Electronic Health Records and Adolescents’ Privacy

 

This blog has written about complaints from both physicians and nurses regarding the costs and time devoured by using Electronic Health Records, which have been imposed on practices despite not adding value.

In a JAMA article published earlier this month, three physicians discuss EHRs’ challenge to adolescents’ and parents’ privacy. So-called minor consent laws permit adolescents to secure health care services without parental consent for drug use, pregnancy and pregnancy preventions, STDs and mental health. These laws underscore the professional consensus that absent confidentiality, adolescents will be reluctant to seek care for sensitive health issues.

With paper records, care provided under minor consent laws was segregated from other medical records and difficult to access. Because EHRs aggregate information for all health care provided within a so-called integrated system, parents have the means to electronically access confidential information, often facilitated by web portals to the records.

The NCPA Fact Checks Obama’s Health Policy Address during SOTU

 

Paid Family and Sick Leave for Workers

The president emphasized the plight of the 43 million American workers who do not have paid sick leave. Many of them feel they cannot afford to take a sick day to convalesce after an illness or to care for a sick child. He proposes to mandate that employers provide seven days of paid sick leave to workers each year.

The president didn’t mention that an estimated 100 million workers who have paid sick leave likely don’t get seven days annually. He also didn’t mention that his own advisor Jonathan Gruber has research showing workers themselves wind up paying the cost of mandatory benefits through lower wages.

Thus, if employers are forced to provide seven paid days off of work for every worker, employers will adjust worker pay to compensate for the cost. This will inhibit pay raises, and it will impact paid vacation days. It could even harm the employment prospects of workers most likely to stay home and care for a sick child.

The president should have called for expanding Health Savings Accounts (HSAs) to all workers, allowing them to set aside funds for medical needs. The president could have also proposed allowing workers to use HSAs to compensate for income lost to sick days.

Currently, workers who have HSAs can use funds from their accounts to replace income lost due to sick days. However, this is considered a non-medical use and exposes workers to a penalty of 20 percent, plus ordinary income taxes.

Are Employers Who Dump Workers Onto Medicaid Corporate Welfare Queens?

 

There have been a lot of predictions about the future of employer-based health benefits under Obamacare. Reports suggest that increasing numbers of small businesses are dropping health benefits and sending their employees to Obamacare’s insurance exchanges, where they are partially subsidized.

Other businesses have found a bigger cost-shifting approach. BeneStream, a new benefits advisor, advises employers how to make their workers dependent on Medicaid, a welfare program fully funded by taxpayers. And businesses are taking advantage of its advice.

So: Are these employers corporate welfare queens?

Moving Beyond the Heliocentric Doctrine of Health Insurance

 

A similar version of this Health Alert appeared at The Daily Caller.

Whether you have job-based health benefits, are in an Obamacare exchange or are on Medicare, you have likely recently gone through the difficult experience called open enrollment. As a result, you may have lost access to your physician or nearby hospital. Think about how little sense this makes. Did you change anything else in your life for the sole reason that the calendar turned a page? I’ll bet you’ve had the same car insurance and homeowner’s insurance for years. If you rent your business premises, your lease can cover whichever period you and your landlord negotiate.

I call this the Heliocentric Doctrine of health insurance: Designing coverage around the period of time the earth takes to revolve around the sun, instead of patients’ health status. It has harmful consequences.

Consider two identical twins, recently diagnosed with the same catastrophic illness last June. They both have the same health insurance. Whether it is through their employer or an Obamacare exchange or Medicare does not really matter.

They have been diagnosed with the same cancer. It is genetically determined: There is nothing that either of them could have done to avoid it. It will require many months of treatment by drugs and surgery, and the treatment will evolve as oncologists observe how the twins’ cancers respond to different therapies.

Generally speaking, both twins have been healthy up to now. All of a sudden, in the second half of 2014, they entered that small minority of patients who, in any period of time, account for a large share of health spending.

Hospitals Only Accounted for 15 Percent of Health Job Growth in 2014

 

Last Friday’s employment report demonstrated once again that Obamacare is not having the effect that the health services industry overall hoped for: Employment in health care is increasing at pretty much the same pace as in the rest of the economy. There is no evidence of an Obamacare jobs bump.

As shown in Table 1 and Table 2, the monthly increase in health jobs for December was 0.23 percent (34 thousand jobs), which is slightly greater than the 0.17 percent increase in non-health, nonfarm payroll. However, those figures are just reversed from November. In the twelve months since December 2013, the rate of growth in health jobs has been exactly the same as non-health jobs.

