Category: Health Care Access

Veterans Wait 3 Months for Primary-Care Appointment vs. 3 Days for Private Patients

I have noted with dismay that the U.S. government is trying to fix the Veterans Health Administration scandal over wait times by throwing more money at a fundamentally broken system.

Jonathan Bush, CEO of athenaHealth, a leading provider of cloud-base electronic health records (EHR’s) has researched his firm’s database to arrive at a shocking conclusion: Patients wait three days, on average, for a primary-care appointment. And that was for well patients: Sick patients got in in one day.

Bush concludes that veterans trapped in the Veterans Health Administration should be able to shop for care outside the VHA.

Research Suggests Los Angeles Has No Cardiologists in Obamacare Networks; Chicago No Diagnostic Radiologists

The American Heart Association commissioned Avalere Health to examine the adequacy of provider networks in health plans on Obamacare exchanges. “Narrow networks” have been in the news, as patients have learned that their Obamacare plans do not cover their preferred physicians. This new research covered nine urban areas, and confirms that patients are right to be concerned. It focused on comprehensive stroke centers, and three specialties affiliated with them: Cardiologists, neurologists, and diagnostic radiologists.

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Narrow Networks Found to Save Money

National health expenditures are rising faster than the economy. Most economists believe this is due to perverse incentives that encourage unnecessary medical spending. More than 30 years ago the RAND Health Insurance Experiment showed that patients spend nearly one-third less when exposed to significant cost-sharing. Yet, health plans continually look for new ways to save money in the absence of a health care market where patients act like consumers.

One such cost-saving method is the increasing use of so-called narrow networks, where health plans restrict the choice of providers in return for lower premiums. Narrow networks are sort of like when you were in high school and your mother took you to Walmart to buy a pair of jeans. She may have refused to shop for jeans at the mall where she knew they would be more expensive. Obama Administration advisor, Jonathan Gruber, wrote about the use of narrow networks in Massachusetts health plans. He found that patients used fewer resources when required to see general practitioners rather than specialty care. According to Gruber:

For Sale Cheap: Your Private Medical Information

Have you ever gone to a party and had the urge to peek inside your host’s medicine cabinet? (Neither have I!) Imagine what could be of interest in there. For those nosy souls who are tempted, you don’t even have to attend a party! It’s all for sale online. Bloomberg published an article about how Big Data is snooping in your medicine cabinet and selling the information to marketers. Here’s the gory details:

Dan Abate doesn’t have diabetes nor is he aware of any obvious link to the disease. Try telling that to data miners.

The 42-year-old information technology worker’s name recently showed up in a database of millions of people with “diabetes interest” sold by Acxiom Corp. (ACXM), one of the world’s biggest data brokers. One buyer, data reseller Exact Data, posted Abate’s name and address online, along with 100 others, under the header Sample Diabetes Mailing List. It’s just one of hundreds of medical databases up for sale to marketers.

The State of Telemedicine — State by State

doctor-technologyThe American Telemedicine Association (ATA) has released two thorough and valuable reports on the state of telemedicine in all fifty states.

The first ranks states by policies on physician practice and licensure. This covers informed consent, standards for the physician-patient encounter, and permission for out-of-state practice. (The latter is the special concern of the proposed interstate compact proposed by the Federation of State Medical Boards).

If telemedicine is to be exploited to its maximum potential, it is critical that the highest professional standards be recognized and adhered to. That means out-of-state practitioners need to be able to treat patients via telemedicine.

Visits to Emergency Departments Increased Three Times Faster in States that Expanded Medicaid than Those that Did Not

The Colorado Hospital Association has issued a report comparing certain trends in states that expanded Medicaid under Obamacare with states that did not. The most important take-away is how much Emergency Department visits increased in expansion states versus non-expansion states:

The average number of emergency department (ED) visits to hospitals in expansion states increased 5.6 percent from second-quarter 2013 to second-quarter 2014. This change was greater than expected from the variation over the last two years, and resulted in the highest number of average visits over that time. In comparison, hospitals in non-expansion states reported a 1.8 percent increase in Emergency Department visits between the second quarters of 2013 and 2014.

There is a Market for Human Organs, Whether You Like It or Not

The buying and selling of human organs was in the news this weekend, via an investigative report in the New York Times. People tend to be moved when they learn about someone donating an organ to someone else who needs it, but they also tend to be disgusted by the notion of a market where people can sell their organs to strangers. Naturally enough, this market consists of high-income patients and low-income donors.

The NYT profiles an Israeli woman who bought a kidney from a Costa Rican donor, for a total cost of $175,000. A donor gets about $5,500. The rest goes to middlemen and medical staff. It doesn’t sound like a great deal for the donor, does it?

Wal-Mart Shakes Up Primary Care — and the Whole System

Wal-Mart has a new take on retail clinics. These newly launched clinics will charge patients $40 for a visit — but only $4 for Wal-Mart associates. Anybody, with or without insurance, can go into one of these clinics and be seen by a qualified health professional, without the usual paperwork. Although the mega-retailer has operated clinics in its stores for a few years now, the new ones are different in a couple of ways.

First, Wal-Mart’s previous clinics were collaborations with local hospitals, which had “mixed success”. So, it appears to have decided to do it alone. I am not surprised. Can you imagine a company like Wal-Mart, which succeeds in an unregulated industry with ruthless price competition, trying to negotiate a deal with hospital executives? The communications challenges must be almost insurmountable — sort of a Mars and Venus situation.

Medical Auction Website Puts Patients in Charge of Prices

MedCity News has profiled Medibid, a business that connects patients to physicians who compete on price, through auctions, to treat them:

Francisco Velazco couldn’t wait any longer. For several years, the 35-year-old Seattle handyman had searched for an orthopedic surgeon who would reconstruct the torn ligament in his knee for a price he could afford.

Out of work because of the pain and unable to scrape together $15,000 — the cheapest option he could find in Seattle — Velazco turned to an unconventional and controversial option: an online medical auction site called Medibid, which largely operates outside the confines of traditional health insurance. The four-year-old online service links patients seeking non-emergency care with doctors and facilities that offer it, much the way Priceline unites travelers and hotels. Vetting doctors is left to prospective patients: Medibid does not verify credentials but requires doctors to submit their medical license number for patients to check.

VA to be Rewarded $17 Billion for Failing Vets

A few days ago, we saw a headline we wished we hadn’t seen, in which a VA official testified to Congress that the VA would need over $17 billion to “fix” the problems that have been denying veterans access to care. Well, it looks like he’s going to get it.

The New York Times reports that a bipartisan bill has been negotiated, that hands $17 billion more dollars to the failed agency. Lawmakers from both sides of the isle hope to pass the bill before the August recess. $10 billion will be allocated to get veterans appointments with private doctors and hospitals when they cannot access the VA system. However, that is not the good news it appears to be.

This looks like it is meant to solve the problem that private providers are increasingly unwilling to see VA patients, because the VA does not pay its bills adequately or timely. So, the solution would be to give vouchers directly to vets, right? No such luck: