May 24th, 2011 by DrWes in Opinion
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With the news that Wellpoint, one of the largest insurance companies in America, will cut off annual 8% payment increases to about 1,500 hospitals if they fail to “test” high enough on 51 quality measures, they have officially defined “quality” health care as checkboxes.
Yep, checkboxes.
You see how do insurers know if we offer each of our patient’s nutritional guidance or exercise counseling?
Well, they check to see of doctors have clicked on a yellow warning box advising we do this. If we have, then not only is that doctor a fine, “quality” doctor, but the hospitals (and it’s computer system and scores of administrative staff that compile and submit this data) are real, fine, “quality” hospitals.
That’s all there is to it.
Never mind if we don’t have time to actually perform the counseling.
* click * * check * * click *
Simple as pie. Efficient, too.
Beautiful bureaucratic quality.
Good luck with that.
*This blog post was originally published at Dr. Wes*
May 19th, 2011 by Jessie Gruman, Ph.D. in Health Policy, Health Tips
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Only one in 10 respondents to a national survey could estimate how many calories they should consume in a day.
Seventy-nine percent make few or no attempts to pay attention to the balance between the calories they consume and expend in a day.
These and other piquant findings from the online 2011 Food and Health Survey fielded by the International Food Information Council Foundation (IFIC) struck home last week as I smacked up against my own ignorance about a healthy diet and the difficulty of changing lifelong eating habits.
The confluence of my failure to gain weight after cancer treatment and a blood test suggesting pre-diabetes meant that as of last Tuesday, I have been on an eat-specific-types-of-food-every-hour-and-write-it-down regimen. And despite a lifetime of recommending that people change their behavior to become healthier, I am frustrated as I try to follow my own advice. I am bewildered about what I’m supposed to eat. Finding it, preparing it and then eating it at the right time requires untold contortions and inconvenience. Writing it all down is tedious. I don’t have time for this – I have a job, obligations. Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
May 16th, 2011 by Lucy Hornstein, M.D. in Health Policy, True Stories
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Insurance companies are supposed to pay for health care, although they do everything they can think of to avoid doing so. One company in particular (a small player here though a much bigger gorilla in other markets) does so by playing with words, even when another behemoth lost a lawsuit over the same issue.
The topic involves paying for preventive services while a patient is in the office for care of an acute illness or management of a chronic condition. The way we communicate with insurance companies about what we do in the office is by way of codes; CPT codes, to be precise. There are separate codes to differentiate between preventive services and the so-called Evaluation and Management (E/M) services. The latter are your basic office visit codes covering all the “cognitive” services I offer — as opposed to procedural codes, where I actually do something to you other than talk with and examine you. Read more »
*This blog post was originally published at Musings of a Dinosaur*
May 15th, 2011 by Happy Hospitalist in Health Policy
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There is a huge myth being unknowingly perpetrated against the general public when it comes to their rights and responsibilities as a patient. It’s a myth that I can remember hearing as far back as my first few weeks of clinicals during medical school. It was a constant presence during my residency training and even now, as a private practice hospitalist I hear misinformation being handed down day after day, month after month.
This myth is perpetrated by doctors, nurses, and therapists of all kinds. What is this myth? That their health insurance company will not pay for the care provided if they want to leave against the medical advice of their physician.
Will my insurance company pay if I leave against medical advice (AMA)? Yes. They will pay. Medicare and Medicaid pay for services that are medically necessary. For example, if you go to the ER and the doctor recommends a CT scan of your chest and you decline, this does not mean the insurance company will deny payment for your visit to the emergency room. This is what the informed consent process is for. If you have been admitted for a medical condition that requires hospitalization and your care plan meets Medicare medical necessity muster, your care will be paid for whether you leave the hospital when your physician believes it is safe or not. Read more »
*This blog post was originally published at The Happy Hospitalist*
April 8th, 2011 by Glenn Laffel, M.D., Ph.D. in Health Policy, Opinion
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One of the great challenges facing the folks who have been tasked to implement the Big O’s health care law is defining “essential benefits,” the core medical services that insurers must cover.
Despite its voluminous nature, the law is remarkably vague in this regard. It does identify 10 care categories that health plans must provide to consumers who use federally-funded health insurance exchanges to select a plan, but the categories and associated lists aren’t comprehensive or specific (the categories appear at the end of this post).
The Institute of Medicine has been tasked to flesh out the lists of required services. It has begun work amid a frenzy of lobbying by private insurers and consumer groups. Habilitative services are one contentious area, and they illustrate the challenges faced by the IOM. Unlike rehabilitative services which help people recover lost skills, habilitative services help them acquire new ones.
Habilitative services can help autistic children improve language skills, or those with cerebral palsy learn to walk. They can also help a person with schizophrenia improve his social skills. Read more »
*This blog post was originally published at Pizaazz*
