Year: 2012

Jul
12

PMSI’s Opioid Summit -Part Two, addiction

Posted by Joe Paduda on Thursday, July 12th, 2012 | Comments

The first part of the report was supposed to be followed quickly by this, the second – however events overtook me, and I’ve just now come back to report on the Opioid Summit put on by PMSI last month in Sarasota.
We now turn to Dr Len Kamen’s talk on addiction – Dr Kamen is an addiction specialist practicing in Philadelphia, with extensive experience in workers comp.
Dr Kamen provided this definition of addiction: “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry”, that has these characteristics:
A. Inability to consistently Abstain
B. Impairment in Behavioral control
C. Craving; or increased “hunger” for drugs or rewarding experiences
D. Diminished recognition of significant problems with one’s behaviors
and interpersonal relationships
E. A dysfunctional Emotional response
Addiction refers to the loss of control over the intense urges to take the drug/substance even at the expense of adverse consequences – jail, divorce, losing custody of children, homelessness…
(The clarity brought by Dr Kamen speaks to an ongoing conversation at Mark Wall’s LinkedIn Group on this issue)
The discussion addressed the “chronic pain dilemma”, attempting to determine if the claimant is addicted to or dependent on opioids. There are three ways to think of chronic pain patients;
– Managed chronic pain patients – an opioid user on low, stable dose with return to function
– Dependent chronic pain patient – opioid user on escalating doses of long/short acting opioids, with high pain levels and low functionality
– Addicted patients – exhibits abusive and aberrant behavior, unstable with no identifiable pathology.
A session at the upcoming NWCI Conference focuses on chronic pain; moderated by Liberty Mutual National Medical Director David Deitz Md PhD, two experts on the subject will provide insights on: creating an effective pain management protocol; at what point in a treatment plan should pain management be utilized; are there effective practice parameters that have been developed to determine if a formal program of pain management is called for and if so, what types of treatments should be a part of such program.
There was a lot more to this, and I’ll be providing additional resources in the next post.

Jul
11

Integrating work comp claims systems…

Posted by Joe Paduda on Wednesday, July 11th, 2012 | Comments

Integrating claims systems with medical management, bill review, UR, and other applications is the holy grail; yet few payers are really, truly, actually “connected”. There’s far too much cutting-and-pasting, systems store pictures of documents instead of capturing key fields on those documents in electronic format, too many yellow stickies on the display stand, lots of toggling back-and-forth between systems, double-, triple, or quadruple-entry of claimant data – you know the drill.
Many reading this likely believe their systems are “integrated”. And many of these many would be mistaken. A survey we conducted in 2010 found four-fifths of claims handlers did not believe their systems were “fully integrated’; almost as many executives believed they were.
There are any number of reasons to integrate these systems, Acrometis has picked six.
They include reduction in network leakage and overpayment of medical bills; higher network penetration; better vendor management; improved direction of care; more effective and accurate state reporting; and enhanced overall efficiency.
Hard to argue with any of these, and even harder to understand why it’s 2012 and adjusters are still stuck toggling between systems, double-entering data, and cutting and pasting from a medical management system into claims. Not only does the lack of integration waste time, it also increases error rates, frustrates adjusters and other claim handlers, and increases medical expense.
It also makes it difficult for payers to comply with unique policyholder or customer demands, limiting the payer’s ability to compete for and win new business.
We are in an “interesting” time; the work comp market is hardening, medical costs increasing, rules and regs changing in several key jurisdictions, and customer demands increasing in number and complexity. Yet insurers and TPAs are still under-staffed, all lack adequate IT resources, there’s precious little time for training, and new competitors are entering the comp market, seeing opportunity to gain from the upswing in pricing.
What does this mean for you?
Successful payers are those that adapt, maximize their resources, and eliminate duplicate work and errors.

