Reforming Health Care One Element at a Time

This from Greg Scandlen:

Too Big To Succeed I participate in a number of discussion groups, often with highly educated experts in health policy. In recent months it has become increasingly difficult to even discuss the health reform proposals There are so many versions and iterations of all these bills and amendments that it has become nearly impossible to discuss any of it. And some of it isn’t even exposed yet, like Reid’s bill. CBO keeps scoring this, that and the other, and it is hard to match up the particular CBO score with the right bill or amendment, let alone compare specifics. Yet every provision is critically important, and not just by itself, but how it interacts with the other provisions. It feels like a shell game, and it is small wonder people are edgy about the whole enterprise. Too many moving parts, too little clarity, too much rhetoric and jargon, and all tainted with political ambitions. I think we are way beyond what the legislative process is capable of doing. There is literally no one in Washington who knows what it is they are voting on anymore. It would be far better to take all these topics one bite at a time, by which I mean separate bills for – Medicare payment reform Insurance regulation Assistance to the needy Management technology upgrades Workforce initiatives Quality improvement initiatives Professional liability reform Each of these is complex by itself. Blending them all together into a single bill is simply impossible. For example, I concede that we need to completely overhaul the regulatory regime currently in place for insurance. Each state has completely different statutes for the individual, small group, and large group markets. Some states have separate regulations for Blue plans, commercial companies, and HMOs. Then ERISA exempts self-funded employers from any state regulation. Regulatory reform is an enormous challenge all by itself and the current bills are way too vague on how, or even whether, that is supposed to happen. For instance, it is not at all clear what will be the state and federal roles for regulating carriers that participate in the Exchange. Who oversees their solvency, reserves, accounting, investment practices? If a company markets exclusively through a national Exchange, what is its state of domicile? Will HMOs continue to be regulated by separate agencies than other carriers as they are in California? Who will regulate brokers? Or take the workforce issue. We are facing substantial shortages of primary care physicians and nurses as the Baby Boom generation retires. Expanding insurance coverage will aggravate the problem. Plus there are new technologies coming on-line all the time. How do we get enough technicians to run the machines? It is not just a matter of giving scholarships to med students or opening more slots in dental schools. The whole licensure and oversight regime currently in place needs to be re-examined. Everyone who looks at it concludes it is a mess. Why at least could there not be interstate reciprocity for licensing and disciplinary actions? Why can’t a physician who is licensed in Arizona prescribe drugs for patients in New Mexico? Or how is it that a doctor who is disciplined in one state can set up shop in the adjoining state? And on and on and on. Because this thing is so big, we are not paying enough attention to the critically important REAL issues.

Political Maneuvering in Health Care

This from Greg Scandlen:

Pay Back is a (you know) Congress and the White House are using the insurance industry as an example of what they would do to the AMA, PhRMA, AHA, and other interest groups that dare to get out of line. This is Chicago-style intimidation at its most vivid. Not that the industry doesn’t deserve it. AHIP is just fine and dandy with mandates and price controls as long as its member companies will prosper. But it was always naïve of them to think it would work that way. There have been four reports come out recently pointing out the obvious – guaranteed issue and community rating without mandatory coverage will raise premiums through the roof. It is a completely unremarkable finding. Every economist on the face of the Earth knows it is true and it has been proven over and over again in states such as New Jersey, New York, and Massachusetts. Now, the government may be able to paper over those premium increases with subsidies, but the underlying effect is still there. And the price has to be paid for by someone — if not by the insured through premiums, then by the taxpayers through subsidies. AHIP and the Blues were all in favor of these rating restrictions and price controls as long as people were forced to buy what they sell. But Congress started to waver on the mandate because it is mean to working people to make them buy what they can’t afford. Well, yes it is. But they still thought it was nice to have healthy young people pay the same premiums as decrepit older people. Well, no it isn’t. We have already reported on the studies by AHIP and the Blue Cross Blue Shield Association. Since then WellPoint has released a study looking at the impact in the specific states where it does business, and Milliman released a report on “Adverse Selection and the Individual Mandate.” Both re-emphasize the message. But Congress and the White House do not like to be contradicted, so National Underwriter reports that the “Administration Takes on Insurance Giant.” It writes, “The White House has accused WellPoint Inc. of “cherry picking certain policies and ignoring major aspects of reform” in a collection of analyses of how health reform might affect some of the states it serves.” And so on, in its continues effort to demonize any person or company who has the “audacity” to disagree with it. But the abuse of power doesn’t stop at the White House. Sen. Jay Rockefeller, jes’ a good ol’ boy from West Virginny, thinks that profits are a terrible thing, according to Reuters. (Hey, Jay, just how did your granddaddy make his money again?) It writes, “Senate Commerce, Science and Transportation Committee Chairman John Rockefeller, in a letter to Cigna, demanded that the company immediately clarify the amount of premiums it receives and the amount of the claims it pays for group health insurance products.” The article adds, “He wrote in the letter that: The analysis shows that in the individual and small group segments, insurers spend a significantly smaller portion of each premium dollar on patient care than they do in their large group businesses.” Well, duh! And so it goes in this new era of a unified America. SOURCE: Milliman Report WellPoint studies National Underwriter Reuters

