Tag: "doctors"

Innovation and Self-Insured Employer Plans

About 175 million people are covered by an employee health plan through their job or the job of a loved one.  More than half of people in employee health plans work for an employer that is self-insured or partially self-insured.  Self-insured plans are ones that are subject to federal law rather than the patchwork of state regulations that insurers must follow.  When employers self-insure, they take on the risk of their employees medical needs and generally have stop loss coverage to guard against any one worker or dependent have exceptionally high medical bills. Whereas insurance is somewhat of a stodgy business, employers themselves are looking for solutions rather than premium hikes year-after-year.  Most of the innovation that occurs in health coverage are experiments being conducted by self-insured employers. These include decision-support tools to make enrollees more informed consumers of medical care. Employers are dumping a ton of money into employee Health & Wellness programs, health risk assessments and chronic disease management.  A few employer plans, like North Carolina-based like HSM Solutions, are outsourcing some medical care for high cost procedures to countries abroad.  CalPERS, the public employee union, has initiated experiments in reference pricing to provide beneficiaries an incentive to seek out lower-cost providers.  These are all examples of self-insured plans looking for solutions to the problem of high medical costs.

A ‘Free Health Clinic’ for Montana State Employees

Before he left office, then-Montana Gov. Brian Schweitzer decided Montana’s 11,000 state workers, retirees and their dependents needed an employee health clinic. Before leaving office he had one created without consulting the legislature. For those of you who have not heard of the concept, it’s sort of like the school nurse, except there are doctors and real medical equipment involved. At most employee health clinics, physician visits are either free or involve no cost-sharing. Montana employees aren’t required to use the clinic; they can continue to see their own doctors with the normal cost-sharing.

Doctors, Hospitals, Medical Groups Demand EHR Rule Delay

electronic-medical-recordElectronic Health Records (EHRs) continue to take on water:

Calls for the Centers for Medicare & Medicaid Services to refrain from finalizing Meaningful Use Stage 3 are increasing, with the American Medical Association and the Medical Group Management Association adding their voices to the din.

Both organizations cite concerns over the proposed rule as it currently stands, with AMA saying in a letter to CMS Acting Administrator Andy Slavitt and National Coordinator for Health IT Karen DeSalvo that the program “will create significant challenges for physicians, patients, and vendors.”

MGMA adds in its own letter to Slavitt that Stage 3 could result in a failure to meet the goals outlined in the American Recovery and Reinvestment Act of 2009. It should be delayed, MGMA says, until it is known what the impact of Medicare Access and CHIP Reauthorization Act of 2015 will be. (Katie Dvorak, FierceEMR, June 3, 2015).

I discussed the stage 3 rule when it was published. The response of these professional groups is stunning: They were all happy to take the almost $30 billion the government handed out to induce them to install Electronic Health Records.

And they led Congress by the nose just a few weeks go to pass the flawed Medicare Access and CHIP Reauthorization Act. At the time, none of them mentioned it was going to increase the burden of EHR compliance. The first organization to explain this consequence was the NCPA, in report I wrote before the law passed. These groups are asking the government for relief from a flawed so-called Medicare “doc fix” for which they themselves had spent years lobbying.

“Transparency” Will Not Fix Medicare Physician Fees

The Government Accountability Office (GAO) has released a report criticizing the way the federal government sets physicians’ fees in Medicare. It concludes that “Better Data and Greater Transparency Could Improve Accuracy.”

I doubt it. Note the mind-numbing detail of this process: The government delegates its assumed authority to a group of physicians who comprise the Relative Value Scale Update Committee (RUC). The government “reviewed 1,278 RUC work relative value recommendations for about 1,200 unique (new and existing) services)” in the last four years.

High U.S. Health Prices From “Market Power”?

The National Academy of Social Insurance (NASI) recently published a consensus report on provider consolidation. Basically, we have a growing problem in that hospitals are buying each other up and also physician practices, which leads to reduced competition and higher prices.