Jul
9

UCDavis – workers comp shifting costs TO other payers…I think not

Posted by Joe Paduda on Monday, July 9th, 2012 | Comments

A few weeks ago the folks at UCDavis published a study on workers comp, asserting that WC payers – insurers, TPAs, but ultimately employers and taxpayers – are heavily subsidized by other insurers, that, in effect, work comp cost-shifts to other payers on a scale almost beyond comprehension.
To quote UCDavis’ press release, “almost 80 percent of these [occupational injury medical and associated] costs are paid by employer-provided health insurance, Medicare, Medicaid, Social Security and other disability funds, employees and other payers..this cost shifting leads to artificially low workers’ compensation premiums that should be used to cover wage replacement and medical care for employees injured on the job.”
Note – I wish I could add a lot more to this analysis, but I’ve asked UCDavis for a copy of the actual report (“Workers’ Compensation Benefits and Shifting Costs for Occupational Injury and Illness.”) twice over the last month, and have had no response whatsoever.
So, rather than wait seemingly forever for my email inbox to chime with the welcome news that Ms. Marjory Spraycar has responded to my entreaties, here’s what I make of this “study”.
First, there’s no indication that researchers Leigh and Marcin factored in settlements; those legal resolutions that result in the claimant assuming all future responsibility for medical and wage replacement issues related to their work comp claim. Simply put, if there’s a settlement, the claimant agrees that they – the claimant – will be responsible for the medical and related costs of that work comp injury going forward (this is simplistic and yes, there are variations, but generally speaking this is the way it works). Not Medicare, or Medicaid, or their Aunt Sally, or Aetna or Blue Cross – the claimant.
For Leigh and Marcin to assert that somehow work comp is “shifting cost” to Medicare et al for reported claims is just not reasonable nor accurate – if Leigh and Marcin have considered settlements (which, as i’ve not been provided a copy of the report, I can only assume they have; after all Leigh and Marcin are professors at a major research institution).
Next, I don’t know if they differentiated among states with no ability to close medicals and those where medicals can be settled. If they have extrapolated data from settlement states to all states, this would be a major error.
Third, they recommend we “Link premiums with company-specific injury experience rather than industry-wide estimates, which would encourage companies to lower premiums by reducing workplace hazards.”
I thought this was what experience rating and ex-mods did; perhaps I am mistaken. or perhaps not.
Finally, there’s absolutely no question work comp pays for treatments to help the claimant get healthy enough to return to work – even when those treatments are for conditions completely unrelated to the work comp injury, and especially when the claimant does not have other health insurance thru their employer or Medicaid. I don’t know if Leigh and Marcin put those expenditures on the work comp payer side of the ledger; somehow I don’t think so. Moreover, the failure of group health payers to deal with obesity problems shifts costs to work comp in a major way, one that – again, I do not think Leigh and Marcin considered.
There were a couple other articles that referenced the study; evidently (this is hearsay) home productivity and fringe benefits were included as part of the study’s analysis of costs due to work comp not paid by the work comp industry.
This is, to be kind, rather a stretch. The ever-quotable Bob Hartwig of III noted workers comp “was never meant to be a form of business interruption insurance, which is what’s being proposed here.”
I remain hopeful I’ll hear from Ms Spraycar or one of her associates at UCDavis. Quite frankly I’m surprised by the lack of responsiveness.
Then again, this is just a blog…

