Welcome to the Spring edition of the Health Wonk Review. With condolences to our east-coast and Great Lakes friends who have been dealing with what probably seems like 47 straight months of winter. Maybe they can call it the “Spring is eventually coming” edition? We’ve got a great round-up of health care articles in this… Read more about Spring Is Here! Health Wonk Review
Health Care Goodies
InsureBlog has the latest Health Wonk Review; the “Pink Edition”, because October is Breast Cancer Awareness month. Check it out!
Julie Ferguson hosted the 191st edition of the Cavalcade of Risk this week – be sure to check it out! She opens with a link to a particularly good article about how we tend to worry about all the wrong things. We worry about being eaten by a shark if we swim in the ocean, but don’t think much about the risk of biking/walking/driving to the ocean in the first place. Even though most people die in rather mundane ways, it’s the dramatic, high-profile dangers that grab our attention. If we’re really paying attention to risk, we’ll focus more on making the ho-hum aspects of our daily routine safer, and not worry so much about being attacked by a bear while hiking. Pretty much sums up what risk-management is all about: first you have to understand the risks!
I liked David Williams’ post about an unintended consequence of the oral chemotherapy parity law in Mass. In his case, he’s getting a refund of previously paid copays because someone on his plan is using an oral medication that can be prescribed for cancer, although in this case it’s used to treat something else. But since his plan covers infused chemo with no cost-sharing, the oral medication must also be covered with no cost-sharing.
Colorado is among the 26 states that have oral chemotherapy laws on the books (I would image that all of the rest will within the next few years), and overall, the concept makes perfect sense: Chemo is chemo, and patients should have access to whatever type of chemo they and their doctors feel will be most successful, without having to consider whether oral chemo will be more expensive. Oral chemo parity laws might end up saving money in the long run, since they avoid the hospital or clinic fees associated with a traditional multi-hour chemo infusion. And oral chemo also makes it easier for the patient to carry on with day to day life. But it would also make sense to have a clause in the law that requires the parity only if the oral medication is actually being used to treat cancer, as opposed to some other use.
Nina Kallen did an excellent job hosting the most recent Cavalcade of Risk – be sure to check it out. It includes a good cautionary tale about avoiding scam artists, from Hank Stern of InsureBlog. (And for a little extra clarification about electronic and telephone applications, there’s also some additional commentary from Bob Vineyard (another… Read more about Avoiding Scams As The ACA Changes The Health Insurance Landscape
Welcome to the Midsummer Health Wonk Review! It’s always a pleasure to host, and this edition actually isn’t a Shakespeare theme, but it is jam-packed with excellent articles from some of the best writers in the healthcare blog world. The HWR had a break before this edition and will have a hiatus after this one too. We’re starting things off with a few articles that help to shed light on some aspects of health care reform that should be straight-forward but sometimes get a bit convoluted with political rhetoric. Then we’ve got several posts about corruption in healthcare and healthcare policy, and lots of posts that provide contrasting and well-reasoned viewpoints on healthcare reform and healthcare in general. We’ll keep things cool with some winter and spring pictures we took around us here in Northern Colorado. Enjoy!
In an excellent piece debunking popular “wisdom” regarding immigrants and healthcare, Joe Paduda of Managed Care Matters explains that when it comes to the Medicare Trust Fund, immigrants put in a lot more than they take out: In 2009, immigrants paid in 14.7% of trust fund contributions but only accounted for 7.9% of its spending, with a net surplus of almost $14 billion. US-born people accounted for a deficit of almost $31 billion in the Medicare Trust Fund that same year. This appears to be a long-term trend: From 2002 to 2009, immigrants contributed $115.2 billion more to the Medicare Trust Fund than they received in Medicare benefits. Joe goes on to explain the details and warn those who rally behind strict immigration reform that they may want to rethink their position. Our Medicare Trust Fund would be in a lot worse shape without the immigrant population.
And if you’re curious about the implementation track for the ACA (and understandably confused by the constant talk of repeal, delay, replace, etc. that we keep hearing from some politicians) Linda Bergthold has what I consider to be a straight-forward and factual review of the situation. To sum it up, she’s predicting that the employer mandate will go into effect in 2015, as currently scheduled (following a one-year delay, but not a repeal), and that the individual mandate will be implemented in 2014, as planned. And while some states that delayed the creation of an exchange marketplace will likely have a tougher time getting everything up and running by 2014, the exchanges will be operational next year. I imagine there will be some bumps in the road as the ACA is fully implemented over the next few years. But we can work on ironing those out as we go – there’s no need to start from scratch.
Although the exchanges are likely to be successful in the long run, it won’t be without significant effort on the part of the people running them. At Health Affairs Blog, Barbara Markham Smith and Jack Meyer explain their recommendations for strategies that can help the exchanges be successful both out of the gates and for the long haul. They discuss pricing (don’t make it too high!) as well as communication/advertising programs that need to be unified, clear, concise and nation-wide in order to generate awareness and interest in as many people as possible. (Unfortunately, there’s a significant portion of the country’s leadership who seem to want the exchanges to fail – even to the detriment of the American people – and are content to spread mis-information about the entire law. This is a considerable hurdle that the exchanges will have to overcome.) Barbara and Jack recommend a temporary respite from the tax reconciliation that will be done to determine whether a person or family that received a subsidy is required to pay back a portion of it due to increased income compared with the prior year. And they also call for fostering increased competition and CO-OP creation in the states have not yet done so. All in all, pretty solid ideas for success in the exchanges and policy-makers would be wise to take heed.
I think of Dr. Roy Poses as the healthcare blog world whistleblower – he can always be counted on to expose nefarious acts in the healthcare industry, and Health Care Renewal is a must-read blog. Here is his take on the recent Transparency International poll that found 43% of US respondents believe that the US healthcare system is corrupt, and that 64% believe that the government is run by big money and special interests. Roy notes that unfortunately, most of the media coverage of the Transparency International poll has focused on world-wide data and/or specifics from far-away lands. Instead of focusing on our own serious problems with corruption in healthcare, it seems that a lot of media outlets (keep in mind that media is sometimes beholden to special interests too…) prefer to present the problem as something that happens in other countries as opposed to something that we need to work on here in the US.
Continuing with the corruption theme, Eric Turkewitz of the NY Personal Injury Law Blog shares a multi-part series about Dr. Katz, who has been rebuked for lying on the stand in a personal injury trial that resulted in a mistrial because of the doctor’s actions. Central to the issue is the practice of independent medical exams (with the word “independent” being very loosely used in this case) conducted by doctors who are hired by insurance companies when they are defending personal injury cases. In the case that Eric is writing about, the doctor makes a 7 figure income from his medical-legal practice, but in one case that has been made public, he grossly over-stated the amount of time he spent with a patient (he claimed it was 10 – 20 minutes, but a secretly-made video recording of the visit showed that it was under two minutes). Eric has looked at additional data and found that the average length of Dr. Katz’s exams was around 4 minutes. Additional details on this story are here. Wow. The doctor was obviously concerned first and foremost with money, but the insurance companies who hired him were likely not doing due diligence to make sure that he was providing accurate data. They may have been more concerned with finding a doctor who would tell them what they wanted to hear rather than the actual details of the patients’ medical cases. Sad all around, but sadder still is the fact that it’s probably not all that unusual.
And for a little more on the cronyism/corruption topic (maybe those corruption figures Roy mentioned from the Transparency International poll were skewed a bit too low?), Hank Stern of InsureBlog writes about agencies and individuals who have been involved with the Obama Administration for some time, and are now finding themselves in lucrative financial and/or influential positions as the ACA gets implemented. In other words, business as usual in the government. Government appointments, grants, etc. are often awarded this way (ie, appearing to be rewards for donations and/or loyalty), in every administration, regardless of which party is in power. There’s ample room for opponents to cry foul, but it also has to be pointed out that presidents and secretaries and others in power have to be able to select people they trust for top leadership positions. And trust is earned over time. There’s a fine line between selecting the right candidate for the job, having that person be someone trusted by the top officials, and avoiding cronyism. I don’t know what the right answer is, but it’s easy to see how the appointments and grants and leadership roles being handed out with the ACA could be construed as rewards for political support and loyalty.
At Health Beat, Maggie Mahar writes a thoughtful and thorough review of Miriam Zoll’s Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies. After reading Maggie’s article, I’m eager to read the book itself (Maggie leaves a bit of a cliff hanger at the end…). Assisted reproductive technology is certainly a blessing to many families. But it can also be fraught with problems that stem from both overly-optimistic expectations on the part of patients (and society in general), over-promising on the part of providers, and a medical field that is largely unregulated and often not covered by health insurance policies.
