Welcome to the Health Wonk Review “Football Is Here” edition because, well, it’s September and that means football season is here! And… we’ve got Peyton Manning!!!
Every time I read a post by Amy Berman on the John A. Hartford Foundation’s blog, I’m blown away by how amazing she is. She was diagnosed with stage IV inflammatory breast cancer nearly two years ago, and chose palliative care rather than aggressive treatment. At this point, she’s doing remarkably well, but she’s also very accepting of the fact that she has a terminal illness. Her article for this edition of the Health Wonk Review is her “(before I kick the) bucket list” and in typical Amy fashion, it’s not about her at all. Instead, what she wants to see before she dies is better health care for all of us, especially older adults and people with advanced illnesses. She’d like more patient-centered care, care that focuses on the needs of the patient’s family (especially if the family becomes primary caregivers), and better coordination of care when patients are being treated by more than one doctor. She’d also like to see treatments that are more aligned with patient goals and quality of life, and have better end of life care that is based on patient preferences (as opposed to the idea that we should preserve and extend life at all costs). Outstanding post Amy, as always.
Health Affairs Blog has a “Contributing Voices” article by Mark Smith (CEO of the CA Healthcare Foundation) titled “Offering Physicians A Grand Bargain”. It’s an excellent piece, and just in time for the annual discussion in Congress regarding cuts to Medicare payments for physicians. Smith notes that it makes a lot of sense to get physicians on board as allies in the efforts to reduce costs. The not-so-great alternative would be to alienate them and possibly motivating them to increase the number of procedures they do in order to make up for a drop in per-procedure revenue. He presents a very well thought-out position, and explains his “grand bargain” to physicians like this: “they can maintain their traditional role, payment methods and scope of practice, or their income, but not both.”
Maggie Mahar of Health Beat Blog brings us a fascinating two-part discussion about the benefits – and indeed, the necessity – of having physicians who really listen to their patients rather than rushing to diagnose an illness. Part One details a story from Dr. Clifton Meador’s book True Medical Detective Stories. A young doctor is stumped in his efforts to pinpoint the cause of a patient’s ailments. She appears to have a neurological impairment, but her symptoms are at their worst in the morning and get better as the day goes on (the opposite is usually true with neurological diseases). But in the course of just talking with her, he finds out that she “dusts” her cat with the insecticide dust that she uses on her roses. Her cat is free of ticks and fleas, but it also sleeps on her pillow with her and the insecticide dust has been poisoning the patient. A less-attentive doctor would likely have referred the patient for endless neurological testing. Part Two of Maggie’s series is called “The Pressure To Diagnose” and is an excellent follow-up to the story about the rose dust on the cat. I especially liked this quote from Dr. Meador: “After 50 years in teaching and practice, I have come to see that not every symptom or set of symptoms has a medical diagnosis to fit. What I am sure about is that every symptom has a cause.” Sometimes determining that cause can be a time-consuming process that only works if the physician is able to set aside pre-conceived notions and really listen to the patient. Maggie’s articles are an excellent reminder of this.
Jon Coppelman of Workers’ Comp Insider shares a sad story of an employee who was injured on the job and needed shoulder surgery, but the workers’ comp carrier denied the claim and it got stuck in appeals for several months. The accident happened in May, and the injured employee died of an accidental hydrocodone overdose in October. He was still waiting for his claim to be approved so that the surgery could be performed, and was taking more than the prescribed amount of hydrocodone in order to deal with the pain. His widow was eventually awarded death benefits under the workers’ comp claim. Jon notes that he wishes all doctors prescribing powerful pain meds could listen to the widow’s testimony first, and maybe be compelled to prescribe drugs that aren’t as addictive or toxic. There is also a lesson to be learned in terms of both the financial and human cost of claims that drag on and on, especially if the victim involved is taking pain meds while waiting for a surgery or treatment to fix the problem.
We all know that the manufacturing of just about everything is outsourced to China or India or similar inexpensive locations these days, but did you know that’s also true of a lot of pharmaceuticals? And that the drugs in question can be manufactured by chemical companies, rather than pharmaceutical companies, which means that there is often very little in the way of oversight? Roy Poses of Health Care Renewal gives us the scoop. The drugs are sold under big-name pharmaceutical labels, with no indication that they are being manufactured overseas. Outsourcing the production of the medications is no doubt cheaper than manufacturing them domestically, but what’s the long-term price to pay for the short-term financial gains enjoyed by the pharmaceutical companies? We know that at least 149 Americans died a few years ago as a result of contaminated Heparin that had been manufactured in China, but this issue is still getting far less attention than it needs. I find it particularly interesting that Americans are often warned to not purchase medications from Mexico and Canada, under the guise that the drugs could be of unknown origin and could be contaminated or of inferior quality. And yet it appears that the same thing could be said of a good chunk of the medications that are sold here in the US too.
