic of the male version of breast cancer awareness; the prostate cancer scare, those who profit from it, and their well-intentioned but harm-causing supporters.

Research says…

John Goodman thinks a recent analysis of Oregon’s Medicaid program is a damning indictment of Obamacare; “a new study finds that (as far as physical health is concerned) there is no difference between being in Medicaid and being uninsured.”

Ezra Klein has a different take on that study; while there’s no question many health status measures did not differ between the Medicaid insureds and uninsured’s, depression was 30% lower among the insured group.  More significantly Ezra notes a wealth of other research has found Medicaid coverage does tend to improve health status.

Thanks to Vince Kuraitis and Leslie Kelly Hall for their editorial on the “duty to share” patient information with the patient.  In the US and the UK, providers have excessive incentives to “hoard” patient data and insufficient incentives to “share” it.  Consistent with a recently released report in the UK, they authors recommend development of an explicit duty to share patient information and discuss barriers and implications.

from the Work Comp World

WorkCompInsider’s Jon Coppelman thinks Massachusetts’ Governor Deval Patrick’s idea to tax workers’ comp indemnity (wage replacement) benefits.  This in a state where those benefits are already inadequate – at best. 

Bad idea, Your Honor.

Mike Allen alerts workers’ compensation payers to the need to prepare for reform; while PPACA doesn’t specifically address workers’ comp, there are a host of implications – especially for tech platforms.

Today’s tech topic

David Harlow’s piece focuses on Massively Open Online Medicine, showing just how diverse – and informed – HWR contributors are. If health sensors and wearable devices do become prevalent, it will likely take a lot of time – and a lot of change by a lot of people and institutions.

The inaugural edition of Health Wonk Review

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Health Affairs hosts this fortnight’s edition of Health Wonk Review, and does it with their usual  thorough style.  Host Chris Fleming’s put together the best o’ the blogs on health care costs and drivers thereof; presents an alternative view of the nursing “shortage” (hint:  there won’t be one); and digs into Louise’ discussion of the merits of charging smokers more for health insurance.

All the best of the blogging world, brought to you each bi-week by your buds at HWR!

Elections have consequences – Health Wonk Review’s post-election edition

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Elections have consequences.  I don’t often quote Karl “Turd Blossom” Rove, but it certainly seems apropos now, three days after an historic election.  There are a plethora of interesting story lines surrounding the election and the hows, whys, and whos thereof.  We’ll keep our focus on those related to health policy, the impact on reform, and let the experts opine.

First out of the blocks is Bob Laszewski with his post listing some of the major health policy issues facing the President and Congress. Included among the challenges is addressing the fiscal cliff – I’m not as optimistic about our “leaders’” ability to get that fixed anytime soon.

Health Affairs’ contribution comes from Tim Jost, “Election 2012: A Win For Health Reform, But Much Work Remains” gets a bit more specific; “November 6 was a good night for health care reform, and for the millions of Americans who will benefit from it, but a great deal of work needs to be done before reform becomes a reality.  It is time for the administration to roll up its sleeves and get to work,” Tim says. He describes the areas where  important guidance and rules are promptly necessary to implement the Affordable Care Act, and he also points out continuing threats to the ACA such as challenges to the preventive services contraception mandate and premium tax credits on the federal exchanges, as well as the looming deficit reduction negotiations. We’ve less than 14 months till this thing fully kicks in, and time’s awasting.

The estimable Maggie Mahar explores the demographics of the vote in “The Nation is Divided, Not between Whites and Minorities, but between the Past and the Future. “ She sees this as a victory by the future population over the past. Maggie’s take is that “Women, minorities, and young people re-elected President Obama…This is not to say that, going forward white men will not also be in positions of power.”

Anthony Wright at Health Access blog is pretty darned excited about the result, and its implications for the nation’s largest (in population) state.  “A Great Night for California and for Health.” Anthony isn’t too giddy to remind us “this isn’t the end of the campaign, but the beginning of ACA implementation and the fiscal fight over Medicaid and Medicare.? 