At Health Business Blog, David Williams explains his skepticism about DealWell, a new Priceline-style website for healthcare services. I am very much in favor of increasing transparency in healthcare pricing and moving away from the proprietary pricing system we have now, where even the most dedicated patient “shoppers” can find it impossible to obtain real healthcare prices before having a procedure. And to that end, I love the idea of a website where people can bid on the care they need and providers can accept or decline the offer depending on their current workload and the payment offered. But David makes some excellent points about the downsides: not being integrated with health insurance is a big one, especially since nearly everyone will have to have health insurance starting in 2014 (even if a procedure is lower than your deductible, it makes sense to stay in network and have the amount you pay be credited towards your deductible, in case you need additional care later in the year). Although DealWell might be a good option for people looking for one-time services that aren’t covered by health insurance (such a LASIK or a dental implant, for example), it’s probably not going to be the next big thing in healthcare price transparency.
Over at Disease Management Care Blog, Jaan Sidorov takes a closer look at the glowing picture painted by CMS regarding ACO pilot programs, digs a little deeper, and gives us a slightly less rosy view of the results. And there’s even a T-Rex analogy, to keep things even more interesting. Jaan points out that the ACOs that didn’t meet the pilot program goals are likely feeling the sting of losing millions of dollars, since the initial investment costs are not cheap. Although 9 of the 32 pilot ACO providers have said that they want to leave the program, I wonder if results will be better as time goes by, mitigating the initial investment costs somewhat? Stay tuned.
Julie Ferguson of Workers’ Comp Insider writes about the July 6th 777 crash at SFO, detailing how the flight attendants did an excellent job of putting their emergency training into practice, saving lives in the process. Julie notes that while it’s easy to shrug off emergency plans simply because we rarely come face-to-face with an emergency, such preparedness can mean the difference between life and death. Does your business have a solid plan in place to deal with emergencies? Has everyone at the business been trained on it? How fast can your building be evacuated if necessary? All good things to think about.
Writing at Health Access Blog, Anthony Wright discusses the one-year delay of the employer mandate portion of the ACA that will require employers with more than 50 employees to provide health insurance to eligible full-time workers. Anthony makes some very important points: the delay doesn’t impact anyone’s eligibility for health insurance and/or subsidies. People who would have been offered health insurance from an employer with the employer mandate in place will still be able to get coverage through their state’s exchange – and if they make up to 400% of the federal poverty level, they’ll qualify for subsidies to help pay for it. In addition, the vast majority of large employers in the US already offer health insurance to their employees and have historically done so without a mandate requiring it. It’s unlikely that a large amount of those employers will suddenly drop their coverage in 2014. But Anthony goes on to note that if the delay were extended for additional years, it could begin to destabilize the financial foundation of the ACA and employers might begin to shift more workers onto exchange plans, relying on tax-funded subsidies to foot a portion of the bill.
The Healthcare Economist, aka Jason Shafrin, brings us a great summary of health insurance in China over the past half century. Until the end of the 1970s, there were three main health insurance systems in China that covered nearly everyone. But the wheels started to come off after that; by 1998 almost half of the urban population had no health insurance, and by 2003, 95% of the rural population in China was uninsured. In the last ten years, China has tackled health care reform in order to try to remedy the problem. While plenty of progress has been made, there is still a long way to go.
Jared Rhoads has written a review of The Autistic Brain by Temple Grandin. His review is a good read, and the book looks like it is as well. Professor Grandin teaches at Colorado State University – my alma mater – and consults for the livestock industry as well as being a bestselling author. She’s an inspiring and accomplished person even without taking into account her own autism. Her book combines her personal experiences with the latest that science has to offer us with regards to autism. If you’re interested in autism, Jared’s summary is that this book is a good place to start learning more. I’m adding it to my list of books to read, so thanks for the tip Jared!
John Goodman lays out some of the results of the ACA thus far (fair enough, but keep in mind that most of the law hasn’t been implemented yet). He details some positives and negatives, both expected and unintended, although his overall take is that the ACA is not a great solution. Strongly worded opinions about the ACA will likely meet with a round of applause from one side of the political spectrum, and boos from the other side. But regardless of your position, I would say that it’s tough to argue with John’s point about high deductible, consumer-driven health plans. I think he’s correct in saying that they’re probably going to be quite popular starting in 2014, when they will be among the least-expensive plans available. This is probably particularly true among people who won’t qualify for subsidies.
