Kings, dogs and Burwells: The latest policy posts from the Health Wonk Review #HWR

BHN is hosting this week’s round-up. In anticipation of the King v. Burwell decision, we offer kings and Burwells. The content of the images is not meant as a BHN endorsement for either position. Same goes for the opinions in these posts. Some say the ruling may come down today, others bet on 6/29. SCOTUS Blog is the site to watch. (For actual posts on the pending decision, see the 6/3 edition.)

Finally, our thoughts are with the members of Emanuel African Methodist Episcopal Church and the staff at one more hospital that had to brace for victims of a mass shooting.

The posts:

  • 512px-BBKing07

    By Roland Godefroy

    Joseph Paduda at Managed Care Matters writes:  Health care cost drivers; or, here’s where you’re getting screwed. Two studies published in Health Affairs shed much light on hospital costs and the societal implications of physician practice consolidation.  Both are a bit scary.

  • A post from Health Affairs analyzes the major elements of the final rule recent Medicare Shared Savings Program Final Rule.Lawrence Kocot, of Ross White,
    burwell

    HHS photo

    and Mark McClellan at KPMG  offer alternatives for CMS and the possible future of the program

  •   From David Willams at the Health Business Blog notes: Long term care insurance -narrow framing is not the problem. Why don’t people buy long term care insurance? Because for many it’s not a good value
  •  David Harlow at the HealthBlawg: Outsourced Chronic Care Management Service256px-King_Kong_1933_French_posters Can Help Physicians and Patients. I wrote this post with a client about Chronic Care Management, a newly-reimbursable service under Medicare as of January 2015, and a service that is specifically non-face-to-face. The federales are dedicating significant funds to this service based on the belief that it will reduce expenditures on other services for multiply-chronically-ill elders.
  • From Boston Health News, links to stories on telemedicine and hospitals as step-down units.
  • From Roy Poses at Health Care Renewal: Health Care Professional Societies Whose Leadership Betrays Their Own Members – the APA Alleged to Have Supported Torture, and Deceived its Members to Collect Money. Health care professionals need to be extremely skepticburwellneonal of the leadership and governance of all health care organizations.  True health care reform requires organizational leaders who understand the health care system, uphold its values, and are willing to be accountable.
  •  Tom Lynch of Workers Comp Insider offers “the word of the week: horrendoma. That’s a description he applies to the healthcare system after looking at billed vs paid hospital data and the concept of charges as a “starting point.” See his post: Hospital Medicare Charges: You Don’t Always Get What You Want.
    By Metro-Goldwyn-MayerReproduction Number: LC-USZ6-2067 Location: NYWTS -- BIOG [Public domain], via Wikimedia Commons

    By Metro-Goldwyn-Mayer, Inc.

  • Henry Stern at InsureBlog asks “What carrier in its right mind would cover” sex change surgery? Transjenner Insurance: In case you were wondering: Yes, ObamaPlans *do* cover sex-changes. InsureBlog has the, er, straight scoop.
  • From Health System Ed: Decrying the End of Private Physician Practice? Not so fast!  Experts have been saying that the private physician practice is no longer sustainable under managed care but then along comes ACOs and perhaps that tune is changing when the focus turns from volume to outcomes.
  • This Health Affairs post focuses specifically on the provisions of the rule dealing with benchmarkingBWburwell2 and distribution of shared savings and losses and suggests that CMS consider the possibility of graduated rates of sharing savings and loss distribution.y Carrie Colla, Scott Heiser, Emily Tierney, and Elliott Fisher at Dartmouth
  • Finally, Brad Wright asks : This Father’s Day, Give 1 For Dad
    In honor of his father, he’s donating to “Give 1 For Dad campaign to fund an important clinical trial for prostate cancer at the Duke Cancer Institute. At issue is that the treatment uses a safe generic drug, which is great because it isn’t toxic like other current treatments, but not so great because no major pharmaceutical companies are willing to fund a clinical trial of a generic drug.”

What does your king look like? king-cobra-405623_640(Click on images for credits, rights.)

Cavalier_King_Charles_Spaniel_Floral

Checking in with this week’s edition of the Health Wonk Review

The new Health Wonk Review is up with a collections of health policy blog posts. Image

This edition includes comments on a Harvard School of Public Health study on “how public and healthcare experts perceive very different reasons for Medicare’s always-impending insolvency.” Also, the latest on the effort to shut down the government in an effort to defund the affordable care act.

With the exchanges coming on line next week, it’s a good time of check in with this crowd.

Beyond the ACA,  local blogger David William takes on those who take on doctor rating programs.

Data, medicine, insurance reform and a round up of health policy blogs

1950s era analog computer

1950s-era analog computer

Health data is a theme of this edition of the Health Wonk Review because it is also the focus of the current Knight News Challenge. That contest rewards media innovation with seed money. They use the word “challenge” literally, asking for innovative responses to question: How can we harness data and information for the health of communities?

Our definitions of “health data” and “news” are broad, and range from projects in traditional newsrooms to consumer-facing technology to crunching big datasets. We’re hoping to find and accelerate projects that use data and public information in innovative ways to create strong information flows about health in our communities.

Check it out. Health care produces big, big data. Health information technology, surveillance data, electronic medical records, clinical trials, NIH databases.  Payers and providers produce endless streams of data for millions of people.  On the other end of the scale, the quantified selfers keep blood pressure, diet and exercise logs.