Jul
2

SCOTUS on health reform – the bloggers respond – Part Two

Posted by Joe Paduda on Monday, July 2nd, 2012 | Comments

The blogosphere’s view of the Supreme Court decision is nuanced, insightful, and often surprising. Following up on our late Thursday night report on initial reactions to the decision, this is a quick tour of “the best of” posts over the weekend.
We start off with views on the Supreme’s ruling that the Feds can’t cut off all Medicaid funding to states that don’t increase Medicaid coverage. Anthony Wright trenchantly observes:
“For the first three years, the federal government would pick up the cost of 100% of the newly eligible. In 2017-18, then the federal government picks up 95% of the tab, and then down to 90%, into the future. Even in the out years, the federal government is providing a 9:1 match.
In terms of investments in health care, or in terms of economic stimulus, there’s no place that can get you the bang-for-your-buck of a 9:1 match. Why would any Governor or Legislature reject this?
Over a dozen years ago, Congress created the SCHIP program, and allowed states to do a child health expansion voluntarily, with no tie to Medicaid funding. The SCHIP program provides a 2:1 match. And ultimately, 50 states took advantage of his benefit.”
Good take; I’d note the political winds have changed pretty dramatically over the last decade, and I would not be surprised to see some conservative govs stand on “principle” and refuse free money even if it gets their poorest citizens health care.
Bob Laszewski notes the 29 governors who’ve expressed outrage/concern/anger over the Feds attempt to require them to expand Medicaid coverage now are in the driver’s seat:
“Whether or not their state gets a Medicaid expansion is now entirely up to them. It’s put up or shut up time for conservative governors and state legislators who said the ACA was an onerous expansion of federal powers over their states.
If some states do reject the Medicaid expansion, consumers between 100% of poverty and 133% of poverty would become eligible for the private federally subsidized insurance in the exchanges since the subsidies start at 100% of poverty.”
Nathan Cortez at Health Reform Watch took the dissenting Justices to task; “What disappoints me about the joint dissent (by Alito, Kennedy, Scalia, and Thomas) is that it doesn’t seem to appreciate why health insurance is a unique problem of unique scale that requires unique solutions like mandates. How do you pretend that the uninsured are pre-commerce? How do you pretend a $2.5 trillion industry doesn’t exist?”
Neil Versel is still surprised about Chief Justice John Roberts’ support of ACA; he also notes that ACA is no panacea, and health care in the US is still, well, in need of improvement. Lots of improvement.
I’ve been reading a history of the New Deal; much of the legal footing for the dramatic expansion of governmental programs was based on the Constitutionally-established ability of the Federal government to tax. One book does not a scholar make, but the precedence is well-established and rock-solid.
I posted Friday about the impact of the decision on workers comp; overall, it is good news indeed – healthier claimants with more coverage = lower work comp costs, although access to primary (and some specialty) providers is going to be tight indeed for several years to come.
Finally, Jaan Sidorov has been tracking goings-on here whilst on vacation in Sweden; he thinks reform is here to stay, and we better get used to it.

Jun
29

UPDATE – Health reform, the Supreme Court decision and workers comp

Posted by Joe Paduda on Friday, June 29th, 2012 | Comments

[see update below]
Now that the Supreme Court has handed down the final word on the PPACA, we can stop speculating and start thinking thru how it will effect workers comp.
Overall, this is good news. That may not sit well with those ideologically opposed to reform, but here’s why.
The most important single impact is this – When injured workers have coverage, there is no need for WC to pay for non-occ conditions for injured claimants (whether the WC payer follows thru on this is a separate issue).
This is also the most significant short term impact, especially in states such as Texas and Florida where almost one in four working age people doesn’t have health insurance. Think of it this way – a claimant needs surgery for a rotator cuff tear, has diabetes and hypertension. If they don’t have coverage, the work comp payer will pay to treat the diabetes and hypertension – those conditions have to be addressed if the claimant is going to recover and get back to work. Now the comp carrier can send those bills over to the health insurer.
And, the adjuster, case manager and UR function won’t have to engage in the back-and-forth with the provider over treatment, delaying treatment and extending disability duration.
There are a plethora of other ways PPACA will impact work comp – here’s a summary
1. There will be somewhere around 24 – 28 million more Americans with health insurance; thus there will be a lotless need for hospitals and other providers to cost shift to work comp to make up for revenues lost due to treating the uninsured. Sure, Medicaid reimbursemt is lousy and Medicare only a bit better but something’s a lot better than nothing.
2. Possibly higher claims frequency, although this is based on assumptions and interpretations. The data indicate those workers with health insurance are more likely to file comp claims than those without, but that appears to be a statistical relationship and not a causal one. Employers who provide insurance have better employee relationships, which appears to make employees less afraid to file WC claims.
3. For the big managed care companies, continuation of a much stronger and tighter focus on managing individual and group health, Medicaid and Medicare will mean less interest in, and resources dedicated to comp. Make no mistake, this is an event for which the big and small health plans were woefully unprepared. Many have been scrambling to adapt, investing in technology, getting bigger via acquisition, and strengthening relationships with providers.
Coventry and Anthem are the large players most invested in comp; they appear to have different strategies and approaches which we’ll explore in a future post.
4. Healthier claimants – those with insurance are healthier than those without, and healthier claimants heal faster and don’t need as much treatment.
5. More science and less art in the practice of medicine as comparative effectiveness research gains traction – good news indeed for comp payers saddled with back surgeries and H-Wave devices.
While some states may decide to not accept funding for the expansion of Medicaid, on balance this won’t be a negative – any additional coverage is a net positive for comp.
UPDATE – A colleague reminded me (after I posted this today) of the access issue – and he is correct. There will (very) likely be an access problem over the near term as primary care providers are inundated with new patients, and over the medium term for specilaists as folks who’ve long avoided care because they could not afford it now get those problems resolved – knee replacements, etc. My colleague’s reminder is well worth considering, and payers would be well-advised to develop strategies to strengthen relationships with primary care – and specialist providers. WC primary care is best delivered by occ med docs, so this may also encourage payers and employers to direct their claimants to docs better equipped to deal with those patients.
What does this mean for you?
Healthier claimants, less cost-shifting, more science, and possibly slightly higher frequency – on balance, good news indeed for workers’ comp.
For those who are interested, I have a rather detailed presentation on this issue; send an email to infoAThealthstrategyassocDOTcom and we’ll get it out to you next week.

