Teladoc Fights Back


This blog noted a few weeks ago that telehealth is facing headwinds. Teladoc, a Texas-based provider of telemedicine services, was being stifled by the Texas Medical Board.

Now, Teladoc has filed both an Initial Public Offering (IPO) and a lawsuit against the Texas Medical Board on antitrust grounds:

The suit alleges that theTexas Medical Board allowed telemedicine to freely operate until 2009, as “telehealth providers, and in particular Teladoc, began to expand in scale.” It continues: “the competitive threat to traditional office- and hospital-based physicians became clear. The TMB began working to stamp out this threat to competing physicians.”

All in all, I’d prefer to see this resolved by the state legislature if the Texas Medical Board itself cannot fix itself. Nevertheless, it is good to see that Teladoc is not quitting without a fight.

House & Senate Agree on Balanced Budget Resolution


The House and Senate Budget Committees have announced that their conference committee has agreed on a balanced budget resolution. The conference report is 106 pages, so it will take me a few days to complete an analysis.

Nevertheless, it is important to recognize that this is an important achievement and the result of a lot of hard work by Dr. Price, Senator Enzi, their colleagues and staff. For many years, the Senate ignored its legal obligation to pass a budget.

With respect to health care, the resolution repeals and replaces Obamacare in full. It also continues to increase Medicare premiums for high-income households, and transitions to Paul Ryan’s “premium support” model for future beneficiaries.

One of the items I had been hoping for is offsets to pay for the bungled Medicare “doc fix” of last month. The resolution states that it accounts for the full cost of that “doc fix” (page 45). Okay, but the current president will not sign this budget. Are we meant to expect that the next President will take responsibility for the unfunded spending authority this Congress gave President Obama?

Health Spending Crushing a Stalled Economy


March’s estimate of last year’s fourth quarter Gross Domestic Product (GDP) showed that health spending was chewing through a weak economy. Today’s release of the advanced estimate of this year’s first quarter GDP might best be described as health spending crushing a stalled economy.

GDP barely budged, increasing by a trivial 0.2 percent annualized. Although personal consumption expenditures increased at a much higher rate, the largest component of that increase was health services, which contributed 0.62 percent to the change in GDP. (Housing and utilities, at 0.59 percent, was second.) Investment spending and exports were in the tank.

Seasonally adjusted at annual rates, GDP increased by only $6.3 billion from the fourth quarter. Health services consumption, on the other hand, increased by $23 billion. This is a dramatic increase in GDP committed to a government-controlled and relatively unproductive sector of our economy.

Banned from Medicare; Still Billing Medicaid


Yahoo! News has a special report about physicians who have been banned from billing Medicare or some state Medicaid programs because of fraud, but are still billing other states’ Medicaid programs:

 A doctor who took kickbacks from a Pennsylvania hospice involved in a multimillion-dollar fraud. An Ohio psychiatrist who billed for treating no-show patients. A Georgia optometrist who claimed he conducted 177 eye exams in one day.

Their transgressions vary. What these doctors have in common is that each was paid by a state Medicaid health insurance program after being kicked out of another state’s Medicaid system or the federal Medicare program.

More broadly, 32 states and the District of Columbia supplied data showing they paid at least $79 million to 269 of the 1,800 providers after their terminations elsewhere. But the data was incomplete. Extrapolating from what could be verified, Medicaid payments to banned providers could easily reach into the hundreds of millions of dollars.

Mind boggling incompetence? Or government business as usual?

Intellectual Property Rights for Global Health


(A version of this Health Alert was published by Forbes.)

patent-pendingRepublican congressional leaders are eager to give President Obama Trade Promotion Authority, or “Fast Track.” Proponents argue that Fast Track will break the logjam holding up important international trade agreements like the Trans Pacific Partnership (TPP), which includes countries as diverse as Australia, Canada, Peru and Vietnam.

Fast Track would allow the president to finalize the agreement before sending it to Congress for a straightforward up-or-down vote within a limited time. However, the likelihood of Fast Track resulting in TPP getting a “thumbs up” from Congress is limited by potential differences between the president and the congressional majority on intellectual property rights.