That’s it for this mid-summer edition of the Health Wonk Review. Many thanks to Julie and Joe for keeping such a great blog carnival going all these years! The HWR now has a summer hiatus. Don’t miss the next edition on August 15th, which will be hosted by David Williams at Health Business Blog.
The latest edition of the Health Wonk Review is over at InsureBlog – don’t miss it! Two of my favorite posts in this edition come from Peggy Salvatore and Joe Paduda. Peggy, writing at Healthcare Talent Transformation, brings us a trip down health insurance memory lane, comparing where we’ve been to where we’re headed. She addresses the conundrum of maintaining private health insurance while also placing numerous government-style restrictions on the health insurance marketplace, both from a vendor and consumer standpoint. Insurers will be required to accept all applicants and compress age-banded premiums into a 3:1 ratio, while consumers will have no choice but to purchase coverage. There will be no more voluntary business arrangement on either side, and yet the plan is to continue to have health insurance be largely private. Definitely some good food for thought in Peggy’s post. I’m generally a fan of regulation, and especially when something as important as healthcare is on the line, I believe regulation is needed in order to advocate for the consumers. But I’m as curious as everyone else to see how this health insurance experiment will look five years down the road.
Joe Paduda, from Managed Care Matters, wrote a piece about the real-life impacts of sequestration on healthcare. Sequestration probably seems like an abstract concept to a lot of people, and appears to be used rather casually by politicians who aren’t likely to be directly impacted by many of the spending cuts. But in case you were curious as to how healthcare sequestration spending cuts are stacking up, Joe’s article is an eye-opener. One important thing to note is that government spending cuts disproportionately affect lower-income and older Americans. People who rely on free and low-cost healthcare, Medicare and Medicaid beneficiaries, the uninsured, people who benefit from public health programs… these people – often the least able to withstand cuts – are the ones who feel the sequestration squeeze first.
Many thanks to Hank for hosting, and for all the excellent articles that were contributed.
Welcome to the Health Wonk Review! It’s an honor to host the HWR, and the posts in this edition are excellent, as always. We’ve got a wide range of topics today, but most of them are at least loosely associated with some aspect of health care reform, so here’s a brief visual summary for you.
Now that you know where we’re heading, here are the nitty gritty details. There’s something for everyone in this edition of the HWR, so keep reading!
Roy Poses, writing at Healthcare Renewal, explains how doctors are pushing back against corporate bosses who put profits above all else. His article describes two recent lawsuits filed by physician groups alleging that the hospital systems they worked for were sacrificing patient welfare in the name of profit. The details are sickening to read: One hospital group encouraged its docs to exaggerate the severity of patient conditions and needlessly admit patients from the ER to hospital beds in order to bill more for their treatment. Another hospital group that owns three hospitals and also partially owns an ambulance company was making patient transfers (using their own ambulance company despite slower response times) a top priority – to the extent that a doctor’s transfer rate was a factor in bonuses and performance reviews. An admin email stated that “the performance we are looking for are transfers.” Wow. Transfers just for the sake of racking up revenue – patient welfare had nothing to do with it, and was likely compromised when the slower ambulance company was used in cases where the transfer was actually warranted. These lawsuits are in their early stages and nothing has been settled in court yet, but they hint at some very serious problems brewing in for-profit (and even some non-profit) hospital systems.
Duncan Cross brings us an emotionally compelling article about Arijit Guha that is a must-read for anyone interested in the problem of under-insurance. Being under-insured might not be quite as bad as being uninsured, but while the uninsured know that they don’t have health insurance, people who are under-insured might not be aware of the specific short-comings of their coverage until they actually have a serious, ongoing medical condition. Arijit was a grad student at ASU, and he recently passed away from colon cancer. During his fight with cancer, he also had to battle his insurance carrier (Aetna) and raise money selling t-shirts in order to fund his treatment. He had a student health insurance policy, and those have long been notorious for having low coverage limits. Duncan has an insider view of some of the medical issues that Arijit had to face, and he, too, attended grad school for a while, working on campus at a job that afforded him faculty health insurance rather than student coverage. He notes that a major problem that wasn’t often addressed in articles about Guha is that the university was the organization responsible for choosing a health insurance plan for its students – Aetna just provided the coverage that the school requested.