Consumer Directed Health Plans

Trends in Employer Contributions to Consumer Driven Health Plans

According to a new survey report released by the Employee Benefits Research Institute (EBRI), among the roughly 4 percent of covered Americans who have consumer-driven health plans, contributions to the plans by their employers are shifting: Workers with employee-only coverage have seen their annual employer contributions decrease, while those with family coverage have seen their annual employer contributions increase. Survey findings include:

• Among workers with an employer contribution, those with employee-only coverage saw their annual employer contributions increase between 2006 and 2008, but fall in 2009.
• Between 2006 and 2008, the percentage of workers with employee-only coverage reporting that their employer contributed $1,000 or more to the account increased from 26 percent to 37 percent, but in 2009, it fell to 32 percent.
• The percentage of workers with an employer contribution of less than $200 increased from 3 percent to 8 percent between 2008 and 2009.
• The percentage of workers with family coverage receiving a contribution of $1,000 or more increased from 59 percent in 2008 to 73 percent in 2009.
• Nearly three-quarters of workers with family coverage in a consumer-driven health plan (CDHP) now receive an annual employer contribution of $1,000 or more.

Data Source: EBRI Notes, November 2009. www.ebri.org

Keeping Drug Costs Under Control

Smart Rx: Drugs that Work and Won’t Break the Bank
If you want a prescription that won’t empty your wallet, while still keeping you well, you might start asking your doctor about drugs you don’t see on TV. [ Associated Press | Nov 4,

Health Care Tort Reform Controversy

Doctors say the price of defensive medicine and malpractice insurance accounts for up to 10 percent of health care spending. Lawyers say malpractice settlement costs amount to less than 0.5 percent of the $2.5 trillion spent each year on health care.

The debate has split along party lines, with Democrats typically siding with lawyers groups and Republicans agreeing with doctors.

http://www.ahiphiwire.org/Clinical/News/Default.aspx?doc_id=440925&utm_source=11/5/2009&utm_medium=email&utm_campaign=HiWire_Newsletter&uid=TRACK_USER

Physician HIT Adoption

Physicians concerned about HIT cost, workflow disruption
An online survey of 1,001 physicians found 82% of respondents cited cost and 74% cited workflow disruption as the major risks for EHR adoption. The survey, by Ingenix, also showed 58% had little or no familiarity with the American Recovery and Reinvestment Act, which offers incentives for switching to electronic health records. Healthcare IT News (11/4)

Hospital Deaths

U.S. data show 32% of deaths occur in hospital
U.S. data showed 32% of all deaths in 2007 occurred in a hospital and the top cause of patient death was septicemia. The U.S. Agency for Healthcare Research and Quality report said the average hospital cost for a patient who died was almost three times as much as for patients discharged alive. ABC News/Reuters (11/4)

Health Plans: Lean Six Sigma Needed

A new report estimates that were all health plans able to perform at the level of the top 10% of plans, the U.S. would avoid up to 115,000 deaths and save at least $12 billion in medical costs and lost productivity every year. 

Source: “U.S. HEALTH CARE QUALITY: STUCK IN NEUTRAL SLOWDOWN HAS IMPLICATIONS FOR REFORM,” National Committee for Quality Assurance (NCQA), October 23, 2009, http://www.ncqa.org/tabid/1077/Default.aspx

Retail Pharmacy Outlets

Community Retail Pharmacy Outlets by Type of Store, 2004-2008

 

	2004	2005	2006	2007	2008
Total Stores	55,375	56,183	56,948	55,866	53,658
Drug Stores	38,780	39,266	39,347	38,917	37,804
Chain	20,849	21,349	21,865	22,029	20,884
Independent	17,931	17,917	17,482	16,888	16,920
Mass Merchant	6,777	7,146	7,438	7,662	6,970
Supermarket	9,818	9,771	10,163	9,287	8,884

 

Data Source: NACDS estimates based on IMS Health and NCPDP data. Franchise operations such as Medicine Shoppe are included as chains.

 

Publication: “NACDS Annual Profile Tracks Declining Number of Stores.” Pharmaceutical Commerce, September 2009. www.pharmaceuticalcommerce.com

Wrong Site Surgeries Really Happen

Editor’s note: Never Events such as wrong site surgeries happen even in the best of places and they happen over and over again.

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RI Hospital Fined $150,000 in Wrong-Site Surgery
Rhode Island’s largest hospital was fined $150,000 and ordered to take the extraordinary step of installing video cameras in all its operating rooms after it had its fifth wrong-site surgery since 2007.