The report was promoted with an op-ed in The Hill by the esteemed Robert A. Berenson (Urban Institute) and G. William Hoagland (Bipartisan Policy Center):

The use of market power—or the ability to raise and keep prices higher than would prevail in a competitive market – is the key reason the United States spends so much more on healthcare than other countries.
For policymakers, tackling the lack of competition is like climbing a mountain. Even the initial steps — creating more competition – may be difficult, but they must be explored before more regulatory action further down the path is considered.

These are remarkable statements; and difficult to accept uncritically.

Draining More Brains: Where Medicine is Heading

Watching the Affordable Care Act roll-out and reading about its gestation in Steven Brill’s book, America’s Poison Pill, makes one very aware that there is a serious brain drain under way in medicine.  Here’s what anyone can see:

Numbers of applicants to medical school, which once was 10 for every place, is now less than 1.  Physicians are telling their children not to go into medicine. There is now more than a 7 foot stack of regulations for the Affordable Care Act. As we all know, the slogan for this whole program has been “the healthcare system is broken.”  (If that is so true, why force feed new people into it?)

Some manifestations:  the adoption of the ICD-10 coding system, which defines conditions needing care in such detail that there is an unacknowledged administrative cost for compliance and a substantial legal and financial risk if there is mis-coding. Another is the forced adoption of Electronic Medical Records, with rules for “Meaningful Use.” This will produce electronic oversight of all medical care, in the guise of supporting “quality of care” and facilitating “Value-based Payments.”  Ultimately, the government regulators expect to have real time access to any person’s care and any physician’s performance.

Are Doctors Becoming Democrats?

Confident DoctorsNew research published in JAMA shows that political giving by physicians has swung significantly towards Democrats and away from Republicans in 20 years or so. In 1993-1994, 69 percent of physicians who made political donations gave to Republicans, and their giving comprised 65 percent of doctors’ political giving. In 2013-2014, 45 percent of doctors who made political donations gave to Republicans, and they comprised 50 percent of doctors’ political giving.

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.

Is Patient Scheduling Software Valuable to Doctors?

I am a huge fan of entrepreneurs who want to make medical care more productive and consumer friendly. I wish all of them the best of success. Unfortunately, I am concerned that one of the trends attracting venture capital is chasing a shrinking market. That trend is patient-scheduling software in physicians’ offices.

I was at an angel investor pitch off in Arlington, Virginia, yesterday where one such firm was seeking investors. Two great incubator/accelerators, StartUp Health in New York and Rock Health in San Francisco (and, now, New York) have invested in Arsenal Health, inventor of Smart Scheduling.

Firms like this promise algorithms that use data to predict cancellations and no-shows. I suppose this is the flipside of ZocDoc, the remarkably successful business that doctors use to find new patients to fill appointments that have been cancelled.

These are all great ideas. I am just not sure they make sense in the future environment, where there will be surplus of patients and a shortage of doctors. A few years from now, when the U.S. has Canadian-style waiting lists to see specialists, why would a physician invest in technology to manage cancellations and no-shows?

Such technology would be very valuable where there is a surplus of doctors competing for a limited number of patients. But I don’t think anyone anticipates that for U.S. health care. I hope I am wrong.

Republicans Reach for Redemption on Medicare “Doc Fix”

Politico reports that Congressional Republicans might be having second thoughts about the extremely flawed, so-called Medicare “doc fix” legislation that they sent to President Obama a few days ago. One of those flaws was that the spending in the bill was not offset by cuts to other federal spending – which is why almost every Democrat in Congress voted for it too.

Well, they appear to be getting the message that NCPA has been sending them since March 25:

…… one GOP source said negotiators had resolved a sticking point over how to offset a recently enacted bipartisan Medicare overhaul that was not entirely paid for. The source said the agreement is likely to offset the overhaul, often called the “doc fix,” starting next year.

Better late than never. How they will get President Obama to sign any bill that offsets spending that was already committed by his signature on March 15 is unclear. (All they had to do in the original bill was remove two short sentences that exempted the spending from the so-called PAYGO scorecards. Had they done so, they would not have to worry about it today.)