Maggie Mahar‘s article at Health Beats will be appreciated by NPs and PAs. Her post A Doctor Confides: “My Primary Doc is a Nurse” is a great look at the increase in the number of PAs and NPs who are providing primary care, and the myriad issues that accompany this change. Maggie delves into topics like turf war and resistance on the part of MDs to accept NPs as quality primary care providers. She also addresses patient and provider satisfaction, patient safety, the cost of primary care, and the shortage of MDs who are choosing primary care versus the willingness of NPs to […]
We’re exited to be hosting the next edition of Health Wonk Review here at the Colorado Health Insurance Insider on Thursday.
Please submit your best recent articles to us by Wednesday at 9 am. You can email them to Louise: firstname.lastname@example.org
Please remember to include:
- Your blog name and URL
- Your post title and URL
- Name the post author if it is not you
- A summary of the post
Welcome to the HealthCare Social Media Review, where you’ll find all sorts of articles on the intersection of healthcare and social media. Over the years, we’ve found social media to be an excellent way to interact with our peers, colleagues, and clients – first with our blog, and now increasingly through Google + (Jay, Louise), Twitter (Jay, Louise), and Facebook. I relied heavily on Twitter when I was looking for articles to include in this HCSM Review, and all of the social media platforms we use are excellent resources when we’re looking for like-minded people or relevant, timely information on a particular topic. We’re honored to be hosting this edition of the HCSM Review. The blog posts included here are all written by people who have a strong social media presence, and we’ve included links to their Twitter, Facebook or Google+ pages so that you can follow them too.
To start things off, we have an excellent article from Nina Dunn (@Spector_health), explaining that we need to get back to basics with social media use in healthcare. Rather than focusing on the negatives (it changes too fast! There are no clear guidelines for how to use it! HIPAA!, etc.), Nina encourages healthcare providers to focus instead on the ways that social media can be beneficial. She notes that just because a platform exists doesn’t mean that you have to use it (ie, you don’t need to be on every social media channel all at once), and that it’s important to know your audience and target your social media presence accordingly. Good content is king (that rule never changes), and social media marketing might require a different mindset when it comes to measuring success – but that’s not a reason to avoid it. All in all, a great read, and a perfect tone for the Healthcare Social Media Review…
David Harlow of HealthBlawg gives us a perfect example of how social media can be very useful in terms of gathering information and engaging people in real time to solve problems. The Office of the National Coordinator (ONC) for Health IT issued a request for information (RFI) on interoperability, asking “What specific HHS policy changes would significantly increase standards based electronic exchange of laboratory results?” The problem appears to basically hinge on the fact that labs receive no financial incentives to make their reports interoperable and compliant with EHR meaningful use standards (medical offices do have a financial incentive to do so). Keith Boone (@motorcycle_guy) blogged about the question, and then the power of social media took over thanks to retweets and […]
We’re excited to host the next HealthCare SocialMedia Review (#hcsm) on Wednesday, March 27th. No specific theme other than articles relating to social media and healthcare/medicine. Please email submissions to Louise: louisen78 at gmail dot com by Monday, March 25th at 6PM MDT. Please include the following information: Email Subject: HealthCare SocialMedia Review Blog Title:… Read more about Welcoming Submissions for the HealthCare SocialMedia Review
Maggie Mahar hosts this week’s Health Wonk Review, with a focus on waste in the healthcare system. It’s an excellent edition, full of great articles. Two of my favorites are stories that might not be covered in the mainstream news – but thanks to excellent healthcare bloggers, we still get to read them. Joe Paduda… Read more about Non-Mainstream Healthcare News
[…] Both of these scenarios describe changes that need to be made anyway in order to improve healthcare outcomes (fewer injection errors and fewer c-sections would be better for patients), and together they would result in $10 billion in healthcare cost savings. If we identify numerous similar situations – and implement changes needed to make improvements – we could make significant headway in reducing the cost of healthcare, which would in turn reduce the price of health insurance.