US-MapWhat would happen if you had to turn those logs over to your insurer? David E. Williams of the Health Business Blog notes that car insurer Progressive gathers lots of info on drivers through its Snapshot device. Then, the company lowers premiums in return for lower risk behavior. He asks “What will it look like when the same approach is applied to health insurance?” Risk assessment also serves as the basis for public policies and day-to-day individual behaviors. At Workers’ Comp Insider, Julie Ferguson looks at real versus perceived risks in her post about how “Your Daily Shower Can Kill You.”

Former VA research chief Joel Kupersmith writes on the Health Affairs blog about data, privacy and genomic research.  He considers the  challenge of balancing the benefits of widely shared genomic data with privacy concerns, in particular the re-identification of individuals.

The Healthcare Economist reports data about long-term care trends and investigates the systems in Austria, England, France, Germany and the Netherlands. For many disabled elderly individuals, a nursing home is their only option.  How do European countries take care of the long-term disabled?

CDC data suggest 200,000 Americans are needlessly dying every year from preventable heart disease, but over the last decade, that number – on an unadjusted basis – has decreased by about 12%, or that there are 28,000 fewer deaths, notes Jaan Sidorov of the Disease Management Care Blog: That being said, while the greatest jumps in saved lives are among persons of color, they still are the most vulnerable to avoidable cardiovascular conditions.  If we are really going to use this information, that insight is what tells us where the resources are really needed

                  Black men are at highest risk of dying early from heart disease and stroke
Black men are at highest risk of dying early from heart disease and stroke

Moving out of the data world, Health Care Renewal asks:  What Sorts of People are “Most Influential in Healthcare?” The post notes that Modern Healthcare answers this question with with a list of managers from hospital systems and  health care corporations — and very few doctors. The list did include the CEOs of Sutter Health and Advocate Health, two companies known for significant mismanagement of health care technology, HCR notes.

Some of the most influential  run corporations that have been cited time and again for ethical/ legal problems, and some of the corporations have paid hundreds of millions of dollars in legal settlements and sometimes pleaded guilty to criminal charges.  The list included not a single doctor in private practice, very few people with backgrounds in medical or health care academics, and a tiny number who have suggested reforms of the sort we discuss on Health Care Renewal. 

dials

On to the ACA

Anthony Wright of the Health Access Blog notes that the first ads from California’s  insurance  exchange  provide some basic information to Californians, but also “introduce some signposts and open some doors.” Health Insurance Resource Center Blog offers Maggie Mahar, who says that some pundits are claiming that young Americans will have little interest in purchasing health insurance through the ACA’s exchanges. In reality, the subsidies available to about nine million of those young people should actually make the exchanges’ comprehensive coverage attractive to them.

Joe Paduda’s post  discusses the origins of the “idea” of the mandate while positing that repealing the law “won’t do anything to solve the underlying issues inherent in today’s health insurance system.” A post on health and higher education comes in from John Goodman’and the Health Policy Blog. In it, he compares the way the two are funded.

InsureBlog’s Bob Vineyard enthusiastically reports on a new health insurance start-up that leans heavily on transparency and features free telemedicine and generic drugs. Find out why he gets to post a picture of the Oscar Mayer Wienermobile.

Colorado Health Insurance Insider says that the idea of the ACA “ was to make sure that large employers offered good qualify coverage in order to avoid paying a fine, it appears that some large employers will opt for the fine instead.”

Finally:

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Dats graphic by Michael Schieben

Forget the Supreme Court — Can Ayn Rand torpedo the health care bill? See the Health Wonk Review for more #HCR

Every two weeks, The Health Wonk Review saves you the troubling of tracking the health policy blogosphere. It also takes all comers, which recently includes a strong libertarian voice from a blog with an ambiguous name. From the digest:

One of the most provocative entries that I received comes from the Center for Objective Health Policy (COHP), a group that reaches out to medical students while arguing that health care reform violates individual rights.

Nathan Fatal explains: “The problem with [the] assumption” that everyone has a “right to health care … is that a right to a good or service would require that somebody provide it, i.e., that somebody be forced to provide it.”

He objects to the individual mandate: “Just as one cannot kick down a neighbor’s door and hold a family hostage until all members pay a small fee toward his healthcare costs, a large number of citizens cannot properly hand the role of hostage-taker to the … government in order to exact indirect but forced payments from all fellow citizens … all such actions are the same since they violate freedom of action by initiating force against innocent people in order to provide ‘basic security’ to those who ‘need’ it.”

Much more on the site from all points on the political spectrum, including thoughts on the pending Supreme Court decision.  Hosted this week by Maggie Mahar at  her new blog home: healthinsurance.org blog

Where can you find the best of #health #policy blogs? On the new Health Wonk Review

Get the views on health reform from the right and the left over at this edition of Health Wonk Review. Take note of the Health News Review entry. That site — which critiques health news coverage — started in Minnesota but features a slew of reviewer from MGH and other Boston hospitals.

This week’s digest is hosted by the Disease Management Blog, which is also responsible for a series of goofy health policy videos, including this one:

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.

 

Reviews and Revues: Health Wonk roundup and Ig Nobels tonight

The new edition of the Health Wonk Review is out, hosted for the first time by the Health Talent Transformation page. It includes a video in honor of the UN’s new ambassador to outer space.

Such a move clearly qualifies for an Ig Nobel award, but the alien ambassador will have to wait until next year. The 2010 Igs will be announced tonight. Too late to get a ticket to this live send-up of silly science, but you can watch a live webcast or read more about it here or on the Ig website. 

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