Louise is one of our “battleground state” contributors and sends us via Colorado Health Insider a post responding to another’s recommendation that one can be “self-insured” if you’re careful enough.  Louise thinks not, saying ”To be fair, I agree wholeheartedly with the tips he gives for “making health insurance a bad bet“.  Things like eating well, exercising, avoiding excess alcohol, not smoking, driving safely, managing stress, safe sex, not sharing needles, etc. are all great ideas.  They’re all things that our family does every day.  I’ve been told I’m a health nut, and I don’t shy away from the accusation.  I make green smoothies (kale and veggies and fruit all blended up – drink up!), exercise nearly every day and refuse to drive if I’ve had even a single glass of wine.  I fully plan on living to be a hundred.  But I would never ever go without health insurance for myself or my family.”

Fortunately, Obamacare (remember when that was a pejorative term?) includes wellness and prevention benefits; new contributor Chuck Smith at informthepatient.com has several posts lauding the benefits of pre-illness care.

John Goodman of the National Center for Policy Analysis contributes “Socialism Kills”, on the impact of “economic freedom” on population mortality. Actually, the research isn’t about socialism per se; rather John cites the libertarian Fraser and Cato Institutes as the source for underlying research on how “economic freedom” contributes to longevity.  I haven’t read the two studies, but I’m curious if those two august organizations factored in the impact of potentially confounding factors, such as the many wars in Africa, rapid rise in starvation in several countries, an deaths from disease.  Also wondering how the headline could possibly be true in the face of data indicating longevity in most European countries exceeds that in the good ol’ US.  In fact, as the only industrialized nation without universal health insurance, we rank behind every EU country in life expectancy – including Greece, Malta, Cyprus (my birthplace) – and even lower than Chile…

I take a different approach, looking at the implications of Obamacare for workers comp - and surprise some by opining that overall, it’s good news indeed.

There are a few folks out there looking at things other than reform and the election – thank goodness!

InsureBlog’s Bob Vineyard reports that more docs are beginning to shun insurance in favor of cash, and explains why.

Dr Roy Poses continues his tireless pursuit of profiteers, this time going after the cozy relationships existing in the medical-publishing industry.

In Marketers’ Systemic Influence over Ostensibly Scholarly, Peer-Reviewed Publications: the Medtronic Infuse BMP-2 Example, Roy informs us:

A US Senate committee report detailed yet another example of how marketers working for industry (in this case, for Medtronic, a biotech/ medical device company) sought to systematically but covertly influence the ostensibly scholarly medical literature and the public discussion to sell more of their product…Those who advocate the evidence-based medicine approach, as I do, must not be naive about the extent that the evidence-base has been deliberately corrupted.  We need stronger measures to protect the integrity of clinical science.

Hospital Quality Reporting in Italy is the subject of Jason Shafrin’s post, wherein he discusses P.Re.Val.E Italy’s hospital quality initiative. Pretty comprehensive approach…

A change in Medicare policy will have a significant impact on post acute care (and home services). Brad Flansbaum digs into the details of a recent settlement between CMS and the Center for Medicare Advocacy.

The American Academy of Family Physicians is pushing back on nurse practitioners’ role in primary care. David Williams explains why they aren’t doing the same to specialists. Evidently the family practice docs are OK if specialists act as generalists, but oh no, not those nurses (disclosure, my daughter is a nurse..)

We wrap up this edition with a state-based discussion of workers comp reform; Tom Lynch of Workers’ Comp Insider offers “A Modest Proposal for New York” for fixing what’s wrong with the state’s workers’ comp system.

Finally, apologies as this, the post-election edition of Health Wonk Review is out a bit later than usual this week as I was in Las Vegas for the National Workers Comp Conference.  Fortunately, my fellow bloggers were able to keep up their writing to keep you, dear reader, fully abreast of the issues and implications thereof.