Jun
28

SCOTUS on health reform – the bloggers respond

Posted by Joe Paduda on Thursday, June 28th, 2012 | Comments

Health Wonk Review is hosting a special edition today compiling the views of the health bloggers on the Supreme Court’s decision on PPACA.
By now all know the Court upheld the Affordable Care Act by the narrowest of margins, with Chief Justice John Roberts the swing vote and author of the majority opinion. The quick synopsis from MCM (that’s me). Everything stands except the Feds’ ability to require states to expand Medicaid coverage or lose all their Medicaid dollars.
While there will still be a significant expansion of coverage, if some states opt out the number of uninsureds will not drop below 18 million as originally forecast. I don’t see a lot of states standing on principle and rejecting the money – which covers up to 90% of the cost for the first few years, and 50% thereafter. Then again, stranger things have happened. The basis for Justice Roberts’ opinion lay not with the Commerce Clause but rather the Constitutional power of taxation. We’re going to start with the legalities.
Which are much more than just “legalities.”
Several contributors explore the issue albeit from different perspectives.
David Harlow of Healthblawg fame finds the dissenting opinions rich in content and entertainment value, especially Justice Ginsburg’s statement “no one would offer the hypothetical and unreal possibility of a vegetarian state as a credible reason to deny Congress the authority ever to ban the possession and sale of goods. The Chief Justice accepts just such specious logic when he cites the broccoli horrible as a reason to deny Congress the power to pass the individual mandate.”
Yowza.
At Health Affairs, Tim Jost digs into the Roberts opinion, citing this key statement: “proper respect for a co-ordinate branch of government requires that we strike down an Act of Congress only if the lack of constitutional authority to pass [the] act in question is clearly demonstrated.” Clearly Roberts felt the “demonstration”, to the extent there was one, was not clear enough.
We welcome back HWR co-founder Matthew Holt to these digital pages. Matthew sees the tie to taxation as a watershed moment; “In any rational society health care ought to be a public good financed through taxation and distributed in some manner that makes rational sense. America has never officially believed that. [emphasis added] Now it at least has affirmed the concept.”
Jason Shafrin sees this from his economist’s perspective; saying the mandate-as-tax logic “is one that economists would support (whether economists support the mandate is a separate issue). All regulation is a form of a tax in that it restricts one’s choices and imposes a cost on consumers and/or producers.”
And Ezra Klein thinks Roberts toed the conservative line; “The 5-4 language suggests that Roberts agreed with the liberals. But for the most part, he didn’t. If you read the opinions, he sided with the conservative bloc on every major legal question before the court…Roberts’s coup in writing an opinion that has found support on both sides must inspire some grudging respect.”
Maggie Mahar – and we are happy to see her back at her signature Health Beat blog – was not only unsurprised by today’s ruling – she called it. Read why she was sure the law would not be overturned in her post, Today, the Supremes sang
At Workers’ Comp Insider, Julie Ferguson did a little live blogging of the Supreme Court ruling, catching some of the major media in “Dewey wins” moment. CEO Tom Lynch weighed in with some analysis of the impact today’s decision.
Jay at Colorado Health Insurance Insider sees Roberts’ decision as not inconsistent with the government activism of the Bush administration. Jay opines “While the individual mandate and wire tapping seem on the surface to be completely different topics, they’re both on the spectrum of government involvement in our lives, and government utilizing its powers to promote an agenda that it views as good for society at large…”
The only part of the ACA seriously affected by the decision was the expansion of Medicaid, which, according to Sara Rosenbaum, was to “reshape Medicaid from a program covering certain categories of the poor into one that offers universal public insurance for all non-elderly low income citizens and long-term legal residents living in poverty.” Rosenbaum believes Roberts was able to convince other Justices to split Medicaid into “two spending programs,” thereby preserving the existing programs while placating the states’ rights advocates.