In a recent Wall Street Journal op-ed, Representative Paul Ryan (R-WI) and Senator Ted Cruz (R-TX) asserted that the administration must pursue a number of negotiating objectives, including “beefing up protections for U.S. intellectual property” if it wants Congress to approve the TPP.

It is uncertain the president is as committed to intellectual property as Mr. Ryan and Mr. Cruz hope, especially with respect to patents for medicines. Although the text of the TPP is not yet available to the public, the U.S. Trade Representative, who negotiates in the president’s name, insists that “TPP countries have agreed to reflect in the text a shared commitment to the Doha Declaration on TRIPS and Public Health.”

The 2001 Doha Declaration was an attempt to limit international trade agreements’ commitment to patent rights that were accepted in the World Trade Organization’s 1995 Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. It insists that low and middle-income countries should have broad latitude to allow generic drug makers to make copies of patented medicines through a legal mechanism called “compulsory licensing.”

Digital Health Funding Maturing Quickly


Startup Health has released the latest issue of its excellent quarterly digital health funding report:


Coming off a hot funding environment in 2014, this year is off to a slower start. Although less capital was invested in Q1 2015 than in Q1 2014, we believe this is due to an increase in investor focus and a sign of a maturing market emphasizing more developed companies that move beyond offering “features” to delivering outcomes and/or reducing costs. Startups need to demonstrate results and early validation, as well as abilities to scale to tap into today’s funding environment.

Senator Johnson Introduces King v. Burwell Alternative


Johnson2Senator Ron Johnson (R-WI) has introduced the Preserving Freedom and Choice in Health Care bill, which he frames as a response to the Supreme Court deciding for the plaintiffs in King v. Burwell. This lawsuit seeks to force the administration to obey the law by not paying tax credits to health plans that operate in states using a federal health insurance exchange (i.e.

Victory for the plaintiffs would cause massive disruption in health insurance in the 36 states using because beneficiaries’ premiums would increase significantly. Up to nine million people would experience this effect.

It is necessary for Congress to have an alternative to Obamacare ready in case the Supreme Court decides in favor of King because President Obama will immediately propose an amendment to change the law to accord with how he is executing it. That is, let tax credits flow through It would be a very simple amendment – just a few sentences. The risk of Congress panicking and simply voting for that amendment, and finally surrendering to Obamacare, is unacceptable.

Medicaid Block Grants = Unconstitutional Coercion?


Professors Sara Rosenbaum and Timothy Westmoreland have an interesting opinion piece in the New England Journal of Medicine with a curious response to the proposal that federal Medicaid funding should be re-structured as block grants (via the Patient CARE Act, proposed by some Congressional Republicans).

It is a pretty well established Republican proposal. It falls short of NCPA’s proposal to convert federal subsidies for health care into refundable tax credits. Nevertheless, it removes the perverse incentive for states to ramp up Medicaid spending beyond what is necessary to pull down more federal funds. In the current system, a state that spends one more dollar on Medicaid will attract between one and nine more federal dollars. This causes states to spend themselves into penury to recover federal dollars.

Ms. Rosenbaum and Mr. Westmoreland suggest that the same Supreme Court that ruled Obamacare’s expansion of Medicaid unconstitutional would do the same for block grants:

Naturopaths Beat Real Doctors in Online Reviews


If it quacks like a duck……

A study of more than 28,000 online reviews of doctors suggests that American healthcare consumers are fondest of naturopaths, audiologists, oncologists and osteopathic physicians among healthcare specialists, and are least satisfied with care given by psychiatrists, dermatologists, orthopedists and family-medicine doctors.

Ironically, the analysis indicates that generally as a doctor’s level of education and training increases, patient satisfaction actually decreases. (Vanguard Communcations)

Maybe people have a higher bar of expectations for physicians than naturopaths? I hope that is what this survey is telling us.

Why Would Health Insurers Learn From Life or Auto Insurers?


Businessman Sitting at His DeskDori Zweig at FierceHealthPayer has written a good article with examples of how life and auto insurers provide excellent customer service, and encouraging health insurers to do the same. It would be a great idea and there are no shortage of consultants providing advice on health insurers to do exactly that. There are entire conferences dedicated to the topic.

Unfortunately, there are significant differences between health, life, and auto insurance that mitigate health plans’ interest in replicating the excellent service we’ve seen from other types of insurer: