Former Tufts doc: “Widespread dishonesty” leads to unjustified health care fees #HCR

Former Tufts doc and current Mainer Howard A.Corwin comments this weekend on the latest in Elizabeth’s Rosenthal’s great NYTimes series on insane health care costs. In her latest piece, she reports that “In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees.”

To which Corwin notes: 

To the Editor:

Doctors call such billing “gaming the system.” There is widespread dishonesty that leads to these unjustified expenses throughout the medical profession. Members of Congress beholden to medical lobbyists allow flawed reimbursement systems and perpetuate them by preventing reform. There is an enormous disparity between what different medical specialists and personnel earn. Unable to rectify these disparities, many physicians resort to these gaming techniques. Unnecessary expensive tests and procedures, upgraded coding, “scratch my back and I’ll scratch yours” referrals and, of course, outright greed lead to extra medical expense.

Honest doctors are demoralized and suffer from this system. Doctors must regain leadership of medicine to rectify these aberrant and destructive practices.

HOWARD A. CORWIN
Center Lovell, Me., Sept. 21, 2014

The writer is a former clinical professor of psychiatry at Tufts University School of Medicine.

Globe: For-profit hospitals in low-income communities want a cut of high fees paid to competitors #healthcarecosts

It is well documented that some Massachusetts hospitals -- read Partners – have the bargaining power to  extract higher pay rates from the feds and private payers.  Today’s Globe offers two takes on the ongoing battles.

This one is behind the paywall: 

images stewardA new coalition led by the state’s biggest health care company and its largest health care union will be pressing for higher payments to community and safety-net hospitals, saying patient care is threatened by a widening gulf between health care in rich and poor areas.

The group, calling itself the Massachusetts Healthcare Equality and Affordability League, will be formally launched Thursday by Steward Health Care System, a for-profit cluster of community hospitals, and Local 1199 of the Service Employees International Union, which represents more than 47,000 workers at sites that care for blue-collar and low-income patients.

And while it would not the odd to hear heated rhetoric from 1199, the story quote Steward’s chief executive, Ralph de la Torre, calling the disparity  “socioeconomic bias and bigotry.”

More on de la Torre in this Globe magazine profile. 

During his career, the 44-year-old heart surgeon-turned-hospital executive has shown himself to be a brilliant maestro, time and again using his relentlessness, charm, vision, and opportunism to turn an array of opponents into a symphony of supporters.

His most recent symphony was his most impressive work. As CEO of the Caritas Christi hospital network, he pushed through an $895 million deal late last year that took a group of community hospitals founded primarily by nuns to care for the poor and put them in the hands of the New York private equity giant Cerberus, a firm that takes its name from the mythical three-headed dog guarding the gates of Hades. To steer the deal through, he orchestrated an unlikely alliance of the Boston Archdiocese, Democratic elected officials, the Service Employees International Union (SEIU), and community organizers in some of the state’s poorest cities – all to support turning the struggling nonprofit hospital chain into a for-profit operation owned by a group of high-flying financiers

And an editorial calling for a correction to high rates driven by a formula designed for struggling rural hospitals. The state’s only technically rural hospitals is in tony Nantucket.

SINCE 2010, Massachusetts hospitals have benefited from an annual bonus in Medicare funding of at least $250 million. Congress is expected to vote to eliminate this windfall in early June, a blow to local hospitals, which may face layoffs and cuts in patient care as a result. But as the system is set up now, the state receives these funds due to a loophole in the national health reform law and at the expense of at least 40 other states. It’s time to find a more sustainable and equitable way to support top-notch medical care.

Single-payer health reform advocates launch new website #HCR #mapoli

The unrelenting supporters of the single-payer approach to health reform  have updated their website. And, it is a quite an update. The old MassCare site was sluggish — infrequently updated and often lacking links to upcoming events. Check it out here or click below. Also in health reform, check out WBUR’s Q & A with David Seltz, the new head of the state Health Policy Commission.

mass care

#mahealthcarecosts: Massachusetts commission meets

  1. More about the chairman. 
  2. HCFA
    Stuart Altman starts w/ a round of introduction. Sec. Bigby talks importance of improving quality of care, not just in cutting cost. #MAHPC
  3. HCFA
    Jean Yang looks forward to next generation of health reform. #MAHPC
  4. HCFA
    Carole Allen, pediatrician, local advocate for children’s health. #MAHPC
  5. HCFA
    More meet the commission: Dr. David Cutler, health economist at Harvard. Marylou Sudders, expert on behavioral health. #MAHPC
  6. HCFA
    Jay Gonzalez, Secretary of Administration & Finance says that controlling health care costs is essential for fiscal health of MA. #MAHPC
  7. HCFA
    Dr. Wendy Everett, president of NEHI, says that the other 49 states are going to be watching us. #MAHPC #mahealthcosts
  8. HealthPolicyHub
    Thinking about health care costs today? Check out @HCFA’s feed – lots of info on MA’s first steps to “crack the cost code” #mapoli
  9. HCFA
    Dr Paul Hattis of @GBinterfaith says statute allows commission to frame, name & if necessary blame & shame to help reduce cost #MAHPC
  10. HCFA
    Rick Lord of AIM and Veronica Turner of @1199mass last to introduce. All the stakeholders working together to lower #mahealthcosts #MAHPC
  11. HCFA
    Chair Stuart Altman says #MAHPC a “sounding board” for the system & not a “one way street.” #mahealthcosts
  12. JC7109
    Groups rally in Lynn against possible cuts to health care – so much for Obamacare http://tiny.cc/g4dknw #MApoli #tcot

Essay contest — Tell a story about the cost of your health care and win $$$ #hcr #healthreform #aca

Ever feel like your doctor has no sense of the cost of the prescription, treatment or scan he or she is ordering? In an ideal word, doctors shouldn’t take cost into consideration when choosing care.

But the health care system doesn’t operate in the real world and often that scan doesn’t represent the best care. And, even insured pateints are in for huge copays and deductibles.

Costs of Care is a Boston group that dares to give “patients and their caregivers information they need to deflate medical bills, while expanding the national discourse on the role of care providers in responsible resource stewardship.”

 Their effort is part of a new push for transparency in health care pricing.

So, you’re thinking – that sounds familiar? Why didn’t my doc explain the difference in costs when he asked me which hospitals I wanted to go to form my surgery?

 Now’s your chance to share that story. The folks at Costs of Care is sponsoring their third annual essay project and they are looking to stories “that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care.”

 Check out last year’s winners here: www.costsofcare.blogspot.com Entries are due November 15 and all “qualifying submissions” appear on the group’s website. The prize –$4,000.

Note that the contest is sponsored by a slew of insurance companies and Beth Israel Deaconess Medical Center. We note that Partners – famous for its high cost care — is not a sponsor.

The group notes that the stories have been used by “the major media and have been used by leading healthcare organizations such as the New England Journal of Medicine and the Institute of Medicine.”

So best not to sign up if you are shy. For more info click here or go to www.CostsOfCare.org. Or, check out their Facebook page.

The “end of fee for service”: Health cost wars break out in in New England #hcr #mapoli #aca

More than a river divides Vermont and New Hampshire. In the state that lives by the motto, ” Live Free or Die,” regulators and politicians declined to set up a health insurance exchange mandated as part of the health reform law. From the June 22 Concord Monitor:

John Lynch signed into law a bill that prohibits New Hampshire from planning, creating or participating in a state health care exchange under the 2010 federal health care law. The Democratic governor did so with the support of the state Insurance Department and conservative Republicans dead set against the health care law passed under the Obama administration.

Opponent were predicting — at the time of this story — that the Supreme Court would rule against the individual mandate and the health law would “fall apart.” That didn’t happen and now the feds will come in and set up the exchange.

Next door in Vermont,  the Green Mountain Care Board is reviewing hospital budgets. From Vermont Public Radio:

The board has established a cap on spending increases of no more than 3.75 percent annually. But as a group, Vermont’s 14 hospitals are seeking increases of roughly 7 percent for the coming 12 month period. “We know there are some legitimate reasons that hospitals might need to grow higher than the 3.75 percent, most of those having to do with circumstances beyond their control,” said Anya Rader Wallack, the chairwoman of the Green Mountain Care Board.

The board may allow some increases above 3.75 percent, if the hospitals can prove that they are using the money to make investments that will lower costs in the long run.

But Wallack says the bottom line is that hospital spending needs to be kept under control: “We have a responsibility to hold down costs. So we’ll be looking at all of these requests with an eye toward how we can stay within that target, because we don’t think Vermonters can afford more than that.”

Welcome to your future Massachusetts.  Health care cost containment can get ugly. For reporting on the Massachusetts cost control law, go no further than the Globe’s special section. From today’s Bill signing story:

Six years after Governor Mitt Romney required every resident to obtain health insurance, Governor Deval Patrick signed a law that many consider the second phase of that groundbreaking experiment: trying to rein in the state’s health costs, which are among the highest in the nation.

The new law — which Patrick signed Monday at a State House ceremony packed with hospital executives, health care advocates, and lawmakers — seeks to keep health spending from growing faster than the state’s economy through 2017. For five years after that, the law aims to further slow spending, to half a percentage point below the growth of the economy.

Health Wonk Review: Wearing the Green for the St. Patrick’s Day Edition

Here in Boston, researchers have looked into that most pressing of St. Patrick’s Day health questions: Is Guinness really good for you? Red wine gets all the press, but Tufts researchers found a positive association between beer and bone density.

For this edition of the Health Wonk Review, we take a a look at the Irish Times and find that even with a national health plan, Ireland has to deal with barriers to care. One story details slow progress in the establishment of promised primary care centers, and another story, asks “Is the EU good for your health?”

So, while we refight the battle over birth control, the Irish health ministry — of the largely Catholic country — is releasing a “sexual health” app.