[…] it may not be what you’d guess. The study he references looked at inpatient costs from 2001 to 2006 (admittedly a bit out of date now, but still relevant and interesting data) and found that the biggest increases were in “supplies and devices”, ICU, and hospital room and board – all three of those areas had double digit percentage increases in costs from 2001 to 2006. I would be very curious to see another column on that chart with 2012 numbers and the corresponding percentage increases… are those three areas still the culprits, or have others (like pharmacy?) surpassed them?
[…] The wealthiest older Americans can probably easily wait until 67 for Medicare. In 2014, individual health insurance will be guaranteed issue, and if paying the premiums is not a problem, that’s a viable alternative for some people. But most Americans are not wealthy enough for those premiums to be easily affordable, even with premium subsidies. More than a few 65 and 66 year olds would likely opt to go uninsured until they reached the new Medicare age, and that brings it’s own host of problems – for the individuals and for taxpayers, hospitals and the entire healthcare system. For people struggling to make ends meet, an extra two years of either being uninsured or stretching to pay health insurance premiums could be a very big deal indeed. And as Maggie points out, it doesn’t even end up saving money.
The proposal to raise Medicare eligibility to 67 is short-sighted and based on the premise that Medicare is an “entitlement” (what about the fact that recipients have been paying into it for decades, to cover the cost of previous retirees’ care?). I suppose it makes sense – at first glance – that we can reduce the amount spent by Medicare if we make people wait an extra two years to enroll. But the practical realities would be a different story: people putting off medical care until age 67 (at which point illnesses might be more progressed and more expensive to treat), people going uninsured, higher premiums within the Medicare system without the younger members enrolled, higher costs borne by employers who cover the cost of healthcare for workers and retirees, and the list goes on. […]
[…] As David pointed out, we really don’t need to be too worried about our medical data being stolen. Medical identity theft is increasingly a problem, but that generally happens when someone attempts to steal an insured’s identity in order to receive healthcare under the victim’s health insurance policy. Again, no theft of sensitive medical records, but a significant problem. Data security absolutely needs to be a priority as we transition to electronic medical records. But for the most part, the problems are not what people think of first (sensitive medical data being compromised), but rather, theft of credit card numbers and social security numbers, as well as people who try to fraudulently use another person’s health insurance coverage.
[…] He notes that the problem of access to care has been well addressed: 30 million additional Americans will soon have health insurance coverage (although we have to bear in mind that health insurance coverage and actual access to care are not necessarily the same thing, especially if the health insurance in question is Medicaid or another public plan). But he goes on to point out that affordability and quality are areas with some wrinkles that still need to be ironed out.
What makes this post especially interesting is Maggie’s equally well-though-out response that she included in the HWR. Be sure to read what both of them have to say. Maggie references a couple of her previous posts and provides plenty of evidence to back up her premise that affordability and quality of care are both being addressed and that the solutions are working (or will be soon). Definitely an interesting collection of views from two of our favorite healthcare writers.
[…] perhaps we need to consider at least some general physical exams to be overutilization of care. I know – that sounds blasphemous and counter-intuitive. But sometimes we have to abandon our preconceived ideas and look at what the evidence is telling us rather than just accepting what we assume we know to be true. I would say that further and more extensive studies need to be conducted before we make any radical changes as far as general physical exams and well-checks. But we definitely need to be taking a much closer look at healthcare over-utilization. Maybe that’s where we can do our “rationing”, and end up with a win-win for everyone: lower healthcare spending and better patient outcomes.
The idea of freezing bananas and then blending them into “ice cream” is not my own. I discovered it online a few years ago, and it has since become so popular that I’ve noticed bananas in the grocery store with little stickers on them letting people know that they can be blended into soft-serve style desserts. But the recipe I’m sharing here is my own creation that came about when I started tinkering with the basic blended bananas idea.
It’s quick, easy, and the sweetness in it comes almost entirely from the bananas. What’s not to love?!
Mocha Chip Banana Soft Serve
2 cups frozen banana chunks
3 Tbsp cocoa
1 scoop chocolate protein powder (try to stick with a brand that doesn’t […]
The American College of Emergency Physicians had their annual meeting in Denver, Colorado this week, and presentations involved several new studies pertaining to people who are the most frequent users of emergency room care. I found that article to be fascinating, in part because it dispels so many myths about emergency room “frequent flyers.” We’ve written before about the fact that most emergency room patients do have health insurance and that emergency room overcrowding cannot be blamed on uninsured patients (as is often cited in casual conversation). Although most emergency room visitors do have health insurance, many of them have public health insurance via Medicare or Medicaid. And since the Medicaid rolls are expected to grow significantly over the next several years, it’s likely that ER overcrowding will grow to become more of a problem as some of those Medicaid patients are unable to access primary care outside the emergency room. […]
There are 110 hospitals in Colorado, and so far CORHIO has connected 27 of them to the health information exchange, and they are actively working on connecting two more. They are also currently working to add 800 more medical offices to the health information exchange, to join the 290 who are already connected.
