Tips from gaining health

A February Edition of the Health Wonk Review Insightful Nuggets From the Best Health Policy Blogs

A valuable nugget & more on the way

Welcome to the Disease Management Care Blogs hosting of the Feb. 28 Health Wonk Review.

This HWR is a summarized compendium of submitted posts by the smartest health policy bloggers in the known universe.  The DMCB assures you that youre in for a special treat because youll find some insightful nuggets that generally go unseen in the mainstream media and academic literature.

When its not mining the HWR for information, the DMCB combines acumen, skepticism, modesty, peer-reviewed science and occasional humor about health policy, care coordination, population health management as well as primary care, the medical home, health insurance and the electronic record.

Its so glad you stopped by.

The DMCB has organized the posts by topic: Obamacares key orms, various health economists latest divinations on health care costs, hospitals, Medicaid, the internet, California, medical education and some British humor.  The quotes that head each section should give you a hint about what youre in for.

“This is a big f—-ing deal.” – Vice President Joe Biden

Whats to Know About the Go-Go Growth of ACOs?

Lots, thanks to this Health Affairs Blog post by Leavitt Partners David Muhlestein. He counts 428 accountable care organizations (ACOs). While all eyes are on the Medicare versions, it turns out the private sector has been on a less visible parallel track with "full or partial capitation models, bundled payments, retainer agreements, in-kind services and subsidies provided by payers, and pay-for-performance incentives." Did you know that most ACOs are in the West Coast and Northeast, or that theres an even split between physician and hospital-led sponsors? Mr. Muhlestein also points out that 2013 will be the year that well get to see some early ACO data. David and the DMCB will be watching very caully and, if we report Medicares outcomes are less than expected, the DMCB is looking forward to getting a "youll regret it" email from somewhere in the Administration.

Whats to Love About the Individual Insurance Market?

Could be lots, says Nicole Fisher of Wright on Health. She wonders if there is a silver lining in the growing evidence that some employers will drop their sponsored health insurance benefit and force their workforce into the individual market. That may force the individual market to have better transparency, less discriminatory underwriting, more choice and increased competition. As result, costs could be lower than expected, consumers will better understand the true costs of health care and portability could paradoxically improve. If things go really well, we could see a self-reinforcing cycle of market demand. And, wonders the DMCB, long lines outside doctors offices.

Maybe, But Whats NOT to Love About the Individual Insurance Market?

Louise of the Colorado Health Insurance Insider blog worries that persons who arent poor but who are also not wealthy are in for some bad news if they believe that the ormed individual market will translate into affordable health insurance.  Unlike todays market, individuals will be less able to trade lower premiums for HSAs, high deductibles and (for persons over 30 years of age) catastrophic coverage. While minimum coverage requirements are a good idea, Louise says theyre also expensive. She suggests it would be good public policy to flexibly accommodate a demand for higher deductibles and lower premiums.

An economic forecaster is like a cross-eyed javelin thrower: they dont win many accuracy contests, but they keep the crowds attention - Anonymous

Persistent Partisan Perfidy on the ACAs Costs

Maggie Mahar, over at healthinsurance.org, indicts the latest libel against Obamacare.  Her ire is directed at those repugnant conservative pundits who should have known better than to glom onto an ill-considered U.S. Internal Revenue Service document about 2016s health insurance costs. Beware, says Maggie, no one really knows what costs will be in 2016. The DMCB is shocked, shocked that economists and actuaries inaccurate predictions are being intentionally misinterpreted for political gain.

Numbers With A Lot of Zeros

Speaking of economists, The Hospitalist Leader has compiled a linked list of peer-reviewed erences that estimates the health care costs for the big name medical conditions. He senses that theres something amiss, because adding them up is much like finding Italys olive oil exports far exceeds that countrys domestic production. He thinks science writers, patient advocates, policymakers and yes, us bloggers, should promote better numeracy and, for starters, contrast any absolute dollar figures with helpful comparisons. Thats why the DMCB is pleased to post this short instructional video on some math basics courtesy of the health insurance professionals who staff the IRS:



100% Coverage of Screening Services Is Not Good Enough?

Guess what?  When health care consumers are thinking about the cost of undergoing screening for a disease, theyre also thinking about the next steps if disease is found.  Quoting a study in the Journal of Health Economics, Jason Shafrin of Healthcare Economist points out that zero dollar coverage for services - while noble - will have less of an impact than anticipated unless its linked to meaningful coverage of treatment of the underlying condition.  In other words, health screening subsidies are not enough to maximize consumer buy-in.  No wonder the DMCB spouse is unfooled by offers to screen some sales prices for a jumbotron-sized flat screen for the living room!

"Phlegm free zone" - Sign seen at a local hospital

The Riddle of Readmissions

In this posted podcast (here), David Williams asks the Robert Wood Johnson Foundations Anne Weiss about the recent depressing report on hospital readmissions.  Based on 2010 Medicare numbers, it doesnt look like the national rate has gone down all that much and that the considerable variation between different areas of the country remains.  David and his guest also chat about some promising best practices that being used in some settings to reduce readmissions, what patients and their families can do about lowering the likelihood of a readmission and whether the practice style of hospitalists is part of the problem or a potential solution.  Despite evidence that population management can reduce readmissions, Ms. Weiss rejects for-profit vendor participation, believing that hospitals should be happy to hire more personnel in lieu of partnering.  Let the "build or buy" games continue, says the DMCB.

"Governor Browns budget plan also counts on $488.4 million in savings from a 10% cut to Medi-Cal reimbursements. Medi-Cal is Californias Medicaid program." 1/30/13 News Report.