Back here in the new world, the great grandchildren of Irish immigrants celebrate their heritage as Linda Leu at the Health Access Blog writes about a report that “highlights the need for cultural competency and language access, to welcome all ethnicities from California (and America’s) diverse communtiies….The Importance of Equity in the Bridge to Reform: As St. Patrick’s Day celebrates Irish ethnic pride, we need to take note of the full diversity of our states and nation. As we get ready for 2014, remember the communities that will be newly served may not look (or speak) the same as those that the current system serves.” 

For the once-a-year step dancers,Gary Schwitzer at Health News Review answers questions about outcomes data on knee replacement surgeryAlso see posts on the JGIM paper on  data on  shared decision-making in prostate cancer surgery & coronary stents decisions   and an online “Daily Deal” coupon for preventive MRI scan – disease-mongering du jour

Boston’s own David Williams notes: “Profits are up at Massachusetts health plans –should you be upset? On his Health Business Blog, he writes: The Globe reports higher profits and CEO compensation at Massachusetts health plans. But profit margins are low and if anything the CEOs are underpaid.”

More of the best of recent health policy posts

At The Hospitalist Leader, Brad Flansbaum examines physician pay,fairness, and how it relates to the reinvigoration of primary care. Specialty physicians take note.”

Another post on health care providers — and their support teams — notes: “There’s been much discussion of the potential impact of health reform, aka Obamacare, on employment”  Joseph Paduda at ManagedCareMatters.com writes: “Most has referenced employers cutting jobs to avoid the mandate or save dollars for premiums.  What hasn’t received much attention are the new jobs – mostly high-paying ones- that will be created as more Americans are insured and seek coverage and care.”

Julie Ferguson of Workers’ Comp Insider asks “If you had to guess what workplace experienced most assaults by customers/patrons what would you guess? If you guessed healthcare, you would be right.” She informs us that 61% of all workplace assaults are committed by healthcare patients, according to a recent report issued by NCCI.

Two posts came in on shady practices.

Colorado Health Insurance Insider offers: Colorado AG Files Lawsuit Against Discount and Mini-Med Health Plan:  “It’s a pretty typical website for that sort of product, with lots of great-sounding claims and sample cases where members have supposedly saved thousands of dollars.  But they also have a link for people who want to “become a reseller”.  And their process of getting recruits enrolled to sell the product is what has come under the watchful eye of the Colorado AG.”

 Calling it “The latest example of misbehavior by a large health care corporation,”  Roy M. Poses at Health Care Renewal writes : Gentiva’s Odyssey Healthcare Settles Again, Signs Yet Another Corporate Integrity Agreement and gets “little more than a financial wrist slap.  The case was about allegations that a for-profit hospice enrolled patients who did not meet the regulations for federal reimbursement for hospice care.  In particular, they were alleged to be patients who really did not seem to have extremely limited life expectancies.  It is true that enrolling such patients lead the government to pay more for their care than might otherwise be the case.  But the real problem is that patients may have been denied treatments that could have improved, or even lengthened their lives. 

Two on workplace wellness:

Wellness Program Implementation at WCS Looks a Lot Like Dating” says Kat Haselkorn Corporate Wellness Insights. This post details the similarities between customer satisfaction and romantic relationships. Although wellness program implementation and dating do not seem to have much in common, we have found that the process of making a client happy mirrors the act of keeping a romantic prospect satisfied. When it comes to setting up a wellness program, we do whatever it takes!

Henry Stern, LUTCF,  at the CBC InsureBlog writes about “Health vs Common $ense, challenging “the conventional wisdom that workplace health promotion programs work.”

And two on HIT:

“Competition today in healthcare encourages care providers to hoard patient data.”  says Vince Kuraitis of the  e-CareManagement blog in a post called “Stage 2 MU Rules : The proposed Stage 2 Meaningful Use rules support moving competition in healthcare to the right bases — sharing and adding value to patient health record data.

Health Affairs offers a post by Danny McCormick, of Harvard Medical School and the Cambridge Heath Alliance, and coauthors David Bor, Stephanie Woolhandler, and David Himmelstein. The title of the post is  “The Effect Of Physicians’ Electronic Access To Tests: A Response To Farzad Mostashari

The four authors of the post are also the authors of an article in the March issue of Health Affairs. The article reported that electronic access to computerized imaging results (either the report or the actual image) by physicians was associated with a 40% -70% increase in imaging tests, including sharp increases in expensive tests like MRIs and CT scans; the findings for blood tests were similar. The article prompted a critical blog post by national health IT coordinator Farzad Mostashari.

Jason Shafrin writes: “Americans are a litigious culture.  The malpractice claims that make it to court, however, are not many as you may think.The Healthcare Economist explains why.

Finally, how does health care In the U.S. compare to other countries?  On the Disease Management Care Blog  Dr. Jaan Sidorov tests our knowledge of and finds: We’re not so bad after all!

So, our days of drinking black — or green  — beer are over. But, on Saturday I’ll boil up some cabbage and — sorry Walter Willett — and a hunk of  corned beef in honor of my Irish nanny and the Readys and Gradys  and Murphys who left their green shores and made their way across the sea to settle in Boston and New York.  Happy St. Patrick’s Day from BHN.

 

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