Category: Health Care Access

Your Kaiser Permanente Doctor Will See You Now – at Target

You probably won’t find more criticism of large health systems on any other health policy blog than you will here. Nevertheless, we like innovation wherever we find it happening, and it is happening in some large health systems:

In a move that reflects the increasing wave of consumer-driven healthcare, Target Corporation is teaming up with Kaiser Permanente to open four in-store Target Clinics in Southern California, taking a host of services directly to thousands of customers.

The clinics opened at Target stores in Vista, San Diego and Fontana, and a fourth clinic will open in West Fullerton Dec. 6. They will be staffed by nurse practitioners from Kaiser.

While Target has maintained clinics for the past 10 years at a number of stores, the partnership will allow for a much broader array of services than it typically offered at retail outlets. Expanded services include telemedicine consultations, prescription reviews, pediatric primary care visits, OB-GYN services, vaccinations and flu shots, pediatric and adolescent care and management of chronic illnesses like diabetes and high blood pressure, according to John Holcomb, vice president of healthcare for Target. (Dan Verel, MEDCity News)

Reducing Readmissions Under Obamacare: Doctor’s Orders?

Last month I wrote about the rise of hospital readmission penalties in fiscal 2015 and questioned the Hospital Readmissions Reductions Program’s effectiveness in increasing quality of care, in part due to factors independent of the hospital that lead to readmission.

Hospitals attempt to combat readmissions by implementing transitional care interventions. The American Journal of Managed Care conducted a controlled trial to evaluate the impact of such programs. Patients were randomly assigned to either standard care or a 90-day hospital-based transitional care program featuring patient education ahead of discharge, post-discharge follow-up, an available hotline and additional interview sessions and symptom checks. No statistical difference in readmission rates between the standard care and intervention group was found. Their findings are consistent with other trials, which have shown that even robust and comprehensive interventions are ineffective in slowing readmissions.

Government Buries Evidence of Poor Access to Care under Obamacare

Thank providence for USA Today, which has given us yet another story describing how poor access to health care is under Obamacare.

People who fell for navigators’ sales pitches and signed up for Obamacare are discovering that it is junk insurance:

“The exchanges have become very much like Medicaid,” says Andrew Kleinman, a plastic surgeon and president of the Medical Society of the State of New York. “Physicians who are in solo practices have to be careful to not take too many patients reimbursed at lower rates or they’re not going to be in business very long.”

Kleinman says his members complain rates can be 50% lower than commercial plans.

“I definitely feel like a bad person who is leeching off the system when I call the doctors’ offices,” she says. Shawn Smith of Seymour, Ind., spent about five months trying to find a primary care doctor on the network who would take her with a new, subsidized silver-level ACA insurance plan.

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?