Heres A Free Baby Elephant!

Joe Paduda cant blame many of the nations governors for bowing to the common sense and fiscal reality of expanding Medicaid in their states, even though it can be viewed as distasteful.  The 100% federal financing is free money and their politically connected hospitals per Medicaid to uncompensated care.  Many states are likely to cut their Medicaid fee schedules, so providers have one more incentive to go along with testing new reimbursement strategies and delivery models.  All in all, he muses, "this is a very good thing."  Next step, muses the DMCB, is to convince the docs.

The Internet is the most important single development in the history of human communication since the invention of call waiting. - Dave Barry

Time To Take On Medical Tourism By Getting "Lean"

Jonena Relth of Healthcare Talent Transformation points out that the times they are a changin. The steady increase in medical tourism is challenging the notion that U.S. domiciled health care is the best, especially when international health systems are adopting U.S. methods and employing U.S. trained physicians who are using state-of-the-art electronic health records that are modeled on U.S systems. The salvation, according to Ms. Relth, is the "Lean" approach that, according to a LinkedIn discussion group, helps providers 1) put patients first, 2) cut waste and 3) eliminate tasks that dont add value.  The DMCBs experience leads it to believe that many of its physician colleagues can accomplish much of that third goal by staying away from LinkedIn.  Maybe its time to change its mind.

"There is science, logic, reason; there is thought verified by experience. And then there is California." - Edward Abbey

Californias Health Insurance Exchange Chassis Unveiled. Next Up: The Hard Part

Health orm advocate Anthony Wright of Californias Health Access Blog really extols the virtues of Covered California, the Golden States health insurance exchange web site. Anthony can be forgiven for his use of terms like "conveniently," "breakthrough," "easier" and "bold" because the sites very existence is an important step forward in having a real functioning web presence where consumers can actually buy health insurance. Whether this leads to marketplace transparency, consumer ease-of-use and increased insurance coverage for Californians remains to be seen. The DMCB took the web sites calculator for a test drive and discovered it and the spouses unsubsidized monthly premium would be $1723 per month, which is about $700 more than it currently pays in Pennsylvania. Nuff said.

A Ballooning Benefit Bonanza, Courtesy of Sacramento

Speaking of California, John Goodman of his eponymously named blog examines the states tax policy, blaming it for a plethora of generous employee benefits. Since higher wages are taxable, loopy loopholes are prompting companies to compensate their employees with home cleaning, personal trainers and the daily delivery of fresh fish. Mr. Goodman faults the unraveling of the 1980s tax orm movement and suggests now is the time for a "progressive flat tax."  Now is also the time for the DMCB Inc. Board of Directors to consider installing a tax deductible gas-powered backyard fire-pit for its two employees. 

Income from Injuries

And Calfornia doesnt stop there. Jon Coopelman of the Workers Comp Insider Blog writes that professional athletes from across the U.S. have discovered that Californias generous workers comp law allows out-of-state players to file claims long after any in-state injury that could have contributed to a disability. Thanks to clever attorneys and vague inclusion criteria, its not hard for any ex-jock who played in the state to convince a California judge that a sports team should cover all future related medical expenses. Jon says its time for the California legislature to stop the abuse and for sports teams to address this in their labor contracts. Until then, the DMCB  invites readers to pay $6 to play to enter an upcoming wiffle ball tourney in Golden Gate Park; participants will receive $1 in California taxable income, $5 worth of beer and a certificate of a compensible injury. Date TBA.

How Much Is That Hospital CEO Worth?

Roy Poses of Health Care Renewal looks at examples of small town hospital CEOs being compensated with lavish pay. Dr. Poses is particularly exasperated because the hospitals are not only public, but theyve had to make tough trade-offs between being profitable and having enough nurses and docs to care for their underserved populations. Roy has little difficulty finding numerous news reports - and most are from California -  that amply demonstrate that there is little correlation between hospital administrators $800K salaries and their institutions financial performance. Roy blasts the gimmicky talking points that have been used justify these outlandish compensation packages, the cluelessness of hospital boards and the publics need to wake up and smell this coffee. The DMCB looks forward to what Roy discovers in 2013 when he compares ACOs financial success with their executives compensation packages.

 "Beware of the young doctor and the old barber." - Benjamin Franklin

Strange Bedfellows

Did you know that 15 new allopathic and 10 osteopathic medical schools have opened since 2002 and that most operate campuses located in Republican Congressional districts?  Wing of Zocks James Lewis reviews the political implications of this, pointing out that these Republicans will gain a new appreciation for the value of our national health care infrastructure. Whats more, theyll probably be reluctant to go along with their House colleagues enthusiasm to reduce the U.S. budget with sacrifices in graduate medical education funding. What delicious irony!

"Bollocks!" An oft-heard exclamation "with a long and distingished history." - Wikipedia

Merry Old En-gland?

Ouch!  The InsureBlogs Mike Feehan looks at a London Daily Mail report on the lowball rate of £20,000 that is used by the Brits National Health Service when it needs to compensate men for a nutty type of wrong side surgery.  The DMCB points out that one historical explanation for higher U.S. jury awards is the need to compensate for future medical services.  Thats less necessary, thanks to the NHS universal coverage.  The comments that follow testily debate whether the incidence of this complication is higher in the Sceptered Isles compared to the U.S.   The DMCB will never be able to think about NHS "budget cuts" in quite the same way.

Thats it for this HWR.  Mark your calendar for the next iteration, due to appear on David Williams smartly written Health Business Blog on March 13!