Health IT has been a major talking point throughout the healthcare reform process, and the steps that CORHIO is taking will no doubt make for a more efficient healthcare system throughout Colorado once the entire state is linked through the HIE. Patients who see multiple doctors or who are treated at more than one hospital […]
David points out that healthcare isn’t like a shopping spree at the mall. He believes “… that patients actually just want to get better and that they will be willing to forego expensive services and products when it makes sense to do so.” I agree. And David links to a study that found evidence-based decision aids can indeed […]
Last spring I wrote about the lawsuit that was filed by the Colorado Attorney General against Consolidated Medical Services, LLC. Consolidated Medical Services was a discount plan (ie, not health insurance but a cheaper substitute that wouldn’t provide much in the way of benefits if a person needed medical care) run by Joseph Benedetto. The Colorado discount medical benefits plans were, according to Colorado Attorney General John Suthers, “… fraudulent, frequently failing to pay patients’ claims as promised.” However, the focus of the lawsuit was the manner in which Benedetto and his LLC went about recruiting affiliate salespeople. According to the AG press release, “Consolidated Medical Services recruited individuals, many of whom are elderly, to market “medical benefits programs” that were advertised as valid substitutes for traditional health insurance.” Salespeople were charged start-up fees and monthly hosting fees in order to sell the discount medical benefits, and virtually none of them made enough money selling the product to recoup the fees they had paid. Only about three percent of the 12,800 affiliates who were recruited between 2008 and 2011 made any money at all selling the discount plan, and most of the few who did make money earned less than they had paid in fees.
Attorney General Suthers’ office announced today that a settlement has been reached with Joseph Benedetto and Consolidated Medical Services, LLC. Benedetto must […]
[…] Both arguments are interesting, and very convincing. I read Jost’s first, and found myself nodding in agreement all the way through. But then when I read Cannon and Adler’s response, I also found their points to be compelling and hard to refute. This could be the sort of issue that many people would see as splitting hairs, but on an issue as contentious as the PPACA, I can see this debate getting quite a bit of traction over the next year as the exchange implementation process churns along. And it makes me glad that Colorado took the initiative early on (despite a lot of political wrangling) to begin the process of creating our own exchange. I know there are many flaws in the PPACA, and that the yet-unanswered question about how the exchanges will be funded starting in 2015 is a valid concern. But it still seems like a better solution than sitting back and waiting for the federal government to set up an exchange for us that 1) would not be tailored to our state’s specific needs and 2) might make Colorado residents ineligible for much-needed tax credits to help pay for health insurance.
[…] I’ve written before about the PCP shortage, which exists even though many patients in well-served areas (and those with good private health insurance) may be unaware of it. Compounding the problem is the often lower median income in many rural communities. There are some exceptions of course, but in general the metropolitan areas of the state have higher average incomes than the rural areas. That means that it’s likely that a higher percentage of rural families – living in areas that are already underserved in terms of healthcare providers – qualify for state and federal health insurance programs that might further limit the options in terms of healthcare providers they can see.
All of this serves to highlight the importance of programs like CREATE Health Scholars. The program is relatively new and its first group of students is now moving on to post-graduate studies in medicine, pharmacy, dentistry and research. It will be interesting to look at the distribution of healthcare providers in rural areas of Colorado a decade from now. Hopefully the CREATE Health Scholars and other programs like it will have helped to close the gap between medically well-served and under-served areas of the state.
[…] Similar strategies – that utilize a variety of tactics introduced together – could likely be helpful in reducing healthcare spending in other areas, like pharmaceuticals for example. Health insurance carriers could be involved in the solution (with more prior authorizations or computer systems that prompt doctors to always start with the lowest-cost drug and then work up, etc.) but with buy-in and cooperation from medical providers, the public and the pharmaceutical industry itself, the impact would likely be far more impressive.