The implications for Medicaid are succinctly summarized by David Williams in his podcast interview with Avalere Health CEO Dan Mendelson.
While David’s got the high level view, Liz Borkowski sees a lot of uncertainty at the Pump Handle; “If some states decide not to go along with the now-optional Medicaid expansion, their poorest residents who don’t already qualify for Medicaid will have neither Medicaid coverage nor subsidies to help them get private coverage.”
Hank Stern’s had it with all this reform and Obama-stuff; he’s ready to pack up and leave, and suggests the medical tourism folks may be big beneficiaries of the Roberts decision
Roy Poses notes the decision – and the PPACA – suffer from a lamentable lack of attention on the concentration and abuse of power that still pervades our health care system; without addressing those issues, we’re unlikely to see any real and lasting improvement.
And of course, there’s the internet’s ability to quickly give us the reaction of the public, Jon Stewart,
and, of course, President Obama…
1774482-obama_oh_snap_super.jpg

Jun
27

Managed care in work comp: worth the cost?

Posted by Joe Paduda on Wednesday, June 27th, 2012 | Comments

Medical cost containment expenses in California have doubled over six years. Yet medical expenses have continued to increase, led by facility and surgery expense, and WorkCompCentral reports the combined ratio hit 122 in 2011, a substantial jump from previous years. (sub req)
Are we wasting hundreds of millions on ineffective programs, or are these programs holding costs well below what they otherwise would be?
The answer isn’t readily apparent and it isn’t straightforward – no surprise there. Let’s reach into the cost containment bucket and see what we are paying for.
Bill review accounts for about $90 million of the $384 million total (based in a cost of about $6 per bill). We will be publishing our second Survey of Bill Review next month; a preliminary review shows most respondents see a good deal of value in bill review although that value would beach higher if UR and BR were electronically and tightly connected.
Networks are a bit knottier. Most incur a percentage of savings fee; I’ve long held that this arrangement – for generalist networks – encourages higher utilization of medical services and can drive up cost. My best guess is network costs in the Golden State account for about $110 million in cost containment expense, and that’s too much by far for many networks that don’t positively affect medical outcomes. (there’s no question some smaller tighter networks can and do have a dramatic impact on outcomes, but they just aren’t used enough.)
Case management can be very useful; if used correctly (Im seeing a pattern here…). Task-based field case management and well-coordinated telephonic CM can be very helpful indeed. Identifying problems, educating the employer about RTW and non-comp-savvy docs about comp, getting the claimant to the right providers and supporting the adjuster in assessing treatment are all necessary and cost-effective. But dumping cases on case managers, or allowing CM to run up lots of hours while doing not much more than documenting the downward spiral of case happens far too often.
And let’s not forget many (but by no means all) TPAs generate additional revenue and profit by employing CM whenever and wherever possible
Utilization review has been around forever, yet it is still misunderstood and controversial. Appropriately employed, UR can help ensure the care that is delivered is the right care for the claimant in the right setting at the right time. Used indiscriminately, it can be a cost driver that infuriates physicians, delays necessary treatment, prolongs disability, and does little to improve outcomes.
I’ll have much more to report on UR next month; we’re closing our first Annual Survey of UR in Workers Comp Friday. To date we have over 150 participants; if you’d like to add your thoughts to the Survey (and get a detailed copy of the report) click here.
The net?
Some payers are doing an excellent job managing medical and managing cost containment – by focusing on outcomes. But most are not.
Paying over a hundred million dollars for network access without clear and convincing proof that they are improving outcomes is not smart.
Using case management and UR indiscriminately across all providers in all cases is a waste of money and counter-productive.
More to come.