The “corporatization” of health care is explained in these two articles from Dr. Jaan Sidorov of Disease Management Care Blog. After reading both articles and thinking back over the last few years as the health care reform bill was crafted and implemented (or at least begun to be implemented), it seems pretty clear that Dr. Sidorov is correct. The fully-public option (sometimes called “Medicare for all”) was off the table almost before it even got on the table, and throughout the reform process there was a lot of focus on integrating large private corporations into the health care reform solutions. I think it’s fair to say that we can expect more “partnering” between large healthcare corporations and the government in the next several years.
Jason Shafrin, aka The Healthcare Economist, explains the details on how much money Medicare wastes each year, and possible solutions to the problem. Although it’s pretty standard for politicians to talk about reducing fraud and waste in Medicare, actually doing so has proven to be a bit trickier. The true amount of waste is hard to pin down, and varies depending on who is giving the answer. And although there are various oversight and accountability programs in place, they haven’t been all that successful yet in reducing the amount of waste and/or fraud.
An insightful post from David Williams of Health Business Blog explains why Republicans have so few ideas for their own healthcare reform platform: their knee jerk “no” reaction to anything that President Obama and the Democrats have offered has left them with few options. Williams proposes that the Dems should just add on the few measures that the Republicans support (selling health insurance across state lines, tort reform and tax deductibility of individual health insurance premiums). If the Republicans have the same immediate “no” reaction, they would, as David says, “paint themselves into a corner.” Healthcare reform is already proving to be a tricky issue for Romney. He’s said that he favors some aspects of the law, which would make it tough for him to do away with the whole PPACA if he becomes president.
Anthony Wright of Health Access Blog has an excellent article, written before the RNC, that preemptively addresses some of the claims he was expecting from convention speakers. He makes some very good points about Medicare, the ACA, cost savings versus cost shifting, and how the Romney/Ryan healthcare agenda differs from the ACA. He notes that Ryan’s healthcare-related budget proposals “…don’t control costs, they simply shift costs, from the federal govt to states (Medicaid block grants) or seniors (Medicare vouchers).“ And while conservatives claim that this sort of cost shifting is necessary in order to get patients to be better healthcare “consumers” who have some “skin in the game”, it’s unlikely to be all that effective. We’ve written several posts over the years about how difficult it is to truly shop around or make informed decisions as a healthcare consumer, and Wright points out that individuals are far less likely (compared with the government and big organizations) to be able to control healthcare costs when “… they lack 1) the information and medical and actuarial expertise to make certain comparisons, 2) the group purchasing power against the big insurers and providers, and 3) the ability to say “no” in all but a handful of situations.”
In a post that is both funny and oh-so-true, Bradley Flansbaum of the Hospitalist Leader shows us how the right and the left argue their positions on resource allocation so strongly – both predicting doom and gloom if cuts are made or taxes increased or changes happen to whatever programs the group in question holds dear. And yet, as Dr. Flansbaum’s clever flow chart shows us, the end result is the same, regardless of the path taken to get there.
Over at Managed Care Matters, Joe Paduda gives us eight rules for using social media for business. He frames it as a what-not-to-do, and anyone in the healthcare industry (or indeed, pretty much any industry) who is using social media would be well advised to heed Joe’s list. Don’t be a jerk, don’t be a spammer, focus on facts (and cite them!) rather than opinions, be relevant and patient, and you’ll get more out of social media than you would otherwise.
InsureBlog’s Bob Vineyard isn’t impressed with a recent article in the National Underwriter Life and Health Edition. The article that sparked his ire is called “Sticker Shock” and describes the author’s frustration with the size of the bill that his girlfriend racked up during seven hours in the ER for a UTI. The bill came to more than $16k, and was reduced to under $13k by Aetna. Then Aetna paid 80% of the bill and the author’s girlfriend was left with almost $3k in out of pocket expenses. The author proposes an MLR for hospitals, limiting them to charges that are a set amount above operating costs (although he does admit that those costs are inflated by the cost of care provided to people who are uninsured and have no ability to pay). Bob is less than thrilled with the MLR for hospitals idea, as he feels that the current MLR rules for health insurance carriers have created more problems than they’ve solved. Read both articles to see two very different takes on the same situation – definitely a good conversation starter.
Kat Haselkorn of Corporate Wellness Insights writes about changing office culture – where possible – to promote fitness-oriented days when employees are encouraged to wear workout clothing, eat nutritious lunches and even workout or go on walks together. It’s taking casual Friday to the next level and walking the walk when it comes to improving employee health. And she reminds us that even if your workplace isn’t likely to ever allow workout clothing and sneakers to be worn to the office, you can still bring your own gear and change into it during your lunch break or right after work to make it easy to sneak in some exercise time.
That’s it for this edition of the Health Wonk Review. We thoroughly enjoyed reading all of the submissions and hope that you find several that you like. Jennifer Salopek will be hosting the next edition on September 27th at Wing of Zock – don’t miss it!
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