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Asian Firm to Launch Innovative TeleMedical Service in U.S.

 

An American entrepreneur has spent two years building a telemedicine business in Singapore and is ready to enter the U.S. market. RingMD is a web-based physician referral, telemedicine website and smartphone application. Prospective patients select doctors by viewing physicians’ profiles, locations, insurance acceptance, ratings or specialties. The software draws information from 543 medical conditions to connect patients with physicians from 17 different specialties. Patients just enter their symptoms (and preferences), and the website app will list qualified physicians who meet their criteria.

Participating physicians charge for consultations by the minute, and their prices vary. Some providers only charge $1 per minute, while others charge $5 per minute. It’s a competitive market with dynamic pricing. Patients select a provider and only pay for the time they need. Currently, most of RingMD’s physicians are based in Asia, but the firm is adding doctors from all over the world.

The 22-year-old CEO of the organization reports he is now considering entry into the U.S. market. But the question remains: Why did a Silicon Valley entrepreneur choose to start his Health Tech venture in Singapore? The Singapore government was impressed enough with the idea that it invested $500,000 through its National Research Foundation to help fund the tech startup. But there must be other reasons.

The Singapore health care system is often touted by conservatives as a model for health reform in this country. Singaporeans have been required to set aside a portion of their income into a Medisave account (6.5 percent – 9 percent) to fund their current and future health care needs since 1984.  Medisave accounts are a type of health savings account (HSA), while MediShield is an insurance scheme that functions similar to a major medical or high-deductible plan.

Obamacare Enrollments Slow to a Trickle

 

Only 102,000 people enrolled in Obamacare via the federally operated exchange during the week of December 27 – January 2, bringing the total to 6.5 million. This supports my previous expectation that Obamacare enrollment is petering out.

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Obamacare Increases ED Use in Los Angeles County

 

Los Angeles County, Obamacare’s Ground Zero (so described because of the huge number of its residents enrolled in Obamacare’s health insurance exchange) is seeing an influx of patients into hospitals’ emergency departments:

Data hospitals report to the state show that as insurance coverage was extended to hundreds of thousands of residents, ER visits for ailments not serious enough to require an admission grew 3.9% in the county in the first half of 2014, compared with the same period the previous year. The growth is in line with annual increases of 3% to 5% in the three years prior to the federal healthcare overhaul. (Los Angeles Times)

This is no surprise to readers of NCPA’s Health Policy Blog. We have always appreciated the evidence that increases in government-funded health coverage lead to increased ED use.

What is interesting about the data from LA County is that ED use in public hospitals declined, while use in private hospitals increased. That might indicate something about the characteristics of the patients newly insured under Obamacare.

Gallup’s Easily Misunderstood Health Insurance Survey is Out

 

For many months, I have struggled with the Gallup-Healthways survey of health insurance, which I criticized in a previous entry. Of all the surveys of health insurance it is the least informative, and I wish the Gallup folks would give their results better context. Unfortunately, because it is the timeliest, the media get excited about it, especially since Obamacare started.

The latest survey, which covers the 4th quarter of 2014, reported that the “uninsured rake sinks to 12.9 percent”. Just look at the graph: What a nosedive in the number of uninsured Americans! Well, not so fast.

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FDA Regulation of Mobile Health Apps is a Real Threat

 

Do you want the Food and Drug Administration (FDA) to regulate your smartphone? Many in the booming digital health industry are indifferent to the risks of the FDA regulating apps as medical devices. As I noted in a recent Health Alert, the FDA’s current doctrine is to allow most new apps onto the market without regulation. However, this openness is defined only in rules written by the FDA itself, not legislation. Rep. Marsha Blackburn and others in Congress have proposed to amend the law to prevent the FDA from overreaching.

Entrepreneurs and patients who think that the FDA’s current posture is eternal should be aware of a campaign to regulate apps for health. Here’s a recent article from Mother Jones:

Online retailers like iTunes and Amazon offer thousands of apps promising all kinds of real-time information about your body — they can measure blood pressure, take your pulse, track your menstrual cycle, and tell you how well your lungs are working. Mobile health is one of the fastest-growing app categories: According to the consulting firm research2guidance, there are 100,000 mobile health apps on the market, double the number available two and a half years ago. The industry is worth some $4 billion today, and analysts predict that it will reach $26.5 billion by 2017.