Jun
26

Progress on opioids – Texas leads the way

Posted by Joe Paduda on Tuesday, June 26th, 2012 | Comments

There’s precious little good news on the subject of opioid overuse in work comp; NCCI and WCRI report increased usage, pill mills abound, CWCI’s research shows longer disability durations, and payers lament their inability to do much of anything to fix the problem.
The last two weeks have brought news that is welcome indeed; early indications are that Texas’ adoption of a restricted formulary has led to significant reductions in the use of opioids early on in new claims, stakeholders are focusing on preparing to address legacy claims, and there may well already be some impact on legacy claims.
For those not deep into this issue, Texas is one of the few states (and almost all the others are monopolistic WC states) that has adopted tight guidelines re the prescribing and dispensing of opioids to workers comp claimants. These guidelines were imposed on all claims occurring on or after September 1 2011. While it is still early, preliminary research indicates a significant impact on prescribing and dispensing patterns. (the changes compare claims occurring from September to November 2011 to claims in the same timeframe in 2010)
– prescription drug costs for drugs “not recommended” (N) for 2011 claims were reduced by 75 percent when compared to 2010
– the number of claims receiving “N” drugs dropped by 54 percent
– total prescription drug costs for 2011 claims declined 26 percent – about $1.4 million
– “the frequency of opioid prescriptions dispensed to injured employees decreased by 10 percent and the costs associated with opioid prescriptions decreased by 17 percent”
Word is there has also been an impact on older, legacy claims. Anecdotally, PBMs are reporting they are seeing changes in prescriptions for some claims that were incurred long before 9/1/11.
The data from Washington state is another indicator that physicians can and do change prescribing patterns when forced to by regulation. Washington saw a significant decrease in the volume and potency of opioid prescriptions after passage of legislation addressing the issue.
What does this mean for you?
Prescribing patterns can be changed. All it requires is:
a) political will; and
b) tough regulations and/or legislation.

Jun
22

Health Wonk Review isn’t waiting for the Supremes…

Posted by Joe Paduda on Friday, June 22nd, 2012 | Comments

Actually, it was.
Faithful readers will note the delay in this biweek’s publication of HWR, a delay that was not an oversight but intentional; like many of you I’ve been waiting breathlessly for news of the Supreme Court’s pending decision on PPACA.
Alas, the distinguished folk in the black robes aren’t cooperating, so I’ll have to proceed without them.
Much as the real world is. For truth be told, the real world is moving rather quickly towards reforming bits and pieces of what passes for a health care system. And herein begins our tale.
We lead with the estimable Maggie Mahar. Maggie believes if the Affordable Care Act’s individual mandate is ruled unconstitutional by the Supreme Court the government will have to take a carrot-and-stick approach to encouraging healthy Americans to buy individual insurance – and it will likely have to focus much more on carrots. The individual mandate isn’t likely to drive much in the way of behavior change as the penalty wasn’t much of a “stick”.
Maggie’s fellows take this a step further, Harold Pollack and Henry J. Aaron explain how a new GOP majority would assault the health reform law, but wouldn’t stop there; Medicaid and Medicare are on the chopping block too.
At HealthAccess.org, Anthony Wright discusses the “evolution” of the GOP; it’s worth pondering the reasons of the amazing switch of Republican leaders on the individual mandate, from originating the idea to disowning it entirely and saying it in unconstitutional. This transformation is first and formost about politics, of course. But it is more than that–it’s that the mandate forces government to take direct and serious action to force insurers to abide by rules that encourage coverage; “showing that governmental action could actually make progress on social issues.”
Horrors!
David Williams, one of the more insightful observers of all things health care related, doesn’t think the GOP is ready or willing to engage in a meaningful discussion of health reform – but it will need to get serious quick if it wants to be taken seriously
The Huffington Post’s Sanjay Sanghoee thinks losing ACA isn’t that big a deal, as it wasn’t going to accomplish much in the first place. If it does get overturned, Sanghoee wants President Obama to push the public option as a much more robust solution that is much more likely to work.
Methinks the New America Foundation’s Justin Jones and Sanjay would have an interesting discussion re the role of the free market; Justin notes that while the Anti-ACA crowd has long vilified the ACA as an unprecedented intrusion of government into the free market, the ACA is actually very market friendly and free-market advocates should consider whether it would really be the end of the world if it is upheld in its entirety.
But the discussion between Justin, Sanjay, and Bob Vineyard of InsureBlog would be even more interesting; Bob thinks we are being “primed for single payer“; Bob says single payer is a “system with a 100% failure rate.”
Love ya, Bob, but I guess it depends on how one defines “failure”; with 50 million uninsured and tens of millions more under-insured, we ain’t exactly a model of success in coverage, or outcomes, or cost!
My contribution this fortnight focuses on the impact of health reform on employment – Massachusetts has been a great laboratory, and the results are instructive.
Roy Poses – who’s been with HWR since its inception seven (!!) years ago draws parallels between Wall Street, the financial debacle, and the inherent issues with conflicts of interest at the highest levels of government and health care.
Roy is joined in his effort to increase understanding of potential conflicts of interest by Alison Hwong, an MD-PhD candidate at Harvard, and Lisa Lehmann, the Director of the Center for Bioethics at Brigham and Women’s Hospital; posting at Health Affairs, Alison and Lisa stress the importance of going beyond simple disclosure of physican-industry financial relationships to help patients understand the context and implications of these relationships.
Neil Versel wants the public to know that they do have a right to access and correct their own health information, though few know about this or do anything about it. Better to do that now than when it’s critical to your life – and perhaps too late.
Among the other hot topics on the minds of bloggers was obesity – childhood and otherwise.
Kat Haselkorn digs into NYC Mayor Mike Bloomberg’s move to shrink the size of sugary beverages – she’s not sure it will succeed, but applauds the politically-sensitive mandate nonetheless.
This isn’t just a NY thing; out West one of our favorite insurance brokers Louise discusses a similar move in Colorado where a new law bans trans fats in “competitive foods” in public schools.
We conclude with thought-provoking posts about things most of us don’t spend enough time thinking about, and Jessie Gruman’s contribution calls for all of us to consider the implications of moving from curative to comfort care whe “Shifting to Palliative Care”.
Julie Ferguson shines a light on an important public health issue: domestic violence in the workplace. Homicide is a leading cause of occupational death in U.S. women, and while work homicides in general are trending down, homicides of women at work are trending up.
Michael Gavin wants workers comp payers to pay attention to the quantity of opioids their claimants are taking, and do something if it gets excessive.
John Goodman opines that failing to make consumers price-sensitive at the point of purchase is one of the biggest problems with health care. No argument there, although it is no panacea – when you’re on the ER table with chest pain you’re not exactly ready to negotiate.
We do know the Supremes’ decision will come down next Monday or Tuesday, and we’ll likely have a special edition of HWR when it does…if Julie says we can.